Data Sheet SW Ishmed Smart Medication

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Smart Medication(Advanced Medical Record)Data Sheet

Data Sheet i.s.h.med Smart Chart (Advanced Medical Record)Page 2 of 14

Intended Use

i.s.h.med Smart Medication supports the drug therapyprocess, starting with the ordering of ready-to-usedrugs and help during the mixing of infusions andcompounds, through to the documentation of theadministration.

Activated orders and medication events are graphicallydisplayed in the chart (i.s.h.med Smart Chart), inaddition to vital signs, nursing procedures and othertime-specific content.

The integration into SAP for Healthcare enablesconnections with other SAP applications such as, forexample, materials management or patient billing.

Optionally, medication data can also be provided via aninterface for processing in unit dose dispensers, as aproject solution.

Performance FeaturesIntroductioni.s.h.med Smart Medication is part of the i.s.h.medAdvanced Medical Record license package (10402194or 10402295). i.s.h.med Smart Chart functionality isused to display the medication in the chart; this is alsopart of this package.

i.s.h.med Smart Medication shares the patient masterand other relevant content with SAP for Healthcare andi.s.h.med, so that no data redundancy results and thesolution is completely integrated into the clinicalhospital information system.

The i.s.h.med Smart Medication functions are availableboth in the inpatient and outpatient environments.

“Making a complex task simple”, this is the main focusof i.s.h.med Smart Medication.

Fig. 1: Overview of the i.s.h.med und SAP components


The goal is to guarantee the user complete control inthe ordering process and a high degree oftransparency. The following points illustrate how this isdone:

· A simple order can be created with just a few clicks.

· The traffic light function indicates to the userwhether the order is complete or not.

· Input areas for more complex orders (e.g. infusions)are only visible when they are required.

· The user is guided through the ordering process byintuitive operation and demand controlled inputfields.

· During data entry the user has access to otherrelevant data (e.g. earlier medication, anamnesisdata, catalogs).

· The user is always oriented: What step am I in?What is left to do?

In addition to these arguments which are specially

related to the ordering process, other generaladvantages of an electronically managed medicationand chart also apply, such as high degree ofavailability, improved patient safety, optimizedmedication consumption, revision-safe documentationor the detailed presentation of the medication in thechart.

i.s.h.med Smart Medication is the further developmentof the classic version of i.s.h.med medication. Somefunctions are currently only available in the classicversion of i.s.h.med medication, however, these can beused seamlessly together with Smart Medication.

Drug Catalogi.s.h.med Smart Medication requires an internal drugcatalog. Data from the relevant country-specific drugrange is imported into the i.s.h.med drug catalog forthis. With regard to the data structure and content(agent standardization, mapping of generic

Fig. 2: Display of medication in the patient record


connections, etc.) formatted catalogs should beprocured from external suppliers for the import.

Characteristics of the i.s.h.med Drug Catalog

· XML import interface for uploading catalog content(initial and delta) which has been formatted withregards to content and structure

· Structuring in a maximum of 3 levels (e.g. genericlevel, brand name, brand name with container size).The hierarchical structuring of the drug catalogoffers

· a comfortable drug search.

· ordering at a generic drug level (with specifi-cation of the drug to be administered at deliverytime).

· aut idem substitution proposals, e.g. within thedrug anamnesis.

· the documentation of orders during the inpatientstay at generic level, as well as ordering in theoutpatient environment with the specification ofthe manufacturer and container size.

· the option of manually creating drugs in thecatalog (e.g. own mixtures, study preparations,etc.).

· the connection of a pharmacy drug catalog.When the pharmacy and formulary catalogs areconnected, purposes and fill sources can beassigned and properties can be inherited acrossthe levels.

· Various comfort functions, such as for creatingnew drugs using a copy template, which aredefinable in the implementation project via theprogramming interface (BAdI).

· Flagging of the drug as a formulary drug for routineordering in the inpatient area, or as preparation fordispensing or prescription printing, which, however,can be subject to country-specific specifications /certifications as is the case in, for example,Germany. Other i.s.h.med modules or specificproject solutions may offer solutions here.

· This flagging of drugs as part of the formulary inconnection with the determination of whether thephysician’s orders should be made at generic levelof specific to a certain preparation, enable thepharmacist effective control of ordering while takinginto account the stock and purchasing situation.

