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Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension

Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension. Ian Spiers Pharmaceutical Terminology Specialist Data Standards and Products. Contents. Information: Paper to IT . *July 13 th 2012. New Drugs New Drugs New Drugs. Discontinued Drugs Discontinued.

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Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension

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  1. Webinar : An introduction to NHS dm+dand SNOMED CT UK Drug Extension Ian Spiers Pharmaceutical Terminology Specialist Data Standards and Products

  2. Contents

  3. Information: Paper to IT • *July 13th 2012 New Drugs New Drugs New Drugs Discontinued Drugs Discontinued • Product Change Product Change Price Change Price Change Price Drug Name Change Drug Name New Drugs New Drugs New Drugs HELP

  4. Why a dictionary is needed? “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” Section 3.21

  5. What will be done? “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 Section 3.22

  6. UKCPRS • The initial products of the Programme: • PCDD (Primary Care Drug Dictionary) • PPA (now NHS Prescription Services) • SCDD (Secondary Care Drug Dictionary) • NHSIA (now NHS CFH) • MDD (Medical Devices Dictionary) • NHSIA (now NHS CFH) • The three dictionaries (PCDD, SCDD, MDD) combined to become the NHS dictionary of medicines and devices (dm+d)

  7. What the dm+d provides: • a unique stable identifier (code) for all drugs and devices • a standard term (description) for all drugs and devices • a structure in which this information will be held What the dm+d does NOT provide: • knowledge for decision support • application functionality

  8. Use Cases • Primary Care • GP Prescribing • GP Dispensing • Nurse Prescribing • NHS Dental Prescribing • Community Pharmacy Dispensing • GP Personal Administration • NHS Prescription Service • (was PPD) Reimbursement • Decision Support links • Electronic Prescribing Guidelines • Secondary Care • Prescribing – no product specified • Prescribing – product specified • In patient Dispensing • Out patient Dispensing • Tablets to Take Away (TTA) Dispensing • Administration • Patient Group Directive Protocols • Ward Stocks • Formulary/Protocol Development • Purchasing

  9. dm+d 5-box data model Paracetamol 500mg Tablets

  10. dm+d 5-box data model • These are all VMP concepts in dm+d • They all have a unique SNOMED CT identifier (Code) and a unique term (description) • e.g. Paracetamol 500mg Tablets has SNOMED CT Code 322236009

  11. dm+d 5-box data model • In dm+d the VMPs • Paracetamol 500mg tablets • Paracetamol 500mg soluble tablets • Paracetamol 500mg capsules • Paracetamol 120mg suppositories • are all associated with the higher level concept with the description • As you can see one VTM may have many VMPs associated to it

  12. dm+d 5-box data model VTM Paracetamol VMP Paracetamol 500mg Tablets

  13. dm+d 5-box data model If we now look at the VMP : Paracetamol 500mg tablets Many companies could make these tablets e.g. Paracetamol 500mg tablets (Actavis UK Ltd) Paracetamol 500mg tablets (Aspar Pharmaceuticals Ltd) Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) • As you can see one VMP may have many AMPs associated to it

  14. dm+d 5-box data model VTM Paracetamol AMP Panadol 500mg Tablets VMP Paracetamol 500mg Tablets

  15. When we add pack information to the description of a AMP we describe a concept known as the Actual Medicinal Product Pack (AMPP) in dm+d dm+d 5-box data model If we now look at the AMP : Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) This company supplies these tablets in different pack sizes Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 16 tablet 2 x 8 tablets Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 12 tablet Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets

  16. dm+d 5-box data model dm+d 5-box data model So the AMP : Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) Can have many AMPPs Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 12 tablet Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 16 tablet 2 x 8 tablets Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets

  17. dm+d 5-box data model VTM Paracetamol AMP Panadol 500mg Tablets VMP Paracetamol 500mg Tablets AMPP Panadol 500mg Tablets 32 tablet 4x 8 tablets

  18. This higher level concept is called a • Virtual Medicinal Product Pack (VMPP) dm+d 5-box data model Look at the following AMPPs Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets Paracetamol 500mg tablets (Teva UK Ltd) 32 tablet 4 x 8 tablets Paracetamol 500mg tablets (Aspar Pharmaceuticals Ltd) 32 tablet 4 x 8 tablets They all have the same VMP Paracetamol 500mg tablets and all have the same pack size The only difference is that they are supplied by different companies All the above AMPPs are associated with the higher level concept with the description

  19. dm+d 5-box data model So the VMPP : Paracetamol 500mg tablets 32 tablet Can have many AMPPs Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets Paracetamol 500mg tablets (Teva UK Ltd) 32 tablet 4 x 8 tablets Paracetamol 500mg tablets (Aspar Pharmaceuticals Ltd) 32 tablet 4 x 8 tablets

