E-drug: Electronic prescribing (cont'd)
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Electronic prescribing; open source solutions; WHO Formulary; HL7:
A recent post noted that the affordability of e-prescribing is a major
barrier to uptake, despite proven benefits. This is especially true in less
developed countries.
One solution to this problem is open source software, available free of
charge. Examples include the Linux operating system, the KDE & Gnome
desktop environment and Open Office. Together, this suite of programs
provides a compellingly cost-effective alternative to the dominant
but increasingly expensive Microsoft offering.
In the medical domain, projects such as GnuMed
(http://www.gnumed.net/) & Oscar (http://67.69.12.117/) are working
to provide similarly cost-effective open source solutions for the
clinician's desktop, including e-prescribing modules and drug and
therapeutic information databases
(http://www.drugref.org/).
The latter obviously needs localisation to suit the varied pharmaceutical
policies of individual countries. The WHO Model Formulary, now available
electronically could be a useful place to start. Unfortunately, it is
currently packaged (both on the Web & on CDROM) in a proprietary
Microsoft format which does not lend itself to easy manipulation.
See: http://mednet3.who.int/mf/modelFormulary.asp.
In addition, it is not clear from the WHO copyright notice whether
extraction and localisation of this information is allowed. It would be good
if WHO EDM could respond to these issues via E-drug.
If e-prescribing is to become generally available there is a need to:
1. Support the development of open source medical software, including
e-prescribing modules.
2. Develop open source tools to allow groups in individual countries to
convert their existing drug and therapeutic resources into electronic
formats suitable for integrating with prescribing packages. This process
could be assisted by providing model electronic information resources (such
as the WHO Model Formulary, Finnish, New Zealand &/or Australian
therapeutic guidelines) and appropriate tools to assist country
groups with editing, localisation and translation. This would
require some alteration of policy
for those governments that currently expect guideline development to be
supported on a "user-pays" principle. A good model is MEDLINE, which the
U.S. government made freely available to the world community at American
taxpayer's expense.
3. Define standard interfaces to allow electronic information resources to
"plug & play" with clinical information / prescribing systems (via a virtual
electronic health record / decision support interface). The aim is to
provide timely decision support (and self-audit of practice), pertinent to a
particular patient, using national best-practice guidelines and drug
information.
Electronic decision support standards was the subject of a recent HL7
Australia conference (see http://www.hl7-australasia.org/2003-SYD.htm); it
is also of ongoing interest to several groups with HL7 International
(http://www.hl7.org).
I note that WHO/EDM and WHO/EURO are founding members of the new
Guidelines International Network (http://www.g-i-n.net). In addition,
GIN is holding a meeting in Edinburgh from 14-15th November 2003 at
which "International collaboration through electronic knowledge
sharing" is a session topic.
It is hoped that the above considerations will be progressed at this
meeting.
--------------------------
Dr. Ken Harvey, Member HL7 Australia
(http://www.hl7-australasia.org); Board Member, Therapeutic
Guidelines Ltd. (http://www.tg.com.au);
Council Member, Australian Consumers Association
(http://www.choice.com.au); Senior Lecturer, School of Public Health,
La Trobe University, Bundoora, 3086,
Australia; Telephone +61 3 9479 1750, Facsimile +61 3 9479 1783,
Mobile 0419 181910;
http://www.latrobe.edu.au/publichealth/kharvey/
Ken Harvey <k.harvey@latrobe.edu.au>
Access Essential Drugs Monitor #32 at http://www.who.int/medicines/mon/mon32.shtml
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