· Master data attributes contain necessaryinformation on process support, such as forexample:

· Logistic information: Connected article master inSAP MM (Materials Management) andassignment to fill sources (including patient-specific provision from care unit stockroom orcentrally in the hospital pharmacy)

· Control of display behabvior of drug in the chart(numbering of treatment days)

Functions for Maintenance of Drug MasterData

· Copy drug

· Assign drug to an existing hierarchy or build a newhierarchy

· Activation / deactivation enables supplements /changes, without influencing the productive orderingprocess.

· Maintenance of the agent table

Medication OrderWhen ordering drugs the system differentiatesbetween:

· Planned administration during the inpatient stay orduring an outpatient treatment

· Determination of drugs which should be given to thepatient (e.g. upon discharge)


· Prescription creation (printout) whereby prescriptionwriting is subject to possibly country-specificdefaults / certifications.

· Drug anamnesis – Long-term medication, which thepatient brings to his admission in the hospital, isdocumented and flagged as such.Optionally the drug anamnesis can be investigatedas a sub-process of the admission documentation inthe outpatient clinic, (with SAP Ambulatory CareManagement for Healthcare (ACM) - 10178675).

The activation of the order triggers the creation ofmedication events for the documentation ofadministrations, dispensing or prescription printing (seeMedication Event section).

Drug SearchSearching for a drug is most efficient when you findwhat you are searching for as quickly as possible. Torealize this seemingly trivial goal a search mustintelligently map the medical logic with which aphysician thinks and acts. The following options areavailable for searching for a desired drug:

· Search for partial strings– e.g. when Volt*50 isentered the system also finds Voltaren® tablets withthe strength 50mg

· Extended search – If an identified drug, which thesystem is searching for, is not available in theformulary list, the system determines the availableequivalent preparations, if administration using autidem substitution logic is intended.

· Search for agents – Regardless of the name of thedrug, the system finds all drugs which contain theagent the system is searching for and which aresuitable for the purpose.

· Search with dosage – When entering the searchstring the user can enter the desired dosage andstrength of the drug. This desired dosage ischecked against the templates or transferreddirectly into the order

· When realizing existing orders (e.g. duringadmission, discharge or when converting to otherdosage forms) the search uses proposals to supportthe search according to an aut idem substitutionlogic or an enhanced search using equivalentagents.

Fig. 3: Example of a simple order


Formulary List, Entire Catalog, SpecialRequests, Favorites

· The drug search is executed for orders

· In the formulary list which contains the drugslisted by the hospital pharmacy as suitable forthe purpose of administration, dispensing orprescription creation.

· In the entire catalog for the purpose ofanamnesis medication.

· Preparations outside the formulary list can beordered via special requests. A special processsupport of the logistic or authorizational process canbe configured using the order status concept.

· The user can use individual settings to influencepersonal habits during the search, the searchresults are presented in a standardized logic.

· There are two possible workflows when compilingorders:

· After a successful search for one drug, an orderwith a green traffic light icon can immediately beactivated with one click. If necessary, orderdetails (dosage, start date) can be changed first.

· The system searches for several drugs – withoutleaving search mode – and collects them in aworklist. In a second step this worklist can beedited in the details and the orders activated.

· Information range:

· Contents of the package information insert canbe called (upload from the external catalog is aprerequisite).

· Personal favorites of the most frequentlyselected drugs / order templates are available.

Start and Duration of an Order

· Default for the start of the medication orders ispreset but can be changed if necessary.

· Orders can be entered:

· Until further notice

· With a determined duration

· With a planned end date

Dosage

Depending on the type of order (standard drug,infusion or nutritional solution) there are different typesof dosage available:

· Simplified dosage with specification of agentstrength instead of dose unit (e.g. 0 – 25mg – 0)

· Determination of administration times whileprovisionally leaving the specific dose open (e.g. 0 –0 – X(18:00) – 0 for an insulin dose to be given at18:00 according to blood sugar determination)

· Dosage with specification of a cycle (e.g. Q4h –every 4 hours)

· Free prescription of individual doses – Themedication events generated by the system arevisible and can be edited at the time the order iscreated. This means you can prescribe, for example

· sliding doses (tapering of agents)

· irregular dosages

· or saturations

in orders, without changing the underlying dose.

· Dosage via decimal numbers or fraction displays forordering e.g. half tablets, if the drug master permitscorresponding divisibility.

