Personalised Medicine: Use Case Pharma
The ERS iEHR-Suite solution for Personalised Medicine, in particular for medication prescription & monitoring, builds on Gaston, a framework for Clinical Decision Support. Gaston Pharma uses the 5 ISO IDMP (Identification of Medicinal Products) standards plus data from the EHR/EMR via HL7 messaging. Gaston Pharma is used in conjunction with existing EHR/EMR and ePrescription systems upgrading those to support Personalised Medicine.
Gaston Pharma is medication monitoring software that, as an alert pharmacist, continuously monitors the well-being of each of your individual patients. It offers you and your employees guidance in the development and implementation of (local) clinical rules for medication monitoring. Gaston learns from previous decisions, effortlessly applies your own clinical rules and only shares relevant information and advice to the healthcare professionals involved.
Gaston pharma provides relevant reports:
Gaston Pharma uses patient-specific data to provide targeted advice. You will immediately notice that there is more control over the workflow behind the notifications. Traditional medication monitoring is often not specific enough as in this case, patient-specific parameters - such as clinical-chemical results, diagnoses, treatments or allergies - are usually not included. Subsequently the result is an enormous amount of non-relevant reports, which causes reporting fatigue and increases the risk that you will overlook reports that are relevant.
Gaston Pharma helps pharmacists and other healthcare providers in the following ways:
• Generates signals based on the Dutch G standard for interaction control, counter-indication monitoring, dual medication, dose control, biomarkers, Adverse Drug Events (ADE’s), Medical Pharmaceutical Decision Rules (MPDRs) or any comparable approach, like those of AEMPS (Spain) or EMA, following the IDMP standard.
• The G-standard / AEMPS / EMA dataset can be adjusted to your local situation.
• Refines signals based on predefined clinical rules.
• Easily handle and manage signals with advice, worklists, checklists and orders.
• Easily define, manage and handle your own clinical rules without technical programming knowledge.
Gaston Pharma consists of 3 modules:
- Guideline Module
- Decision Module
- Reporting Module
The Guideline Module contains an guideline editor with which you can easily enter your own rules via a drag and drop interface that applies to your specialty or profession.
The Decision Module (DM) ensures the implementation of the rules that have been introduced with the guideline editor. It allows the computer to perform all necessary steps. The DM communicates with all information systems around the patient, such as the Electronic Health Record (EHR), the general practitioner information system (GPIS), the pharmacy information system (PIS), the hospital information system (HIS), the anaesthesia device or the patient monitor, but also with the electronic system of the city pharmacy or the regional / hospital laboratory information system (LIS).
The Reporting Module helps you and your employees with daily use. With this module you can view and handle all generated notifications/alerts. It is also possible to view the history of reports and settlements. You can show these results in various ways with reports, tables and graphs.
Gaston Pharma is used by Royal Dutch Pharmacists Association (KNMP) to define Medical Pharmaceutical Decision Rules (MPDRs). This is a new development in The Netherlands beyond simple interaction control.
Medical Pharmaceutical Decision Rules (MPDRs), a new way of implementing pharmaceutical care, are an important tool for providing optimal care for the individual patient. For patient centric and Personalized care. This is necessary because there are more and more elderly people with multiple disorders/pathology receiving polytherapy with multiple medicines.
Working with MPDRs is a way of delivering pharmaceutical care that structurally combines multiple patient characteristics. Traditional medication monitoring is based on two factors. The pharmacy in-formation system provides only limited information, for example that drug A does not coincide with drug B. MPDRs go many steps further, because they combine a variety of patient characteristics, such as: age, gender, disorders and contraindications, lab values (e.g. renal function, sodium and potassium) and the medication of various prescribers. Also with MPDRs is checked for missing medication, which is a huge improvement compared to the traditional medication monitoring.
MPDRs makes pharmaceutical care much more focused on the patient and his personal characteristics. When a pharmacy employee writes a drug that could lead to one of the MPDRs, a flow chart is run in the background. The pharmacy employee only sees a signal in his system if the specific combination of the various factors, medication and available patient characteristics actually constitutes an MPDR.
In The Netherlands a nationwide used set of 27 MPDRs are defined. Also local defined MPDRs for use in one hospital/region become increasingly available and it would make sense to establish cross EU collaboration for defining MPDRs.