Real-Time Access through Integrated Clinical Systems

Clinical Systems such as Electronic Medical Records (EMRs) and Pharmacy Practice Management Systems (PPMSs), that are integrated with the Electronic Health Record (EHR), provide continuous real-time access to the Pharmaceutical Information Network (PIN) and the Provincial Client Registry (PCR).  As the health care provider works in the patient's record on their local system, the patient's demographic and medication profile data is automatically exchanged with PCR and PIN. As additional new data is recorded in the local system by the pharmacist or physician, it is automatically sent to PIN, and immediately available for all other health care providers connected to the EHR.

EHR Integration in POS Systems: Patient Care Storyboard

A typical scenario is described for a patient to better understand the benefit of integrating the EHR with Point of Service (POS) systems.


eDemo: PIN in the Health System

A typical scenario is described for a patient to better understand how the Pharmaceutical Information Network (PIN) is used throughout the health system.

Real-Time Integration Frequently Asked Questions (FAQs)

Getting Help


When to contact my system vendor?

For any questions, concerns, or problems with your integrated system, your first point of contact for requesting assistance should always be your local system vendor support line.

Also, contact your local vendor support line if your system requires changes to settings, such as to have one or more users work temporarily ‘offline’ from the Electronic Health Record (EHR).



What if I can’t connect to the Electronic Health Record (EHR)?

For any questions/concerns/problems with your integrated system, your first point of contact for requesting assistance should always be your local system vendor support line.

What if my password does not work?

If you need a password reset, call the Provincial Help Desk at 780-412-6778 or 1-877-931-1683. Be sure to specify that you are working in a real-time integrated system, NOT Alberta Netcare Portal.

What if I find that data on the patient’s Medication Profile is incorrect?

If you find incorrect data on the Electronic Health Record (EHR) Medication Profile that can’t be resolved, call the Provincial Help Desk at 780-412-6778 or 1-877-931-1683. Be sure to specify that you are working in a real-time integrated system, NOT Alberta Netcare Portal.

When do I contact my eHealth Consultant?

eHealth consultants are available to help with getting you set up for access to the Electronic Health Record (EHR), and can provide assistance with understanding the information available in the EHR, regardless as to the type of access you have.

Your site’s Access Administrator (AA) should have contact information for your eHealth Consultant. If not, the following number can be used to reach the eHealth Support Team: 1-855-643-8649.




About Alberta Netcare Real-Time Integration


How is Real-Time Integration different than connecting to Alberta Netcare Portal?

The Alberta Netcare Medication Profile presented is the same data from PIN, for both real-time integrated systems, and for Alberta Netcare Portal (ANP). Real-time integration presents the Medication Profile right within the local system’s screens, relieving the user from having to sign in to ANP. Also, data created within the local system is automatically sent to the Electronic Health Record (EHR) instantly, in real-time.

Why should I connect with the Electronic Health Record (EHR) in Real-Time?

The key benefit of connecting to the Electronic Health Record (EHR) in Real-Time is the ability to share a much more complete patient medication profile through an existing workstation – not just the standalone local data. Changes to prescription status (ex. discontinue, hold/release), are immediately updated and dispenses are immediately added to the patient’s profile.

What are the Health Professional’s responsibilities when interacting with the Electronic Health Record (EHR)?

  • Health Care Providers must not share User IDs, they must only use their own credentials to log into the Electronic Health Record (EHR).
  • Health Care Providers must share responsibility for accuracy of patient data on the EHR. Health Care Providers viewing data in the EHR must ensure they are working with the correct patient file and must verify the information with the patient. Any data inaccuracies found, which cannot immediately be resolved, should be reported to the Provincial Help Desk.


What information is on the Alberta Netcare Electronic Health Record (EHR) Medication Profile?