Other Order Attributes

Depending on the purpose of the order, other detailscan be entered:

· Administration duration – e.g. application duration ofa transdermal medication (TTS); runtime of aninfusion

· Order for drug kits – e.g. eye ointment from a drugkit with separately defined information onadministration time and dosage

· Patient own medication (e.g. for long-termmedication with a rare or foreign preparation)


Intravenous TherapyIntravenous therapies (therapeutic infusions, volumeinformation, parenteral nutrition TPN) are subject toother order specifications:

· Infusions can

· be called as a pre-made drug in the catalog.Indicators in the catalog determine whether apre-made infusion can be changed, i.e. ifadditional ingredients can be supplemented atthe time of ordering.

· be individually combined at the time of ordering,with a carrier solution and one or moreingredients.

· Be, like all other drugs, part of an order templateand then be preset with all non-patient-specificorder parameters (e.g. height and weight mustbe supplemented, the calculation guideline isalready in the template).

· Flow rates can be defined at the time of ordering.

· Flow rates defined at the time of ordering arecalled within the administration documentationand then, where necessary, adapted orsupplemented (e.g. with bolus doses or breaks).

· Flow rates can be calculated by the system intemplates according to various criteria, includingthe use of agent-based dose calculators.

Compounds, Patient-Individual Manufacture

As in freely combinable infusions, i.s.h.med SmartMedication also supports the ordering of patient-individual in-house creations (e.g. dermatological) viathe selection of individual components and thedefinition of quantity relationships.

Fig. 4: Example of a complex order


Change Functionsi.s.h.med Smart Medication supports all adaptations tomedicinal therapy with clear selection lists with theoption of editing one or more orders.

The user can adapt the current medication, view, edit or directlyrelease drafts for new or changed orders, as well as transferorders from the patient’s history into the current case.

The In Processing list collects all orders which the usernewly creates by editing, transferring or selecting adrug. Depending on the usage and personal way ofworking, the user can either initially compile a worklistor execute and complete each change individually.

It is possible to cancel individual processing at anytime. Closing the application enables you to savestarted processing in one step, e.g. if the user mustinterrupt his work on the medication because of anemergency.

Conversion Functions

· Creation of current medication via conversion of apatient’s documented anamnestic orders (long-termmedication) to preparations from the formulary list

· Creation of current medication via conversion ofdrugs from the patient’s past cases to preparationsfrom the formulary list

· Changing of an order to dispensing or prescriptionprintout

· Copying of an order

Adaptation of Current Medication

· Conversion of an order into another dosage form(e.g.: oral continuation of an antibiotic therapy whichwas started postoperatively as intravenous).Automatic proposals based on the levels of the drugcatalog are used here.

· Suspension / resumption of an order (e.g.suspension of an oral therapy on the day of

Fig. 5: Conversion from existing medication


surgery). The suspension can also be planned forthe future.

· (Early) ending or extending of an ongoing order

· Change dose – The function has a special logic forinfusions depending on whether the infusion isintermittent or continual and whether these arecurrently still ongoing.

· Proposal of alternatives (enhanced aut idemsubstitution)

New orders can result from changes to the patient’smedication; these can be displayed in the chart orcontinued in the same line under specificcircumstances.

Order TemplatesOrder templates can be defined for the order process,which accelerate the process in two ways:

· Order template groups enable fast ordering, even ofcomplex therapies, which are compiled of severaldrugs as well as different dosage forms andpurposes.

· Orders with complex attributes can be saved asorder templates. The next time the template is usedall attributes of the template are already presetaccordingly.

Diagnoses, organizational units and users can all beassigned to an order template, so that possible ordertemplates are immediately proposed during the search.

Process Logic of Order in Cooperation withOccupational Groups

The i.s.h.med status profile is used to adapt theindividual release steps of an order to suit the specialworkflows of a hospital. The number of process stepsrequired and the connected roles can be determinedon a clinic-specific basis. The following workflows canbe mapped:

· Support of a multi-occupational group order creationprocess, e.g.

