Transcript Positive Identification for Patient Medication Safety Auto

Positive Identification for
Patient Medication Safety
Auto-Id Interface Specifications
PARTNERS
H E A L T H CA R E
SY S T E M
HIBCC meeting, January 19, 2006
Positive ID Agenda
•
•
•
•
•
•
•
•
•
•
•
Partners Healthcare
Partners Healthcare Signature initiatives
PosID Goals
PosID Target
In the Beginning…medication errors
PosID Development
Team Assumptions
Project Sequence
Result
Next steps
Technical Discussion
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Partner’s Healthcare
Boston, Massachusetts
Founding members are
• Massachusetts General Hospital
• Brigham and Women’s Hospital
- plus several other area hospitals
Teaching affiliate of Harvard Medical School
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Partners Healthcare
Signature Initiatives
• Focused effort by Partners to lead cultural
change across the healthcare system.
• Invest in methods to provide integrated
care.
• Standardize additional proven best
practices
• Promote technology that improves the
quality, safety, and efficiency of care for
patients
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Partners Healthcare
Signature Initiatives, con’t
Five System-wide projects with one common goal :
To deliver better care to patients
• Care that is:
Safer
Better coordinated
More reliable in delivering proven interventions
• With systems that support providers in
“doing the right thing.”
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Our Committee’s initiative:
Positive Identification for Patient
Medication Safety
Enhancing patient safety by reducing
medication errors system-wide
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Committee Goals
•Collect and leverage work done by others
on Positive ID around patient safety
•Provide an outline of recommendations
and guidelines for other entities
•Make guidelines available for vendors that
want to work with PHS
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Five Applications for Bar Codes
• Employee Badge
• Patient Wristband
• IV Medications
• Non-IV Medications
• Patient Care Devices (monitors, pumps)
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
In the beginning…med errors
• Tale of two IV pumps. The start of MGH
Pharmacy IV bar code programming.
• Evolution to the concept of IV pump library
to both check and enforce guidelines.
• Then….SmartIV
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Development “Definitions”
• “POSITIVE ID” at PHS
– (a) ‘irrefutable, certain’ identification and
data transmission system
– (b) Standardized system focused on
PHS Medication Safety
• 1D / 2D
– 1D requires “connected” central lookup
system
– Data payload 2D>>1D
• 15 characters vs 180 characters
• DATA
– Usable, interpretable
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Team Starting Assumptions
•Not all PHS sites have ‘real time’
wireless connectivity
•Connectivity not always 24/7/365
•PHS entities won’t have all ‘back
end systems’ in place
simultaneously
•Mandates/Benefits are real!
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Team Starting Assumptions (2)
• Only one bar code per drug package !
• Only one handheld scanner per caregiver !
• ‘Scan-ability’/patient impact are primary concerns
– Ease of use = reduced training cost
– Enhancements driven by patient care considerations
• Immediate caregiver benefits will speed adoption
–
–
–
–
Automated documentation
Intuitive ‘device connectivity’
Automated drug recognition
Improved patient safety
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Project Sequence
• UHC Tech Report used as a starting point
• Bar Coded Medication Administration
Detailed Recommendations
• Prior PHS projects / research used and
revalidated
• Visits and interviews of all PHS hospitals
• Draft of Standard
• Validation of concepts with participants
• Executive presentation to Chief Nursing
Officers
• Use by vendors
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Result
PHS “Positive ID Standard”
• Choose data elements that will be in bar code;
identify minimum data
• Standard and economic structure for data in the
bar code so it can be read easily by various
applications
• Provide extensibility
• Ensure patient care continuity even when network
is “down”
• Permit point-to-point Communication between
patient care devices
• Foundation for migration
• KEEP IT SIMPLE
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Next ….
• At the point of critical mass - strong need has
been expressed on many fronts
• Recognition of the value of open standards
• Need the help and guidance of HIBCC for next
steps in definition and adoption of Positive ID.
• Draw on the HIBCC standards expertise
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Introduction to Patient Positive ID
Presented by the principal architect and author:
Harry Manolopoulos
- IT Management
- Consultant to Partners Healthcare
Signature initiatives
- Former HIBCC member and Committee
Chairperson
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Scope
•
•
•
•
•
•
Employee Badges
Patient Wristbands
IV Medications
Non-IV Medications
Device License Plates
Blood Products (Future)
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Design Goals
• The interface message structures should
be extensible to provide additional
information functions as the capabilities of
information systems expand.
