uk dose syntax and medication archetypes apr 2015
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A Dose syntax for community medication?
Dr Ian McNicollSCIMP
HANDIHealthopenEHR
Gyle meeting April 2015
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Introduction
Former Clydebank GP
Health Informatician since 2000
freshEHR Clinical Informatics
Co-chair openEHR Board
SCIMP
HANDIHealth
Commercial software developer
‘GP Accounts’
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Community medication stakeholders
GPs
Nursing
Mental health teams,
Pharmacy
Secondary care inpatients
Secondary care outpatients
Nursing homes
Unscheduled care
Patients
GP prescriptions
anticipatory care supply
repeat dispensing
transitions of care
own supply
patient access
patient-led reconciliation
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Current position
No clear visibility of other prescribers actions
Patient often only the knows the whole picture
No clear governance
Non- standardised representation of medication between systems
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What’s the solution?
‘Closing the Loop’ commission
‘patient medication record’
‘community’ record
Inpatient prescribing excluded other than at transitions of care
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Supported Meds Reconciliation
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Danish single medication record database
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The interoperability challenges
How do we resolve the ‘wicked’ interoperability issues?
Standardised, computable ‘medication models’
‘Medication event’ vs. ‘Medication statement’
Product vs. dose based prescriptions
Computable dose amounts / timings’
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NHSS Medication ModelsBased on GP2GP medication models
merge in requirements for
ECS / KIS / ePharmacy / SCI-GW
Other UK models : SCR, IHR, EPS2
Aligned with PRSB / RCP Headings
Can we persuade systems suppliers to adopt?
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Modelling approach
Based on openEHR but technology neutral
models of ‘clinical content’
Exchange -> messages / APIs
SCI-XML, GP2GP, HL7 FHIR inte
can be used natively inside openEHR-based systems
Aligned with dm+d, CUI
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open, shared data models - ‘Archetypes
• Clinically-led + collaboratively authored– open-source ‘crowd-sourcing’ methodology– Shared open repository ‘CC-BY-SA’ licence
• Agility in response to continually changing clinical demand– Clear ownership, change request mechanism– Tight version control
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GP2GP ‘medication item’ archetype
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Product vs dose based prescribing
Unavoidable
due to difference in the process of inpatient vs. outpatient prescribing
Dose:
Product:
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Dose syntax??
How can we capture a prescription like …
“Co-codamol 8mg/500mg/5ml oral suspension 5-10mls 4-6hourly for 7 days for
pain, maximum 40mls daily”
that makes the drug name, dose amount, timing and maximum dosage computable
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Dose syntax - aims
GP, outpatient, community, transitions of care prescriptions
support automated medicines reconciliation at transitions of care
calculate Total Daily Dose for quality assessment purposes
explore usage as data entry method
Out of scope
inpatient prescriptions
complex GP prescriptions
patient usage instructions ‘before meals, ‘take with water’
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Dose syntax - sources
Blue Wave / English NHS /CfH Dose syntax work
Comprehensive, complex
Low uptake
Uni. Dundee ‘EBNF’ Dose syntax
Successful use as research tool
Confined to GP prescriptions
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Blue Wave work
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CFH Abstract Dose Syntax
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Uni. Dundee Parsable dose syntax
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Archetype + Dose syntax
Proposed solution is a mix of archetype’ structural model + parsable syntax which carries dose amount + timing
“10mg td”
“3 n”
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Syntax overview
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“1 n:3d;1 m+pm & 2 n:4d"
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Examples I
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Examples II
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IDCR Transfer of Care Summary
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OPENeP Medchecker
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What’s next?
Implementer feedback?
Is this implementable?
Reference parser
GUI challenge
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Discussion