webinar ihe pharmacy domainupdate 20150909 final

8/20/2019 Webinar IHE Pharmacy DomainUpdate 20150909 Final

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Jürgen Brandstätter, MScCo-chair Pharmacy Planning committeeCo-chair Global Deployment Coordination Committee (GDC)IHE International BoardCodeWerk Software GmbH, Austria

IHE Pharmacy Domain Update

Webinar


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Learning objectives

• Understand PHARM vision, mission and strategic goals

• Understand PHARM domain's liaison and collaboration with HL7 andISO

•Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and

Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain,FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work


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Learning objectives



•Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and





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What is IHE?

eHealth Projects

IHTSDO

IETF

Standards

Use cases typically require

„combinations“ of standards

- but how to compose?


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What is IHE?

eHealth Projects

IHTSDO

IETF

Standards Profiling and Testing


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ProductsProjects

IHE methodology

Use Case

Identifyavailablestandards

Products

declareIHE

Easy to integrate products

RFPs

with IHEreqs


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IHE: Difference to classic SDO

• Classic Standards Developing OrganizationDevelops „ future“ standards in certain areas

• IHEUses „existing“ standards to profile Interoperability use-cases

IHE is a non-profit association dedicated to interoperability in health

information technology.

IHE: A forum for agreeing on how to implement

standards and processes for making it happen


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Pharmacy within IHE landscape

Pathologysince 2006

Radiation Oncology

since 2004

Radiologysince 1998

Cardiologysince 2003

Patient Care Devicessince 2005

Patient Care Coordinationsince 2005

Eye Caresince 2006

Quality

Research & Public Healthsince 2007

Laboratorysince 2003

(Healthcare)IT Infrastructure

since 2003

since 2008

Pharmacysince 2008

IHE Dental

IHE Endoscopy


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Our needs in hospital

Cover the overall medication workflow from

prescription via validation and dispense to the

administration to the patient

http://santemeuse.free.fr/images/medicaments3.jpghttp://prevenir.free.fr/Route/Routeimages/accident%20mortel.jpghttp://www.biotonus.ch/spip/IMG/jpg/radiologie011-4.jpghttp://homepage.hispeed.ch/piben/radiologie/Salledig.jpg


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Our needs in community

Cover the overall process fromplanning medication and

prescription at the GP via dispense

at the Pharmacy to ambulant

administration


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IHE Pharmacy overview

Vision: “Pharmacy processes runs seamless in the community and hospital

domain as well as cross-domain.”

Mission: “IHE Pharmacy produces profiles and guidance that addressesinformation sharing, workflow and patient care in both community andhospital domain.”

Most actively involved …

• Many European countries• USA/Canada• Australia

1 whitepaper, 6 profiles, Whitepaper work on certain (rather complex) topics

Sponsors & Supporters

• EAHP, NICTIZ, Réseau Phast


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Strategic goals

• Promote widespread adoption and implementation of IHE Pharmacy developed

profiles by ...• Marketing and promoting the profiles globally• Reaching out for national/regional e-Prescription programs in order to

• (1) learn requirements and demands which lead to developments withinIHE Pharmacy and

• (2) stimulate leveraging of IHE Pharmacy profiles as basis for their

national specifications• Improve information exchange between healthcare providers and organizations

that depend on Pharmacy related workflows and processes

• Develop ways to automate collaborative workflow between physicians andpharmacists in both community and hospital pharmacy environment

• Establishing and maintaining collaboration to ...

• other IHE domains• HL7 Pharmacy• ISO TC215 WG6 Pharmacy• NCPDP

Big success: European Commission recognizes27 IHE prof iles that “ should be referenced in

public procurement documents” 1)

-> 2 Pharmacy profiles included (PRE, DIS)!