• The interface should support versioning
and be backwards compatible with earlier
versions where possible.
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Design Goals
• Message components should be optional
and combinable to provide a range of
protocol options.
• The interface should include standard
definitions for data elements.
• The message structures should be clearly
discernable from the other information.
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Design Goals
• The message structures should provide
the ability to identify the issuing provider
within a provider network.
• The message structures should be
designed to result in a very compact
symbol.
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Design Goals
• In some cases, the symbol may include
information for different purposes in
concatenated messages structures and
each message structure and its’ purpose
should be clearly discernable.
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Message Structure
• Messages are comprised of tags bracketing
sections (similar to XML and HTML) and three
letter record identifiers with pipe “|” field
delimiters (similar to HL7).
• Records are constructed with mandatory data
occurring first, most likely used data next and
rarely used data last. This optimizes the record
size for the shortest length.
• Trailing empty fields and delimiters “|||||” may be
omitted from the data. (shorter message = more compact
symbol)
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Message Structure
• Line Terminators (Record Separators) are
Line Feed characters. [LF]
• Symbol data may contain multiple
messages.
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Message Structure
Sample Message:
<SEID>[LF]
<SEID> Tag indicates the start of Employee Badge Data
<EID>[LF]
<EID> Tag indicates the start of an EID message
VER|1.0[LF]
VER version record
EII|MGH|345782|4445556|[LF]
EII record, Issuing entity, Badge ID, Employee ID
EI2|Manolopoulos|Harry|Q|[LF]
EI2 record, Employee Last Name, First name, M.I.
<\EID>[LF]
<\EID> End Tag completes the EID message
<\SEID>[LF]
<SEID> Tag indicates the end of Employee Badge Data
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Employee Badges
• Basic Information:
– Issuing Entity
– Badge ID
– Employee ID
(Issuing Entity) and Badge ID are the primary
identifiers for systems. Lost badges are easily
deactivated and replaced without affecting HR and
other systems using the Employee ID
• Secondary Information:
– Employee Name
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Employee Badges
• Sample Data Message:
<SEID>
<EID>
VER|1.0
EII|MGH|345782|4445556|
EI2|Manolopoulos|Harry|Q|
<\EID>
<\SEID>
Version 1.0
Issued By: MGH
Badge ID: 345782
Employee ID: 4445556
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Patient Wristbands
• Basic Information:
–
–
–
–
–
–
Issuing Provider
Patient ID
Date Of Birth
Gender
Visit Number / Band Number
Admit or Visit Date
• Secondary Information:
– Patient Name
– Admitting Physician ID and Name
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Patient Wristbands
• Sample Data Message:
<SPID>
<PID>
VER|1.0|
PII|2105559|19671211|F|MGH|1|20060119|
PI2|Testpatient|Margarette|
PHY|612|Gooddoctor|Lester|J|
<\PID>
<\SPID>
Version 1.0
Issued By: MGH
Patient ID: 2105559
Visit: 1st on 01/19/2006
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
DOB: 12/11/1976 Gender: F
Admit Physician: 612 Lester J. Gooddoctor
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications
• Intended for use with “Smart” infusion pumps
containing drug libraries.
• Includes patient information, drug identification
and order administration (delivery)
• Can Check:
–
–
–
–
–
Right patient
Known drug (in drug library) / Right Drug
Safe dose (per drug library)
Right Time (scheduled dose modes)
Authorized Override of medication limits
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications
• Basic Information:
– Patient Information
– Care Area and Indications
– Drug Identification for Primary Additive
– Primary Additive Final Concentration
• Secondary Information:
– Delivery Rate
– Scheduled Dose Modes
– MFG’d for another provider xref
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications
• Secondary Information:
–
–
–
–
–
Dose Tracking
Inventory
Recipe Style Additives and Diluent Info
Custom Messaging
Patient Clinical Advisories
• Administration Information:
–
–
–
–
Set Care Area
Alarm Points
Set Override Codes / Badge ID’s
Library ID for Drug Library check
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications (SmartIV)
• Sample Message:
<SmartIV>
<ORDERS>
VER|1.3|
CAR|ICU|CARD|
PID|210559|Testpatient|Margarette||F|19671211|39|YR|
DID|644345|Framicil|2|mg|1|ml|
VTI|644345|300|ml|
VDR|644345|3|ml|HR|
<\ORDERS>
<\SmartIV>
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications
• Sample Message:
<SmartIV>
<ORDERS>
VER|1.3|
CAR|ICU|CARD|
Care Area: ICU Cardio
PID|210559|Testpatient|Margarette||F|19671211|39|YR|
Patient ID, Name, Gender, DOB and Age
DID|644345|Framicil|2|mg|1|ml|
Drug ID, Name, Final Conc.
