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Development of SW Interface Between Healthcare Standards—DASTA and HL7 sustainability Article Development of SW Interface between Healthcare Standards—DASTA and HL7 Simona Plischke 1, Jana Machutova 1, Pavel Stasa 2,* and Jakub Unucka 2 1 LogTech, s.r.o., Gen. Sochora 6176/6A, 708 00 Ostrava, Czech Republic; [email protected] (S.P.); [email protected] (J.M.) 2 Department of Economics and Control Systems, VSB-Technical University of Ostrava 17. listopadu 2172/15, 708 00 Ostrava, Czech Republic; [email protected] * Correspondence: [email protected]; Tel.: +420-597-324-449 Received: 21 August 2020; Accepted: 15 September 2020; Published: 16 September 2020 Abstract: The prescription and administration of drugs are the most common process that takes place in hospitals. Although a relatively simple process, it is considered the riskiest process in hospitals because mistakes during drug administration are among the most common ones. The aim is to introduce technological and process changes that will contribute to maximally increase the safety of the medication process and the efficiency of drug management. To support the automation of the medication process, it is desirable to use the international standard Health Level 7 (HL7). However, the Czech healthcare system currently supports the local healthcare standard—DASTA. For that reason, the paper introduces some of the options how to transfer data from DASTA to HL7 and deals with the development of a software (SW) interface that converts data necessary for robotic preparation of patient medication from the Czech DASTA data standard to the HL7 international standard used by selected robotics. Based on the performed analyses, a combination of robotics for the preparation of single-dose packages of drugs with one of the automated warehouses is recommended. Keywords: IDH; SW interface; DASTA; HL7; automated preparation of drug 1. Introduction The prescription and administration of drugs are the most common process that takes place in hospitals. Although a relatively simple process, it is considered the riskiest process in hospitals because mistakes during drug administration are among the most common ones. Normally, a hospital with, for example, 500 beds administers over 1,600,000 drugs per year (with an average of nine drugs administered to a patient per day). However, the number and typology of mistakes they make are often not even monitored. Even with the correct administration of drugs at the level of 99.9%, there would be 1643 medication errors in such a hospital in one year. Until recently, interest in healthcare errors—and the role of the human factor in them—was very low. Unlike areas with a high degree of potential risk (e.g., air, rail, and maritime transport, nuclear power, chemical industry, etc.), when in case of disaster, the massive loss of life and extensive damage to property and the environment occurs, in fact, accident in health care concerns individuals. Therefore, they do not individually attract such great social and political attention. However, this does not mean that they are not serious and, not at all, that they do not happen. In general, the medication process in Czech healthcare facilities (unlike other hospital processes) has not been much innovated over the past few decades—the same manual decentralized preparation of drugs by nurses in wards is still applied. Unlike the clinical part of hospitals, institutional pharmacies do not use worlds’ common technologies and techniques; rarely, a clinical pharmacist is involved in the medication process, and patient verification and administration record are not sufficient, so the ability Sustainability 2020, 12, 7649; doi:10.3390/su12187649 www.mdpi.com/journal/sustainability Sustainability 2020, 12, 7649 2 of 33 to verify the correctness of administration is limited (there is usually no clear and complete record of drug administration); stock records of medicines are administratively very demanding and, therefore, confusing and unreliable; the time of preparation of medication is time-consuming, etc. An important factor increasing the risk of the process is the lack and overload of nurses. Despite the obvious success of Czech hospitals in increasing the safety of the medication, it is indisputable that the current decentralized manual preparation of drugs by nurses in wards carries a number of safety risks for patients in inpatient wards and also a number of economic and procedural inefficiencies for the entire hospital. The safety of the drug delivery process increases with the introduction of new technologies and innovative approaches. The current safest and most effective practice is the automated preparation of drug therapies for individual patients centralized in a hospital pharmacy using robotically prepared single-doses of