Transcript Medication_data_in_patient_summaries_Dipak_Kalra

June 20 - 21, 2016
US FDA White Oak Campus
Medication data in patient summaries
Dipak Kalra, EuroRec
Julie James, Blue Wave Informatics
Cross-border health care
The context for sharing summaries
Unscheduled care
(emergency,
unexpected)
Generic patient summary
Scheduled care
(planned by clinician,
arranged by patient)
Procedure referral summaries
Long term care,
and acute
exacerbations,
complications
(predictable, even if not
predicted)
Condition specific summaries
are needed,
including care plans
Specialist referral
(e.g. within a European
Reference Network)
Customised summaries,
multimedia, molecular…
All of these kinds of summary require the accurate sharing
of a patient’s medication profile, across borders
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undertaking clinical and
industry research
planning and budgeting
national health services
commissioning
purchasing healthcare services
public health
screening, prevention
optimising clinical
outcomes
Whittington
Hospital
delivering
person-centred,
empowered care
Healthcare Record
maximising
reimbursement
John Smith
DoB
: 12.5.46
practicing
personalised / predictive
medicine
optimising costs
complying to clinical guidelines
and practising safely
managing local services
and resources
aligning clinical workflows
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The “Medication Profile”
• Use of medicines is the commonest intervention in
healthcare
• Information about an individual’s medication use over their
lifetime and managed as a coherent whole but presented
appropriately for context, is central to providing good
quality care: this is “the Medication Profile”
• Patient summaries describe a “point in time” sharing of
(medication) information, which is one of the use cases of
the “Medication Profile”
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Medication Data in Patient Summaries
• Patient Summaries
– The Continuity of Care Record (CCR) in the US
– European Patient Summary Guidelines in Europe
• Similar description, purpose and intentions…..
• Both specifications include medication information as core to
their requirements
– But neither give much if any definition of the data elements,
OR how they should be populated
• As a “snapshot” there is no sense that, for these specifications, that the
data elements need maintaining over time, but neither is there any
sense of how long their information could or should be considered
“valid”
• EHR specifications were also examined, but not detailed here
© Blue Wave Informatics LLP, 2016
CCR / EuPS Comparison
CCR
EuPS
Description
Core data set of the most relevant
administrative, demographic, and clinical
information facts about a patient’s
healthcare, covering one or more
healthcare encounters
Minimum set of information needed to assure
healthcare coordination and the continuity of care
Purpose
A means for one healthcare practitioner,
system, or setting to aggregate all of the
pertinent data about a patient and forward
it to another practitioner, system, or setting
to support the continuity of care
To support the objective of continuity of care and
patient safety across borders
Secondary purpose of being available as
reference material for Member States
enhance patient safety, reduce medical
errors, reduce costs, enhance efficiency of
health information exchange, and assure
at least a minimum standard of health
information transportability when a patient
is referred, transferred, or is otherwise
seen by, another practitioner
“Essential and understandable health information”
made available “at the point of care to deliver safe
patient care during unscheduled care [and
planned care]” but which should have its “maximal
impact in unscheduled care”
Intent
© Blue Wave Informatics LLP, 2016
Medication Data Elements
Definition
CCR
EuPS
Medication
“List of current medicines”
Description of the medicinal “List and describe the patient’s
product itself (be it
current medications and pertinent
prescribed, dispensed, (self) medication history”
IDMP
administered, statement
about)
Medication
“Activity”
and Status
Description of the role in the
Medication Process that the
medicinal product played
(e.g. being prescribed,
administered, or
statemented)
“list and describe the patient’s
current medications and pertinent
medication history”
“Defines the <Status> of the
<Product>.
[Active, On Hold, Prior History No
Longer Active]”
Dosage
Description of the full set of “<Directions> is the instructions
Instructions information that supports the (SIG) component describing the
correct administration of a intended patient use of the
<Product>. Can be used to map a
medication to a patient in
single SIG or a complex recurring
order for it to have its
SIG like a tapered dose or sliding
therapeutic effect
scale. Recurring SIG segments are
represented by repeating the
<Directions>
tag and its children.”
© Blue Wave Informatics LLP, 2016
All prescribed
medicines whose
period of time
indicated for the treatment
has not yet expired
whether it has been
dispensed or not
Described as individual
components only, not as a whole
unit (e.g. dose quantity,
frequency, duration etc.)
EuPS “Medication List”
• Currently, the EuPS does not require a machine readable
identifier for the “Medication” – whereas other specifications do
- because no pan-European Medication code system is
available
• EuPS requires “active ingredient substance(s)”, strength(s) and
dose form
•
But, as epSOS showed, this is not enough because there is no fully
suitable code system(s) (terminology) for these concepts, especially when
one moves away from simple chemical substances into biologics etc.
© Blue Wave Informatics LLP, 2016
How could IDMP help?
• IDMP can provide machine readable identifiers (“codes”) for
the “Medication” available for each jurisdiction, and human
readable names
• It also provides a generic representation of all medications,
that is independent of jurisdiction (the PhPIDs of 11616)
• This information can be used directly in patient summaries or
provide input to existing healthcare medication terminologies
such as the NHS dm+d (UK), the G-Standaard (the
Netherlands) or RxNorm (the US)
© Blue Wave Informatics LLP, 2016
And to support “Interoperability”
• The PhPIDs can support mapping between different
medication terminologies, including those of different
jurisdictions
– A medication is described using a code from a particular
code system in one application or jurisdiction can still be
“understood” in another environment, by means of the PhPID
representation
© Blue Wave Informatics LLP, 2016
Example
•
In France:
– Deltazen LP Gé 300 mg Gélule à libération
prolongée (Sanofi-Aventis)
IDMP PhP4 ID
Diltiazem hydrochloride 300mg
modified release capsule
In Ireland:
– Adizem-XL 300mg Prolonged release capsules
(Mundipharma)
– Tildiem LA 300mg Prolonged release capsules
(B&S Healthcare)
© Blue Wave Informatics LLP, 2016
Challenges for a trustworthy medication
profile
• Identifying medicinal products - across countries - is an important
priority!
• Standards are needed for the structure and semantics for
representing medication items in a profile AND for populating
these items from data from the Medication Processes
• How are particular items described? One off prescriptions, as
required items…
• The Profile needs clear removal or archiving criteria: on what basis
are items deprecated? How to document the rationale?
• How is "currency to be defined", and conflicts between EHR
systems to be reconciled?
• Should the “archive” always be communicated as part of the profile?
• The Profile needs clear inclusion criteria: grey areas include
immunisations, purchased medication, medical devices, herbal
and other complementary therapies, blood products…
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Conclusions
• Health summaries (not one standard summary!) can play
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important roles in cross-border and within-border care
co-ordination
Standardised representations of (most of) the summary content
are vital to enable EHR systems support (care pathway tracking,
decision support, trends etc.) and wider uses of the health data
Harmonising the unplanned care summary (~ International
Patient Summary) is an important first step
Since medication information vitally underpins continuity and
safety of care, globally robust medicinal product identification is
also an important step
However we next need urgently to standardise on a trustworthy
Medication Profile (= structure + content + workflows + policies)
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