IBM Drug Information System (DIS)
Overview
IBM Canada Health Care Team
Pharmaceutical Information Network
Agenda
•
Welcome and Introductions
•
Drug facts - Medication management business drivers
•
IBM’s experience with Canadian drug information systems
•
Pharmaceutical Information Network (PIN) functional overview
– What is PIN?
– Demonstration
•
Solution Components
– Evolving to a full-function pharmaceutical information management solution
2
•
Lessons learned
•
Questions and Discussion (over wine!)
Global Business Services
Pharmaceutical Information Network
Background: IBM’s Role in Canadian Drug Information
Systems
BC – IBM Integrated,
Implemented, Operated
and Maintained
PharmaNet
AB – IBM Designed, SK – IBM Designed,
Customized,
Developed, Installed,
Implemented and
Maintained, Deployed
Maintain PIN
and Operated PIN
25,000 Users, 100M+
Prescriptions
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QC – IBM
Selected,
Designed and
Implementing
SQIM
Pharmaceutical Information Network
Drug facts - Medication management business drivers
•
In Canada, more money is spent on drugs than on
physicians. (Canadian Institute for Health Information, Health Expenditure
Trends 1975-2002)
•
Drugs account for the second largest category of health
expenditures (next to hospital services). (Canadian Institute for
Health Information, Drug Expenditures in Canada 1985-2001)
•
In 2001, spending on drugs was expected to have
reached $15.5 billion, representing 15.2% of total
health care spending. (Canadian Institute for Health Information, Drug
Expenditure in Canada 1985-2001)
•
Two recent Canadian studies on health reform both
specified the need for Canada-wide catastrophic drug
coverage. (The Health of Canadians – The Federal Role (Kirby Report,
September 2001; Building on Values - The Future of Health Care in Canada,
Romanow Report, November 2002)
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Pharmaceutical Information Network
Background: PIN in Alberta
•
IBM designed, developed and deployed
Seniors Drug Profile, Pharmaceutical
Network and the 1st Alberta Electronic
Record
•
Facilitated extensive clinician engagement
as part of the PIN design and
implementation
•
Developed support infrastructure for
EMR/EPR vendor messaging
implementation
•
IBM has provided Transition and Change
Management support and deployed all of
these applications, to health care providers
throughout Alberta, since 1999
•
IBM is currently contracted by AH&W to
deploy Alberta NetCare (AB EHR)
– Includes EMR system messaging and
Pharmacy system batch upload
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Pharmaceutical Information
Network (PIN)
Functional Overview
Pharmaceutical Information Network
PIN Overview – Solution evolution
1999
2000
2001
2002
2003
2004
2005
2006
2007
PIN Version 3
PIN Version 2
•
•
•
•
7
PIN Version 1
Created by IBM and Alberta Health
and Wellness
Medication Profile Viewer and
Electronic Prescribing
Deployed to practitioners
throughout Alberta
Version 1 medication profile viewer
deployed in Saskatchewan
Global Business Services
• Technology Refresh and
Performance Testing
• Deployed to Alberta
• Version 2 ePrescribing
deployed to Saskatchewan
practitioners
• Addition of Pan-Canadian
standard HL7 V3 (CeRx)
compliant messaging
• Update of Graphical User
Interface
• Completion scheduled for
March 31, 2008
2008
Pharmaceutical Information Network
PIN Overview: What is PIN?
•
A solution that:
– Links community physicians, pharmacists,
hospitals and other authorized health care
providers by providing them confidential
shared access to patients’ active medication
profiles
– Provides online decision-support tools for
prescribing, dispensing, compliance
monitoring, research and policy development
– Existing EMR or EPR CPOE functions ‘build
the script' and then communicate with PIN for
interaction checking and to create the
electronic prescription
– Pharmacy systems also communicate with PIN
to conduct interaction checking at dispense
time
– These prescribing and dispensing records are
stored in PIN’s database for access by other
providers
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Pharmaceutical Information Network
PIN Overview: How is PIN delivered?