The Alberta Netcare Electronic Health Record (EHR) Medication Profile includes:
  • Prescriptions written by a prescriber using a system that is connected to the EHR using real-time system to system (S2S) messaging. These include physicians and pharmacists.
  • Prescription status such as discontinue or hold/release.
  • Dispenses from almost all pharmacies in Alberta, usually within 24 hours of the dispense being given to the patient.
  • Informational prescriptions for medications that the patient is taking but were not prescribed in Alberta, either because they are over-the-counter medications or were prescribed/dispensed out-of-province.
  • Allergies and Intolerances from any health care provider with update access to the EHR.
  • Professional Services provided to patients in pharmacies.
  • Care Plan details for patients, as prepared by pharmacists will begin to be sent to the EHR in late 2014.


Where does the data in the Electronic Health Record (EHR) come from?

The majority of records on the EHR Medication Profile are dispenses submitted by community pharmacies each day via Pharmacy Batch. Dispenses also come from Alberta Cancer Centers.These dispenses result in inferred prescriptions generated by PIN, which have information based on the dispense, rather than what was actually prescribed.

Prior to 2007, Alberta Blue Cross submitted dispenses to the EHR, but in 2007 that feed was replaced by Community Pharmacy direct Pharmacy Batch submissions.

Note: Hospital Pharmacies are NOT currently submitting dispense data to the EHR.

Pharmacy Batch: Prescriptions inferred from dispenses received from community pharmacies. This occurs through daily batch submissions of dispenses from each pharmacy.

Triplicate Prescription Program (TPP): Prescriptions may be accompanied by an additional TPP icon to indicate the drug is reported and monitored under the Alberta Triplicate Prescription Program operated by College of Physicians and Surgeons of Alberta (CPSA).

Cancer Board: Prescriptions inferred from Alberta Cancer Centre dispenses. These are submitted through daily batch submissions.

Blue Cross: Historical prescriptions inferred from records submitted by Alberta Blue Cross. Note: The Alberta Blue Cross feed was decommissioned in December 2007. It was replaced by direct submissions from community pharmacies.

‘Real’ Prescriptions in the Medication Profile are entered by physicians and pharmacists, connect to the EHR either through Alberta Netcare Portal or via their own real-time integrated systems. Over time, as more prescribers connect to the EHR in real-time, the full ‘real’ prescription will be more prevalent in the profile.



What if I suspect that there is data missing from the patient’s profile?

A number of reasons may account for an incomplete Medication Profile. Not all prescribers are currently networked with the Pharmaceutical Information Network (PIN), and prescribed records only go back as far as June 2003, while dispensed records may go back to December 1999. Keep in mind that you are only responsible for your own data entry in PIN.
  • If prescribed data does not display: Check that the prescription was set up for the correct patient.
  • If dispensed data does not display: The pharmacy in question may have an error (such as demographics) in their Pharmacy Batch file.


Who operates and controls the Electronic Health Record (EHR)?

The Electronic Health Record (EHR) systems such as PIN and PCR are operated by Alberta Health (AH), in cooperation with Alberta Health Services (AHS).

Governance for the collection of health information is covered under the Health Information Act (HIA). Standards for privacy and data sharing are governed by Alberta's Freedom of Information and Protection of Privacy Act.

The data found on the EHR is owned by the health care professionals using the EHR; they are the custodians of the data.



Who monitors the drug data in the Electronic Health Record (EHR)?

Alberta Health (AH) monitors the exchange of data between systems and the Electronic Health Record (EHR), for the purposes of maintaining performance of the systems. Only authorized health care professionals can view the medication profile for individual patients.

The Alberta Medical Association (AMA) monitors dispenses of drugs under the Triplicate Prescription Program (TPP). AH provides a daily report of TPP-only drug dispenses to the AMA.



What is CeRx?

CeRx, pronounced See-rex, is a Canadian Electronic Drug standard for exchanging data between two systems, such as between a pharmacy system and Alberta Netcare’s PIN system. Alberta Health (AH) works closely with Canada Health Infoway to implement the CeRx standard for System to System (S2S) messaging, to enable real-time integration of local clinical systems for community pharmacies and medical clinics.


