Data Sheet SW Ishmed Smart Medication

®

i.s.h.med

Smart Medication (Advanced Medical Record) Data Sheet

Health care is too important to stay the same.TM

Intended Use

Performance Features Introduction

i.s.h.med Smart Medication supports the drug therapy process, starting with the ordering of ready-to-use drugs and help during the mixing of infusions and compounds, through to the documentation of the administration.

i.s.h.med Smart Medication is part of the i.s.h.med Advanced Medical Record license package (10402194 or 10402295). i.s.h.med Smart Chart functionality is used to display the medication in the chart; this is also part of this package.

Activated orders and medication events are graphically displayed in the chart (i.s.h.med Smart Chart), in addition to vital signs, nursing procedures and other time-specific content.

i.s.h.med Smart Medication shares the patient master and other relevant content with SAP for Healthcare and i.s.h.med, so that no data redundancy results and the solution is completely integrated into the clinical hospital information system.

The integration into SAP for Healthcare enables connections with other SAP applications such as, for example, materials management or patient billing. Optionally, medication data can also be provided via an interface for processing in unit dose dispensers, as a project solution.

The i.s.h.med Smart Medication functions are available both in the inpatient and outpatient environments.

“Making a complex task simple”, this is the main focus of i.s.h.med Smart Medication.

Fig. 1: Overview of the i.s.h.med und SAP components

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The goal is to guarantee the user complete control in the ordering process and a high degree of transparency. The following points illustrate how this is done: · A simple order can be created with just a few clicks. · The traffic light function indicates to the user whether the order is complete or not. · Input areas for more complex orders (e.g. infusions) are only visible when they are required.

related to the ordering process, other general advantages of an electronically managed medication and chart also apply, such as high degree of availability, improved patient safety, optimized medication consumption, revision-safe documentation or the detailed presentation of the medication in the chart.

· The user is guided through the ordering process by intuitive operation and demand controlled input fields.

i.s.h.med Smart Medication is the further development of the classic version of i.s.h.med medication. Some functions are currently only available in the classic version of i.s.h.med medication, however, these can be used seamlessly together with Smart Medication.

· During data entry the user has access to other relevant data (e.g. earlier medication, anamnesis data, catalogs).

Drug Catalog

· The user is always oriented: What step am I in? What is left to do? In addition to these arguments which are specially

i.s.h.med Smart Medication requires an internal drug catalog. Data from the relevant country-specific drug range is imported into the i.s.h.med drug catalog for this. With regard to the data structure and content (agent standardization, mapping of generic

Fig. 2: Display of medication in the patient record

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connections, etc.) formatted catalogs should be procured from external suppliers for the import.

Characteristics of the i.s.h.med Drug Catalog · XML import interface for uploading catalog content (initial and delta) which has been formatted with regards to content and structure · Structuring in a maximum of 3 levels (e.g. generic level, brand name, brand name with container size). The hierarchical structuring of the drug catalog offers

· This flagging of drugs as part of the formulary in connection with the determination of whether the physician’s orders should be made at generic level of specific to a certain preparation, enable the pharmacist effective control of ordering while taking into account the stock and purchasing situation. · Master data attributes contain necessary information on process support, such as for example: · Logistic information: Connected article master in SAP MM (Materials Management) and assignment to fill sources (including patientspecific provision from care unit stockroom or centrally in the hospital pharmacy)

· a comfortable drug search. · ordering at a generic drug level (with specification of the drug to be administered at delivery time).

· Control of display behabvior of drug in the chart (numbering of treatment days)

· aut idem substitution proposals, e.g. within the drug anamnesis.

Functions for Maintenance of Drug Master Data

· the documentation of orders during the inpatient stay at generic level, as well as ordering in the outpatient environment with the specification of the manufacturer and container size.

· Copy drug

· the option of manually creating drugs in the catalog (e.g. own mixtures, study preparations, etc.).

· Activation / deactivation enables supplements / changes, without influencing the productive ordering process.

· the connection of a pharmacy drug catalog. When the pharmacy and formulary catalogs are connected, purposes and fill sources can be assigned and properties can be inherited across the levels.

