Towards interoperable digital medication records on FHIR: development and technical validation of a minimal core dataset.

Abstract

Background: Medication errors represent a widespread, hazardous, and costly challenge in healthcare settings. The lack of interoperable medication data within and across hospitals not only creates administrative burden through redundant data entry but also increases the risk of errors due to human mistakes, imprecise data transformations, and misinterpretations. While digital solutions exist, fragmented systems and non-standardized data continue to hinder effective medication management.

Objective: This study aimed to assess medication data available across the multiple systems of a large university hospital, identify a minimum data set with the most relevant information and propose a standard interoperable FHIR-based solution that can import and transfer information from a standardized drug master database to various target systems.

Methods: Medication data from all relevant departments of a large German hospital were thoroughly analyzed. To ensure interoperability, data elements for developing a minimum dataset were defined based on relevant medication identifiers, the Health Level 7 Fast Health Interoperability Resources (HL7® FHIR®) standard, and the German Medical Informatics Initiative (MII) specifications. The dataset was further enriched with information from Germany's most comprehensive drug database and European Standard Drug Terms (EDQM) to enhance medication identification accuracy. Finally, data on 60 frequently used medications within the institution was systematically extracted from multiple medication systems and integrated into a newly structured, dedicated database.

Results: The analysis of all the available medication datasets within the institution identified 7,964 drugs. However, limited interoperability was observed due to a fragmented local IT infrastructure and challenges in medication data standardization. Data integrated and available in the new structured medication dataset with key elements to ensure data identification accuracy and interoperability, successfully enabled the generation of medication order messages, ensuring medication interoperability and standardized data exchange.

Conclusions: Our approach addresses the lack of interoperability in medication data and the need for standardized data exchange. We propose a minimum set of data elements aligned with German and international coding systems, to be used in combination with the FHIR standard for processes such as the digital transfer of discharge medication prescriptions from intensive care units to general wards, which can help to reduce medication errors and enhance patient safety.