United Kingdom Clinical Products Reference Source

1. United Kingdom Clinical Products Reference Source DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust & Hon Treasurer, SCATA Dictionary of medicines+devices

2. UKCPRS DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust & Hon Treasurer, SCATA dm+d

3. dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo

4. dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo

5. 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.”

6. 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.”

7. 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

8. 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

9. 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

10. What the Dictionary will NOT provide • knowledge for decision support • application functionality

11. dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo

12. 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?

13. The m in dm+d

14. 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

18. Virtual Therapeutic Moiety Virtual Medicinal Product Actual Medicinal Product Actual Medicinal Product Pack Virtual Medicinal Product Pack

19. Virtual Therapeutic Moiety SNOMED CT & Decision Support UK Namespace Virtual Medicinal Product Actual Medicinal Product Actual Medicinal Product Pack Virtual Medicinal Product Pack

20. Relationship to SNoMedCT • Directed acyclic graph structure • Is_a (manifestation of) • Object – Attribute – Value triples • Object-HAS-Value

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

29. dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo

30. The d in dm+d Recent project - 4 domains • Anaesthesia • Cardiology • Orthopaedics • Blood product transfusion Project reports by 31 Mar 05

31. The d in dm+d Recent project - 4 meetings • 6 Dec 04 • 17 Jan 05 • 21 Feb 05 • 14 Mar 05

32. 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]

33. ‘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

34. 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

35. 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

36. SNOMED CT & Decision Support Virtual Therapeutic Device UK Namespace Virtual Medical Device Actual Medical Device Virtual Medical Device Pack Actual Medical Device Pack

37. 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

38. 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

40. 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

41. dm+d • How it all began - NHS policy • The story so far • The d in dm+d - the recent project • Demo

42. Demo • C:\Program Files\Blue Wave\dm+d Demo Browser for Anaesthetic Devices\dm+d Browser for Anaesthetic Devices.exe

43. 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

44. 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