•
Conceptually simple:
– Central clinical data repository for each
jurisdiction
– No duplicate data entry
– Links existing heterogeneous systems
•
Other Points
of Care
Two access methods:
– From EMRs/EPRs and Pharmacy
Systems through system-to-system
messaging that is transparent to users
– Through a Web browser where systemto-system capability is not available or
not required
Central Clinical
Data
Repository
Pharmacies
Physician
Offices and
Clinics
Hospital
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Pharmaceutical Information Network
How does PIN work in a physician’s office?
Receptionist
Printed Prescription
EMR
EMR
History
Patient
EMR
Physician, at
point of care
Nurse
EMR
System-to-System Interface
10
Patient takes
printed EMR
prescription to
pharmacy
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PIN
Database
In Alberta, PIN is currently
supporting EMR system messaging
with 10 EMR system vendors:
•
•
•
•
•
•
•
•
•
•
Clinicare
EMIS
Jonoke
Med-Access
Microquest
Nightingale
Optimed
Practice Solutions
Telin
Wolf
Pharmaceutical Information Network
PIN Overview: Functionality Summary
PIN Web GUI
Create and Manage Prescriptions
– Hold, Release, Renew, Discontinue, etc.
Messaging
Create and Manage Prescriptions
– Hold, Release, Renew, Discontinue, etc.
Create and Manage Allergies / Intolerances
Create and Manage Allergies / Intolerances
Contraindication / Dosage Management
Contraindication / Dosage Management
– Drug to Drug, Drug to Allergy, Over/Under dose
– Drug to Drug, Drug to Allergy, Over/Under dose
Masking
Masking
Drug Monograph
Drug Monograph
Patient List
Reports and Reference Links
– Access Report, Medication Reconciliation Report
Create and Manage Device Prescriptions
Record Patient Observations
Record Patient Notes
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Pharmaceutical Information Network
PIN Overview: Benefits of PIN
•
Accurate and complete patient medication profile
– Data from from multiple sources and multiple health service providers can be
viewed by any authorized user
– Active medication profile (prospective view of treatment intent)
•
Legible prescriptions
– Reduced transcription errors
– Reduced phone calls between pharmacies and physicians
– Can be understood by the patient
•
Decision support tools
–
–
–
–
–
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Warnings for drug-drug interactions and drug-allergy interactions
Dosage checking
Duplicate therapy
Online reference tools
PIN also provides a foundation for other drug utilization review requirements
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Pharmaceutical Information Network
PIN Overview: PIN V1 to PIN V2 - Technology Upgrade
and Performance Testing
Objective
Technology Upgrade Results
Scalability
•
Availability
Performance
Portability
•
•
•
•
•
•
Vitality
•
Both vertical and horizontal scalability of the PIN application and database have
been proven
Very high transaction volumes achieved
PIN positioned for failover and high availability
GUI response times met all Alberta targets
PIN is now operating system independent and is currently running on both Windows
and Unix platforms
Database conversion effort has been greatly reduced due to use of Hibernate
objects
PIN aligned with CHI reference model through externalization of Person, Facility,
Provider and Security interfaces
Custom components updated to commonly used components. The utilization of
commonly used open source components
Extensive performance and scalability testing was executed throughout the PIN V2 development effort,
resulting in the system meeting all response time and transaction volume targets
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PIN Overview: PIN V2 to PIN V3 - CeRx Messaging
Support
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•
•
•
