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United Kingdom Clinical Products Reference Source. DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust & Hon Treasurer, SCATA. Dictionary of medicines+devices. UKCPRS. DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust & Hon Treasurer, SCATA. dm+d. dm+d.
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United Kingdom Clinical Products Reference Source DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust & Hon Treasurer, SCATA Dictionary of medicines+devices
UKCPRS DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust & Hon Treasurer, SCATA dm+d
dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo
dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo
Information for Health 1998 “There is a lack of standardisation in the UK in describing medicines, appliances and medical devices, in how such descriptions are organised, and in linking knowledge required for decision support to these descriptions.”
Information for Health 1998 “Work will begin on a national project to develop the UK Standard Clinical Products Reference Source (UKCPRS), bringing together all existing initiatives associated with the coding of drugs etc.”
Information for Health 1998 “is most sensibly done on a national basis, but must engage the relevant stakeholders…..”. The m of dm+d began in late 2000
Why is it needed? • enable the unique id of medicines and devices for inter-operability • facilitate re-engineered (paperless) processes • enable links to knowledge bases • integrate with clinical terminology (SNoMed CT) • support electronic records and clinical messaging
What the Dictionary will provide • a standard term (description) for all drugs and devices • a unique stable identifier (code) for all drugs and devices • a structure in which this information will be held
What the Dictionary will NOT provide • knowledge for decision support • application functionality
dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo
Phases • Phase 1 – Primary Care medicines • Phase 2 – Secondary Care medicines • Phase 3 – Devices (some prescribable) • Anaesthetics • Blood products • Orthopaedics • Cardiology and Cardiac surgery • Phase 4 – NPfIT/C4H?
Use Cases - m • Computerised prescribing • Dispensing against prescription • EDI of prescribing and dispensing information, without human intervention if possible • Medicines administration • Decision support using Ontology • Reimbursement against dispensed products
Virtual Therapeutic Moiety Virtual Medicinal Product Actual Medicinal Product Actual Medicinal Product Pack Virtual Medicinal Product Pack
Virtual Therapeutic Moiety SNOMED CT & Decision Support UK Namespace Virtual Medicinal Product Actual Medicinal Product Actual Medicinal Product Pack Virtual Medicinal Product Pack
Relationship to SNoMedCT • Directed acyclic graph structure • Is_a (manifestation of) • Object – Attribute – Value triples • Object-HAS-Value
Virtual Therapeutic Moiety SNOMED CT & Decision Support Is_a UK Namespace Virtual Medicinal Product Is_a Actual Medicinal Product Is_a Is_a Is_a Actual Medicinal Product Pack Virtual Medicinal Product Pack
Virtual Therapeutic Moiety SNOMED CT & Decision Support Is_a UK Namespace Virtual Medicinal Product Is_a Actual Medicinal Product Is_a Is_a Is_a Actual Medicinal Product Pack Virtual Medicinal Product Pack
Virtual Therapeutic Moiety SNOMED CT & Decision Support Is_a UK Namespace Virtual Medicinal Product Is_a Has Actual Medicinal Product Has Is_a Is_a Is_a Actual Medicinal Product Pack Virtual Medicinal Product Pack Has Has
SNOMED CT & Decision Support Virtual Therapeutic Moiety Therapeutic decision UK Namespace Virtual Medicinal Product Actual Medicinal Product What the doctor prescribes What the patient swallows Virtual Medicinal Product Pack Actual Medicinal Product Pack What the Pharmacy buys when stocks run low What the Pharmacy dispenses
SNOMED CT & Decision Support Virtual Therapeutic Moiety e.g. atenolol Therapeutic decision UK Namespace Virtual Medicinal Product Actual Medicinal Product e.g. atenolol 100mg tablets What the doctor prescribes e.g. atenolol 100mg tablets (Alpharma) What the patient swallows Virtual Medicinal Product Pack Actual Medicinal Product Pack e.g. Atenolol 100 mg tablets x 28 tablet What the Pharmacy buys when stocks run low e.g. Atenolol 100 mg tablets (Alpharma) x 28 tablet What the Pharmacy dispenses
