quested from and retrieved from the family physician’s electronic records in several ways: as an order or prescription, from a medication list, or from a progress note. In this case, the demonstration participants chose to use the HL7 CDA to retrieve the prescription information, which was then used to drive clinical decision support (drug–laboratory interaction) and to inform the clinicians of the potential ADE.

During the demonstration, it became clear that while an ADE can be recorded as an allergy or as a problem on a problem list, current data standards do not support the documentation of an ADE as such. An ADE is not an allergy, although some individuals do have allergies to certain medications. This observation prompted HL7 to define a specification for representing ADEs. Finally, patients should be able to authorize release/transmission of their data. The demonstration showed that this functionality is not possible with the current systems and standards. Box 2-2 presents the results of the demonstration in terms of a report card summarizing progress to date on interoperability standards in health information management systems.

From the data standards perspective, the assessment of systems functionality was based on whether a standard exists and was/was not used in the demonstration, whether there are nonstandard methods for executing the task, or whether no technology exists to solve this interoperability issue.

BOX 2-1
Final ADE Scenario for Interoperability Demonstration

  • A 78-year-old woman sees her family physician at a small office practice. She is diagnosed with hypertension. A prescription is generated and sent to the pharmacy.

  • A few days later, she is taken to the emergency room and admitted to the hospital with symptoms of diarrhea, disorientation, and a rash. The physician orders a complete blood count and electrolyte replenishment.

  • Laboratory results indicate hyponatremia. Is the rash a new adverse event associated with losartan/hydrochlorothiazide (Hyzaar)?

  • An adverse event message is sent to the FDA.

  • Decision support prevents prescription of a second counterindicated drug (triamterine-hydrochlorothiazide). A different medicine (metoprolol) is prescribed instead. The patient improves and is discharged.

  • The patient’s family physician reviews the inpatient laboratory results and the discharge summary.

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