1) http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2015_199_R_0011

http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2015_199_R_0011http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2015_199_R_0011


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Learning objectives



• Overview of existing PHARM profiles and Community and HospitalPharmacy, including Community Medication Prescription and





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Liaisons

ISO TC 215 WG6 „Pharmacy“ / CEN TC 251Global recognition

HL7 PharmacyBase Standards

IHE PharmacyProfiling Layer

Friendly

collaboration


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Liaisons

ISO TC 215 WG6 / CENGlobal recognition


IHE PharmacyProfiling Layer

Contributions

ISO Standards

Base andlegal bindingstandards


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Liaisons

ISO TC215 WG6 / CENGlobal recognition


IHE PharmacyProfiling LayerProjects

High-level

TechnicalProfiles

(Use Cases)

ISO Standards


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Learning objectives




Dispense, Hospital Medication Workflow, Medication Treatment

Plan


• Understand how PHARM work benefits the pharmacists

• How to get involved in PHARM committee work


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Our approach

• Create and maintain a common data model• A common approach for Community and Hospital Pharmacy environment

• Profile existing standards• Hospital pharmacy: HL7v2.x standard (Message-based)• Community pharmacy: HL7v3 CDA standard (Document-based)

• Technical Framework describes the details of each Integration Profile• Use-case• Actors, Transactions

• Connectathons to validate implementations of the IHE Pharmacy Integration

Profiles• First tested at European CAT in Pisa/Italy, April 2011


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What has been done?

• 7 profiles for …

… Hospital Pharmacy

• HMW Hospital Medication Workflow

… Community Pharmacy

• CMPD Community Medication Prescription and Dispense

• PRE Content Profile: Medication Prescription

• PADV Content Profile: Pharmaceutical Advice

• DIS Content Profile: Medication Dispense• PML Content Profile: Pharmacy Medication List

• MTP Content Profile: Medication Treatment Plan1)

1) Currently in publishing process


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The White Paper…

• IHE White Paper Foundation of all current profiles

• Final version

Released in early 2010

• 78 pages

Community Pharmacy use cases

Hospital Pharmacy use cases

Harmonization of actors definitions

Current version:

ftp://ftp.ihe.net/Pharmacy/White%20Paper/IHE_Eur_Pharmacy_White_Paper_Final_Text_1.3.3.pdf


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IHE Pharmacy – Key process

Prescription

Specialist, GP

Pharmaceutical

advice

Pharmacist

Dispense

Pharmacist

Administration

Patient, Nurse, Family member

Rejected Repeat

dispense

Dispensed

ApprovedPrescribed

Clinical result of medication

Validation of the prescription(ICA check, etc.)


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Hospital Pharmacy profile

Workf low and ContentHospital Medication Workflow (HMW)

– Basic use case:

• Hospital physician prescribes in a ward

• Hospital pharmacist reviews orders

• Pharmacy technician dispenses

• Nurse administers drugs to the patient

– Systems it would impact:

• Prescription placer modules

• Pharmacy (Validation, encoding…) software

• Medication dispensing systems

• Medication administration informer modules

– Based on HL7 v2.5/v2.6:

• Message based to fit into hospital environment


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HMW Interoperability Model


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HMW Interoperability Model

Medication

Dispenser

(supply and distribution arecovered, but not profiled yet)


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Community Pharmacy profiles

WorkflowCommunity Medication Prescription and Dispense(CMPD)

•Technical Integration, Actors, Transactions, based onIHE ITI XDS

Content (based on HL7v3 CDA extended wi th HL7 Medication CMETs)

Prescription (PRE)• In sync with upcoming ISO DTS 17523

“Requirements for electronic prescriptions”and ePrescription guideline of the EU / eHGI

Dispense (DIS)• In sync with upcoming ISO DTS 19293

“Requirements for the record of DispenseMedicinal Products”


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Community Pharmacy profiles

Content (based on HL7v3 CDA extended wi th HL7 Medication CMETs)Pharmaceutical Advice (PADV)