· Maintenance of the agent table

· Various comfort functions, such as for creating new drugs using a copy template, which are definable in the implementation project via the programming interface (BAdI). · Flagging of the drug as a formulary drug for routine ordering in the inpatient area, or as preparation for dispensing or prescription printing, which, however, can be subject to country-specific specifications / certifications as is the case in, for example, Germany. Other i.s.h.med modules or specific project solutions may offer solutions here.

· Assign drug to an existing hierarchy or build a new hierarchy

Medication Order When ordering drugs the system differentiates between: · Planned administration during the inpatient stay or during an outpatient treatment · Determination of drugs which should be given to the patient (e.g. upon discharge)

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Fig. 3: Example of a simple order

· Prescription creation (printout) whereby prescription writing is subject to possibly country-specific defaults / certifications.

· Search for partial strings– e.g. when Volt*50 is entered the system also finds Voltaren ® tablets with the strength 50mg

· Drug anamnesis – Long-term medication, which the patient brings to his admission in the hospital, is documented and flagged as such. Optionally the drug anamnesis can be investigated as a sub-process of the admission documentation in the outpatient clinic, (with SAP Ambulatory Care Management for Healthcare (ACM) - 10178675).

· Extended search – If an identified drug, which the system is searching for, is not available in the formulary list, the system determines the available equivalent preparations, if administration using aut idem substitution logic is intended.

The activation of the order triggers the creation of medication events for the documentation of administrations, dispensing or prescription printing (see Medication Event section).

Drug Search Searching for a drug is most efficient when you find what you are searching for as quickly as possible. To realize this seemingly trivial goal a search must intelligently map the medical logic with which a physician thinks and acts. The following options are available for searching for a desired drug:

· Search for agents – Regardless of the name of the drug, the system finds all drugs which contain the agent the system is searching for and which are suitable for the purpose. · Search with dosage – When entering the search string the user can enter the desired dosage and strength of the drug. This desired dosage is checked against the templates or transferred directly into the order · When realizing existing orders (e.g. during admission, discharge or when converting to other dosage forms) the search uses proposals to support the search according to an aut idem substitution logic or an enhanced search using equivalent agents.

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· With a determined duration

Formulary List, Entire Catalog, Special Requests, Favorites

· With a planned end date

· The drug search is executed for orders · In the formulary list which contains the drugs listed by the hospital pharmacy as suitable for the purpose of administration, dispensing or prescription creation. · In the entire catalog for the purpose of anamnesis medication.

Dosage Depending on the type of order (standard drug, infusion or nutritional solution) there are different types of dosage available: · Simplified dosage with specification of agent strength instead of dose unit (e.g. 0 – 25mg – 0)

· Preparations outside the formulary list can be ordered via special requests. A special process support of the logistic or authorizational process can be configured using the order status concept.

· Determination of administration times while provisionally leaving the specific dose open (e.g. 0 – 0 – X(18:00) – 0 for an insulin dose to be given at 18:00 according to blood sugar determination)

· The user can use individual settings to influence personal habits during the search, the search results are presented in a standardized logic.

· Dosage with specification of a cycle (e.g. Q4h – every 4 hours)

· There are two possible workflows when compiling orders: · After a successful search for one drug, an order with a green traffic light icon can immediately be activated with one click. If necessary, order details (dosage, start date) can be changed first. · The system searches for several drugs – without leaving search mode – and collects them in a worklist. In a second step this worklist can be edited in the details and the orders activated. · Information range: · Contents of the package information insert can be called (upload from the external catalog is a prerequisite). · Personal favorites of the most frequently selected drugs / order templates are available.

Start and Duration of an Order · Default for the start of the medication orders is preset but can be changed if necessary. · Orders can be entered: · Until further notice

· Free prescription of individual doses – The medication events generated by the system are visible and can be edited at the time the order is created. This means you can prescribe, for example · sliding doses (tapering of agents) · irregular dosages · or saturations in orders, without changing the underlying dose. · Dosage via decimal numbers or fraction displays for ordering e.g. half tablets, if the drug master permits corresponding divisibility.

Other Order Attributes Depending on the purpose of the order, other details can be entered: · Administration duration – e.g. application duration of a transdermal medication (TTS); runtime of an infusion · Order for drug kits – e.g. eye ointment from a drug kit with separately defined information on administration time and dosage · Patient own medication (e.g. for long-term medication with a rare or foreign preparation)

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· Flow rates can be defined at the time of ordering.

