Toward Interoperable Digital Medication Records on Fast Healthcare Interoperability Resources: Development and Technical Validation of a Minimal Core Dataset

Abstract

Background: Medication errors represent a widespread, hazardous, and costly challenge in health care settings. The lack of interoperable medication data within and across hospitals not only creates an 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 nonstandardized data 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 dataset 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. To enhance medication identification accuracy, the dataset was further enriched with information from Germany's most comprehensive drug database and European Standard Drug Terms (EDQM) to further enrich medication identification accuracy. Finally, data on 60 frequently used medications in the institution were systematically extracted from multiple medication systems used in the institution and integrated into a new structured, dedicated database.

Results: The analysis of all the available medication datasets within the institution identified 7964 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.

Keywords: FAIR; FHIR; Fast Healthcare Interoperability Resources; Findability, Accessibility, Interoperability, and Reusability; dataset; digital; electronic health records; medication error; medication records; software; standardization; technical; validation.