Here is the release:
Media release : Another milestone reached - Webstercare becomes the first organisation to start using the Pharmacist Shared Medicines List
20 December 2019: The Australian Digital Health Agency, together with Webstercare – the creator of the Webster-pak® – has today launched a new clinical document within My Health Record to reduce medication-related problems in Australia, and specifically those experienced by Australia’s older population.The Pharmacist Shared Medicines List (PSML) is a consolidated list of medicines prepared by a pharmacist and uploaded to a patient’s My Health Record. The PSML will compile both prescription and non-prescription medicines, including over-the-counter and complementary medicines, such as vitamins and herbal remedies.
The overview the PSML will provide for healthcare providers will enable them to make more informed prescribing and treatment decisions and assist in reducing medication mishaps.
Particularly relevant at times of transitions of care, the PSML is a comprehensive list of medicines at a specific point in time, such as on discharge from a hospital when a patient’s care is being transferred to another health care provider – a common occurrence in Australia’s elderly population.
Associate Professor Chris Freeman, National President of the Pharmaceutical Society of Australia says the Pharmacist Shared Medicines List represents a significant professional contribution of pharmacists to My Health Record.
“As PSA’s Medicine Safety: Take Care report found, 250,000 hospital admissions in Australia each year are due to medicine-related problems and half of these are preventable. The pharmacist contribution of PSML to a person’s My Health Record means patients and health professionals will have access to more complete and accurate information about their medicines, including non-prescription medicines such as painkillers and herbal remedies. By having access to this information, decisions about prescribing, dispensing and administration of medicines will be more informed and safer,” says Associate Professor Freeman.
George Tambassis, National President of the Pharmacy Guild of Australia says “The Guild has advocated for the benefits of the My Health Record as an opportunity for pharmacists to be more actively involved in the clinical care of patients. The PSML will enhance the accuracy of medicines information in My Health Record as it provides a consumer’s comprehensive list of medicines at a point in time, curated by a pharmacist”.
The first Pharmacist Shared Medicines List was uploaded into the My Health Record system today at Metropolitan Pharmacy Services, a community pharmacy in Leichhardt, Sydney.
“Many of our patients using our dose administration aids are older Australians. Our Webster-pak® system provides assistance to ensure they are taking their medicines safely and at the right time each day, which may help them stay in their own home, instead of needing additional care,” says Webstercare Managing Director, pharmacist and inventor of the Webster-pak®, Gerard Stevens AM.
“But the pack itself only contains those medicines taken orally and packed in the Webster-pak®. The addition of the Pharmacist Shared Medicines List in My Health Record will allow pharmacists using Webstercare systems to better communicate the complete list of a consumer’s medicines in a single clinical document. This will make a big impact – for that person’s GP, specialist, clinician at the local hospital – by giving them a better understanding of the medicines that person is taking.”
The Agency is working with software providers to integrate the Pharmacist Shared Medicines List functionality into other pharmacy systems across the country.
Improving medicines safety is a core component of the Australia’s National Digital Health Strategy, endorsed by all state and territory government through the COAG Health Council.
Agency Chief Executive Officer, Tim Kelsey says, “Improving the safe use of medicines is a core priority of Australia’s National Digital Health Strategy. Shared medicines lists will provide early benefits and help clinicians get more of the information they need to make challenging health decisions on behalf of their patients. The Agency will soon be releasing the first National Medicines Safety Blueprint, which will chart the course for holistically improving our digital health environment to reduce the number of medication-related problems experienced everyday by Australians.”
ENDS
Here is the link:
Here is some more info:
Pharmacist Shared Medicines List
There’s a new way for you and your healthcare providers to securely access a list of medicines you take uploaded by your pharmacist. The Pharmacist Shared Medicines List. Helping reduce medicine-related problems in Australia.
What is the Pharmacist Shared Medicines List?