Real-Time Access


What is the difference between Alberta Netcare Portal Access, Remote Access, and Real-Time Access?

View the Alberta Netcare Learning Centre's Access page for a detailed explanation of various types of access, and how remote access tokens (FOBs) are used.

Who can access the Electronic Health Record (EHR)?

A pharmacy Access Administrator (AA) determines who will have access to the Electronic Health Record (EHR). Generally, all pharmacy staff need dispense access and all pharmacists need dispensing plus prescribing access (view is automatically included).

If a site regularly uses the same people for part-time coverage for vacations and emergencies it is recommended that they add these people to the list of those who need access.

It is important for Access Administrators to understand that they need to be proactive where possible in ensuring that new staff have the proper Alberta Netcare credentials and remote access tokens prior to beginning employment.

Pharmacy Access Administrators must have a record of all health care providers at that pharmacy who have access to the EHR.



Why doesn't my Electronic Health Record (EHR) User ID and password work in my real-time integrated system?

When using a real-time integrated system, your system will prompt you to login to your local system, followed by entering your Alberta Netcare RSA FOB ID and Token to login to the Alberta Netcare Network.

Your system may also prompt you to enter your Alberta Netcare Electronic Health Record (EHR) User ID and Password or your system may automatically connect your local system ID to the EHR ID, allowing you to skip this entry.

If you have already successfully used your Alberta Netcare RSA FOB ID and Token to login to the Alberta Netcare Network, but you are having trouble with your EHR login, first check with your vendor support desk to ensure any automatic login credentials are set up correctly.

Note that the Alberta Netcare EHR ID and Alberta Netcare Portal ID can be different. For example, user Elizabeth Anderson may have:

  • Alberta Netcare EHR ID sometimes known as PIN/PD ID: EANDERS (or sometimes EANDERS2)
  • Alberta Netcare Portal ID: ELIZABETHANDERSON (or sometimes LIZANDERSON)


What do I need to log into the Electronic Health Record (EHR)?

If you already have a remote access token (also known as RSA FOB token), you will only need an Electronic Health Record (EHR) ID and Password, associated with the site where you are working. Your site Access Administrator (AA) and Transition Coordinator (TC) will work together to get the correct credentials assigned to you.

Notes to Access Administrators:

  • All pharmacists must be set up as a type of ‘Pharmacist’ in stakeholder.
    Historically a number of pharmacists were entered manually and were entered as admins. Work with your TC to verify if any duplicate users exist and transition users to the appropriate User IDs prior to System to System (S2S) integration.

  • All users and Access Administrators must understand that users can keep their remote access tokens even if they leave the facility that initially procured the token. Users must keep their token active even if they leave a S2S PIN/Alberta Netcare integrated job site.

  • This is differentiated from the EHR User ID and Password, which is entered, only after a user has successfully logged in the Alberta Health (AH) Network. The EHR login requires that the user be recognized by Alberta Netcare as being ‘assigned’ to the site where they are working.



What if I can’t connect to the Electronic Health Record (EHR)?

In order allow a user, without access to the Electronic Health Record (EHR), to work in a real-time integrated site (ex: Relief Pharmacists), the user should work with the Access Administrator (AA) at the site to:
  • If possible, reorganize the workflow to place staff that do not have access to the EHR in positions where direct access may not be required (ex: checking, counting dispenses).
  • In situations where the only user working at the pharmacy does not have access to the EHR, it may be necessary to contact vendor support to allow the user to set the system to work in an offline mode.
    • In offline mode, all dispenses that are to be transmitted to the EHR are placed in a queue to be submitted once an authorized user logs into the EHR.
    • Dispenses that are submitted are recorded in the Pharmaceutical Information Network (PIN) using the credentials and facility of the logged in user that sent the dispense. The local system also maintains a log of the user who originally created the dispense.



