Epharmacy in the Netherlands André Blom KNMP Michiel

Epharmacy in the Netherlands André Blom KNMP Michiel Sprenger Vu. Mc, NICTIZ (per 1/3/08) , IHE

Agenda 1. Status (e)pharmacy 2. Interoperability scenario’s in hospital and community pharmacy 3. Dutch drug database G-standard

Current status (e)pharmacy (1) The netherlands • 16 mio people • 100 hospitals (8 academic) • 1800 community pharmacies • 100 hospital including hospital pharmacies • > 10 transmural pharmacy service points • • 3 main community pharmacy system suppliers (local) > 5 hospital pharmacy system suppliers (usually integrated within hospital information systems, local) • • Long tradition in pharmacy IT > 25 years Worldwide unique datamodel drugs (G-standard) Basis for advanced electronic medication surveillance Broad collaboration and exchange in primary care

Currrent status (e)pharmacy (2) • • > 20 regional networks for extended exchange edifact messages between regional healthcare providers (prescriptions/ referrals/ discharge summaries/ lab results) 70% community pharmacies exchange medication data via local networks for medication surveillance during evening hours/duty (edifact) 30% locum gp’s exchange professional summaries (edifact) Electronic prescribing in primary care : 50 -80% • directly from gp to pharmacy of choice via local networks Electronic prescribing in secondary care • 30% clinical • 15% outpatient clinic No significant electronic prescribing or exchange exit medication in transmural care Edifact : de facto standard in primary care Hl 7 vs 2. x : de facto standard in secondary care

National ehealth strategy (1) • National infrastructure (aorta) • AORTA basic infrastructure • National registration system for identification and authentication of patients, healthcare providers, insurers • National switch point (LSP) with a reference index for routing , identifcation, authentication, authorisation and logging • Care service providers for communication and services between local environments • Information systems of care organisations (GBZ) • Message standard (HL 7 vs 3. 0) Interoperability and standards HL 7 vs 3. 0 (reference model) basis for EHR SNOMED CT terminology

National ehealth strategy (2) • Ehealth applications National EHR Virtual record comprising of a set of applications connected to national infrastructure 1. Electronical Medication Record (EMD)- history dispensed medicine - now in pilot 2. Patient summary (PS) locum GP – now in pilot 3. Followed by extended EMD • Includes allergies & contra-indications & lab & AE • Delivery and usage of medication 4. Future applications • E-diabetes • E-labs • E-emergency • E-pathology • E-radiology Eprescription Introduction of digital signature for physicians (through a new medicine act)

Medication processes Hospital pharmacy • • • Inpatient (clinical) treatment Outpatient treatment Emergency treatment • Complete overview hospital medication processes are being currently defined including a national set of functional guidelines by Dutch Asscociation of Hospital Pharmacists (NVZA) and NICTIZ • Available Quarter I 2008

Clinic Medication order Hospital pharm - 2. Prescribing 1. Intake 3. Control & intervention (intramuraal) 4. Dispensing 5. Admin no no Medication Cnange? Discharge ? 6. Evaluate yes Yes ER 20. Emergency room yes 7. Define exit medication consult Intake ? 21. Admin no Prescription 10. Outpatient consult 11. Prescribing Exit medication 12. Control & intervention (extramuraal) (Community/outpatient) pharmacy Outpatient clinic 13. Dispense 14. Use

Exit medication includes • Prescription that patient brings to pharmacy of choice • Information for gp and pharmacist regarding changes in medication related to intake of patient (home medication) in order to update their EMR Relevant integration aspects : • Integration with information system of hospital’s pharmacy • Integration with information system of community pharmacist’s • Integration with GP information system for receiving acknowledgements

Other business processes pharmacy (in addition to dispensing) • • • Dispensing Counselling Pharmaceutical consultations • Medicine Use Reviews (MUR) • Pharmacotherapeutical Treatment Plans (FTP) Medication surveillance (repeat) prescriptions Adherence and Concordance programmes Pharmacotherapy audit meetings (PTAM) Public Health Prevention programmes Financial declaration of services at the national insurers /governments Additional processes within the pharmacy are: • Reporting and evaluation of adverse effects • Reporting and evaluation of medication errors • Contribution to scientific research • Contribution to disease management programmes Relevant integration aspects To be defined

E-lab • • • Information exchange important between (community) pharmacies and (clinical) labs Lab information improves medication surveillance by pharmacists • Retrieve lab history • Order lab tests Labs can better interpret data if they have medication use of patients • Retrieve medication use Relevant integration aspects Integration within (hospital) pharmacy information systems Integration within lab information systems National e-labs programme Collaboration between NICTIZ, IHE and healthcare providers

G-Standaard / Dutch Drug Standard Structured drug database with information about: • • • the backbone, based on a fixed set of characteristics prescribing, ordering, administering, reimbursement medication surveillance: • contra-indications • Allergies • Pharmacogenetic data • drug-interactions • dosage check • label texts, etc. logistics (in cooperation with GS 1) Legislation

Physician Manufacturer prescription visit Pharmacy medication Patient invoice goods order invoice Wholesaler Health insurer

History • Developed by KNMP and privatized in 1999 (Z-index) • structure is based on roughly 25 years of practical experience • pharmaceutical content is maintained by a dedicated group of more than 20 full time pharmacists • installation of committees for reimbursement, pharmacotherapy, logistics and identification. • technology working group for modifications to the database • International orientation • E. g. member of SNOMED, GS 1 -HUG, CEN/ISO, HL 7

Standardized identification The medicinal products are identified by a set of identifying characteristics • ingredient • pharmaceutical dosage form • route of administration • strength • packing • quantity per packing • etc. The characteristics are based on national standards and on international standards where possible: • substance name: INN • pharmaceutical form and route of administration: Standard terms of European Pharmacopeia Commission • strength: SI-units

Structure

Structure • • at this moment the structure is a national standard (NEN 7507: Basic structure of a drug database) next step: international ISO standard