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In November 2006, Saskatchewan Health and IBM, with funding from
Canada Health Infoway, launched the PIP Phase 2.4 – CeRx project
Enhanced PIN to support CeRx messaging
Results - 52 messages supported, GUI updated to use new, CeRxcompliant data model
Availability – 1st Quarter 2008
PIN V3 - CeRx highlights
– The solution supports V01R04.3 of the CeRx specification (Sept 11, 2006
“Stable for Use” version plus all Urgent Release updates)
– The IBM project team worked closely with Canada Health Infoway throughout
the project and requested/recommended a number of specification changes
– Infoway has reviewed and approved the project’s CeRx requirements
documentation
The project is currently in User Acceptance Testing with Saskatchewan Health. Final performance testing is in
progress
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PIN Deployment in Saskatchewan
Pharmaceutical Information Network
The Saskatchewan Pharmacy Information Program (PIP) vision is to
provide end-to-end support for the prescribing, dispensing, and claims
adjudication processes
2
Clinician
Reviews Patient
Chart
Clinician
3
Review Medication
Profile
4
Identify Problem
5
Review Reference
Material / Clinical
Guidelines
6
Review Treatment
Alternatives / Best
Choice Guidelines
7
Generate Prescription
Using Clinical Tools
8
Record, Print And
Sign Prescription
11 Review
Medication Profile
Pharmacist
12 Retrieves (or enters)
Prescription
Pharmacy
Pharmacy
Information
Information
Program
Program
13 Review Prescription
and Reference Material
Review Prescription
14 Using Clinical Tools
15 Submit Drug Claim
for Adjudication
Pharmacist
16 Record Dispensed
Medication
1
Patient Presents
At Clinician
Office
9
Provide Patient with
Prescription
Fill
17 Prescription
and Dispense
Medication
Patient Presents at
10 Pharmacy with
Prescription
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Pharmaceutical Information Network
Progress towards this vision began with the ‘All Drugs for All People’
(ADAPT) project’s extension of current business practice to include all
dispensed medications
Pharmacy
Pharmacy
Information
Information
Program
Program
Adjudication
Adjudication
ClaimsHistory
History
Claims
(fromADAPT)
ADAPT)
(from
ADAPT function
11 Review
Medication Profile
PIN function
Pharmacist
12 Retrieves (or enters)
Prescription
Complete
Complete
Dispensing
Dispensing
Record
Record
15 Submit Drug Claim
for Adjudication
Pharmacist
16 Record Dispensed
Medication
Fill
17 Prescription
and Dispense
Medication
Patient Presents at
10 Pharmacy with
Prescription
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Pharmaceutical Information Network
Building on ADAPT, the initial phase of Saskatchewan’s
program provided a medication profile viewer for clinicians
2
3
Review Medication
Profile
4
Identify Problem
Clinician
Reviews Patient
Chart
Pharmacy
Pharmacy
Information
Information
Program
Program
Adjudication
Adjudication
ClaimsHistory
History
Claims
(fromADAPT)
ADAPT)
(from
ADAPT function
11 Review
Medication Profile
PIN function
Pharmacist
12 Retrieves (or enters)
Prescription
Complete
Complete
Dispensing
Dispensing
Record
Record
Medication
Medication
Profile
Viewer
Profile Viewer
Clinician
15 Submit Drug Claim
for Adjudication
Pharmacist
16 Record Dispensed
Medication
1
Patient Presents
At Clinician
Office
Fill
17 Prescription
and Dispense
Medication
Patient Presents at
10 Pharmacy with
Prescription
18
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Pharmaceutical Information Network
Recent phases have introduced PIN’s prescribing support and decision
support tools that subsequent phases will extend to pharmacists
through functions supported by the CeRx message specification
2
Clinician
Reviews Patient
Chart
Clinician
1
3
Review Medication
Profile
4
Identify Problem
Pharmacy
Pharmacy
Information
Information