• Used for … – Validating a prescription

» e.g., Medication Interaction Checking IssueManagement

– Managing of prescriptions and dispenses (Change,

Cancel, …)» Always related to PRE, DIS or MTP

Pharmacy Medication List (PML) • Information on prescribed and dispensed medication to a

patient• Contains Prescription-, Dispense-, Pharmaceutical Advice

Items• „On-demand“ document

Medication Treatment Plan (MTP) • Information on planned medication to a patient• Contains Medication Treatment Plan Items (alike PRE items)• Prescriptions and Dispenses may be referencing MTP


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CMPD actor diagram


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Create Prescriptions/Dispenses

Create

Prescription

Create Dispense


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Create Prescriptions/Dispenses

Create

Prescription

Create Dispense

Medication Interaction Checking


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Manage Prescriptions/Dispenses

Manage Prescriptions/Dispensations


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Manage Prescriptions/Dispenses

Manage Prescriptions/Dispensations

Medication Interaction Checking

Query/Retrieve Medication


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Query/Retrieve MedicationDocuments


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The way of a prescription

PRE

Physician prescribesa prescription with 5prescription items

PI 1

PI 2

PI 3

PI 4

PI 5


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PADV


PRE

Physician changes PI 1

PI 1

PI 2

PI 3

PI 4

PI 5

PADV 1PADV

PADV 3

Physician cancels PI 3


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PADV


PRE

PI 1

PI 2

PI 3

PI 4

PI 5

PADV 1

Pharmacist dispensesall PIs

DIS

DIS 1 DIS

DIS 2

DIS

DIS 4 DIS

DIS 5


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PADV


PRE

PI 1

PI 2

PI 3

PI 4

PI 5

PADV 1

Physician changes dosageof DIS 2

and instructs the patient tostop intake of DIS 5

DIS

DIS 1 DIS

DIS 2

DIS

DIS 4 DIS

DIS 5

PADV

PADV 2

PADV

PADV 5


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Planning / Actual

PRE DIS DISPADV

Change

Plan

Actual

Action

Physicianstarts

medicationtreatment

Physicianchangesdosage

Patientruns out ofmedication

s

Physicianchangesdosageagain

Logical flow Leads to

PRE DIS

MTPPADV

ChangePADVChange

Reference to MTP Reference to PRE Reference to DIS

Time

…


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Becoming real – in epSOS

European Patient Smart Open ServicesGoals (relevant for IHE Pharmacy)

• Cross-border prescription and dispense

• Demonstrated in pilot use

Covered use-cases

Prescription query (cross-border)

Dispense create (cross-border)

Community Pharmacy profiles used

Content: PRE, DISSynced

1) Concept derived from epSOS

2) Worked in sync with epSOS

3) Further elaborated in IHE

B i l i A i


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Becoming real – in Austria

Austrian e-Medication project

Goal of the project• Increasing patient safety by providing a “Medication List” of a patient for physicians andpharmacists to support prescribing and medication interaction checking

•Nation-wide rollout (8 mio people): All physicians and pharmacists will be connected•Rollout and startup on volunteer basis 2016, mandatory use for physicians and pharmaciesstarting 2017

To achieve the goal …

•… prescriptions and dispenses have to be captured electronically to act as data-source for themedication list (e-prescription/dispense system)

•does not replace paper prescription yet (just for capturing data)!

Covered use-casesPrescription create / query / cancel / change

Dispense create / query / stop intake / change dosage (including OTC)

Query Medication List

Community Pharmacy profiles usedWorkflow: CMPD

Content: PRE, DIS, PADV, PML Embedded into national Health Recordinfrastructure (ELGA)based on IHE XDS


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Becoming real – in Saudi Arabia

Saudi e-Health Exchange projectGoals of “Medication track”

• Introducing e-Prescription/Dispense (replacing paper)• Providing a “Medication List” of a patient for physicians and pharmacists• including hospital medications (out of discharge summary)• Provide a central service for “Medication Interaction Checking”• Specification phase now completed

Covered use-casesPrescription create / query / cancel / change / suspend

Dispense create / query / stop intake / change dosage / suspend (including OTC)