Soon your pharmacist will have the software to connect to and be able to upload a document called the Pharmacist Shared Medicines List (PSML) to your My Health Record.The Pharmacist Shared Medicines List is a list of medicines that may include those prescribed by your doctor, non-prescription medicines including over-the-counter or complementary medicines (such as vitamins or herbal medicines) you may take. This list will include details on how and when you take your medicines at the time the list was created.
If your pharmacist has uploaded a Pharmacist Shared Medicines List, you can find it in the ‘Documents’ section in your My Health Record.
Watch now: The Pharmacist Shared Medicines List - Kevin's story
The Pharmacist Shared Medicines List in My Health Record can help reduce the 250,000 medicine-related problems in Australia every year. See how the Pharmacist Shared Medicines List in My Health Record can help older Australians like Kevin reduce the chances of medicine-related problems. Read the media release here.What is the difference between the Pharmacist Shared Medicines List and the Medicines Information view?
If you have a Pharmacist Shared Medicines List in your My Health Record, your healthcare providers will be able to quickly access your most up-to-date information.This document can only be added to your My Health Record by your pharmacist.
You will find the Pharmacist Shared Medicines List in the ‘Documents’ section in your My Health Record.
The Medicines Information view can quickly look for, sort and display your most important health information in your record in date or by medicine name.
Rather than opening every document available in your My Health Record, the information in the Medicines Information view can be gathered from your most recent prescription and dispense records, your most recent shared health summary or hospital discharge summary prepared by your healthcare providers, or if you’ve added any medications or any allergies or adverse reactions.
You will find the Medicines Information view in the ‘Documents’ section in your My Health Record.
So what this is, is essentially Shared Health Summary(SHS), for your medicines filled in by the pharmacist.
As such it has all the problems of the SHS.
It is not clear in the description what happens if you go to more than 1 pharmacist – say while on holidays etc. Do they update or leave as is? Does it expire after some defined period. Once created is it updated with every dispensing event etc.?
A cynic might say the ADHA failed to get the GPs to buy in to the #myHealthRecord so the pharmacists were the next to be worked on!
It is also by no means clear how the work of setting it up for an individual is paid for – or is it just part of the service?
Of course, inevitably both it and the Medicines Information View will be consulted and if different how is the difference resolved?
I wonder do patients always get asked if they want this list uploaded and what control do they have for potentially sensitive medications?
Again this rather looks like a solution in search of a problem.
What do others think?
David.
16 comments:
This Pharmacist Shared Medicines List is exactly the same as the ED stuff - a technology solution devoid of any connection with medical reality. Are we really supposed to believe that pharmacists will spend significant amounts of (unpaid) time talking with patients, correlating/curating the data and then uploading it? And then expecting physicians to take much notice of it?
Not only is it "a solution in search of a problem" it's a solution that creates problems of its own.
ADHA seems to be suffering from some sort of government dementia.
Like Monday's ED blog and comments this pharmacy stuff is just another addition to an increasingly muddled and haphazard potpouri of discombobulated solutions looking for a problem.
The more these techo-driven solutions get pushed the more clinicians will turn their backs as they have already done with the ADHA and the My Health Record.
Don't expect anything to change. The techies won't listen to health professionals because the techies believe the health professionals need their help to practice medicine better, but don't know they need help
> an increasingly muddled and haphazard potpouri of discombobulated solutions looking for a problem
Commenters on this blog don't seem to believe it, but there agency (and NEHTA before it) s an active program of clinical consultation where a lot of this stuff comes from. It's not invented by technologists without prompting.
But the outcomes do match my personal experience: anytime you get N clinicians in the room, you'll get N different opinions about what should be done, all radically different.
A more formal capturing of this comes from Wes Rishel, a gartner analyst who was very active in HL7 before retiring:
> For any consensus process, any time the consensus group changes, so does the consensus.
This is now known as the Wishel rule at HL7.
And if you're paying attention, you can see that this, not formal requirements analysis, is the actual problem.
It's so easy to go off at a tangent, chasing rainbows, diverting attention from the essence of the problem; what we see here is a high jacking.