About the Provincial Client Registry (PCR)


What is PCR?

The Provincial Client Registry (PCR) is an Alberta Health (AH) identity management application used to manage client demographics for the Ministry, Electronic Medical Records (EMR) and pharmacy community stakeholders.

PCR provides a central repository of demographic information for all clients that have encountered the health system. It is also a repository for the ministry’s personal identifiable data attributes for insured residents and uninsured persons that have encountered the health system. With the linking of a client’s identity within PCR, it is possible to link all clients’ individual health records to a single, composite record using probabilistic matching. This composite record of a client (ex: person/patient) is available to all PCR users.



What is the role of PCR within the Electronic Health Record (EHR)?

The Alberta Netcare Electronic Health Record (EHR) has developed a common set of registries for secure and unique identification of clients, providers and service locations. Identifying individuals uniquely via PCR is the first step to securely adding health information to their record. This work will support the secure authorization and authentication of all health service providers accessing the Alberta Netcare EHR.

What value and benefits does PCR provide?

  • Trusted patient identification system that uniquely identifies a client for the purpose of building the client’s individual Electronic Health Record (EHR).
  • Accurate, consistent, timely identification of clients within and across health jurisdictions.
  • Reduced costs associated with client misidentification.
  • Minimized risk to client’s safety through misidentification.
  • Most current client demographic data available provincially and is used at registration.
  • Reduced effort and time to register clients.
  • Improved health care delivery to the client at the point of care.


  • What is the target state for PCR?

    The goal of the Provincial Client Registry (PCR) is to build a single identity for each client in the provincial health system regardless of the contributing source. On-going data remediation and identity management of the contribution sources by all participating stakeholders will ensure the integrity, completeness and accuracy of the demographic data is maintained. Key PCR demographic data elements will be recognized as “trusted source” for the provincial Electronic Health Record (EHR).

    What information is stored in PCR?

    PCR contains client demographic information such as the name, date of birth, gender, address and phone number. No clinical information is stored in PCR.

    How does PCR search for a person?

    Many users are familiar with search interfaces on websites and software applications. Often, search forms will accept special characters called “wild cards” that can be used to stand for unknown portions of a search string. For example, entering a last name of BERG* will find the names BERG, BERGA, BERGER, BERGSON, etc.

    Even without the use of wild card characters, some search engines will return all results that are equal or similar to the search string. For example, a library search for author BERGER may also return author PETERSON-BERGER. However, most search engines produce results based on spelling, so that when searching for the name KING, a search for KINGG will not return any results.

    In contrast, searches in PCR are not based on spelling but on the sounds of a name: Each name is broken into a row of syllables, each of which is reduced to a sound pattern (phonem). When a user searches for a name, the sound pattern of the search string is compared to the sound patterns of existing identities, and matching results are returned. Therefore, a search for KINGG may return results like KING, KUONG, KEUNG, KYONG, GANG, SPENCER-KING, and so on.



    I know this person exists – why don’t I get a result?

    If minimum search criteria have not been met for a PCR Enterprise Master Person Index (EMPI) search, or if no person identities exist that match the submitted criteria, the search will return without any results. However, it may happen that a user submits a search for a name known to exist as a person identity, but still does not receive any results. This can happen when the name is “too common to be found”.

    Some names, like SMITH, are very common; therefore their sound pattern will occur frequently in the EMPI. Other names may not be as common, but have similar sound patterns to other common names. If the EMPI has too many occurrences of a particular sound pattern, such a pattern will be excluded from searches – otherwise searches would take too long to run and use up too much computing resources. In this case, the search will behave as if the name that is searched for hadn’t been provided – there is not enough information and the search will return no results.



    Why is more information better when searching?

