Updated: Feb 1, 97
OPADE

Project Code:   A2027 Project value:   2366 KECU EC contribution:   1600 KECU No of partners:   8 No of countries:   5 Duration:   36 months

Contact: Dr. Isabelle de Zegher BIM S.A. Kwikstraat 4 B-3078 Everberg, Belgium Tel.: +32.2.759.59.25 / 719.26.19 Fax: +32.2.725.47.83 E-mail: idz@sunbim.be

Project overview

OPADE aims at developing an intelligent, multilingual computerised drug prescription system, adapted to different European countries. That will apply at the prescription at the patient bedside in connection with the hospital information system, or during consultation by general practitioners.

It is expected that the efficacy and safety of drug prescription will be increased, by including a critiquing system based on knowledge of drugs and patient data, and that the drug prescription costs will be decreased by presenting various possible strategy of prescription, among which the physician can choose the equivalent less expensive solution.

Purpose and objectives

• optimisation of drug prescription at the medical and economical level;
• telemaintenance of the drug knowledge base of the CDPS from existing, validated and maintained external knowledge sources;
• edi transfer of the patient drug prescription entered through the CDPS to third parties.

Results

OPADE is an alpha version of a computerised drug prescription system to be used by various types of users (physicians working within hospital or within community practice; nurse and potentially students) to enter a drug prescription for patients he/she is responsible for. The system, which gathers automatically available information from the local medical record, allows to first make an assessment of the patients medical and socio-economical state. At prescription time, knowledge based windows allow to enter drug regimen within the shortest possible time.

While the user is entering a prescription, the underlying decision support system performs medical as well as cost-oriented ( reimbursement, cheaper generic, cheaper packaging ...) pre-defined controls; additional customised controls, called Prescribing Principles can be entered within the system and checked.

All interactions between the user and the system are based on tailored windows with associated menus so as to avoid typing of text. Following user preferences, the system issues warnings and suggestions under the form of buttons-icons changing colours whenever there is messages of interest for the user.

When a prescription is definitively entered, the user can request the system to print the prescription, to send a prescription message to third party and to generate tailored explanations for colleagues, nurses or the patient him/herself.

Telemaintenance of a drug knowledge from external sources

Knowledge on drug changes weekly and it is unrealistic for clinical sites running a CDPS to maintain themselves the drug knowledge needed for such a system: input from external Drug Databases (DDB) who validate and maintain information on drug, is necessary.

Within OPADE we developed structured edi messages for drug information transfer as well as associated prototype tools which allow:

• to build a message from existing data at the emitting DDB site, and
• to check ate the OPADE receiving site consistency of information coming from various, heterogeneous sources.

Through this telemaintenance mechanism installed in the 4 countries (France, United Kingdom, Sweden and Italy), information gathered from a remote source DDB can automatically be entered within the drug knowledge base of a running OPADE system; in case of conflict a log file of errors is produced by the system, so as to allow human experts to enter manually the necessary corrections.

Transfer of patient drug prescription

Once a prescription is saved within the OPADE data base, the user can decide to print it on paper or to send it by structured edi messages to third parties such as other physicians, pharmacists and reimbursement organisms. The edi drug prescription messages implemented within OPADE do follow closely the highly structured representation of the prescription and its associated regimen stored within OPADE.

Benefits for users

In the design of OPADE, particular attention was paid to the integration of the system in clinical practice in an undisturbing way, while providing complete knowledge on drugs and additional support in terms of reminders, cost information and explanation to patient.

Increase safety and decrease drug cost

If OPADE is indeed accepted and used by all prescribers within a clinical institution, the system should be further used to introduce a positive feed back loop in the prescribing process. The output of the system can be studied to identify prescription patterns at the individual or institutional level: these patterns can be further analysed by local therapeutic committee and customised controls based on new Prescribing Principles can be derived to correct bad prescribing practice and/or to enforce adequate practice.

Once introduced in the system knowledge base, these new controls will be the source of new types of suggestions or reminders. Several studies have showed that attitudes of clinician are influenced by an "alerting system": new alerts generated by OPADE should influence directly the prescribing attitude of clinicians from both medical and economical point of views.

Increase treatment efficacy

A difficult problem of drug prescribing is the lack of compliance to treatment: this is true mainly for long lasting chronic disease. It is evident however that to be efficient, a drug must not only be ordered by the doctor but taken correctly by the patient. OPADE is providing written explanation to patients aimed to improve their compliance: these explanations are tailored to the type of patient in terms of pathology education .... Because the language used is closer to what the patient generally understands compliance and hence efficacy of treatment will be potentially increased while the cost of the drug for a similar effect will relatively decrease.

Two directions are currently developed to exploit OPADE results:

• Development of a full fledged drug prescription package to be integrated in a general prescription system
• Offering of services based on the results acquired within the project for hospitals, ministries acquired within the project for hospitals, ministries of health, pharmaceutical companies and international organisations (CEN, WHO, EDA).

Consequences of OPADE:

• Contribution to the building of pharmaco-telematics concepts; identification of areas such as pharmaco-economics, general prescription optimisation where tools involving all actors (patient, physician, decision makers and payers) need to be developed and agreed upon so as to reach a consensus while increasing the ratio cost-efficacy.
• Possibilities of using certain basic and conceptual results of OPADE (prescription model, prescription view of the patient record, model of the drug knowledge base, model of prescribing principles) as inputs for research projects to be presented at the fourth framework programme.
• Identification of technological areas such as integration of heterogeneous databases and installation of telemaintenance mechanisms where tools still need to be refined.

List of Deliverables

Year 1

• Study of CDPS (4/R/P)
• General functions of OPADE (6/R/I)
• Necessary input for a CDPS (9/R/P)
• User Interface for CDPS (12/R+P/I)

Year 2

• Specification of the order optimizer (3/R/I)
• External IS integration (6/R/I)
• Building of country customised drug KG (3/R+P/I)
• Prescription kernel: alpha-release (2/S/I)
• Database interface:alpha-release (12/S/I)

Year 3

• Drug DB: alpha-release (2/S/I)
• OPADE alpha-release (4/S/I)
• Building and maintaining drug KB: release (9/S+R/R)
• Site installation (10/R/R)
• Alpha-evaluation (6/R/R)
• Beta-evaluation (12/R/P)

List of Participants

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