The Medication Profile in Netcare contains the same data as the PIN application. It is accessible in real-time integrated systems and Netcare. With RTI, the Medication Profile is visible on the local system's screens, eliminating the need for separate login to Netcare. Any new data entered into the local system is automatically transmitted to Netcare in real-time.

RTI enables pharmacy teams to access a more complete provincial medication profile from within their pharmacy system and to submit supported prescription, dispense and other information to Netcare as part of their normal workflow.

Real-time submission makes new information and prescription-status changes available to other authorized healthcare providers more quickly. It also allows pharmacy teams to identify rejected transactions at the time of processing so that errors can be reviewed and corrected promptly.

RTI is also required for community pharmacies under the Alberta College of Pharmacy’s Standards for the Operation of Licensed Pharmacies.

• What are health professionals’ responsibilities when interacting with Netcare applications?
  Health care providers must not share user IDs and must only use their own credentials to log into Netcare.

• Health care providers must share responsibility for accuracy of patient data in Netcare.
  Health care providers viewing data in Netcare must verify they are working with the correct patient file and must verify the information with the patient. Data inaccuracies which cannot immediately be resolved should be reported to the Primary and Preventative Health Services – Service Desk: 780-924-0094.

The Medication Profile includes:

• prescriptions written by a prescriber (including physicians and pharmacists) using the PIN application or a system that is connected to Netcare using real-time integrated clinical systems
• prescription status, such as discontinue or hold/release dispenses from almost all pharmacies in Alberta
• informational prescriptions for medications the patient is taking that were not prescribed in Alberta. This could be 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 Netcare
• pharmacy care plans
• professional services provided to patients in pharmacies
   

Dispense are submitted daily by community pharmacies via RTI. Dispenses also come from Alberta cancer centers. These dispenses result in inferred prescriptions generated by the PIN application, which contains information based on the dispense, rather than what was originally prescribed.

Note: Hospital pharmacies do not currently submit dispense data to Netcare.

• Tracked Prescription Program (TPP): Prescriptions may be accompanied by an additional TPP icon to indicate the drug is reported and monitored under the 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 connected to Netcare either through Netcare or via their own real-time integrated systems. Over time, as more prescribers connect to Netcare in real-time, the full ‘real’ prescription will become more prevalent in the profile.

Not all prescribers are currently networked with the PIN application, and prescribed records only go back as far as June 2003, while dispensed records may go back to December 1999. Remember, you are only responsible for your own data entry in the PIN application.

• If prescribed data does not display: check that the prescription was set up for the correct patient.
• If dispensed data does not display: if the patient can indicate the pharmacy that dispensed the medication, contact the pharmacy to advise them they have missing data. 

Netcare applications and systems such as the PIN and PCR applications are operated by Primary and Preventative Health Services, in cooperation with Alberta Health Services. 
Governance for the collection of health information is covered under the Health Information Act (HIA). 

The data found in Netcare applications is owned by the health care professionals using Netcare; they are the custodians of the data.

Primary and Preventative Health Services monitors the exchange of data between systems and Netcare for the purposes of maintaining system performance. Only authorized health care professionals can view the medication profile for individual patients.
The Alberta Medical Association monitors dispenses of drugs under the Tracked Prescription Program (TPP). Primary and Preventative Health Services provides a daily report of TPP-only drug dispenses to the Alberta Medical Association. 

If you have questions, concerns, or encounter issues with your integrated system, your primary contact for seeking assistance should always be your local system vendor. Additionally, contact your local vendor support line when your system needs changes to settings, such as temporarily enabling one or more users to work 'offline' from Netcare.

For any questions, concerns, or issues with your integrated system, your first point of contact for requesting assistance should always be your local system vendor support line. If your local system vendor is unable to assist, contact eHealth Services Provider Support at 1-855-643-8649 or eHealthProviderSupport@gov.ab.ca.

If you need a password reset, call the Primary and Preventative Health Services – Service Desk at 780-924-0094 and request a “Netcare and PIN/PD password reset.” To avoid confusion, do not refer to RTI, as the service desk agents do not provide RTI support.

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

eHealth consultants can help you set up access to Netcare applications and help you understand the information in Netcare, regardless of your current level of access. 

The Netcare Authorized Approver for your facility should have the contact information for your eHealth Consultant. If not, contact eHealth Services Provider Support at 1-855-643-8649 or eHealthProviderSupport@gov.ab.ca.

Accessing Netcare from a community facility is considered remote access and requires an RSA SecurID token for authentication. 