    If an Unique Lifetime Identifier (ULI) is available then it can be used to search PCR. If an ULI is not available a search query to the PCR Enterprise Master Person Index (EMPI) requires a minimum of the following query parameters:
    • Last Name and First Name
    • Last Name and Middle Name
    • Last Name and Date of Birth

    If a patient search by name is not successful, the user is encouraged to add more information to the search, such as middle name, birth date, gender, or phone number. The more information is provided by the user, the stronger the search will be and the higher the chance of getting accurate results.

    Search is…

    ...when using these parameters

    Weak

    Last name, first name
    Last name, middle name
    Last name, first name, middle name
    Last name, first/middle name, gender

    Often sufficient

    Last name, birth date
    Last name, birth date, gender
    Last name, first/middle name, phone number
    Last name, first/middle name, phone number, gender

    Strong

    Last name, first/middle name, birth date
    Last name, first/middle name, birth date, phone number
    Last name, birth date, phone number



    How many results can I get?

    PCR searches will return a maximum of 20 person identities. POS applications can configure the number of results returned to be less than 20, for example to only return the top 3 at most. If the number of results is not restricted to a small number, then a result set of more than 3 person identities is an indicator that the search was not strong enough and may be refined by providing more information.

    What is the "score"?

    PCR will rate each search result in terms of how well it matches the search criteria that were provided. This evaluation is provided by a numerical score. Records will be returned in descending value of match score, so the most likely matches are at the start of the list. Typically, the correct candidate record lies within the top 3 in the list.

    The score should always be considered to help determine whether a result represents the identity of the person that was searched for. A low score can be an indicator that the search was not strong enough and may be refined by providing more information.




    Viewing the Integrated EHR Medication Profile


    Where do the Prescriptions on the Electronic Health Record (EHR) come from?

    The majority of records on the EHR Medication Profile are dispenses submitted by community pharmacies each day via Pharmacy Batch. Dispenses also come from Alberta Cancer Centers.

    These dispenses result in inferred prescriptions generated by PIN, which have information based on the dispense, rather than what was actually prescribed.

    Prior to 2007, Alberta Blue Cross submitted dispenses to the EHR, but in 2007 that feed was replaced by Community Pharmacy direct Pharmacy Batch submissions.

    Note: Hospital Pharmacies are NOT currently submitting dispense data to the EHR.

    Pharmacy Batch: Prescriptions inferred from dispenses received from community pharmacies. This occurs through daily batch submissions of dispenses from each pharmacy.

    Cancer Board: Prescriptions inferred from Alberta Cancer Centre dispenses. These are submitted through daily batch submissions.

    Blue Cross: Historical prescriptions inferred from records submitted by Alberta Blue Cross. Note: The Alberta Blue Cross feed was decommissioned in December 2007. It was replaced by direct submissions from community pharmacies.



    Which prescriptions are eligible for dispensing?

    Any prescription that is not discontinued, expired, or ‘assigned’ to another pharmacy is eligible to be dispensed.

    Note: ‘Assigned’ is used only for electronic authoritative prescriptions (eRx). A pharmacy that is not integrated in real-time, assigns the eRx to indicate they are dispensing at this pharmacy, and the dispense will be sent to the Electronic Health Record (EHR) in the next pharmacy batch submission.



    Why can’t Pharmacy Batch Inferred Prescriptions be refilled in real-time mode?

    PIN does not accept real-time dispenses (from a real-time integrated system), if the dispense uses a Pharmaceutical Information Network (PIN) prescription number for a pharmacy batch inferred prescription. Pharmacy Batch inferred prescriptions cannot be refilled in real-time mode, because the real-time dispense has more complete data than the original batched dispense, and must replace the old pharmacy batch inferred prescription on the Electronic Health Record (EHR). As a result, the new inferred prescription has more complete information.

    What are Clinically Relevant Prescriptions?

    When presenting drug data, PIN rules are defined to identify the most clinically relevant prescriptions using a complex algorithm based on a number of factors.