drugs. Every movement of such a single dose within the hospital is completely transparent and ensures maximum safety for the patient. For efficiency, records, and safety reasons, this approach is combined with the use of automated warehouses to manage drugs that cannot be prepared in individual doses. Zhou et al. [1] published a study about the safety of the drug delivery system that fully considers the clinical drug safety decision support system in various businesses. They used the object-oriented method, the client-server (C/S) architecture method to design the system, and strict access control and realized the basic data maintenance, information query, drug prevention, a variety of interface design of the business, information query, prescription, prescription management. Technology to automate aspects of the dispensing process of drugs is described, e.g., in [2–4]. These articles present the background to automation, giving details of the main pharmacy-based, original pack dispensing systems that are currently available. Le Gonidec et al. [5] presented a study focused on the performances of the automated dispensing system in terms of single-dose packaging, single-dose dispensing, dispensing error rate, and security of the medication circuit. The 76 plus or minus 5% of the prescribed medications are automatically dispensed. The packaging working flow rate is 377 units doses per hour, and the dispensing working flow rate is 537 doses per hour. The dispensing error rate is 0.5% due to wrong delivery orders, mainly generated by the Pharma® computer-order entry software. Another study dealt with automated drug dispensing systems but from a different point of view. Skyggedal et al. [6] measured dexamethasone residue left on the suction cup after the production of 100 and 400 dexamethasone tablets and after 20 paracetamol tablets used as a negative control. Results: It has been found that 32.9 µg and 49.5 µg of dexamethasone have been transferred to the suction cup in the two experiments. This is approximately 1 per mile of the dexamethasone content in a 40 mg tablet. The reason for their research was that the risk of drug-drug cross-contamination in drug-dispensing robots in hospital pharmacies causes cumbersome restraints to be put on the production of the robot, for example, by scheduling high-risk drugs to be dispensed at the end of the day. The solutions described below are compliant, for example, with the requirements of the European Association of Hospital Pharmacists [7] and the recommendations of the Expert Group on Safe Medication at the European Council [8]. In the current medication process, the medication process itself is separate from the drug distribution and management process. However, an innovative approach through digitalization, at all levels, integrates these processes and creates a closed cycle (see Figure1). Sustainability 2020, 12, 7649 3 of 33 Sustainability 2020, 12, x FOR PEER REVIEW 3 of 32 Figure 1. DiagramDiagram of of the the safe safe and and effective effective medication process. The automated and safe medication process, as cancan be seen in Figure1 1,, proceeds proceeds as as follows: follows: 1. TheThe doctor doctor prescribes prescribes a a schedule schedule of of medi medicationcation in in the the Information Information System (IS). 2. TheThe clinical clinical pharmacist cancan verifyverify the the medication, medication, possibly possibly corrected corrected as as needed needed (e.g., (e.g., exchange exchange for forappropriate appropriate drug drug or adjustsor adjusts the the strength strength of theof the dose). dose). 3. TheThe original original packages packages of of medicines medicines are are divided divided in intoto the the institutional institutional pharmacy and repackaged intointo sachets sachets containing containing a a single single dose dose of a specificspecific medicine.medicine. A A barcode barcode and other necessary informationinformation about about the the medicine medicine are are printed printed on on these these bags. bags. 4. TheThe pharmacist completescompletes thethe therapy therapy (robotically-bound (robotically-bound single-dose single-dose packs packs and and non-single-dose non-single- dosepacks) packs) and preparesand prepares them them for transport for transport to the to ward. the ward. 5. NursesNurses give give this this therapy therapy (already (already prepared prepared in the the pharmacy) pharmacy) to patients at the right time. 2. Related Related Work Work 2.1. Healthcare Healthcare Standards The integration of heterogeneous healthcare data sources is an important and necessary step to enable thethe useuse of of valuable valuable information information in clinicalin clinical research. research. As mentioned As mentioned below, below, many authorsmany authors address
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