Dr Martin Wilson, GP Steve Roberts, Pharmacist (17/10/08, In The Zone Breakfast)

1. This demonstration shows a number of ePharmacy components working together using a Medicines Reference System. On each slide, click the or the flashing yellow square Screenshots from Medtech and Toniq have been used to illustrate how ePharmacy might work. This is not an endorsement of these products, and changes made to the screenshots do not represent planned modifications by the vendors. The workflow shown here does not necessarily show how best to use Medtech or Toniq, but has been chosen to provide a simple demonstration of the concepts of ePharmacy in action.

2. During consultation get medication profile symptoms of depression

3. First get a medications history Connecting to shared patient information ... Downloading medication profile ... Locating current medicines ... Updating local data ... Add checked items to local patient record Note that downloading and updating might, as an alternative, happen automatically in the background at the start of the consultation.

4. First get a medications history

5. Now prescribe some Prozac symptoms of depression

6. Now prescribe some Prozac proz

7. Make that a generic prescription

8. Check out that alert! fluoxetine (as hydrochloride) 20mg capsules

9. Check out that alert! fluoxetine (as hydrochloride) 20mg capsules fluoxetine (as hydrochloride) 20mg capsules Fluoxetine belongs to SSRIs, and has the following interaction information for patient’s current mediciations: Aspirin increased risk of bleeding when SSRIs given with aspirin

10. Check out the treatment guidance fluoxetine (as hydrochloride) 20mg capsules fluoxetine (as hydrochloride) 20mg capsules

11. Check out that advice about starting doses

12. Note recommendation to consider 10mg dose is specific to NZ

13. Look for 10mg dose form fluoxetine (as hydrochloride) 20mg capsules fluoxetine (as hydrochloride) 20mg capsules

14. There are no 10mg tablets or capsules – so investigate fluoxetine (as hydrochloride) 20mg capsules

15. Check out the products

16. The tablets are scored, but check out the endorsement.

18. Type in the dosage and it’s ready to go fluoxetine (as hydrochloride) 20mg tablets: dispersible 0.5 1 wk 4 Take half a tablet once a day for a week tabs tabs Once Daily (OD)

22. The electronic prescription is sent to a shared information source, where it is held until a pharmacist requests it. R X Prescription details are stored in the patient’s medication profile. Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

24. Patient takes paper prescription to pharmacy Image credit http://bobdunndesign.com/cartweb/~3347921/jworthen/jworthen/

25. The pharmacist scans the barcode on the prescription, and uses it to retrieve the electronic prescription and patient medication profile. R X Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

26. This locks the prescription in the shared information source so that it cannot be dispensed at any other pharmacy. R X Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

27. Review prescription items 15/08/2008 Miss Katherine Adams A3 (Dr Sam Eaves) Accept Medicine Quantity Repeats fluoxetine (as hydrochloride) 20mg tablets: dispersible 4 tabs 0 Note to pharmacist: if not picked up in 10 days refer back to me Endorsement: prescribed in a daily dose that is not a multiple of 20 mg Indication: Depression and associated anxiety Instructions to patient: Take half a tablet once a day for a week Stock Summary Brand Manf Pack SOH SOO PP($) FLUOX PACI 30 11 0 0 New patient New prescriber Reject All F11 Accept Details F12 Fluoxetine has the following interaction information for patient’s current mediciations Aspirin: increased risk of bleeding when SSRIs given with aspirin The pharmacist now views the downloaded prescription items and checks stock availability.

28. New patient 15/08/2008 Miss Katherine Adams (Dr Sam Eaves) Miss Katherine Adams 22 Upton Cres, Cashmere, Paremata DOB: 09 Mar 1987 NHI: ABC1234 Rx code: A3 C reate new patient record U pdate existing patient record 1 Adams Mr Alan 22 Upton Cres 17/09/78 ABC1234 2 Adams Mrs Catherine 33 Coldstream Court 01/03/52 ABC1234 3 Adamson Mr Peter 15 Rathbone St 12/06/50 ABC1234 4 Adamson Mrs Sally 15 Rathbone St 12/09/48 ABC1234 DOB NHI Patient is new to this pharmacy. Check the list of similar patients before confirming that this is a new one. Reject All F11 Accept Details F12