    Some of these factors include:

    • Whether the prescription is continuous or short term.
    • Whether the prescription was created as a ‘real’ prescription vs inferred from a dispense.
    • Whether there is recent dispense activity.
    • Whether the prescription has been discontinued or renewed.
    • The half-life of the drug, as defined by First Data Bank (FDB).


    What is an Active Prescription?

    An Active State means the patient is estimated to be currently taking the drug.

    What is a Recently Active Prescription?

    A recently active state means the patient is estimated to have stopped taking the drug but there may still be residual effects, including a potential for drug interaction.

    What is an Inactive/Historical Prescription?

    An Inactive status means the patient is estimated to no longer be taking the drug, nor has any residual effects. This data is considered to be historical and is not included in interaction checking by the Pharmaceutical Information Network (PIN). Historic Prescriptions only need to be viewed when there is a specific reason to look back in time. Users must be aware that for patients with a high volume of prescription/dispense history, there can be up to several minutes wait for the Electronic Health Record (EHR) to send the data to the user’s system.

    How does a prescription become Historic?

    A prescription is moved to Rx History:
    • When the prescription has depleted it's dispenses (Recently Active), and the prescribed drug is deemed to have reached five times its half-life, according to an algorithm in First Data Bank (FDB).
    • After 30 days, in the case of compound prescriptions and any drugs without FDB half-life information.


    What is an Assigned Prescription?

    ‘Assigned’ is used only for ePrescriptions, to allow a pharmacy that is not integrated in real-time, to indicate they are filling the ePrescription.

    In order to support ePrescribe, the Electronic Health Record (EHR) will allow any non-integrated pharmacy in Alberta to login to the Pharmaceutical Information Network (PIN) webpage, and print out a copy of an electronic prescription for them to dispense. The pharmacy must only print a prescription if the patient has specifically asked for that prescription to be filled immediately at that pharmacy. The act of the pharmacy printing the prescription will cause PIN to set the status of the prescription to 'assigned', which is synonymous with being dispensed. This is to ensure that no other pharmacy can dispense it without first contacting the original pharmacy for a transfer of the prescription.



    What does the 'blue page' icon (TPP icon) mean?

    The Triplicate Prescription Program (TPP) icon indicates the drug is reported and monitored under the Alberta Triplicate Prescription Program operated by the College of Physicians and Surgeons of Alberta (CPSA).

    What are Electronic Health Record (EHR) Clinical Bulletins?

    Electronic Health Record (EHR) Clinical Bulletins are brief, high priority, cross-interface notifications to all Alberta EHR users regarding some kind of issue that may pose a risk using the EHR. Bulletins are very rare, and are not specific to a patient. They are presented only when a user first logs in to the EHR from their local system.


    Dispensing and Updating in the Integrated EHR Medication Profile


    What is sent to the Electronic Health Record (EHR) from my real-time integrated system?

    For real-time integrated systems the following data is sent to the Electronic Health Record (EHR):
    • All drug dispenses to human patients are automatically sent to the EHR.
    • All prescriptions are automatically sent to the EHR, as well as any changes to the prescription status such as Discontinue, Hold, and Release.
    • Over-the-counter sales, such as Schedule 2 sales, can electively be sent to the EHR. These are deemed ‘Other Medications’.
    • Devices are NOT sent to the EHR.
    • Dispenses for animals are NOT sent to the EHR.
    • Allergies and Intolerances can electively be sent to the EHR.
    • Professional Services can electively be sent to the EHR. This includes Care Plans, which are considered a type of Professional Service.


    What does the PIN Rx# mean on a printed prescription or label?

