If there is one area that eHealth can assist in more than most, it is the ability to help doctors and pharmacists make informed decisions concerning an individual’s medication history. That is one of the driving forces behind the MedView Wave 2 project, which is aimed at providing a consolidated view of medications so that pharmacies and GPs have the ability to call up a profile and make more informed decisions about prescribing and dispensing.
MedView is one of the more scalable Wave 2 projects and is intended to be a national repository that will allow clinicians, pharmacists, aged care facilities and hospitals to see a combined list of prescribed and dispensed medications regardless of how many different doctors or pharmacies the patient has attended.
Bringing together software vendors from each of those areas – primary care, aged care and acute care – the project is utilising the existing eRx Script Exchange electronic prescription platform as well as partnering with number of different software vendors. These include GP software providers Best Practice and Zedmed, pharmacy software vendors Fred, Simple Aquarius and Pharmhos, aged care software specialist iCare, and acute care prescribing and dispensing systems BOSSnet and Pharmhos's Merlin.
The initial MedView trial will focus on the geographic area of Geelong, and is aiming to involve every pharmacy in that city and a significant proportion of GPs, along with Geelong Hospital and targeted aged care facilities. Working in close partnership with the Barwon Medicare Local, MedView’s momentum is rapidly building towards deployment.
And more recently, the Australian Association of Practice Managers (AAPM) has joined the project and will promote it to its membership as a practical means of providing additional benefit to their patient cohorts.
Software integrated with HI Service
Progress to date has been rapid, according to David Freemantle, general manager for eHealth at Fred IT Group and the lead spokesperson for the MedView project. Part of the work has involved ensuring that aged care and acute care software is integrating the Healthcare Identifiers Service, as is being done by GP desktop and pharmacy dispensing software providers. And the core medications information is being enabled by electronic transfer of prescriptions (ETP) using the services of eRx Script Exchange.
“It is such a basic concept, really,” Mr Freemantle says. “Pharmacies have been using computerised dispensing systems for 20 years but they’ve never been able to look at a consolidated history of medications for a patient. It has really been enabled by ETP.”
The project is leveraging National E-Health Transition Authority (NEHTA)-defined specifications and services, including secure messaging, HL7 CDA (clinical document architecture), Australian Medicines Terminology (AMT) and various others.
However, one of the prime roles of the project is the integration of the HI Service. To date, all of the vendors involved in the project have passed their Compliance, Conformance and Accreditation (CCA) testing, Mr Freemantle says. GP software vendors have been working on this for some time through the GP Software Vendors Panel, and through this project, individual healthcare identifier (IHI) functionality is being driven in the pharmacy, acute and aged care software sectors as well.
IHIs are also included in the eRx messages transmitted between clinical systems, he says.“The HI Service is integrated at the GP and pharmacy desktop ends — after authenticating the user, the clinical system authenticates the patient’s IHI and adds it to their patient record. The only real change in eRx from the ETP side is that it will now be able to transfer that IHI and a consent flag for MedView participation.
“eRx will see the consent flag and a copy of the prescription and dispense records will be sent to MedView through the standard ETP process. When a GP or a pharmacist is wanting to view the record in MedView, using their clinical system they initiate a query of MedView with the click of a button. Based on the patient’s IHI, the medications data is then displayed in the MedView viewer, which provides the ability to filter, sort and save the view.”
Patient consent is an area many involved in eHealth are working on, and it will be a big factor in the national PCEHR initiative. For this project, patient consent is again captured within the pharmacy and GP desktop systems, Mr Freemantle says.
“The doctors and pharmacists will ask for the patient’s consent to send the information to MedView. The patients likely to benefit most are the elderly, infirm or chronically ill, most of whom have a long-term relationship with their healthcare providers and a consistent care team, who will capture consent.
“We’re in the transitional planning process with NEHTA to investigate the transition into the national PCEHR. MedView is a relatively localised trial which will demonstrate the capabilities of the system and the technologies, with the next step being integration to the national PCEHR.”
The project is currently completing vendor integration testing. “We are in testing at the moment,” Mr Freemantle says. “We have a test system up and running that can demonstrate full integration through the ETP process, the HI Service at Medicare for the patient IHI, capture patient consent and then view a medications history in MedView for that patient. This is the pointy end of the project, and it is great to see the hard work starting to pay off!”
The process of recruitment will shortly speed up, along with deployment throughout Geelong. The goal is to have the pharmacies in Geelong along with all of the general practices using Best Practice and Zedmed recruited to the project.
Also involved is Geelong Hospital, which uses the BOSSnet prescribing system and the Merlin dispensing system, and an aged care facility, which is being assisted by iCare.
Aged care signs on
Chaolin Chang, product strategy and development manager with iCare, says the MedView project is extremely important for the aged care sector for a number reasons.
“This is a health initiative that is designed to improve resident health outcomes,” Dr Chang says. “It will create a national conformant medicines repository that provides the ability to view a combined record of community prescribed and dispensed medications for residents.”
For aged care facilities, it will allow medications to be managed to ensure safe and effective outcomes, reduce errors and medication risk and reduce adverse drug events, including medication dispensing errors, he says.
“There will be access to medication information at the point of care which will give healthcare providers a real-time view of medication information,” he says. “This provides a more complete basis for decision-making, improved communication between clinicians and ensures appropriate follow-up after discharge from hospital.”
iCare has completed the work necessary to add Individual Healthcare Identifiers (IHI) functionality to its software, and is currently working with a residential aged care facility (RACF) in the pilot phase. RACFs will have to apply for a HPI-O and potentially a HPI-I, but all care staff will be trained on the use of healthcare identifiers, Dr Chang says.
He says that when a resident is first admitted to a facility who has previously consented to having their medicines information submitted to the MedView medicines repository, the GP will be able to look up all previous medications prescribed by other authorised doctors.
“This will bring benefits to the resident including reducing unnecessary repetition of information and filling out forms, repeating their history and avoiding unnecessary risks in their medications as well as transfers and discharge.”
David Freemantle says this is an interesting project to work on because there are a number of dependencies that are out of the control of the trial partners which could make or break it.
“The technology works and we have now demonstrated that, but it is the dependencies on external services and specifications – such as Healthcare Provider Identifiers (HPI-I and HPI-O) – that we have limited control over which creates a challenge,” he says.
“We are actively involved in assisting practices and pharmacies to apply for their HPI-O and HPI-I at a later stage, but it can be a slow process. As practitioners and patients build their understanding of the benefits of such systems, I’m sure these issues will gradually iron themselves out.”
It is also pointing the way to the future, when the infrastructure requirements of eHealth are going to become enormous, he says. “The infrastructure requirements are going to grow rapidly as data increases exponentially across the whole PCEHR system.”