I am reminded of a blog a few days ago and associated comments. Bernard pointed out that the first question to be answered is "What is relevant clinical information?".
I suggest you all return to that point and answer the question.
The PCEHR/MyHR it is said is a political tool not a clinical tool. Therefore having clinicians as sacrificial pawns and now pharmacists and specialists would seem the correct thing to do. Are they the right stakeholders to be designing a consumer tool? Are they the right pawns to coerce those champions of transparency and collaboration?
Just another seemingly random feature release. Make you wonder what the product managers are doing or not doing.
@ 7:55 PM ""What is relevant clinical information?". That's not so easy.
I think it's a really hard question which probably explains why NEHTA, ADHA and advocates of digital health (technologists and clinicians) all seem to avoid attempting to answer it. That might be because the more they attempt to answer it the more they get entwined in what appears to be a problem without boundaries.
Even so, it seems like a great place to start as the intellectual challenge and discipline involved will more than likely expose the major deficiencies in previous approaches to developing a shared health record.
@ 5:35 PM Relevant! MMmm ... not all can be considered 'atomic' data
Some is 'basic' administrative [eg. record linkage ID data, multiple permutations of data like name, DoB, GP, address]
Some is 'numeric' [eg. BP, PR, Hb, HbA1C, .....]
Some is 'text narrative' [eg. anatomical pathology report, specialist letter / opinion, ....]
Some is a combination of numeric and text [eg. medication taken and adverse events,
Some is graphical [eg. operation notes, extent of burns, location of 'stab' wounds, .....]
Some will not be 'relevant', some will be 'relevant'.
What is the definition of 'relevant?
What are the inter-relationships and inter-dependencies of these types of data?
@7:03pm
Most of the data you describe is an observation, and the more complex ones like anatomical pathology should ideally be more than text, and have some atomic data. Many numeric results stand alone and can be identified by a eg LOINC code and don't need further modelling.
This type of data can be encoded in many formats eg HL7V2 or FHIR (or CDA, HL7V3, OpenEHR) and the important thing is the terminology and modelling and not the format. I am focussed on HL7V2 because I need to move data now and its supported in a non tested way, sort of like the web in the 90s.
However if you want to move data around the format and the compliance with the format become critical as the recipient should have the same understanding of the data. Things like Medication are usually modeled in the format (eg HL7V2 or FHIR) and there is context around medication eg started, stopped, dispensed etc. Likewise allergies and demographic data is usually modeled with the format. Clinical models need to be dynamic and anyone should be able to create a model at will if they need one and ideally any format should support an overlayed model that does not have to be understood by the recipient, but can be used if they so desire.
So the ingredients of useful eHealth are clinical modeling from the level of a single atomic stand alone observation to a complex histology report, A format to encode the data that supports models and is tested for compliance at both sender and recipients ends and access to terminology.
HL7V2 can do this with archetypes in V2 and I believe FHIR can, but I have not seen it working. What we lack is governance to ensure sender and receiver compliance and the infrastructure to develop format agnostic models. I don't think MyHR adds anything, as it does not have atomic data and does not support models. Its just been an expensive distraction that has tried to be the only game in town and has destroyed progress on useful eHealth. That appears to be because its driven by people with no real understanding of health or software, whereas understanding both is essential for trying to progress the landscape. I guess its just another example of what Ronald Reagan described as the scariest words in the English language.. "I am from the government and I am here to help"
Excellent Andrew. Thank you for your contribution. It's most reassuring to know that at least one person clearly understands and most importantly has a capacity to communicate their reasoning succinctly. Again, many thanks.
Many thanks to Grahame Grieve for teaching (some of) us about Rishel's rule.
As a clinician in a diagnostic specialty with an interest in information management, I have certainly encountered this in practice. We have tried to define standard reporting templates for specific conditions, but find that everyone has a different idea of what exactly is needed from these (partly because different clinicians have different information needs for their particular activities).