Program
Program
5
Review Reference
Material / Clinical
Guidelines
Adjudication
Adjudication
ClaimsHistory
History
Claims
(fromADAPT)
ADAPT)
(from
6
Review Treatment
Alternatives / Best
Choice Guidelines
Complete
Complete
Dispensing
Dispensing
Record
Record
7
Generate Prescription
Using Clinical Tools
8
Record, Print And
Sign Prescription
Patient Presents
At Clinician
Office
Medication
Medication
Profile
Viewer
Profile Viewer
Clinical
Clinical
Decision
Decision
SupportTools
Tools
Support
Complete
Complete
Prescribing
Prescribing
Record
Record
9
Provide Patient with
Prescription
ADAPT function
11 Review
Medication Profile
PIN function
Pharmacist
12 Retrieves (or enters)
Prescription
13 Review Prescription
and Reference Material
Review Prescription
14 Using Clinical Tools
15 Submit Drug Claim
for Adjudication
Pharmacist
16 Record Dispensed
Medication
Fill
17 Prescription
and Dispense
Medication
Patient Presents at
10 Pharmacy with
Prescription
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Pharmaceutical Information Network
As it evolves, Saskatchewan’s Pharmaceutical Information Program
provides an increasingly rich source of information for research,
planning, and program management processes
Information
Information
Warehouse
Warehouse
• Quality Council
• Academic, Research, and
Professional Analysis
• Health System Analysts
and Planners
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• Query
• Reporting
• Analysis
Information Types
• Prescribing
• Dispensing
• Allergies
• Alerts
• Audit
• Others
<Anonymize>
Pharmacy
Pharmacy
Information
Information
Program
Program
Adjudication
Adjudication
ClaimsHistory
History
Claims
(fromADAPT)
ADAPT)
(from
Complete
Complete
Dispensing
Dispensing
Record
Record
Medication
Medication
Profile
Viewer
Profile Viewer
Clinical
Clinical
Decision
Decision
SupportTools
Tools
Support
Complete
Complete
Prescribing
Prescribing
Record
Record
Pharmaceutical Information Network
PIN Demonstration
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Pharmaceutical Information Network
Patient Lookup
Various search options are provided.
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Pharmaceutical Information Network
Patient Medication Profile
3. The New Rx button is selected
to begin a new prescription
2. Details of each prescription are
provided by selecting the
associated link
1. The left-hand screen shows the patient’s
current profile, the right hand shows the
dispense history
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Pharmaceutical Information Network
Create a Short-term Prescription
The patient has presented with strep throat and
will receive a short term prescription for Biaxin.
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Pharmaceutical Information Network
Create a Short-term Prescription
The physician can search for the formulation
desired, and can also use favorites
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Pharmaceutical Information Network
Create a Short-term Prescription
Review
Rx is then
selected
If a favorite isn’t used, the relevant prescribing
information is filled in
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Pharmaceutical Information Network
Create a Short-term Prescription
2. Once the pharmacist has entered the
prescription through their pharmacy system, this
status will be change to “filled”
1. The resulting prescription is then shown and
can be printed and provided to the patient.
Multiple prescriptions can be created before
saving and printing
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Pharmaceutical Information Network
Multiple Drug Renew
1. The patient will be away
for an extended period and
requires all continuous
prescriptions to be renewed.
2. The physician can choose the Multiple Rx
Options button to perform activities on multiple
prescriptions at a time.
