Integration Solution. Integrating CPhA s drug and therapeutic content with clinical management systems. Integration PlugIn Solution_PHARMACISTS.

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1 Integration Solution Integrating CPhA s drug and therapeutic content with clinical management systems Integration PlugIn Solution_PHARMACISTS.indd 1 11/14/2016 2:50:30 PM

2 Background Healthcare practitioners in Canada continue to struggle with increased expectations and demands to be more efficient in their practices while still improving patient outcomes. Now that Canadian pharmacists are engaging in their expanded scope of services, further pressures are exemplified to ensure that proper patient assessments/treatments, medication reviews and vaccine injection programs are incorporated into their daily routines without negatively impacting patient outcomes or their current responsibilities of medication management and providing medication advisories to other clinicians. Although great advancements have been made with the introduction of clinical management systems (CMS) such as Pharmacy Management Systems and Drug Information Systems, most solutions are segregated; therefore, clinicians continue to struggle with accessing critical information at the point of care. Pharmacists are forced to abandon their CMS during the point of care or dispensing to launch another application, open a separate device, or use another workstation to research or consult a decision support tool to complete an assessment, determine an appropriate treatment option, or confirm appropriate drug therapies. Depending on the availability or accessibility of these independent systems, a clinician may elect to forego the investigation and prescribe or dispense a therapy that may not align with current therapeutic evidence. PMS and DIS solutions use American-based drug databases and consequently clinicians find themselves challenged to ensure that they are accessing Health Canada approved drug information instead of the U.S versions. Google Computer Technology Information overload Unstructured Accessibility Development Sources Segregated EMR Books Evidence Backlog Applications Mobile EHR Out of date Software CMS Systems Internet Pressure Time Databases American Information technology DIS Queries API Desktop Communicate Intranet Journals Multitasking 2 RxTx Integration Solution Integration PlugIn Solution_PHARMACISTS.indd 2 11/14/2016 2:50:30 PM

3 Overview CPhA s Integration Solution provides third-party clinical management systems (CMS) with Canadian drug and evidence-based therapeutic information (RxTx) at the point of care for maximum efficiency and usability. This integration solution enhances web-based and client-server applications with seamlessly integrated content, providing access to critical drug and therapeutic information directly from RxTx to help reduce medication errors and improve patient outcomes. Special consideration was taken in the design to limit the required development for third-party vendors wishing to offer this integration solution. Features Codified RxTx content (Snomed, ICD-9, ICD-10) DINs associated with drug monographs Health Canada Advisories, Warnings and Recalls are linked to the appropriate drug in the CMS and automatically alerts the user In-context RxTx search returns based on searches performed within the CMS Ability to launch the full RxTx application directly from the CMS Limited development requirements for CMS vendors Works through general text search or imbedded drug or condition radified table selections Benefits Improved efficiencies in pharmacy workflow Immediate access to critical drug and therapeutic information at the dispensing stations and patient consultation rooms instead of only through a dedicated terminal. Bi-weekly updates of CPhA content Printable Information for the Patient handouts (drug monograph part III and therapeutic conditions) Advantages 97% of chain pharmacies and over 500 hospitals already subscribe to CPS/RxTx Designed to work with all CMS Provides the full spectrum of support for selecting appropriate medication therapy Fully bilingual 100% Canadian content RxTx Integration Solution 3 Integration PlugIn Solution_PHARMACISTS.indd 3 11/14/2016 2:50:30 PM