29. New prescriber 15/08/2008 Miss Katherine Adams (Dr Sam Eaves) Dr Sam Eaves 566 Broadway, Newmarket, Auckland Registration A88984-3 C reate new prescriber record U pdate existing prescriber record 1 Cox Dr Katie Park Road Medical Centre A01234-5 2 Davidson Dr Peter Park Road Medical Centre A01234-5 3 Eccles Dr Jo 151 Carlton Gore Rd A01234-5 Registration Doctor is new to this pharmacy. Check the list of similar prescribers before confirming that this is a new one. Reject All F11 Accept Details F12

30. fluoxetine (as hydrochloride) 20mg tablets Sam Eaves  New patient has been added  New prescriber has been added Reject Rx F11 The pharmacist chooses from the list of matching products. (In this case there is only one product in the list.)

31. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. Note to pharmacist: if not picked up in 10 days refer back to me Endorsement: prescribed in a daily dose that is not a multiple of 20 mg Indication: Depression and associated anxiety Fluoxetine has the following interaction information for patient’s current mediciations Aspirin: increased risk of bleeding when SSRIs given with aspirin Check out the patient’s medication history. Reject Rx F11

32. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. View Alert F11 Setting Rx FLUOX 20mg 4 PACI 15/08/08 depression and associated anxiety 1/1 Eaves GP Take half a tablet once a day for a week 566 Broadway, Auckland 0 The medication profile is integrated with the Toniq history grid processing History grid 4 tab disp 20mg Fluox (fluoxetine (as HC 90 tab EC 100mg Ethics Aspirin EC (aspirin) 90 tab LA 95mg Betaloc CR (metoprolol) 1 inj Vaxigrip (influenza vaccine) 90 tab 40mg Lipex (simvastatin) 30 tab 500mg paracetamol

33. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. View Alert F11 Setting Rx paracetamol 500mg 30 04/04/08 sprained ankle 1/1 Eaves GP take 1-2 tabs four hourly PRN 566 Broadway, Auckland 0 The medication profile is integrated with the Toniq history grid prescribed History grid 4 tab disp 20mg Fluox (fluoxetine (as HC 90 tab EC 100mg Ethics Aspirin EC (aspirin) 90 tab LA 95mg Betaloc CR (metoprolol) 1 inj Vaxigrip (influenza vaccine) 90 tab 40mg Lipex (simvastatin) 30 tab 500mg paracetamol

34. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. View Alert F11 Setting Rx Ethics Aspirin EC 100mg 30 14/07/08 prevention of heart disease 1/1 Jones hosp take 1 tab once daily Dunedin Public Hospital 0 The medication profile is integrated with the Toniq history grid dispensed: Amcal George St History grid 4 tab disp 20mg Fluox (fluoxetine (as HC 90 tab EC 100mg Ethics Aspirin EC (aspirin) 90 tab LA 95mg Betaloc CR (metoprolol) 1 inj Vaxigrip (influenza vaccine) 90 tab 40mg Lipex (simvastatin) 30 tab 500mg paracetamol

35. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patients who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. Note to pharmacist: if not picked up in 10 days refer back to me Endorsement: prescribed in a daily dose that is not a multiple of 20 mg Indication: Depression and associated anxiety Fluoxetine has the following interaction information for patient’s current mediciations Aspirin: increased risk of bleeding when SSRIs given with aspirin Check out the same guidance that the prescriber saw Reject Rx F11

36. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. Note to pharmacist: if not picked up in 10 days refer back to me Endorsement: prescribed in a daily dose that is not a multiple of 20 mg Indication: Depression and associated anxiety Fluoxetine has the following interaction information for patient’s current mediciations Aspirin: increased risk of bleeding when SSRIs given with aspirin Check out the same guidance that the prescriber saw G uidance Reject Rx F11

37. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. Note to pharmacist: if not picked up in 10 days refer back to me Endorsement: prescribed in a daily dose that is not a multiple of 20 mg Indication: Depression and associated anxiety Fluoxetine has the following interaction information for patient’s current mediciations Aspirin: increased risk of bleeding when SSRIs given with aspirin Accept the prescription Reject Rx F11

