Envisioning seamless sharing of digital meds data in Wales

Digital Health and Care Wales (DHCW) is embarking on the creation of a shared medicines record for the whole of the country. The Digital Medicines Transformation Portfolio will include a shared medicines record, a patient access project, a secondary care ePMA programme, and a primary care electronic prescription service.

At our Better Meds community event in April, Keith Farrar, Deputy SRO at DHCW, presented the shared digital medicines record vision for Wales. He provided some reasoning for why it is worthwhile to invest in medicines:

1. Widespread therapeutic use
   Medications are the most widely used therapeutic intervention, with almost everyone receiving some form of medication, including surgical patients.
   
   
2. Prevalence of medication errors
   Medication errors are common and harmful, occurring in about 10% of all written prescriptions and 5% of all drug administrations. These errors account for 6.5% of all hospital admissions.
   
   
3. Importance of medicine management
   Managing medicines is crucial for several reasons:
   - Addressing antimicrobial resistance, a critical public health issue. 
   - Enabling better treatment and procurement strategies through an effective epidemiological perspective.
   - Facilitating the development of AI support systems with accurate and comprehensive medication data.
   
   

The medication journey involves numerous interactions with various applications and systems, even for the same patient and the same medicines. In acute care, medication data is constantly being transferred between different settings. This creates several medication data silos that must exchange information efficiently to ensure continuity and accuracy of care.

The shared medication record will be a centrally held FHIR store populated by all significant medicine events in any approved healthcare system across the country. Data will be pulled from secondary, tertiary, community, and primary care, along with citizen systems and wider services such as social care, care at home, care homes, private care and hospices. It will record every new prescription, prescription update, dispense, and administration for each patient and make it available to health and care professionals in a context-specific way at the point of need.

Creating a shared medication record revolves around the adoption and implementation of robust standards. These standards include patient identifiers, organisation identifiers, encounter context, user identifiers, medicine identifiers, and meta-data codes (such as dosage information). Additionally, message structures and behaviors are defined using FHIR. The key to success lies in achieving interoperability and widespread adoption of these standards. Interoperability enables all healthcare systems to connect seamlessly through a unified set of APIs, ensuring that medication data can be accurately and efficiently shared across different platforms and care settings. This standardised approach is essential for creating a cohesive and reliable medication record accessible to all healthcare professionals when needed.

As Keith remarked, standards are essential because computers require precise instructions to process and exchange information effectively, ensuring consistency and reliability in data handling.

The envisioned benefits of the project are:

• Reduced risk of errors while transcribing by providing timely access to patient medicines and allergy information.
• Reduction in transcribing time as clinical data is made available and shared electronically, releasing time to care.
• Supporting NHS Wales research as medicines and allergy data is made available.
• Empowering patients in their health care by giving them secure access to their records.
• Projections estimate the integrated record will reduce errors by at least 40% and save 800 bed days and £383,000 annually.