    In order to record a dispense, the Pharmaceutical Information Network (PIN) needs to attach it to a prescription. If a PIN prescription number (Rx#) is not already provided for the dispense, then PIN will create an inferred prescription as a place-holder. PIN will assign a unique PIN prescription number, and attach the dispense.
    • Similar to the way pharmacy systems work. Pseudo prescriptions are created on local pharmacy systems that have the order details and subsequent dispenses are attached to it.
    • If a paper prescription is received from a patient that has a PIN Rx# on it and it can’t be found on their Electronic Health Record (EHR) profile, the user needs to request a prescriptions that have been created or updated (discontinued, dispensed, etc.) in the specified time frame.
    • If a real prescription exists in the EHR, then the pharmacy system will allow the user to add a dispense against the prescription.
      Note: The pharmacy system may still create a placeholder prescription on the local database, but in order to see the prescription as it was entered by the prescriber, details of the real original prescription from PIN must be viewed.


    What dispenses are accepted by the Pharmaceutical Information Network (PIN)?

    The Pharmaceutical Information Network (PIN) accepts dispenses for drugs only. PIN does not accept devices.

    Regardless of the product identified on a PIN prescription, PIN will not prevent a dispenser from changing the dispensed drug to a completely different product from what was originally prescribed.

    PIN accepts dispenses for humans only. PIN does not accept dispenses for animals or for administrative purposes.

    Any drug prescription for a human patient that is not discontinued, expired, or ‘assigned’ to another pharmacy, is eligible to be dispensed. Note:‘Assigned’ is used only for electronic authoritative prescriptions (eRx).



    Why can’t Pharmacy Batch Inferred Prescriptions be refilled in real-time mode?

    The Pharmaceutical Information Network (PIN) does not accept real-time dispenses (from a real-time integrated system), if the dispense uses a PIN prescription number for a pharmacy batch inferred prescription. Pharmacy Batch inferred prescriptions cannot be refilled in real-time mode, because the real-time dispense has more complete data than the original batched dispense, and must replace the old pharmacy batch inferred prescription on the Electronic Health Record (EHR). As a result, the new inferred prescription has more complete information.

    What should I do with the Electronic Health Record (EHR) Pharmacy Batch Inferred Prescriptions?

    The shortest answer is: Nothing.

    When a user needs to dispense for the first time in the integrated environment, they will be presented with the combined profile view of Alberta Netcare and local data.

    • Dispense data that was previously submitted to the Pharmaceutical Information Network (PIN) using the Electronic Health Record (EHR) Pharmacy Batch may be seen in the profile view.
    • It is recommended that a pharmacy work as they normally do in regards to filling and refilling prescriptions. That is, as the users dispense prescriptions, dispense data will be submitted to the EHR and this information will begin to populate the EHR and the previously submitted pharmacy batch information will slowly fall off into history on its own.
      • For a short period of time (3 to 6 months) the combined profile may show a number of inferred prescriptions that were created via Pharmacy Batch. These pharmacy batch records will move to history on their own.
      • Note: A user can discontinue prescriptions (inferred or real) on the Alberta Netcare profile if they wish to clean up the profile, but it is not necessary because over time the natural discontinuations and creations of prescriptions and dispenses will synchronize the records that are seen on the EHR with those that are maintained on the local system.


    What is ePrescribing?

    Electronic prescribing (e-Prescribing) is the process of electronically creating, signing and transmitting a prescription from the prescriber. The prescriber’s Electronic Health Record (EHR) login ID serves as their electronic signature. The electronic version of the prescription is ‘authoritative’ and there is no paper prescription. Any pharmacy connected to the Pharmaceutical Information Network (PIN) can dispense an electronic prescription.

    What if the patient does not have a Personal Health Number (PHN)? (ex. Out of Province)

    Even if the patient does not have a Personal Health Number (PHN), the dispense is automatically sent to the Electronic Health Record (EHR), and the user is prompted to find the patient’s PHN and add it to the patient’s record. The user will be prompted to enter the PHN, once per patient encounter.

    The EHR keeps a record of all dispenses rejected due to missing PHN, as part of the data quality improvement initiative.