Query Medication List

Central Medication Interaction Checking and Issue Management

Community Pharmacy profiles usedWorkflow: CMPD

Content: PRE, DIS, PADV, PML Embedded into Saudi e-HealthExchange infrastructure (SeHE)

based on IHE XDS

B i l i S it l d


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Becoming real – in Switzerland

Swiss e-Medication projectGoal of the project (Geneva driven)

• Increasing patient safety by sharing the “Medication Treatment Plan” of a patient between allstakeholders (hospitals, private physicians, pharmacists, home care, …)• Defining a national profile for sharing patient’s medication related information in relation with

the forthcoming federal law on the electronic patient record (2017)

• Cantonal roll-out – hospital, physicians, pharmacists and home care will be connected to theshared treatment plan module of the regional Health Information Exchange

• Rollout and startup first quarter 2016 on a voluntary basisTo achieve the goal …

• Implementation of IHE content profiles based communication in the regional HIE• Implementation of the management of the CDAs as an OpenSource project (eHealth-Connector)

in order to ease the integration by third party vendors

• Wide concertation will all stakeholders in the country in order to promote the national exchangeformat

Covered use-casesQuery Medication List and Medication list updatePrescription create / query / cancel / change

Dispense create / query / stop intake / change dosage (including OTC)

Add comments to plan / prescription / dispense (home care)

Community Pharmacy profiles used

Content: MTP, PRE, DIS, PADV, PML

L i bj ti


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Learning objectives








Oth Ph ti iti


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Other Pharmacy activities

• IHE started by covering the clinical part of the medication circuit:

From prescription to administration

• Based on thede facto

standards: CDA and HL7 v2.

• This clinical part must be interoperable with other parts:

• The distribution / supply of medication across and

inside institutions• The management of medications

• Other processes using medication (radiology, surgery)

S l f P d t f H lth


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Supply of Products for Healthcare

• A cross-domain and cross-standard guidance on how toexchange information for the supply of products:

• Order from suppliers, delivery inside an institution,automated dispensing, traceability, barcode-enabled trackingand stock management

• Whitepaper being developed, work on profiles starting aswell

• GS1 and HL7 are the enabling standards

S l d


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Supply – areas covered

Catalog maintenance

Orders and returns

Inventory management

Usage report & tracking

Billing

Selection of vendors | Pricing & Contracts | Update product dataInternal data (Clinical data, internal prices, usage rules, usage

instructions)

Availability and recall

Permissions, availability, recall

Stock orders and bulk orders

Consignment items

Point of care ordering & order processing

Consult product data

Consignment items

Patient charges / intra-hospital chargesHospital billing

Manufacturer Distributor Hospital

Dispensing

Systems Point of care

Patient usage

Stock status, consumption

C Ph P fil


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Common Pharmacy Profile

• Health IT is moving to support innovation, distributed

applications, mobile computing, web-enabled solutions, ...• This requires faster-to-adopt, faster-working interoperability.

• HL7 FHIR is a draft standard that enables it.

• A new set of profiles is being created to advise implementershow to prepare for the new standard:

• “ The Common Pharmacy Profile”

• Includes aspects like workflow management, constraints andrecommendations to support from traditional systems to mobileapplications

• We do this by using the best of our existing profiles, our experienceand preparing a common profile, ready for the future challenges

“C ” P


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“Common” Panorama

Dispensing Administration

Supply

MedicationLists

ADEreporting

Planning

MedicationStatements

MedicationCatalog

PrescribingReview / Advice

For CommunitiesFor HospitalsFHIR-based (common)

ADE = Adverse Drug Event

Oth ti iti


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Other activities

• Medication Catalog / Formulary• How do we identify medication across different systems? Are

names sufficient? Are codes necessary? How do wedistribute the medication attributes across several systems?

• Medication Data capture / Medication Documentation

• How to retrieve data from prescriptions, dispenses, etc. Inorder to create a “medication list”

• Medication Administration (in Community domain)• More and more eligible to document electronically also in

Community domain

• Ambulant Chemotherapy, Controlled drug-substitution, ...