Intravenous Therapy

· Flow rates defined at the time of ordering are called within the administration documentation and then, where necessary, adapted or supplemented (e.g. with bolus doses or breaks).

Intravenous therapies (therapeutic infusions, volume information, parenteral nutrition TPN) are subject to other order specifications: · Infusions can · be called as a pre-made drug in the catalog. Indicators in the catalog determine whether a pre-made infusion can be changed, i.e. if additional ingredients can be supplemented at the time of ordering. · be individually combined at the time of ordering, with a carrier solution and one or more ingredients. · Be, like all other drugs, part of an order template and then be preset with all non-patient-specific order parameters (e.g. height and weight must be supplemented, the calculation guideline is already in the template).

· Flow rates can be calculated by the system in templates according to various criteria, including the use of agent-based dose calculators.

Compounds, Patient-Individual Manufacture As in freely combinable infusions, i.s.h.med Smart Medication also supports the ordering of patientindividual in-house creations (e.g. dermatological) via the selection of individual components and the definition of quantity relationships.

Fig. 4: Example of a complex order

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Change Functions

Conversion Functions

i.s.h.med Smart Medication supports all adaptations to medicinal therapy with clear selection lists with the option of editing one or more orders.

· Creation of current medication via conversion of a patient’s documented anamnestic orders (long-term medication) to preparations from the formulary list

The user can adapt the current medication, view, edit or directly release drafts for new or changed orders, as well as transfer orders from the patient’s history into the current case.

· Creation of current medication via conversion of drugs from the patient’s past cases to preparations from the formulary list

The In Processing list collects all orders which the user newly creates by editing, transferring or selecting a drug. Depending on the usage and personal way of working, the user can either initially compile a worklist or execute and complete each change individually. It is possible to cancel individual processing at any time. Closing the application enables you to save started processing in one step, e.g. if the user must interrupt his work on the medication because of an emergency.

· Changing of an order to dispensing or prescription printout · Copying of an order Adaptation of Current Medication · Conversion of an order into another dosage form (e.g.: oral continuation of an antibiotic therapy which was started postoperatively as intravenous). Automatic proposals based on the levels of the drug catalog are used here. · Suspension / resumption of an order (e.g. suspension of an oral therapy on the day of

Fig. 5: Conversion from existing medication

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· Entry in system by trainee physicians, activation by responsible ward physician

surgery). The suspension can also be planned for the future. · (Early) ending or extending of an ongoing order

· Entry in system by physicians, activtion by pharmacist following medical (e.g. interactions, correct dosage) and logistical (e.g. which aut idem drug is currently in stock) check

· Change dose – The function has a special logic for infusions depending on whether the infusion is intermittent or continual and whether these are currently still ongoing.

· Flagging of changes made by physicians for nursing staff

· Proposal of alternatives (enhanced aut idem substitution) New orders can result from changes to the patient’s medication; these can be displayed in the chart or continued in the same line under specific circumstances.

Order Templates Order templates can be defined for the order process, which accelerate the process in two ways: · Order template groups enable fast ordering, even of complex therapies, which are compiled of several drugs as well as different dosage forms and purposes. · Orders with complex attributes can be saved as order templates. The next time the template is used all attributes of the template are already preset accordingly.

· Option of physician’s (daily) signing off on patient’s medication (Confirm Order) · Determination of the drug to be used for administration documentation in case of orders at generic level · Automatic generation of administration events using configured system parameters (event generation horizon) and drug-related information stored in the catalog · Consideration of usual care unit / ward routines during generation of medication events (administration times can be configured on a care unit-specific basis, but can be overwritten at the time of ordering)

Diagnoses, organizational units and users can all be assigned to an order template, so that possible order templates are immediately proposed during the search.

· Forwarding of status of an order using an installation-specific status concept for mapping certain subprocesses or the generation of corresponding worklists and overviews (e.g. presentation of certain order to senior physician for activation)

Process Logic of Order in Cooperation with Occupational Groups

Medication Event

The i.s.h.med status profile is used to adapt the individual release steps of an order to suit the special workflows of a hospital. The number of process steps required and the connected roles can be determined on a clinic-specific basis. The following workflows can be mapped: · Support of a multi-occupational group order creation process, e.g.

i.s.h.med Smart Medication generates medication events using the criteria specified in the order by the physician. These events support the delivery process and / or the logistics chain within the hospital pharmacy or a unit dose system connected in a project, and represent the basis for documentation in the record or chart (usually for the nursing staff).

