UK Dose syntax and medication archetypes apr 2015
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This document discusses developing a standardized computable "dose syntax" for representing community medication information across different healthcare systems. It proposes a solution that combines an openEHR archetype structural model with a parsable syntax to capture dose amounts and timings. Examples of the syntax are provided to represent prescriptions like "10mg twice daily" in a way that is computable. The goal is to improve medication reconciliation at care transitions by making prescription data electronically exchangeable and analyzable across primary, community, and secondary care settings. Feedback is sought on implementing this approach.
UK Dose syntax and medication archetypes apr 2015
- 1. A Dose syntax for community medication? Dr Ian McNicoll SCIMP HANDIHealth openEHR Gyle meeting April 2015
- 2. Introduction Former Clydebank GP Health Informatician since 2000 freshEHR Clinical Informatics Co-chair openEHR Board SCIMP HANDIHealth Commercial software developer ‘GP Accounts’
- 3. 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
- 4. 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
- 5. What’s the solution? ‘Closing the Loop’ commission ‘patient medication record’ ‘community’ record Inpatient prescribing excluded other than at transitions of care
- 7. Danish single medication record database
- 8. 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’
- 9. NHSS Medication Models Based 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?
- 10. 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
- 11. 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
- 12. GP2GP ‘medication item’ archetype
- 13. Product vs dose based prescribing Unavoidable due to difference in the process of inpatient vs. outpatient prescribing Dose: Product:
- 14. 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
- 15. 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’
- 16. 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
- 17. Blue Wave work
- 18. CFH Abstract Dose Syntax
- 19. Uni. Dundee Parsable dose syntax
- 20. Archetype + Dose syntax Proposed solution is a mix of archetype’ structural model + parsable syntax which carries dose amount + timing “10mg td” “3 n”
- 21. Syntax overview
- 22. “1 n:3d;1 m+pm & 2 n:4d"
- 23. Examples I
- 24. Examples II
- 29. IDCR Transfer of Care Summary
- 31. What’s next? Implementer feedback? Is this implementable? Reference parser GUI challenge
- 32. Discussion