Learning objectives


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Learning objectives



• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription andDispense, Hospital Medication Workflow, Medication Treatment Plan




S d d t h h bit ?


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So, do we need to change our habits?

eHealth is going to play a very important role in our

real life in Hospital and Community Pharmacies Emergence of patient-enabling solutions

Increased trend to automate distribution of

medications

Traceability becomes important – for clinical

reasons, as well as prevention of falsification

We (pharmacists) have to focus on the:

Clinical Pharmacy

Use of medication across settings and domains

Oncology Pharmacy

Social Pharmacy

Pharmacy Informatics

…

Patients must be our main

concern!

For Pharmacists, IHE Pharmacy,


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, y,means:

Improved Hospital Pharmacy information

through integrated access to medicationinformation

Reduced physicians and nurses callbacks to

pharmacists due to lack of medication

information

Eliminating pharmacist call backs to physicians

and nurses to resolve medications issues

Reduced pharmacists time to process special

authority requests and logistics

IHE Pharmacy

is the key to help us find solutions!

Learning objectives


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Learning objectives



• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription andDispense, Hospital Medication Workflow, Medication Treatment Plan




How to participate in IHE Pharmacy


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How to participate in IHE Pharmacy

• Committee work follows the IHE Profile Cycle• Annual cycle

• Sep – Dec: Call for proposals

• Dec – Jun: Working on work-items

• Jun – Jul: Public comment• Jul – Aug: Ballot & Release

• Opportunities for IHE members (and non-members) toparticipate in cycle

• Register at http://groups.google.com/group/ihe-pharmacy

Meetings are F2F and TConsJust join in!

Participate IHE’s Profile Cycle

Links

http://groups.google.com/group/ihe-pharmacyhttp://groups.google.com/group/ihe-pharmacyhttp://groups.google.com/group/ihe-pharmacyhttp://groups.google.com/group/ihe-pharmacy


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Links

• White Paperftp://ftp.ihe.net/Pharmacy/White%20Paper/

• Technical Frameworkshttp://www.ihe.net/Technical_Framework/index.cfm#pharmacy

• Pharmacy Wikihttp://wiki.ihe.net/index.php?title=Pharmacy

Strategic planning page

• http://wiki.ihe.net/index.php?title=PHARM_Strategic_Planning Roadmap

• http://wiki.ihe.net/index.php?title=PHARM_Roadmap Committees

• http://wiki.ihe.net/index.php?title=Pharmacy_Planning_Committee • http://wiki.ihe.net/index.php?title=Pharmacy_Technical_Committee

• Google group• http://groups.google.com/group/ihe-pharmacy

ftp://ftp.ihe.net/Pharmacy/White%20Paper/http://www.ihe.net/Technical_Framework/index.cfmhttp://wiki.ihe.net/index.php?title=Pharmacyhttp://wiki.ihe.net/index.php?title=PHARM_Strategic_Planninghttp://wiki.ihe.net/index.php?title=PHARM_Roadmaphttp://wiki.ihe.net/index.php?title=Pharmacy_Planning_Committeehttp://wiki.ihe.net/index.php?title=Pharmacy_Technical_Committeehttp://groups.google.com/group/ihe-pharmacyhttp://groups.google.com/group/ihe-pharmacyhttp://groups.google.com/group/ihe-pharmacyhttp://groups.google.com/group/ihe-pharmacyhttp://wiki.ihe.net/index.php?title=Pharmacy_Technical_Committeehttp://wiki.ihe.net/index.php?title=Pharmacy_Planning_Committeehttp://wiki.ihe.net/index.php?title=PHARM_Roadmaphttp://wiki.ihe.net/index.php?title=PHARM_Strategic_Planninghttp://wiki.ihe.net/index.php?title=Pharmacyhttp://www.ihe.net/Technical_Framework/index.cfmftp://ftp.ihe.net/Pharmacy/White%20Paper/


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Changing the Way Healthcare CONNECTS

http://www.ihe.net