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Depending on the purpose of the order, different subsequent processes are triggered: ·

For orders which lead to an administration of drugs the system generates one event for each administration time, with the dose to be administered at this time.

· For orders which lead to the printing of a prescription the system generates one event with the permitted prescription quantity or container size and, where necessary, the next repeat event (i.e. the patient collects a new prescription). · For orders which define the dispensing of drugs the overall ordered quantity is totaled. The event generation is oriented simultaneously towards the stored issue quantities, as in prescription printing.

Event Generation for PRN Medication The system generates one event for each day with the maximum allowed daily dose. The individual events are individually created depending on the administration documentation. The system displays a warning message when the maximum allowed daily dose has been administered.

Event Generation for Immediate Dose When creating an order you can use the optional entry of an initial immediate dose to control that, in addition to the cycle times, an immediately effective event is generated with the specified dose.

until the end, which may have been determined under consideration of any defined suspensions. Systemwide and drug-specific generation times which may have been stored in the system are also taken into account.

Delivery Drugs are delivered either in the care unit or outpatient clinic or centrally in the hospital pharmacy. Both scenarios are supported. · The delivery process in the care unit is supported by special views of the clinical work station. · The filling of dispensers can be supported by separate lists, as can the delivery of intravenous therapy, taking into account shift times or similar criteria. · Optional: The procurement process for the care unit stockroom is not supported by i.s.h.med medication, but by the corresponding functions in SAP Patient Management and / or SAP MM. · The delivery process in the hospital pharmacy is oriented towards the inventory-managed stockroom and is supported accordingly with pick and fill lists. · Multi-level process logic using printouts of lists and an exclusion list is supported. Example:

Event Generation for Compounds or Drugs

· Collection of all preparations which are required in one issue cycle using overviews which includes total quantities of each drug

Event generation for compounds or drugs which generally cannot be dosed precisely:

· Distribution to OU or patient-specific containers in an additional step

Event generation is oriented towards the indicators of the drug master and the information in the order (e.g. influence of the logistics chain; provision of the individual dose or the overall order quantity)

Continuing the Order The equivalent of continuing the orders in the paper chart is represented by an automatism in the system, which generates medication events for active orders

· Concluding stockroom-relevant posting

Preparation Optionally i.s.h.med medication offers a preparation screen within the delivery process, which displays the proportional quantities of ordered intravenous therapies and enables the documentation of the delivery of the required bag.

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administration or individual administrations for the events entered in this way.

Documentation of Administration The documentation of the drug administration is first subject to an organizational concept and the determination of how (possibly at which care unit/ward) documentation should be executed. The documentation of the delivery (distribution of filled dispensers) may be different than the actual administration documentation of the individual administration.

· Optional: In the clinical work station the drug administration documentation can be combined with the view of the upcoming nursing services (with i.s.h.med nursing as part of i.s.h.med Advanced Medical Record - 10402194). This enables the support of nursing services taking into account the drug administration.

· Quick Administration function – Several medication events, also for several patients, can simultaneously be documented as administered from an overview list in the clinical work station.

Prescription Printing and Output

· Prerequisite: No check condition, in case of timecritical drugs no deviations which exceed the tolerated times. · In case of infusions the system also takes into account whether several bags are necessary and flow rates can be documented together with their runtimes, bolus administrations and breaks.

Orders with the Prescription Print purpose can be printed individually or collectively on prescription forms. The permitted issue quantities (definition in the drug catalog) are taken into account by the system which calculates repeat events so that a renewal prescription can be issued at the right time.