Not only that, but the requirements change with the individual patient's circumstances - what is "relevant" (@07:53) depends on the particulars of the patient's situation. Previous appendicectomy is unlikely to be relevant when treating a cervical spine fracture, but may be very important in assessing a new scan for abdominal pain several years later - particularly if the "appendicectomy" was for, say, complications of a carcinoid tumour, rather than a purely inflammatory cause.
A possible way forward would be to retain all the available information in a structured/modelled format (perhaps a series of archetypes or resources), as described by Andrew McIntyre, at source, and allow clinical applications to search for what the user wants / thinks they need. But there would be at least two major problems : maintaining an up-to-date index/register of the available information, from multiple sources, in a standard searchable structure ; and alerting the user to relevant information that she or he did not ask for. Not to mention, of course, the difficulty of getting all that information out of pdfs and handwritten records into clinical models...to what extent do people think that NLP can help here ?
@12:13pm
Its the difficulty in getting agreement that really requires 2 level modelling where the "template" or archetype can be changed without changing the standard. The general idea is that an archetype is the maximal model where all requests are catered for, but only the data relevant to the current situation is actually populated.
It also allows people who do not agree to go their own way, but archetypes provide metadata that allows other people/software to know what might be there and how to find it. This is a good way to start, and with time models can converge, or not. We have been using archetypes in V2 for > 10 years and they evolve by changing versions or creating new archetypes, but the old data is compliant with a model and can be accessed for decision support.
This is a layer of complexity that exists outside the standard and is ignored by most systems, which is a great thing, as getting everyone to support something new on a specific date is impossible, particularly with no working governance. We can still export to PIT, or drop a pdf into a folder is that is is what is required, and it often is! We need to start with receiver compliance, so sender compliance can be enacted, but no leadership in sight, so probably not going to happen, so health data remains an unreliable hacked together hodge podge... meanwhile in my day surgery we can't use hot packs as specified by government rules, because someone might get burnt. With software however anything goes, I still can't believe that.
As to NLP, Its wonderful for population stats, but on its own, for a single patient, its difficult to trust it when decision support is the aim.
@9:20 PM "This is a layer of complexity that exists outside the standard and is ignored by most systems"
I may be wrong here but would it be fair to say that the reason most systems ignore the "layer of complexity" to which you allude is because the developers of those systems are disinclined and/or unable to let their development teams get involved in that level of complexity?
Its pretty hard to get basic standards compliance on the menu, let alone something above that. In order to use models you have to be sure you have the basic messaging reading/writing/escaping correct and this is not the case.
I often hear that "We have been doing it this way for 15 years and it hasn't caused a problem" as a reason not to fix errors I consider a clinical risk. Without the need to actually be tested, compliance is not an issue, they want features that can sell the product, not well tested low level code. Given that bodies like the ADHA/NEHTA/DOHA don't seem to understand messaging/software at any level of depth there is no pressure to get it right. The response of vendors is often that doing something complex would take a lot of development time, so the ADHA solution is to move the entire document to pdf as they have already announced one of the many past deadlines to axe the fax. They seem to miss the point that messaging pdf is pretty much what modern fax achieves today, so rather than axing the fax they are reinventing the fax.
Many of the software companies are now investor led rather than technology companies, there is no passion to do great software, its shareholders that must be satisfied and in a market with no regulation or governance that means "Ship it now". I am sure its a case of careful what you wish for, as I hate to think what sort of compliance program they would come up with. We used to have AHML which did the work to do testing at a starting, sensible, affordable level, but that was just to easy for a government to get behind so they have disappeared.
That fits 100 percent with what I thought. I asked the question looking for reassurance and validation of my perspective. Much appreciated Andrew. Thank you.
Here is an example of the issues with non compliant messages and software the came though on a support email today. What if there was something critical in the discharge summaries??
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Dear sir/madam
I have just returned from holiday.
my hospital discharge summaries for the 7 patients are all EMPTY.
please check and re load or re send for me.
The specialists letter are coming through fine.
Thanks
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