· Entry in system by trainee physicians, activationby responsible ward physician

· Entry in system by physicians, activtion bypharmacist following medical (e.g. interactions,correct dosage) and logistical (e.g. which autidem drug is currently in stock) check

· Flagging of changes made by physicians fornursing staff

· Option of physician’s (daily) signing off onpatient’s medication (Confirm Order)

· Determination of the drug to be used foradministration documentation in case of orders atgeneric level

· Automatic generation of administration events usingconfigured system parameters (event generationhorizon) and drug-related information stored in thecatalog

· Consideration of usual care unit / ward routinesduring generation of medication events(administration times can be configured on a careunit-specific basis, but can be overwritten at thetime of ordering)

· Forwarding of status of an order using aninstallation-specific status concept for mappingcertain subprocesses or the generation ofcorresponding worklists and overviews (e.g.presentation of certain order to senior physician foractivation)

Medication Eventi.s.h.med Smart Medication generates medicationevents using the criteria specified in the order by thephysician. These events support the delivery processand / or the logistics chain within the hospital pharmacyor a unit dose system connected in a project, andrepresent the basis for documentation in the record orchart (usually for the nursing staff).


Depending on the purpose of the order, differentsubsequent processes are triggered:

· For orders which lead to an administration of drugsthe system generates one event for eachadministration time, with the dose to beadministered at this time.

· For orders which lead to the printing of aprescription the system generates one event withthe permitted prescription quantity or container sizeand, where necessary, the next repeat event (i.e.the patient collects a new prescription).

· For orders which define the dispensing of drugs theoverall ordered quantity is totaled. The eventgeneration is oriented simultaneously towards thestored issue quantities, as in prescription printing.

Event Generation for PRN MedicationThe system generates one event for each day with themaximum allowed daily dose. The individual events areindividually created depending on the administrationdocumentation. The system displays a warningmessage when the maximum allowed daily dose hasbeen administered.

Event Generation for Immediate DoseWhen creating an order you can use the optional entryof an initial immediate dose to control that, in additionto the cycle times, an immediately effective event isgenerated with the specified dose.

Event Generation for Compounds or DrugsEvent generation for compounds or drugs whichgenerally cannot be dosed precisely:

Event generation is oriented towards the indicators ofthe drug master and the information in the order (e.g.influence of the logistics chain; provision of theindividual dose or the overall order quantity)

Continuing the Order

The equivalent of continuing the orders in the paperchart is represented by an automatism in the system,which generates medication events for active orders

until the end, which may have been determined underconsideration of any defined suspensions. System-wide and drug-specific generation times which mayhave been stored in the system are also taken intoaccount.

DeliveryDrugs are delivered either in the care unit or outpatientclinic or centrally in the hospital pharmacy. Bothscenarios are supported.

· The delivery process in the care unit is supported byspecial views of the clinical work station.

· The filling of dispensers can be supported byseparate lists, as can the delivery of intravenoustherapy, taking into account shift times or similarcriteria.

· Optional: The procurement process for the care unitstockroom is not supported by i.s.h.med medication,but by the corresponding functions in SAP PatientManagement and / or SAP MM.

· The delivery process in the hospital pharmacy isoriented towards the inventory-managed stockroomand is supported accordingly with pick and fill lists.

· Multi-level process logic using printouts of lists andan exclusion list is supported. Example:

· Collection of all preparations which are requiredin one issue cycle using overviews whichincludes total quantities of each drug

· Distribution to OU or patient-specific containersin an additional step

· Concluding stockroom-relevant posting

PreparationOptionally i.s.h.med medication offers a preparationscreen within the delivery process, which displays theproportional quantities of ordered intravenous therapiesand enables the documentation of the delivery of therequired bag.


Documentation of AdministrationThe documentation of the drug administration is firstsubject to an organizational concept and thedetermination of how (possibly at which care unit/ward)documentation should be executed. Thedocumentation of the delivery (distribution of filleddispensers) may be different than the actualadministration documentation of the individualadministration.

· Quick Administration function – Several medicationevents, also for several patients, can simultaneouslybe documented as administered from an overviewlist in the clinical work station.

· Prerequisite: No check condition, in case of time-critical drugs no deviations which exceed thetolerated times.

· In case of infusions the system also takes intoaccount whether several bags are necessary andflow rates can be documented together with theirruntimes, bolus administrations and breaks.

· Individual administration for precise documentation:

· Documentation of deviations in administrationtime, dose, scrap quantities, etc. withcorresponding reasons

· Documentation of a witness

· Substitution logic (e.g. in case of a change ofpreparation and leftover quantities in the careunit stockroom, etc.)

· Documentation of a checked administrationcondition with the possibility of calling lab values.