4 Conceptual Designs PMS Accessing RxTx Therapeutic Content Patient, Test Age: 45 G:Male QuickCode: TPatient HCN: XXX XXX XX Family Dr.: Greene, Walter Last Name Patient First Name Test Gender Male D.O.B. May 7, 1975 Address Main St. E HCN xxx xxx xxx Address 2 Apartment 54 City Ottawa Prov. ON Fam. Dr. Walter Greene Patient Profile P.C. K1G XXX City Ottawa Prov. ON Plan Profile Phone L.patient@anywhere.ca 613-xxx-xxxx Phone Walter.Greene@anywhere.ca 613-xxx-xxxx All Rxs Mobile 613-xxx-xxxx Fax 613-xxx-xxxx Active Rxs Not Disp. OTC Res Prescribe Current Medications Ramipril 2.5 mg/day Elocom Once Daily Lipitor 20 mg/day Condition Onset Date Allergies Penicillin Add allergy Lab Results Hypertension 12/06/07 Psoriasis 11/02/15 Comments Consult Notes Add Problem Diabetes Mellitus (Type 2) Diabetes Mellitus Once the search is completed in the CMS, the user can select the RxTx button to search CPhA content for the appropriate therapeutic topic. CMS developers can apply this logic to any field within the CMS that displays conditions. Any condition field in the CMS that uses a codified table (ICD-9, ICD-10 and Snomed) will provide a more accurate match to the CPhA content, as it is also codified. Introduction Classification Goals of Therapy Investigations Therapeutic Choices Choices During Pregnancy Therapeutic Tips Risk Factors and Strategies Assessment and Management Algorithms Drug tables Suggested Readings References Launch RxTx Find Kerry Mansell, BSP, PharmD, CDE Terra Arnason, MD, PhD, FRCPC Date of Revision: April 2016 Introduction Diabetes mellitus is a chronic metabolic disturbance characterized by fasting and/or postprandial hyperglycemia. Rather than a single disease entity, diabetes mellitus is a heterogeneous syndrome that is caused by an absolute or relative lack of insulin, resistance to the action of insulin, or both. Dysglycemia is a term that describes abnormal blood glucose levels without a definite threshold. The term reflects current evidence that minor degrees of blood glucose abnormalities, even those that do not meet the diagnostic threshold for diabetes mellitus, are still associated with increased cardiovascular risk. 1 Long-term diabetes mellitus may lead to complications that involve the small blood vessels (microangiopathy), large blood vessels (macroangiopathy) and nerves (neuropathy) of multiple organs and systems. Because diabetes is associated with significant dysfunction of numerous metabolic pathways, clinicians must pay close attention to factors such as hypertension and dyslipidemia in addition to blood glucose. Heart disease is the most common cause of death in patients with diabetes. 2 Diabetes Mellitus Table 7. Insulin and Analogues Introduction Classification Goals of Therapy Investigation Therapeutic Choices Choices During Pregnancy Therapeutic Tips Risk Factors Assessment and Management Algorithms Drug tables Suggested Reading References Launch RxTx Find Class Drug Onset Peak Duration Comments Cost b Very Rapid-acting insulin aspart min min 4 5 h Appearance: clear. $$$ Insulin NovoRapid Analogues Very Rapid-acting insulin glulisine min min 4 5 h Appearance: clear. $$$ Insulin Analogues Apidra Very Rapid-acting insulin lispro min min 4 5 h Appearance: clear. $$$ Insulin Analogues Humalog Caution product concentrations differ. Rapid-acting Insulin insulin, regular min 2 4 h 5 8 h Appearance: clear. $$ Humulin R, Novolin ge Toronto Rapid-acting Insulin pork insulin 30 min 2 4 h 5 7 h Appearance: clear. $$$$/ Used only Hypurin if human insulin or analogues 10 ml Regular not tolerated. vial Intermediate-acting insulin, NPH 1 2 h 5 8 h h Appearance: cloudy. $$ Insulin Humulin N, Novolin ge NPH Intermediate-acting pork insulin, NPH 1 3 h 6 12 h h Appearance: cloudy. Used only $$$$/ insulin Hypurin NPH if human insulin or analogues 10 ml not tolerated. vial Long-acting insulin detemir 1.5 h Flat, no 6 24 h Appearance: clear. Do not mix $$$$$ Insulin Levemir discernible with other insulins. At low doses, Analogues peak duration of action is shorter and may require BID administration to maintain fasting glucose targets. a Insulin products are shown in order of onset of action, with the very rapid-acting insulin analogues at the top. Mixed insulin products are grouped at the end of the table. b Cost of 5 3 ml cartridges unless otherwise specified; includes drug cost only. Legend: $ < $25 $$ $25 50 $$$ $50 75 $$$$ $ $$$$$ $ The user can review the various subsections by selecting one of the section headers on the lefthand menu. Note: The Integration Solution honours internal links select a drug name (in red in the drug table) to open a new window with that product monograph. 4 RxTx Integration Solution Integration PlugIn Solution_PHARMACISTS.indd 4 11/14/2016 2:50:31 PM

