E-Prescription Distributed
System
E-prescription
• E-prescribing is simply an electronic way to generate
prescriptions through an automated data-entry process
utilizing e-prescribing software and a transmission
network which links to participating pharmacies
Challanges
Both patients and health care professionals benefit from system.
Improved patient safety:
• Problems resulting from poorly hand-written prescriptions are eliminated
• Access to patient's medical history
• Alert systems
• Shorter wait for the customer at the pharmacy
• No paper prescription to keep track of
Convenience for the healthcare professionals:
• Offers true provider mobility
• Improves reporting ability
Process
• Patient visits a physician
• Physician then writes a prescription based on examination
• Physician transmits the prescription to an appropriate
pharmacy using a computer or a hand-held device such as a
Blackberry
• Software routes the prescription through the provider’s secure
server to the pharmacy
• E-prescription software is able to automatically create and
store electronic records
Process for Creating and Managing a Prescription
Electronically
•
System infrastructure may be based entirely on
a) a device, or on a server located in the local environment
b) remotely through an application service provider (ASP)
environment.
Process for Creating and Managing a Prescription
Electronically (cont.)
E-prescription Process Map:
• Steps involved in e-prescription creation and management are illustrated
below
Sign on
Identify
patient
Review
Current
pt.date
Select drug
Enter
parameters
Signature
Review alerts and advisories
Print or
send Rx
Pharmacy
review and
process
Process for Creating and Managing a Prescription
Electronically (cont.)
Signing On
• A user of the system—clinician, staff, etc.—signs in by
performing some sort of authentication to prove his or her
identity.
Identifying the Patient
• In order for the e-prescribing process to begin, the clinician
needs to identify the patient within the e-prescribing system.
Review Patient Data
• After the identifying the patient in the system the clinician will
have access to the patient medical history.
Process for Creating and Managing a Prescription
Electronically (cont.)
Selecting the Drug, Entering Parameters, and Signing
Functions performed by E-prescribing systems:
• Review patients’ current medication list and medication
history information
• Work with an existing medication
• Prescribe or add new medication
• Complete the prescription
• Output prescriptions
• Other functions
Process for Creating and Managing a Prescription
Electronically (cont.)
Review Alerts and Advisories
• The prescription information generally consists of a list of drugs, mode of
administration, quantity and period of administration.
• drugs that a patient is allergic to are kept in a database.
• patient’s expenditure would be given to the patient before discharge from
hospital
• After diagnosis, the doctor prescribes the right quantity and dosage of the
medication.
• Where a drug is not available, it is reordered from the store or the
manufacturer and dispensed to patient.
Process for Creating and Managing a Prescription
Electronically (cont.)
/Check drug Items on prescription list
Dispensing
Checking – drug items
/Not all drugs Item on list checked
/Dispensed
reordering
Administering
/Drug not in stock or below reorder level
Figure 1
System Architecture
Application architecture design and deployment characteristics:
• zero-layer
• three-tier
• 99.9% availability and connectivity
•
•
User Interface Tier
The presentation tier has application code
Application code is able to render WML and JSP pages to
–
–
–
–
•
•
mobile devices
pocket PC
PDAs
desktop, and Smart Phone
The pages are viewable through the use of PC Internet Explorer, Web and WAP
browser.
The WAP browser will suffice to display database queries submitted to the server.
System Architecture(Cont.)
As an example In Figure 2, the client is thin and typically includes a graphical users’ interface
written in WML that runs from a micro browser.
Middleware
Client
Jsp /Services
Rendering
Engine
WML
Web/ Wap
browser
User
eHealth
Services
ODBC
JDBC
Database
Figure 2
Communication Route
System Architecture(Cont.)
Application Server Tier
• The application server tier




provides access to data tier
implements business logic
data validation
responsible for all database transaction handling
• client and e-Prescription application communication is handled by HTTP
and the wireless application protocol
• e-Prescription server and the application server tier communication is
handled by HTTP and the wireless application protocol
• application server and database communication is performed via JDBCODBC drivers.
System Architecture(Cont.)
Database Server Tier
•
The data layer stores and maintains:
 data for the system security policy
 network security protocols
 other techniques (such as firewall, password control, secure access,
antivirus, and etc)
•
When medications are prescribed to a patient, the details are recorded in the
central server.
•
The pharmacist is able to retrieve a patient’s medication information in order to
dispense the appropriate drugs as soon as the patient completes his encounter with
the doctor.
•
A patient’s medication information includes: patient’s identity, drug identity,
method of administration, etc.
System Architecture(Cont.)
The medication is monitored by the pharmacist Figure 3 depicts patient’s medication
details retrieved by a physician.
Figure 3
Conclusion
The e-Prescription allows physicians to capture and view patients’ medication
details avoids problems of prescriptions by pharmacists . The access to the
patient’s medical records real-time improves patient’s care by ensuring that
correct information such as the appropriate medication to be administered is
retrievable and legible.
In addition, the application improves efficiencies of health care services by
eliminating time-consuming call-backs that may be associated with treatment
processes.
References
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7.
Ikhu-Omoregbea, Nicholas. "Formal modeling and design of mobile prescription applications." 2008.
Department of Computer and Information Sciences Covenant University . 15 Apr. 2009
<www.jhidc.org/index.php/jhidc/article/viewPDFInterstitial/15/49>
Department of Health and Ageing. “Consultancy in Electronic Prescribing and Dispensing." June
2008. Australian Government. 15 Apr. 2009
<www.health.gov.au/internet/main/publishing.nsf/Content/.../$File/DOHA08-ePrescribing%20reportFinal290708.pdf>
The eHealth Initiative and The Center for Improving Medication Management. "Electronic Prescribing:
Becoming Mainstream Practice ." June 2008. eHelath Initiative. 15 Apr. 2009
<www.jhidc.org/index.php/jhidc/article/viewPDFInterstitial/15/49>
Physician Assessment Study. Southeast Michigan ePrescribing Initiative (SEMI), March 2008.eHealth
Initiative Blueprint: Building Consensus for Common Action. October 2007.
<www.ehealthinitiative.org/blueprint>
Industry Facts-at-a-Glance. 2008. National Association of Chain Drug Stores.
<http://www.nacds.org/wmspage.cfm?parm1=507>
National Progress Report on E-Prescribing. 2007.
<http://www.surescripts.com/pdf/National-Progress-Report-on-EPrescribing-1.pdf>
E-Prescribing Overview. 2008. Centers for Medicare & Medicaid Services.
<http://www.cms.hhs.gov/eprescribing/>