Standards and Guidelines for Electronic Medical Record Systems in ...

i. EMR systems
ii. Patient Identifier Cross-reference Consumer actor for patient identification which allows
multiple systems using different patient identifier domains to determine patient
identification from a different patient identifier domain using a cross-referencing manager.
iii. PIS
In the interaction between EMR system and PIS, priority activities are correct patient identification,
medication prescription and dispensing. The EMR system, which is the primary actor, serves to
identify patients, place prescription orders and receive dispensing information. The EMR system
requires the cooperation of the Patient Identifier Cross-reference consumer actor to provide
support.
Therefore, the three use cases that can be implemented in this EMR-PIS profile are:
i. Dispensing only – the pharmacist receives a paper prescription and creates a filler
prescription in the PIS for dispensing.
ii. Prescription and dispensing - Prescription placed by a clinician. The prescription is
electronically transmitted to the pharmacy.
iii. Prescription, dispensing and PIS identification of patients - Order placed by a clinician,
electronic transmission of prescriptions, the PIS has the ability to query the EMR system for
patient demographics, with EMR acting as a Master Patient Index (MPI), or directly from a
MPI separate from the EMR system.
The information interaction between PIS and EMR can be summarized as follows;
i. Patient Identification - Based on the Patient Identifier Cross-referencing (PIX) and /Patient
Demographic Query (PDQ) profiles
ii. Prescription transmission
iii. Dispensing information transmission
In an ideal environment, the interactions listed above would be implemented in the order listed,
with patient identification first, followed by transmission of prescription information, and finally
the transmission of dispensing information. However, in a resource-constrained setting, greater
clinical value is accrued by implementing the above interactions in reverse order, starting with
transmission of dispensing information, followed by transmission of prescription information and
patient identification. Description of the identified profiles therefore follows this order.
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