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Multiple Drug Renew
The physician selects
the drugs to renew
and then selects the
Renew button
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Pharmaceutical Information Network
Multiple Drug Renew
The physician enters the desired therapy end
date or duration of therapy, and all selected
drugs are renewed appropriately
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Pharmaceutical Information Network
Multiple Drug Renew
The renewed prescriptions are now ready to
save and print
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Pharmaceutical Information Network
Support for Allergy Information
PIN can capture allergy information for a patient,
and use it to warn physicians of potential allergy
to drug interactions
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Pharmaceutical Information Network
Dispense Screen
Based on user feedback, PIN V3 has been
enhanced to include a dispense view and report
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Pharmaceutical Information Network
Favorites
To facilitate the prescribing process,
practitioners can save “favorites” that can be
selected and pre-populate the fields during
PIN’s prescribing functions
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Pharmaceutical Information Network
User Preferences
The receipt of warnings and the requirement to
manage drug interactions and overdose situations
can be customized on a per-user basis
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Pharmaceutical Information Network
Medication Reconciliation Form
A very successful
addition to PIN’s
functionality has been
the Medication
Reconciliation Form
which is being used by
hospitals in
Saskatchewan to
provide preadmission
drug information
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Pharmaceutical Information Management
Solution Components
Pharmaceutical Information Network
Pharmaceutical Information Management solution
components
Provider and
Provider
and
Patient
Access
Patient Access
Clinical Pharmaceutical Information Management
Clinical Pharmaceutical Information Management
2
Pharmacy
Office
System
Provider
Provider
and
and
Patient
Patient
Portal
Portal
Physician Office
System
5
Clinical
Viewer
3
2
Prescribing
Functions
Knowledge and
CDS Tools
Dispensing
Functions
1
Prescribing Messages
Dispensing Messages
System –
System
to – –
to –
System
System
Access
Access
2
Integration
Broker and
Message Switch
(EHR)
Clinical
Pharmaceutical
Information
System
4
Claims Message
Registries
(EHR)
Secure
Secure
Network
Network
5
6
Patient
Access
38
2
5
2
Hospital
Information
System
Pharmaceutical
Pharmaceutical
Claims
Claims
Administration
Administration
Standards
Global Business Services
Active
Medication
Profile
Public and Private
Claims
Adjudication and
Administration
Dispensing and
Claims
Information
Pharmaceutical Information Network
PIN as an Infoway Drug Information System (DIS)
e-Health
e-HealthShared
SharedServices
Services
Jurisdiction
Jurisdiction
EHR Data and Services
Public Health
Comm.
Disease
Surveillance
Enterprise
RIS / PACS
Drug
Information
System
Enterprise
Shared Health
Record
EHR Integration Services
Provider
Registry
EHR Index
Integration
Broker
Security
Management
Client
Registry
Privacy
Management
EHR Portal
ADT
Clinical
Information
System
Insured
Clients
Registry
Physician
Office System
Pharmacy
System
Prescription
Drug Program
Regional Health
Regional Health
Authorities
Authorities
Point of Service
Point of Service
39
Ministry of Health
Ministry of Health
Global Business Services
Physician Office
Physician Office
Comm. Health
Comm. Health
Centres (CHCs)
Centres (CHCs)
Point of Service
Point of Service
Registration
System
Pharmacy
Pharmacy
Point of Service
Point of Service
Professional
Professional
Association
Association
Pharmaceutical Information Network
PIN as an Infoway Drug Information System (DIS)
e-Health
e-HealthShared
SharedServices
Services
Jurisdiction
Jurisdiction
A jurisdiction’s Client and
Provider Registry data is
accessed through PIN’s
external interface
EHR Data and Services
Public Health
Comm.
Disease
Surveillance
Enterprise
RIS / PACS
Drug
Information
System
PIN will use the
security and privacy
services provided by
Ontario’s EHR
Enterprise
Shared Health
Record
EHR Integration Services
Provider
Registry
EHR Index
Client
Registry
Integration
Broker
Security
Management
PIN can also integrate
with an Ontario
Provider and Client
Portal
Privacy
Management
PIN is currently
available to Alberta
NetCare users through
the Orion portal
EHR Portal
ADT
Clinical
Information
System
Insured
Clients
Registry
Physician
Office System
Pharmacy
System
Physician and Pharmacy
office systems will
interact with PIN via
CeRx HL7 V3 messages
an HL7 V3 system to
access and populate its
Drug Repository
Prescription
Drug Program
Regional Health
Regional Health
Authorities
Authorities
Point of Service
Point of Service
40
Ministry of Health
Ministry of Health
Global Business Services
Physician Office
Physician Office