· Documentation of self-administration by the patientor by a care-giver.

· Emergency situations (ad hoc event):Documentation of a drug administration withoutpreceding order. The acute event can documentboth a single dose without a preceding order as wellas the documentation of an additional dose outsideof the planned administrations of an existing order.

· Barcode support for the selection of events to bedocumented with the possibility of executing a quick

administration or individual administrations for theevents entered in this way.

· Optional: In the clinical work station the drugadministration documentation can be combined withthe view of the upcoming nursing services (withi.s.h.med nursing as part of i.s.h.med AdvancedMedical Record - 10402194). This enables thesupport of nursing services taking into account thedrug administration.

Prescription Printing and OutputOrders with the Prescription Print purpose can beprinted individually or collectively on prescription forms.

The permitted issue quantities (definition in the drugcatalog) are taken into account by the system whichcalculates repeat events so that a renewal prescriptioncan be issued at the right time.


Prerequisites forImplementationModulesi.s.h.med Smart Medication is part of the licensei.s.h.med Advanced Medical Record (10402194 or10402295). Prerequisites for this package are:

· License and installation of SAP PatientManagement (IS-H) (10178662)

· License and installation of i.s.h.med Basis MedicalRecord (10402193 or 10402294)

· Licenses for i.s.h.med Named Users (10402192)

· Some functions are currently only available in theclassic version of i.s.h.med medication, however,these can be used seamlessly together with SmartMedication.

Integration· i.s.h.med Smart Medication is called from the

patient profile

· The functionality of i.s.h.med Smart Chart is used todisplay the medication in the chart.

System· i.s.h.med Smart Medication is available from

i.s.h.med SAP 6.0 EHP 7 SP 9 onwards.

· Generally, i.s.h.med can be technically run on thehardware which is necessary for SAP PatientManagement. We recommend the scaling of thisconcerning CPU performance, RAM, possibleserver clusters etc. in accordance with theforeseeable system load (number of users etc.) (seealso SAP note number 1517664).

· The supported operating system platforms,database systems, etc. are the same as those forSAP ERP Release 6.0.

Smart UI(see also SAP note number 1782982)

The following recommendations apply for the use ofSmart UI components:

· SAP GUI for Windows 7.30 or higher

· SAP Netweaver 7.0 SAP EHP3 SPS 05 or higher

·

· SAP Netweaver Business Client (NWBC) 4.0 forDesktop or higher

· Prerequisites for the use of WebDynpro technology

· Microsoft Silverlight Version 4 or higher (for thePatient Groups and Smart Chart components)

The following recommendations apply for a Smart UIinfrastructure:

· ABAP application serverHardware – Server:

· CPU: 2x Xeon E5-2680 v2

· RAM: 512 GB RAM

· Model: e.g. HP BL460c G8

· Additionally, if terminal servers are used (e.g.CITRIX) Hardware – Terminal server:

· CPU: 2x E5-2680 v2 10-Core 2.8 GHz

· RAM: 64 GB RAM

· HDD: 2x 200GB SSD as RAID-1

· Model: e.g. HP DL360p G8


· Work station – local NWBC installation or terminal -server (e.g. Citrix XenDesktop 7.x)Hardware – Client:

· CPU: Core i5

· RAM: 8 GB RAM

· Graphic: Separate graphic card

· Monitor: e.g. 22“ (TFT) with a resolution of1920*1080 pixels (recommendation)

e.g. 19” (TFT) with a resolution of1280*1024 pixels (minimum)

· IT network: At least 1 GBit/s network speed on client

Other Prerequisites· Once a year the customer must provide voluntary

information on license-relevant audits (number ofusers, number of patients treated each year). In thelicense contract Cerner expressly reserves the rightto perform license checks.

· Services are required for productive use (some canbe executed by the customer).

Cerner Corporation / 2800 Rockcreek Pkwy / Kansas City, MO 64117 / USA

This document contains Cerner confidential and/or proprietary information belonging toCerner Corporation and/or its related affiliates which may not be reproduced or transmittedin any form or by any means without the express written consent of Cerner. All Cernertrademarks and logos are owned by Cerner, Corp. All other brand or product names aretrademarks or registered marks of their respective owners.

Data Sheet SW ishmed Smart Medication en.docx Released Date: 03/15

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Data Sheet SW Ishmed Smart Medication