For Primary Additive
VTI|644345|300|ml|
Total Volume to be Infused
VDR|644345|3|ml|HR|
Volume Delivery Rate
<\ORDERS>
<\SmartIV>
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications
• Sample Message:
<SmartIV>
<ORDERS>
VER|1.3|
CAR|ICU|CARD|
Care Area: ICU Cardio
PID|210559|Testpatient|Margarette||F|19671211|39|YR|
Patient ID, Name, Gender, DOB and Age
DID|644345|Framicil|2|mg|1|ml|
Drug ID, Name, Final Conc.
For Primary Additive
VTI|644345|300|ml|
Total Volume to be Infused
DDR|644345|3|mg|HR|
Drug Units Delivery Rate
<\ORDERS>
<\SmartIV>
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
IV Medications
• Work In Progress:
VTBI Equivalent for drug units
PCA
Best Practices Drug Libraries
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Non-IV Medications
• Primarily intended for use when
repackaging medications in order to
provide unit of use or ordered dose auto-id
labeling.
• Supports a tagged (wrapped) and
untagged (unwrapped) message structure
to minimize symbol size.
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Non-IV Medications
• Basic Information:
–
–
–
–
–
–
–
–
–
NDC#
Provider Drug Alias
Lot Number
Dose Amount and Units Of Measure
Expiration Date
Protocol Number for investigational drugs
Dose Form and Dose Route
DrugName
Bottle ID
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Non-IV Medications
• Secondary Information:
– Patient Identification
– MFG’d for another provider xref LotNumber
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Non-IV Medications
• Sample Message:
<SDID>
VER|1.2|
DIL|3680043262|3012345678|4555A34561|30|mg|20071212||Pill|Oral|
Pseudoephedrine HCL 30 mg|
<\SDID>
NDC: 3680043262
DrugAlias: 3012345678
LotNumber: 4555A34561
Amount: 30
AmountUnitsOfMeasure: mg
Expiration Date: 2007/12/12 – December 12th, 2007
Protocol Number: none
Dose Form: Pill
Dose Route: Oral
DrugName: Pseudoephedrine HCL 30 mg
BottleID: 123
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Non-IV Medications
• Work In Progress:
Order Administration like SmartIV
(give instructions, times, etc.)
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Device License Plates
• Primarily intended to identify a device for
association with another device or patient.
• Basic Information:
– Type of Device (IV Pump, Vital Sign Monitor,
etc.
– Manufacturer
– Model Number
– Serial Number
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Device License Plates
• Sample Data Message:
<DEV>
DEV|01|SIGMA|SPECTRUM|700188|
<\DEV>
SIGMA IV Pump
Model SPECTRUM
Serial Number 700188
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Device License Plates
• Work In Progress
ID’s for Bluetooth association
Communication Protocols information
Inventory and Asset tracking
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Current Use of Spec
• DELTEC CADD-PRIZM II pump implements basic
SmartIV.
• SIGMA Spectrum to implement in 2006
• MEDEX to adopt 06/07
• MISYS Pharmacy utilizes MiSim MLPS on Intermec
printers to enable SmartIV symbol generation by printer
middleware.
• ALARIS uses MiSim in clinical trials of their interface.
• FDA interested in working with team on Device License
Plates.
• Codecorp CR3 scanner with display PosID decoder
under development.
• Public Review
PARTNERS
H
E A L T H
C
A R E
S
Y S T E M
Positive Identification for Patient Medication Safety
Auto-Id Interface Specifications
Positive Identification for Patient
Medication Safety
Auto-Id Interface Specifications
PARTNERS
H E A L T H CA R E
SY S T E M