Virtual Therapeutic Moiety SNOMED CT & Decision Support Therapeutic decision UK Namespace Virtual Medicinal Product What the anaesthetist wants to give Actual Medicinal Product What the anaesthetist actually gives Actual Medicinal Product Pack Virtual Medicinal Product Pack What the Pharmacy buys when stocks run low What the Pharmacy supplies
Virtual Therapeutic Moiety SNOMED CT & Decision Support e.g. atracurium Therapeutic decision UK Namespace Virtual Medicinal Product e.g. atracurium injection 10mg/ml What the anaesthetist wants to give Actual Medicinal Product e.g. atracurium 25mg in 2.5 ml (Glaxo Smith Kline) What the anaesthetist actually gives Actual Medicinal Product Pack Virtual Medicinal Product Pack e.g. atracurium 25mg in 2.5 ml – 5 ampoule packs What the Pharmacy buys when stocks run low e.g. atracurium 25mg in 2.5 ml (Glaxo Smith Kline) – 5 ampoule pack What the Pharmacy supplies
dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo
The d in dm+d Recent project - 4 domains • Anaesthesia • Cardiology • Orthopaedics • Blood product transfusion Project reports by 31 Mar 05
The d in dm+d Recent project - 4 meetings • 6 Dec 04 • 17 Jan 05 • 21 Feb 05 • 14 Mar 05
The d in dm+d Recent project – 4 representatives • Chris Barham – AAGBI • Tom Clutton-Brock – RCoA • Tony Madden – SCATA • Andrew Norton – IOTA • [Roger Tackley – SNOMED]
‘Equipment’ Power source needed Not disposable! Cost £k Capital Record output ‘Devices’ No power source Disposable (reusable) Cost p or £ Revenue Record use Scope - d
High level use case - d Provision of unambiguous electronic coded and human readable text descriptions to identify anaesthetics medical device products and associated attributes used in clinical care
Detailed use cases - d • Peer to peer communication • use of bougie in difficult intubation • Clinical Governance and Audit • has changing from Brand X to Brand Y 25G Pencil point spinal needles led to an increased incidence of PDPH? • Adverse event recording • COETTs with faulty cuffs • Implicit knowledge • “RAE” = preformed South-facing • Stock control
SNOMED CT & Decision Support Virtual Therapeutic Device UK Namespace Virtual Medical Device Actual Medical Device Virtual Medical Device Pack Actual Medical Device Pack
SNOMED CT & Decision Support Virtual Therapeutic Device Therapeutic decision UK Namespace Virtual Medical Device Actual Medical Device What you ask the ODP for What the ODP gives you & you actually use Virtual Medical Device Pack Actual Medical Device Pack What the ODPs order when stocks run low What the Supplies Dept. actually orders
SNOMED CT & Decision Support Virtual Therapeutic Device Therapeutic decision UK Namespace Virtual Medical Device Actual Medical Device e.g. standard type #3 LMA What you ask the ODP for e.g. standard type #3 Portex disposable LMA What the ODP gives you & you actually use Virtual Medical Device Pack Actual Medical Device Pack e.g. a box of standard type #3 LMAs What the ODPs order when stocks run low e.g. a box of standard type #3 LMAs from Portex What the Supplies Dept. actually orders
What you record on the anaesthetic chart Virtual Therapeutic Device Therapeutic decision Virtual Medical Device Actual Medical Device e.g. standard type #3 LMA What you ask the ODP for e.g. standard type #3 Portex disposable LMA What the ODP gives you & you actually use Virtual Medical Device Pack Actual Medical Device Pack e.g. a box of standard type #3 LMAs What the ODPs order when stocks run low e.g. a box of standard type #3 LMAs from Portex What the Supplies Dept. actually orders
dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo
Demo • C:\Program Files\Blue Wave\dm+d Demo Browser for Anaesthetic Devices\dm+d Browser for Anaesthetic Devices.exe
Summary dm+d : • ensures the unique id of medicines and devices in use in the NHS • is integrated with the NHS standard clinical terminology SNoMedCT • will be maintained & issued as part of the NHS terminology service • is the defined standard for holding medication information in the NHS CRS
Conclusion • 5 box model for drugs seems to work for devices (as defined) • We haven’t broken the model! • Now up to NPfIT/C4H • Watch this space