5 Conceptual Designs PMS Accessing CPS Content Current Medications Ramipril Elocom Lipitor 2.5 mg/day Once Daily 20 mg/day Health Canada Advisories New Statins Labeling Update: Risk of increased blood sugar levels and diabetes. ( ). More... Modify Cancel If there is no room on the CMS screen to add an RxTx button, the third-party developers can add a right-click mouse option so a menu will appear. The menu will then include the RxTx button. This screen shows a right-click menu, pointing at Ramipril. When selected, the system will look at the drug name and return the product monograph from RxTx. This can be made available anywhere drug names are listed in the CMS. Ramipril Full Monograph Summary of Product Information Indications and Clinical Use Warnings and Precautions Adverse Reactions Drug Interactions Dosage and Administration Overdosage Actions and Clinical Pharmacology Dosage Forms, Composition and Packaging Information for the Patient ramipril Angiotensin Converting Enzyme Inhibitor Sivem Pharmaceuticals ULC DIN(s): , , , Date of Revision: September 5, 2014 Summary Product Information Route of Administration Dosage Form/Strength Nonmedicinal Ingredients Oral Capsules 1.25 mg, 2.5 mg, 5 mg, 10 mg Gelatin, pregelatinized starch, titanium dioxide The 1.25 mg capsules also contain: yellow iron oxide. The 2.5 mg capsules also contain: D&C red No. 28, FD&C red No. 40 and yellow iron oxide. The 5 mg capsules also contain: FD&C blue No. 1 and FD&C red No. 40. The 10 mg capsules also contain: D&C red No. 33, FD&C blue No. 1, FD&C yellow No. 6 Launch RxTx Find Current Medications Ramipril 2.5 mg/day Elocom Once Daily Lipitor 20 mg/day Health Canada Advisories New Statins Labeling Update: Risk of increased blood sugar levels and diabetes. ( ). More... A red exclamation mark appears beside a drug name, to alert the user that there is a Health Canada Advisory, Warning or Recall associated with the drug. As in RxTx, the user can select the pink message to launch the Health Canada web page for that advisory. The thirdparty developers will be given the code to have this automatically appear. This code can be used in all areas of the CMS where drug names are listed. RxTx Integration Solution 5 Integration PlugIn Solution_PHARMACISTS.indd 5 11/14/2016 2:50:31 PM

6 Technical Overview The following information is not meant to provide all detailed development requirements for third-party solutions, but a general explanation of the integration solution design. CPhA s Integration Solution has been designed to ensure that third-party vendors wishing to implement connectivity to RxTx will require limited development time. In order for CMS solutions to integrate with RxTx, the following development will be required: CPhA Subscription Authentication To access CPhA drug and therapeutic content, users must have a subscription to RxTx. The Integration Solution is designed to check against the user login within the CMS system, and then send that information back to CPhA for authentication. This information includes: CPhA username/password, professional ID, unique client key and location key. The user s subscription model will determine what content is allowed to be displayed within the Integration Solution window. Developer Requirements Within the CMS, the user profile must include: The ability for the user to enter their user name and password The user s professional ID The ability to pass through a unique client key The ability to pass through a unique location key Enable any firewall or proxy to accept the unique URL to CPhA Once this information is passed through to CPhA s Licence Manager, it will authenticate the user s subscription and pass back a session key identifying the appropriate access to specific RxTx content. Displaying RxTx Content The CPhA integration solution is designed to work with any field that searches/stores drug or therapeutic content. The solution works best when the CMS has drug and condition codified databases installed. All RxTx content is codified and will have greater chances of providing an exact match for the desired content than from a general text search alone. RxTx therapeutic content (Therapeutic Choices and Therapeutic Choices for Minor Ailments) includes Snomed codes, 1CD-9 and ICD-10 codes. All drug monographs include their associated DIN. The application will work without codified data; however, the user may see a selection list to choose from before the desired information is returned. 6 RxTx Integration Solution Integration PlugIn Solution_PHARMACISTS.indd 6 11/14/2016 2:50:31 PM

7 Developer Requirements 1. For each drug field, an RxTx symbol or right-click menu item can be added and have a simple web call such as: a. When a drug table with a DIN are installed in the CMS: URL + Session Token + DIN b. With/without drug table name search: URL + Session Token + Drug Name (brand or generic) 2. Establishing the Health Canada Advisories can be similar. a. (on display) URL + Session Token + DIN / Drug Name. 3. For each condition field, an RxTx symbol or right-click menu item can be added and have a simple web call such as: a. If Dx tables (with codes) are installed in the CMS, then: URL+ Session Token + Dx Code type (Snomed, ICD-9 or ICD-10) + Dx Code b. If no Dx tables (with codes) are available in the CMS, then: URL + Session Token + Dx Name CMS INTERNET CPhA LICENCE MANAGER Explanation 1. When a user logs into a CMS that has a CPhA integration solution installed, the CMS will look for the CPhA user name/password along with other key information in the user profile and send it through to the CPhA Licence Manager for authentication (follow blue arrows). 2. Once authenticated, the CPhA Licence Manager will return a session key back to the CMS in preparation for that user to access CPhA content (follow blue arrows). 3. When the user requests information for CPhA drug and therapeutic information, the CMS will send the request along with the session key to retrieve the desired information from the RxTx database (red arrows). 4. RxTx will return the appropriate data, based on the user s subscription permissions. RxTx Integration Solution 7 Integration PlugIn Solution_PHARMACISTS.indd 7 11/14/2016 2:50:32 PM

8 Michel Gaudette, Director, Sales & Business Development, 1785 Alta Vista Drive, Ottawa, ON Canada K1G 3Y6 Tel.: , ext. 297 or Mobile: Skype: mgaudettecpha Fax: Integration PlugIn Solution_PHARMACISTS_Nov16 Integration PlugIn Solution_PHARMACISTS.indd 8 11/14/2016 2:50:32 PM