38. Sam Eaves 566 Broadway, Newmarket, Auckland MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. Note to pharmacist: if not picked up in 10 days refer back to me Endorsement: prescribed in a daily dose that is not a multiple of 20 mg Indication: Depression and associated anxiety Fluoxetine has the following interaction information for patient’s current mediciations Aspirin: increased risk of bleeding when SSRIs given with aspirin Accept the prescription Reject Rx F11

39. Medicines are picked and labelled

40. The bag is labelled with the prescription number

41. The bag is scanned at the point of sale when the patient picks up the medicine. A message is sent to the shared information source indicating the medicine has been picked up. $3.00 Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

42. The prescription is removed from shared information source. The patient’s medication profile is updated. Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

43. Sam Eaves MUST be ENDORSED for patinets who can’t swallow whole tabs/caps. If written for a daily dose that is NOT a multiple of full tablets, it is DEEMED endorsed. Tabs should be combined with caps to facilitate incremental 10mg doses. Setting Rx FLUOX 20mg 4 PACI 15/08/08 depression and associated anxiety 1/1 Eaves GP Take half a tablet once a day for a week 566 Broadway, Auckland 0 processing The pharmacy has not stored the medication profile – local pharmacy data contains only medicines dispensed at this pharmacy. The pharmacy has not stored the medication profile – local pharmacy data contains only medicines dispensed at this pharmacy. 4 tab disp 20mg Fluox (fluoxetine (as HC

44. The medication profile is available to authorised parties throughout the health system, such as on hospital admission, visiting a specialist, etc. Ms Katherine Adams, 22 Upton Cres, Cashmere DOB 9 Mar 1987 Medication Profile Summary Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

45. ePharmacy copes with a range of more complex situations, including repeats, partial dispensing, and owes. It allows a patient to obtain repeats from a different pharmacy if desired. It allows a pharmacy to dispense only some of the items on a prescription with the patient getting the remaining items from a different pharmacy.

46. This demonstration has shown a number of ePharmacy components working together using a Medicines Reference System. more complex example

47. The following example shows a more typical processing of a prescription in a pharmacy. Both patient and prescriber are already in the pharmacy database. Note: Habitrol is prescribed by brand because dose instructions are different for the different brands. R X Prescription No.123456-1234567890 Dr Sam Eaves, General Practitioner 566 Broadway, Newmarket, Auckland Phone 09-766 5676 Fax 09 783 6778 Dr Sam Eaves NZMC Reg No. A88984-3 Mr James Quinn 78 Hillmorton Ave, Parnell, Auckland GMS:A3 DOB: 15 Jun 1978 NHI: ABC1234 15 Aug 2008 Habitrol (nicotine 2mg) gum: chewing chew one piece slowly for approx. 30 minutes when urge to smoke occurs, max. 20 pieces daily Mitte: 96 pieces sumatriptan (as succinate) 50mg tablet Sig: 1 or 2 tabs as soon as possible after onset of migraine (do not take second dose for same attack if no response to first dose); repeat after at least 2 hours if migraine recurs; max. 6 tabs in 24 hours Mitte: 4 tabs

48. The pharmacist scans the barcode on the prescription, and uses it to retrieve the electronic prescription and patient medication profile. R X Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

49. This locks the prescription in the shared information source so that it cannot be dispensed at any other pharmacy. R X Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

50. Review prescription items 15/08/2008 Mr James Quinn A3 (Dr Sam Eaves) Accept Medicine Quantity Repeats Habitrol (nicotine 2mg) gum: chewing 96 pieces 0 Indication: adjunct to smoking cessation Instructions to patient: chew one piece slowly for approx. 30 minutes when urge to smoke occurs, max. 20 pieces daily Stock Summary Brand Manf Pack SOH SOO PP($) HABITROL NOC 96 37 0 0 HABITROL NOC 96 37 0 0 Reject All F11 Accept Details F12 The patient doesn’t have his Quitline card with him, but wants to pick up the sumatriptan now. sumatriptan (as succinate) 50mg tablet 4 tabs 0