Comm. Health
Comm. Health
Centres (CHCs)
Centres (CHCs)
Point of Service
Point of Service
Registration
System
Pharmacy
Pharmacy
Point of Service
Point of Service
Professional
Professional
Association
Association
Pharmaceutical Information Network
Lessons Learned
• Stakeholder engagement at both advisory and working group-levels provides valuable
guidance in release and change management planning
– Physicians, pharmacists, and other providers and their respective professional associations
– Claims administration and health sector clinical information management representatives
•
Early availability of clinically relevant medication information is invaluable to jump start
adoption
– All Drugs, All People – Community dispensed medications initially, followed by inpatient
medications
•
Pharmaceutical information is core data for many clinical health information initiatives; the
pharmaceutical information program must align with other Ontario health sector initiatives
– Primary Care Teams, Community Health Centres, Chronic Disease Prevention and Management
•
Implement the full-function pharmaceutical information solution through a series of
complementary projects
– Ensure each project provides stakeholder business value
•
Develop a strong change management program to encourage early adoption and sustain
use
– Communication planning and materials, implementation planning and installation services, training
materials and support, post-implementation evaluation and issue resolution
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Pharmaceutical Information Network
PIN Value Summary
•
Provides functions and information that address key business drivers
– Improve patient care and quality and provide clinicians with information to support
appropriate drug therapy
•
Integrate with provincial investments and provide an Infoway-compliant Drug
Information System (DIS)
– Can be implemented as a standalone system or as an Infoway-compliant EHR Data and
Service Drug Information System (DIS) provider
•
Support ePrescribing through both Web GUI and Infoway-compliant CeRx HL7 V3
message interfaces
•
Proven solution backed by IBM experience and integration capability
– First installed in 2002, two versions since then have modernized the solution and expanded
its function
– Production installations in both Alberta and Saskatchewan
42
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Questions?
Supporting Material
Pharmaceutical Information Network
Phase 1 - CeRx Messages – 33 of 52
45
•
Prescribing
•
Dispensing
– Create New Prescription
– Clinical Pre-Determination
– Stop Prescription
– Hold Prescription
– Release Prescription
– Revoke Dispensing Permission
– Record Non-Prescribed Drug
– Update Non-Prescribed Drug
– Fill Prescription
– Transfer Prescription
– Prescription Pickup
– Abort Fill
– Record non-Fill of Prescription
•
Consent
•
Common Functions
– Mask Clinical Data
– Unmask Clinical Data
– Record Consent
– Retract Request
– Add Record Note
Global Business Services
•
Patient Queries
•
Allergies/Intolerances
•
Drug Queries
– Get Dispenses for a Drug Prescription
– Get Single Drug Dispense Details
– Get Patient Medication Details
– Get Patient Medication Summary
– Get Patient Other Medication Details
– Get Medication Profile Generic Query
– Get Patient Drug Contraindications
– Add Allergy, Intolerance
– Update Allergy, Intolerance
– Get Patient Allergies, Intolerances
– Get Allergy, Intolerance Change History
– Get Drug Documentation Information
– Search Drug Products
– Query Drug Detail
– Contraindication Checking Against a Full Set of
Drugs
Pharmaceutical Information Network
Phase 2 - CeRx Messages – 19 of 52
•
Patient Queries
– Get Patient Drug Dispense History
– Get Patient Prescriptions, Never Dispensed
– Get Patient Prescriptions with Remaining
Dispenses
– Get Patient Drug Prescription Order Summary
– Get Prescription Drug Order with No Dispenses
– Get Drug Prescription Event History
•
Device Prescribing/Dispensing
– Create Device Prescription
– Fill Device Prescription
– Get Dispenses for a Device Prescription
– Get Patient Device Dispense History
– Get Single Device Dispense Details
– Get Patient Device Prescription Order Summary
– Get Prescription Device Order with No
Dispenses
– Get Device Prescription Event History
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•
Patient Observations
– Record Basic Patient Observations
– Review Basic Patient Observations
•
Patient Notes
– Add Patient Note
– Remove Patient Note
– Query Patient Notes
Pharmaceutical Information Management Solution
Transition States
Pharmaceutical Information Network
Current state - Starting point
Pharmacy
Pharmacy
Connectivity
Connectivity
Pharmaceutical
Pharmaceutical
Claims
Claims
Administration
Administration
Pharmacy
Office
System
Claims Message
System –
System
to – –
to –
System
System
Access
Access
Secure
Secure
Network
Network
Public and Private
Claims
Adjudication and
Administration
Dispensing and
Claims
Information
Comprehensive record of
dispensed medications?
