Newfoundland and Labrador to automate pill prescriptions

Newfoundland and Labrador is about to create a province-wide drug information system that will connect pharmacists, physicians and patients while providing a stepping-stone towards an electronic health record.

Health and Community Services Minister Tom Osborne on Thursday announced a partnership with the Newfoundland and Labrador Centre for Health Information (NLCHI) that will see Emergis build and maintain the system, which will be known as the Pharmacy Network. The database will be based on a pan-Canadian electronic drug messaging standard devised by Canada Health Infoway called CeRx that will ensure its reusability and interoperability in other Canadian jurisdictions, officials said. Systems Xcellence of Milton, Ont., which worked on B.C.’s PharmaNet project, is a subcontractor on the Pharmacy Network, as is Courtyard Group and zedIT Solutions of St. John’s, Nfld.

The three-phase project, which is expected to take about two years to launch and will cost approximately $25 million, will begin in community pharmacies, where local doctors will be equipped with a “viewer” that shows a patient’s profile, including the medication they have been prescribed in the past. Stage two involves bringing in lab records and other data into the system so that doctors and other health-care staff can have access to some of that lab information where appropriate. The third stage will offer an electronic prescribing capability so doctors can key into the system and link their medication decisions directly to the patient’s pharmacy.

Many e-health initiatives in the last five years have been focused on creating electronic patient records that are shared among hospitals, clinics and physician’s offices. According to NLCHI CEO Steve O’Reilly, Newfoundland and Labrador are focusing on the pharmacy side to minimize the adverse reactions patients suffer when they receive the wrong drugs.

“When they’re admitted or discharged, the handoffs that happen in and out of institutions is a tremendous source of errors and miscommunications,” he said. “The pharmacists have been one of the staunchest supporters. They already stand in front of the keyboards every day, it’s second nature to them.”

Two years ago Newfoundland set up a client registry where every citizen can create a unique identifier to be commonly used among health-care providers. That, along with the recent acquisition of a digital archiving system by NLCHI, puts the province well on its way to a comprehensive electronic medical record, Emergis chief executive Francois Cote said in a conference call, but what physicians really want is data about lab results and medications.

“If you look at the EMR, that’s the cart before the horse. There’s no one entry point . . . the data that’s going to feed the EMR comes from the sort of solution that we’re going to be deploying,” he said.

Donald Rowe, secretary-registrar with the Newfoundland and Labrador Pharmacy Board, said the province began to face major data management challenges more than 10 years ago when several hospital boards were merged into one, even though each continued to use different records systems. He said the industry will welcome the Pharmacy Network once it’s set up.

“A lot of the interactions that pharmacists deal with now could be headed off at the pass by the doctors at the point of prescribing,” he said. “It could avoid a lot of the double doctoring that goes on.”

Rowe praised the broad consultation undertaken by the NLCHI, including interviews with more than 800 stakeholders from pharmacy associations, health-care provider associations and drug store chains. That should help avoid the “shouting matches and noses being out of joint” that have plagued projects affecting the pharmacy industry that didn’t seek out feedback, Rowe said.

“Most people assume that this information is already networked and shared,” O’Reilly added. “Once the public at large understands that it’s not, there’s going to be a real change in expectations on the part of the patient.”

Newfoundland is one of the last provinces in Canada that has not set up with online adjudication system for pharmacists. Such a system would provide real-time decisions on claims made under the provincial Newfoundland and Labrador Prescription Drug Program (NLPDP). In March, however, the government committed to funding in its budget to implement such a system and support the Pharmacy Network.

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