    When to Discontinue (Stop) / Hold (Suspend) / Release a prescription?

    Pharmacists have prescribing permissions and may choose to discontinue, hold, or release any prescription, from any prescriber, based on their consultation with a patient, or with the prescribing physician. These changes to the prescription status are automatically sent to the Electronic Health Record (EHR).

    Can I use the Electronic Health Record (EHR) to transfer a prescription into or out of my pharmacy?

    The existing Standards of Practice regarding the communication requirements between pharmacists for transferring a prescription from one pharmacy to another have not changed and must be followed prior to a prescription being dispensed.

    Once the necessary authorization has been received from the sending pharmacy the prescription will be filled using the same process to dispense an Electronic Health Record (EHR) prescription for the first time.

    • If the previous pharmacy was not connected via System-to-Sytem (S2S), the current pharmacy will send a dispense that will create a corresponding inferred Rx in the Pharmaceutical Information Network (PIN).
    • If the previous pharmacy was connected via S2S, the current pharmacy can dispense against the inferred PIN prescription. Note: Prescription still needs to be transferred as part of the existing manual prescription transfer process. PIN does not prevent any pharmacy from dispensing against any active prescriptions. PIN will capture the fact that multiple pharmacies have dispensed against a prescription but does not enforce transfer rules.



    Correcting the Integrated EHR Medication Profile


    What if my local system has the same patient Unique Lifetime Identifier (ULI) on more than one file or multiple ULIs for one patient?

    • If a patient has two files on the local system with the same Unique Lifetime Identifier (ULI), there is a very high risk of incorrect data being sent to the Electronic Health Record (EHR). Prior to going live with real-time integration contact the system vendor and your Transition Coordinator (TC) to determine the best approach to get the right data under the right ULI.
    • If a patient has two different ULI’s (duplicate records in the Provincial Client Registry (PCR)), then one must be specified as the primary ULI, and the other as alternate. Patient records under an alternate ULI can be viewed, but not updated in the Pharmaceutical Information Network (PIN). Only primary ULI’s can have new records added.


    How do I remove an incorrect dispense from the Electronic Health Record (EHR)?

    When a dispense is cancelled or removed from the local system, it is automatically removed from the Electronic Health Record (EHR), as long as it’s cancelled from the same provider or facility that created it.

    What if I want to change a dispense on the Electronic Health Record (EHR)?

    Once sent to the Electronic Health Record (EHR), dispenses cannot be changed. They must be cancelled and replaced. Any dispense that is ‘cancelled' (retracted) in the local system, will automatically be cancelled from the EHR. If this was a first dispense, which generated an inferred prescription, then the Pharmaceutical Information Network (PIN) automatically removes that prescription along with the dispense.

    What if a prescription has an error?

    Once sent to the Electronic Health Record (EHR), prescriptions cannot be changed. They must be cancelled and replaced. Any prescription that is ‘cancelled' (retracted) in the local system, will automatically be cancelled from the EHR, as long as it is cancelled by the originating prescriber. A prescription can only be cancelled on the same day it is created. After that, it must be discontinued with an appropriate reason such as ‘created in error’.

    How do I remove an incorrect allergy on the Electronic Health Record (EHR)?

    An Allergy or Intolerance cannot be removed from the Electronic Health Record (EHR). It must be refuted.

    What if data has been found on the wrong patient’s record on the integrated pharmacy system?

    Health Care Professionals should contact their Transition Coordinator (TC). The TC will coordinate a call to the Provincial Help Desk, and ensure the correct process is followed to ensure data integrity.
    • The Help Desk will generate a trouble ticket.
      Note: In S2S, a patient Electronic Health Record (EHR) alert can be added to a patient record.
    • A new patient record on the local system should be generated and new data created under that record.
      Note: the TC may need to work with the vendor workarounds.
    • The old patient record should be deactivated once all data has been fixed on the EHR.