RTI access is based on user role and profession. Pharmacy Authorized Approvers determine who will have access to Netcare. All pharmacy staff require dispense access and all pharmacists need dispensing plus prescribing access (viewing access is automatically included).

If a site frequently relies on specific individuals for part-time coverage during vacations and emergencies, it is advisable to include these individuals on the list of those requiring access.

Authorized Approvers should proactively ensure that new staff obtain the necessary Netcare credentials and remote access tokens before starting their employment.
They must also have a record of all health care providers at that pharmacy who have access to Netcare.
 

To allow a user who does not have Netcare access to work in a real-time integrated site (e.g., relief pharmacists), the user should work with the Netcare Authorized Approver at the site to consider rearranging the workflow to position staff without Netcare access in roles that may not require direct access (e.g., checking, counting dispenses).

In situations where the only user at the pharmacy does not have Netcare access, you may need to reach out to vendor support to enable the user to switch the system to offline mode. In offline mode, all dispenses that need to be sent to Netcare are stored in a queue that is submitted once an authorized user logs into Netcare.

When dispenses are submitted, they are recorded in PIN using the credentials and facility of the user who sent the dispense. The local system also keeps a record of the user who initially created the dispense.
 

EHR Integration enables your pharmacy system to seamlessly communicate key information about your patient with the EHR at the point of care. This communication happens in real time while you are interacting with your patient. Consequently, you do not have to leave your pharmacy system to view medication information in Netcare.

When patient information is updated in real-time, the quality of data increases — and, most importantly, patient safety improves. There are several additional advantages to integrating your pharmacy system with the provincial electronic health record:

• You can automatically view, add, and update patient medication information in the EHR as you perform these functions in your local system.
• No need to open Netcare to view dispenses from another pharmacy. You can access your patient's provincial Medication Profile within your pharmacy system.
• You can send updates to the EHR in real time while you are with your patient.
• Your medication dispenses are immediately available to other clinicians.
• Quickly add new patients to your system using information from the provincial client registry.
• Efficiently check eligibility for Alberta government-sponsored programs and obtain/verify PHNs from within your pharmacy system. For example, check eligibility for the influenza vaccination program through the Alberta Health Care Insurance Plan.
• Gain better insight into your patients by accessing information about other medications (including Schedule 2 drugs) your patients are taking and other pharmacies they may have visited.
   

To enroll, contact eHealth Services Provider Support at 1-855-643-8649 or eHealthProviderSupport@gov.ab.ca, 8:15a.m. - 4:30p.m. Monday - Friday.

The PCR is a Primary and Preventative Health Services identity management application used to manage patient demographics for the Ministry, Electronic Medical Records (EMR) and pharmacy community stakeholders.

It serves as a central repository for demographic information and personal data of all patients who have encountered the health care system. By linking the identity of a patient in the PCR, their individual health records are combined into a single accessible composite record that is accessible to all PCR users.

It securely identifies patients across the province, prevents duplicate records, and ensures health information—like prescriptions, labs, and immunizations—is accurately linked to the correct individual.

• It is a trusted patient identification system that uniquely identifies a patient to build the individual electronic health record of that patient.
• Offers accurate, consistent, and timely patient identification within and across health jurisdictions
• Helps avoid costs associated with patient misidentification
• Minimizes the risk to patient safety via misidentification
• Offers the most current patient demographic data available provincially and is used at registration
• Reduces time and effort to register patients
• Improves health care delivery to the patient at the point of care

The PCR aims to create a unified patient identity across the health system. Ongoing data management by all stakeholders ensures data integrity, completeness, and accuracy. Key PCR demographic data is considered a trusted source for Netcare.

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

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.

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.

The PCR contains patient demographic information such as the name, date of birth, gender, address, and phone number. No clinical information is stored in PCR.
If available, use a patient’s Unique Lifetime Identifier (ULI) to search the PCR. 
If a ULI is not available, the search query should include one of the following combinations:

• Last Name and First Name
• Last Name and Middle Name
• Last Name and Date of Birth

The application may not return search results if the minimum search criteria are not met or if the name entered is too common to yield precise search results.
If a name-based patient search is unsuccessful, enhancing the search with additional details, like middle name, birth date, gender, or phone number, increases the likelihood of obtaining 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

PCR searches will return a maximum of 20 person identities. Point of Service (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.

The PCR assigns a numerical match score to each search result, with higher scores indicating better matches. Records are presented in descending order of match score, placing the most likely matches at the top. Typically, the correct record is among the top 3. Consider the score to assess if a result represents the searched person's identity. A low score suggests a need for additional information to refine the search.