48
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Pharmaceutical Information Network
Transition state 1 – Medication Profile – Alternative 1 –
Existing Claims Administration System
Pharmacy
Pharmacy
Connectivity
Connectivity
and Provider
and
Provider
Access
Access
Pharmaceutical
Pharmaceutical
Claims
Claims
Administration
Administration
Pharmacy
Office
System
System –
System
to – –
to –
System
System
Access
Access
Web Browser
Drug Profile
Viewer
49
Secure
Secure
Network
Network
Global Business Services
Claims Message
Public and Private
Claims
Adjudication and
Administration
Dispensing and
Claims
Information
Comprehensive record of
dispensed medications
Pharmaceutical Information Network
Transition state 1 – Medication Profile – Clinical
Pharmaceutical Information System
Provider
Provider
Connectivity
Connectivity
and Access
and Access
Clinical Pharmaceutical Information Management
Clinical Pharmaceutical Information Management
Medication
Profile
Functions
Pharmaceutical
Pharmaceutical
Claims
Claims
Administration
Administration
Knowledge
Tools
Pharmacy
Office
System
System –
System
to – –
to –
System
System
Access
Access
Hospital
Information
System
Secure
Secure
Network
Network
Clinical
Pharmaceutical
Information
System
Medication
Profile
Comprehensive
dispensed
medications record
Integration
Broker and
Message Switch
Medication
Profile
Message
Claims Message
Registries
(EHR)
Clinical
Viewer - Drug
Chronic Disease
Information
System
Chronic Disease Prevention and Management
Chronic Disease Prevention and Management
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Public and Private
Claims
Adjudication and
Administration
Dispensing and
Claims
Information
Pharmaceutical Information Network
Transition state 2 – Prescribing support
Provider and
Provider
and
Patient
Access
Patient Access
Clinical Pharmaceutical Information Management
Clinical Pharmaceutical Information Management
Prescribing
Functions
Pharmaceutical
Pharmaceutical
Claims
Claims
Administration
Administration
Knowledge and
CDS Tools
Pharmacy
Office
System
Provider
Provider
Portal
-1
Portal - 1
Physician Office
System
Prescribing Messages
Dispensing Messages
System –
System
to – –
to –
System
System
Access
Access
Integration
Broker and
Message Switch
(EHR)
Clinical
Pharmaceutical
Information
System
Comprehensive
dispensed
medications record
Claims Message
Hospital
Information
System
Secure
Secure
Network
Network
Registries
(EHR)
Clinical
Viewer - Drug
Standards - 1
51
Global Business Services
Active
Medication
Profile
Public and Private
Claims
Adjudication and
Administration
Dispensing and
Claims
Information
Pharmaceutical Information Network
Transition state 3 – Dispensing support (full ePrescribing)
and patient access
Provider and
Provider
and
Patient
Access
Patient Access
Clinical Pharmaceutical Information Management
Clinical Pharmaceutical Information Management
Prescribing
Functions
Pharmacy
Office
System
Provider
Provider
and
and
Patient
Patient
Portal - 2
Portal - 2
Physician Office
System
Prescribing Messages
Dispensing Messages
System –
System
to – –
to –
System
System
Access
Access
Hospital
Information
System
Clinical
Viewer - Drug
Secure
Secure
Network
Network
Patient
Access
52
Integration
Broker and
Message Switch
(EHR)
Knowledge and
CDS Tools
Clinical
Pharmaceutical
Information
System
Registries
(EHR)
Standards - 1
Global Business Services
Dispensing
Functions
Active
Medication
Profile
Comprehensive
dispensed
medications record
Claims Message
Pharmaceutical
Pharmaceutical
Claims
Claims
Administration
Administration
Public and Private
Claims
Adjudication and
Administration
Dispensing and
Claims
Information