51. Review prescription items 15/08/2008 Mr James Quinn A3 (Dr Sam Eaves) Accept Medicine Quantity Repeats Habitrol (nicotine 2mg) gum: chewing 96 pieces 0 Indication: adjunct to smoking cessation Instructions to patient: chew one piece slowly for approx. 30 minutes when urge to smoke occurs, max. 20 pieces daily Stock Summary Brand Manf Pack SOH SOO PP($) HABITROL NOC 96 37 0 0 HABITROL NOC 96 37 0 0 Reject All F11 Accept Details F12 Review the other prescription item. sumatriptan (as succinate) 50mg tablet 4 tabs 0

52. Review prescription items 15/08/2008 Mr James Quinn A3 (Dr Sam Eaves) Accept Medicine Quantity Repeats Indication: treatment of acute migraine attacks Instructions to patient: 1 or 2 tabs as soon as possible after onset of migraine (do not take second dose for same attack if no response to first dose); repeat after at least 2 hours if migraine recurs; max. 6 tabs in 24 hours Stock Summary Brand Manf Pack SOH SOO PP($) IMIGRAN GLSK 4 37 0 0 MYGRAN ARPH 2 0 0 12.19 SUMAGRAN PACI 4 0 12 0 ARROW SU ARPH 4 2 12 0 Reject All F11 Accept Details F12 sumatriptan (as succinate) 50mg tablet 4 tabs 0 Habitrol (nicotine 2mg) gum: chewing 96 pieces 0 Accept the checked items.

53. sumatriptan (as succinate) 50mg tablet Sam Eaves Reject Rx F11 1 50mg Tablets 4 GLSK 37 IMIGRAN sumatriptan (as succinate) 50mg 2 50mg Tablets 2 ARPH 0 MYGRAN 12.19 3 50mg Tablets 2 PACI 0 12 SUMAGRAN 50 4 50mg Tablets 4 ARPH 2 12 SUMATRIPTAN ARROW The pharmacist chooses from the list of matching products for the sumatriptan. Mr James Quinn

54. Reject Rx F11 Indication: treatment of acute migraine attacks Instructions to patient: 1 or 2 tabs as soon as possible after onset of migraine (do not take second dose for same attack if no response to first dose); repeat after at least 2 hours if migraine recurs; max. 6 tabs in 24 hours Accept this prescription item.

55. Medicines are picked, labelled, and dispensed.

56. The patient is given a copy of the prescription, to enable him to obtain the Habitrol from another pharmacy, at another time. R X Prescription No.123456-1234567890 The paper prescription has: Dr Sam Eaves, General Practitioner 566 Broadway, Newmarket, Auckland Phone 09-766 5676 Fax 09 783 6778 Dr Sam Eaves NZMC Reg No. A88984-3 Mr James Quinn 78 Hillmorton Ave, Parnell, Auckland GMS:A3 DOB: 15 Jun 1978 NHI: ABC1234 15 Aug 2008 Habitrol (nicotine 2mg) gum: chewing chew one piece slowly for approx. 30 minutes when urge to smoke occurs, max. 20 pieces daily Mitte: 96 pieces sumatriptan (as succinate) 50mg tablet Sig: 1 or 2 tabs as soon as possible after onset of migraine (do not take second dose for same attack if no response to first dose); repeat after at least 2 hours if migraine recurs; max. 6 tabs in 24 hours Mitte: 4 tabs DISPENSED DISPENSED

57. A message is sent to the shared information source indicating the sumatriptan has been picked up. Another message returns the Habitrol prescription item, which unlocks it. R X Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

58. The medication profile shows that the Habitrol has not been dispensed, but the Imigran has. Mr James Quinn, 78 Hillmorton Ave, Parnell DOB 15 Jun 1978 Medication Profile Summary Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

59. The Habitrol can be picked up from another pharmacy if desired. If it is never picked up, it will eventually expire and be removed from the shared information source. Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah Blah blah blah and blah

60. This demonstration has shown a number of ePharmacy components working together using a Medicines Reference System.