When presenting drug data, the PIN application rules are defined to identify the most clinically relevant prescriptions using an algorithm that considers various 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)

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.

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.

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).

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

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.

An inactive status means the patient is estimated to no longer be taking the drug, and there are no lingering effects. This data is considered historical and is not considered for interaction checking by PIN application. Historic prescriptions should only be reviewed when necessary. Note that for patients with extensive prescription histories, there may be a delay of several minutes in receiving data from Netcare.

Short term Other Medications move to history after 3 months.
Continuous Other Medications move to history after 18 months.
Note: Other Medications can include pharmacist entered information about medications prescribed out of the province or country.

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

Netcare Clinical Bulletins are important notifications sent to all Netcare users connected via RTI, highlighting potential risks when using the system. These bulletins are rare and do not relate to a specific patient. They are shown to users only when they log in to Netcare from their local system for the first time.

Sent automatically

The following information is automatically sent to Netcare:

• All medications dispensed to patients
• All immunizations
• All prescriptions
• Changes to a prescription’s status, including:
  • Discontinued
  • On hold
  • Released

Sent optionally

Your pharmacy can choose to send:

• Over-the-counter sales, including Schedule 2 products.
  • These appear in Netcare as “other medications.”
• Allergies and intolerances
• Professional services.
  • This includes care plans, which are considered a type of professional service.

Not sent

The following information is not sent to Netcare:

• Devices
• Medications dispensed for animals

To record a dispense, the PIN needs to attach it to a prescription. 
If a prescription has been created directly in PIN or via RTI , PIN generates a PIN prescription number (Rx#) 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. 

The PIN application accepts dispenses for drugs only. The PIN application does not accept dispenses for devices.

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

The PIN application accepts dispenses for humans only. The PIN application does not accept dispenses for animals or for administrative purposes.
Any drug prescription for a human patient that is not discontinued, expired, is eligible to be dispensed.

Even if the patient does not have a PHN, the dispense is automatically sent to Netcare, 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.

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).

The existing standards of practice regarding communication between pharmacists when transferring a prescription from one pharmacy to another remain the same and must be adhered to before a prescription can be dispensed.

Once the necessary authorization is received from the sending pharmacy, the prescription is filled using the same process to dispense a Netcare prescription for the first time.

If the previous pharmacy was not connected via System-to-System (S2S), the current pharmacy will send a dispense that will create a corresponding inferred Rx in the PIN application. 

If the previous pharmacy was connected via S2S, the current pharmacy can dispense against the inferred PIN prescription that was previously created. Note: The prescription still needs to be transferred as part of the existing manual prescription transfer process. The PIN application does not prevent pharmacies from dispensing against active prescriptions. The PIN application will register when multiple pharmacies have dispensed a prescription but does not enforce transfer rules.

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.

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).

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.

If a patient has two files with the same ULI in the local system, there is a high risk of sending incorrect data to Netcare. Before going live with RTI, contact the system vendor to ensure data is correctly linked to the right ULI.
If a patient has two different ULIs (duplicate records in the PCR), one must be specified as the primary ULI, and the other as an alternate. Patient records under an alternate ULI can be viewed but not updated in the PIN application.

If a cancellation (retraction) or deletion is initiated by the same provider or facility that originally created the dispense, it will be automatically removed from Netcare.

Once they are sent to Netcare, dispenses cannot be changed. They must be canceled and replaced. If a cancellation (retraction) or deletion is initiated by the same provider or facility that originally created the dispense, it will be automatically removed from Netcare. If it is a first dispense that generates an inferred prescription, the PIN application automatically removes that prescription along with the dispense.

Once they are sent to Netcare, prescriptions cannot be changed. They must be canceled and replaced. If a cancellation (retraction) or deletion is initiated by the same provider or facility that originally created the dispense, it will be automatically removed from Netcare. A prescription can only be canceled on the same day it is created. After that, it must be discontinued with an appropriate reason, such as 'created in error'.

An allergy or intolerance cannot be removed from Netcare Portal. It must be refuted via the PIN application or RTI

Health care professionals should contact the Netcare Authorized Approver of the pharmacy that created the incorrect data. The Netcare AA should verify the incorrect data, then contact the Primary and Preventative Health Services – Service Desk to create a ticket and follow their instructions to remove the incorrect data.

A new patient record on the local system should be generated and new data created under that record. Note: The pharmacy may need to work with the vendor for possible workarounds.

The old patient record should be deactivated once all data has been fixed in Netcare.