Dear All, The Medication work in NHS CFH uses a model that can be found in the following document (page 10 has the overview diagram) http://www.connectingforhealth.nhs.uk/systemsandservices/data/scg/publicatio ns/SCG0002.pdf The other issues mentioned see in line comments
The issues that are outstanding at the moment from my perspective are: . How to allow concatenation of Drug, form and dose at varying degrees of granularity. I.e. Ibuprofen; tablet; 400mg as three items, Ibuprofen tablet; 400mg as two items, Ibuprofen 400mg; tablet as two items, Ibuprofen tablet 400mg as one item. There is ongoing work to look at this and come up with a means that all are equivalent - not sure how far this has got - will chase up . What to record in terms of the drug name - do we include the trade and generic - either or both. We also need to allow in many jurisdictions for the fact that the pharmacist may be able to substitute another brand even if the trade name is given. In my opinion you must record the actual drug which is given to the patient so in dm+d terms (dictionary of medical devices and drug) a pharmacist states the AMPP (actual medical product pack - antipressan 50mg (Tera UK Ltd) 28 tablet (2x14 tablets)) that is dispensed. When prescribing it is reasonable for this to be done by stating VTM (Virtual therapeutic moeity - e.g. atenolol), VMP (virtual medicinal product - atentolol 50mg tablets) or AMP (Actual medicinal product - antipressan 50mg (Tera UK Ltd) . How comprehensive to make it in regard to all the possible complexities of drug administration. I think we should start with the root that will allow growth to immunisations, formulations and more complex orders (specifically medications in infustions) Regards Steve _____ From: [email protected] [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Sam Heard Sent: 24 November 2008 18:47 To: 'For openEHR clinical discussions' Subject: RE: Top 10 of Detailed Clinical Models Hi Stefan I think this is an excellent place to start. There are a few things to say: 1. Can you please add this to the openEHR wiki under http://www.openehr.org/wiki/display/healthmod/Health+Information+Models+Home 2. Dispensing is used for pharmacy delivery 3. We need to think of all the different points at which it may be appropriate and I think naming them will be better than levels. Why? Because prescribing a drug does not mean it is being taken, even dispensing. So the near patient reporting is always critical to know exactly what is being taken. We need lookups that patients can use to enter medication they are taking - bar code readers may be in home computers soon for recording all sorts of things - or perhaps in the phone (you can already use a camera for this with tickets etc) a. I would suggest we use: i. At prescription ii. At dispensing iii. Near patient with medication present iv. By report (professional, patient or carer) How does that sound? The issues that are outstanding at the moment from my perspective are: . How to allow concatenation of Drug, form and dose at varying degrees of granularity. Ie Ibuprofen; tablet; 400mg as three items, Ibuprofen tablet; 400mg as two items, Ibuprofen 400mg; tablet as two items, Ibuprofen tablet 400mg as one item. . What to record in terms of the drug name - do we include the trade and generic - either or both. We also need to allow in many jurisdictions for the fact that the pharmacist may be able to substitute another brand even if the trade name is given. . How comprehensive to make it in regard to all the possible complexities of drug administration. I think we should start with the root that will allow growth to immunisations, formulations and more complex orders (specifically medications in infustions) Cheers, Sam From: [email protected] [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Stef Verlinden Sent: Monday, 24 November 2008 8:15 AM To: For openEHR clinical discussions Subject: Re: Top 10 of Detailed Clinical Models I couldn't agree more. >From my perspective I would like to advocate that this DCM/archetype takes the self-registration of drug use by the patient/ citizen into account. I really think that for the coming years self-registration will be the fastest route to a drug use registration that provides the best possible reflection of the reality. Also if we don't come up with a good solution that allows citizen involved, other parties, who might have less interest in open standards, could take over that domain. Since I've been trying to work this out for quite some time now, I finally took the time to write down my thoughts on this topic. For those of you interested it can be found here: http://www.vivici.nl/a_three_level_model_for_the_registration_of_drug_use/ Maybe this can be of some help in the discussions coming... Cheers, Stef Op 23-nov-2008, om 20:21 heeft Sam Heard het volgende geschreven: Thanks William. So lets do a medication archetype that contains all the standard information constructs required to do this, and CCD and CCR. We can include Microsoft if we want as well just to have the world reasonably covered off. The point here is there are a plethora of specifications being developed and no one knows quite what they mean or how to use them. Lets do it in openEHR and try to nail it down. Cheers, Sam From: [email protected] [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Williamtfgoossen at cs.com Sent: Sunday, 23 November 2008 7:15 AM To: openehr-clinical at openehr.org Subject: Re: Top 10 of Detailed Clinical Models Hi Thomas, The Netherlands is implementing the exchange of medication messages in order to achieve the full list of a patient of current and past medications and prescriptions. Current pharmacy and gp systems have a DSS system in place that tackles interactions. It is probably not perfect, but coming in the direction you suggest. I agree that this is an interesting topic to tackle further and harmonize. A lot is already put into the HL7 CEN ISO CDISC and IHTSDO harmonization work, where pharmacy is now a priority topic. William In a message dated 22-11-2008 12:20:57 W. Europe Standard Time, thomas.beale at oceaninformatics.com writes: Gerard Freriks wrote: >When medication is considered be aware that there is already a huge >amount of requirements collection in HL7v2, HL7v3 space and in >European standards. >I think that with a limited amount of work the Clinical Models can be >produced and discussed. >In addition we need this all over the world and there is one European >project needing it : epSOS. > * I would suggest that the 2 key requirements today are: a) being able to merge medication lists for a given patient from multiple sources b) being able to handle entries in the list that were prescribed (and that are recorded in some structured, standard way) and medications that the patient says they are on already, including non-prescription and herbal etc. Being able to do this would generate a list that can actually be used for decision support (interactions testing) for a new prescription. I don't think either of these is dealt with directly by any of the current standards. - thomas beale Sincerely yours, dr. William TF Goossen director Results 4 Care b.v. De Stinse 15 3823 VM Amersfoort the Netherlands email: Results4Care at cs.com phone + 31654614458 fax +3133 2570169 www.results4care.nl Dutch Chamber of Commerce number: 32133713 _______________________________________________ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical *********************************************************************** This message may contain confidential and privileged information. If you are not the intended recipient you should not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents. To do so is strictly prohibited and may be unlawful. Please inform the sender that this message has gone astray before deleting it. 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