· Individual administration for precise documentation: · Documentation of deviations in administration time, dose, scrap quantities, etc. with corresponding reasons · Documentation of a witness · Substitution logic (e.g. in case of a change of preparation and leftover quantities in the care unit stockroom, etc.) · Documentation of a checked administration condition with the possibility of calling lab values. · Documentation of self-administration by the patient or by a care-giver. · Emergency situations (ad hoc event): Documentation of a drug administration without preceding order. The acute event can document both a single dose without a preceding order as well as the documentation of an additional dose outside of the planned administrations of an existing order. · Barcode support for the selection of events to be documented with the possibility of executing a quick

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Prerequisites for Implementation Modules i.s.h.med Smart Medication is part of the license i.s.h.med Advanced Medical Record (10402194 or 10402295). Prerequisites for this package are: · License and installation of SAP Patient Management (IS-H) (10178662) · License and installation of i.s.h.med Basis Medical Record (10402193 or 10402294) · Licenses for i.s.h.med Named Users (10402192) · Some functions are currently only available in the classic version of i.s.h.med medication, however, these can be used seamlessly together with Smart Medication.

· The supported operating system platforms, database systems, etc. are the same as those for SAP ERP Release 6.0.

Smart UI (see also SAP note number 1782982) The following recommendations apply for the use of Smart UI components: · SAP GUI for Windows 7.30 or higher · SAP Netweaver 7.0 SAP EHP3 SPS 05 or higher · · SAP Netweaver Business Client (NWBC) 4.0 for Desktop or higher · Prerequisites for the use of WebDynpro technology

Integration · i.s.h.med Smart Medication is called from the patient profile · The functionality of i.s.h.med Smart Chart is used to display the medication in the chart.

· Microsoft Silverlight Version 4 or higher (for the Patient Groups and Smart Chart components)

The following recommendations apply for a Smart UI infrastructure: · ABAP application server Hardware – Server:

System

· CPU:

2x Xeon E5-2680 v2

· i.s.h.med Smart Medication is available from i.s.h.med SAP 6.0 EHP 7 SP 9 onwards.

· RAM:

512 GB RAM

· Model:

e.g. HP BL460c G8

· Generally, i.s.h.med can be technically run on the hardware which is necessary for SAP Patient Management. We recommend the scaling of this concerning CPU performance, RAM, possible server clusters etc. in accordance with the foreseeable system load (number of users etc.) (see also SAP note number 1517664).

· Additionally, if terminal servers are used (e.g. CITRIX) Hardware – Terminal server:

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· CPU:

2x E5-2680 v2 10-Core 2.8 GHz

· RAM:

64 GB RAM

· HDD:

2x 200GB SSD as RAID-1

· Model:

e.g. HP DL360p G8

· Work station – local NWBC installation or terminal server (e.g. Citrix XenDesktop 7.x) Hardware – Client: · CPU:

Core i5

· RAM:

8 GB RAM

· Graphic: Separate graphic card · Monitor: e.g. 22“ (TFT) with a resolution of 1920*1080 pixels (recommendation) e.g. 19” (TFT) with a resolution of 1280*1024 pixels (minimum) · IT network: At least 1 GBit/s network speed on client

Other Prerequisites · Once a year the customer must provide voluntary information on license-relevant audits (number of users, number of patients treated each year). In the license contract Cerner expressly reserves the right to perform license checks. · Services are required for productive use (some can be executed by the customer).

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The information in this document contains general technical descriptions of specifications and options as well as standard and

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individual cases. Thus all requested specifications and options are to be defined individually in the contract. Cerner reserves the right to modify the design, packaging, specifications and options described herein without prior notice. SAP and other SAP products and services mentioned herein as well as their respective logos are trademarks or registered trademarks of SAP SE in Germany and in several other countries. Documentation supplied to Cerner by third parties and included with this documentation is not warranted for accuracy or completeness. All personal and patient data displayed in Software Screenshots or

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otherwise in this document are imaginary. Screenshots were created on Cerner owned systems for the purpose of presentation. Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced. i.s.h.med is not intended to be used for monitoring, clinical diagnostic, and/or therapeutic purposes, or to replace clinical judgment or responsibilities. Healthcare professionals should always refer to the primary information source before making any clinical diagnostic plan or treatment.

Cerner Corporation / 2800 Rockcreek Pkwy / Kansas City, MO 64117 / USA This document contains Cerner confidential and/or proprietary information belonging to Cerner Corporation and/or its related affiliates which may not be reproduced or transmitted in any form or by any means without the express written consent of Cerner. All Cerner trademarks and logos are owned by Cerner, Corp. All other brand or product names are trademarks or registered marks of their respective owners. Data Sheet SW ishmed Smart Medication en.docx

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Released Date: 03/15

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