  20. dm+d 5-box data model VTM Paracetamol AMP Panadol 500mg Tablets VMP Paracetamol 500mg Tablets VMPP Paracetamol 500mg Tablets 32 tablet AMPP Panadol 500mg Tablets 32 tablet 4x 8 tablets

  21. dm+d 5-box data model Each dm+d concept has additional information associated to it (Attributes) e.g. VMP Paracetamol 500mg Tablets Has the attribute of dose form populated with tablets Has the attribute of routepopulated with oral The different dm+d concepts have different attributes associated to them that are applicable to the concept level Some but not all of the attributes have SNOMED CT identifiers

  22. Key dm+d documents

  23. NHS Standard SNOMED CT as a Fundamental Standard • SNOMED CT has been approved as a Fundamental Standard by Information Standards Board for Health and Social Care (ISB HaSC). The Information Standards Notice (ISN) issued to notify this approval signals that SNOMED CT will be mandated for coded business interchanges between electronic healthcare record systems which support individual patient care by 2015. • Where pharmaceutical products are required to be represented then dm+d should be used.

  24. NHS Standard dm+d as a ISB Fundamental Standard • The Information Standards Board (ISB) approved dm+d as NHS Standard for communicating medicines information (an Interoperability Standard). • Electronic systems that exchange or share information about medicines relating directly to a patients care must adhere to the Standard by using dm+d identifiers when transferring information and should also use dm+d descriptions • For licensed medicines only at this stage. Other content within dm+d such as medical devices are excluded in terms of complying with the Standard although users can use all the content within dm+d • Health and Care Organisations, System Suppliers and Pharmaceutical companies must comply with requirements in standard by 30th June 2017 • The Electronic Prescription Service, Summary Care Record and Electronic Yellow Card Reporting already meet the requirements of this standard • For further information on the ISB standard http://www.isb.nhs.uk/library/standard/84

  25. Information Strategy The Power of Information: Putting all of us in control of the health and care information we need • DH Strategy document makes specific reference to the use of SNOMED CT and dm+d • It recommends that where IT systems reference medicines they use dm+d for coded information • Standardising on a single set of identifiers means that IT systems can more easily interoperate and information more readily shared

  26. 4 Key Points about dm+d • dm+d concepts have unique identifiers and associated textual descriptions • dm+d consists of a 5-box data model • All dm+d concepts and some attributes use SNOMED CT concept identifiers • It is designed for both primary and secondary care

  27. Any questions? Please put yourself on mute when not talking. Many Thanks.

  28. SNOMED CT UK Drug Extension • dm+d and SNOMED CT have a different structure and release format • SNOMED CT UK Drug Extension is produced to provide seamless links from SNOMED CT root node to dm+d concepts through one terminological structure • Mainly a technical transform which utilises some but not all information from dm+d • Defines relationships between concepts and has additional concept classes • Released 4 weekly

  29. SNOMED CT UK Drug Extension VTM Nifedipine (product) IS_A AMP Adalat LA 30mg tablets (Bayer Plc) (product) VMP Nifedipine 30mg modified-release tablets (product) IS_A Has_VMP Has_AMP VMPP Nifedipine 30mg modified-release tablets 28 tablet (product) AMPP Adalat LA 30mg tablets (Bayer Plc) 28 tablet 2x14 tablets (product) IS_A

  30. SNOMED CT UK Drug Extension Trade Family Adalat 10mg capsules (Bayer Plc) Adalat 5mg capsules (Bayer Plc)Adalat LA 20 tablets (Bayer Plc)Adalat LA 30 tablets (Bayer Plc)Adalat LA 60 tablets (Bayer Plc)Adalat retard 10mg tablets (Bayer Plc)Adalat retard 20mg tablets (Bayer Plc) Trade Family Group

  31. SNOMED CT UK Drug Extension Trade Family Adalat LA (product) Trade Family Group Adalat (qualifier value) VTM Nifedipine (product) Has_TRADE_ Family_Group IS_A IS_A AMP Adalat LA 30mg tablets (Bayer Plc) (product) VMP Nifedipine 30mg modified-release tablets (product) IS_A Has_VMP Has_AMP VMPP Nifedipine 30mg modified-release tablets 28 tablet (product) AMPP Adalat LA 30mg tablets (Bayer Plc) 28 tablet 2x14 tablets (product) IS_A

  32. dm+d links to SNOMED CT etc etc IS_A Snomed® CT™ International Release cardiovascular drug IS_A NHS dictionary of medicines and devices calcium channel blocking agent IS_A VTM Nifedipine (product) VMP Nifedipine 30mg modified-release tablets (product) VMPP Nifedipine 30mg modified- release tablets 28 tablet (product) AMP Adalat LA 30mg tablets (Bayer Plc) (product) AMPP Adalat LA 30mg tablets (Bayer Plc) 28 tablet 2x14 tablets (product)

  33. SNOMED CT root node Example of VTM in SNOMED CT UK Drug Extension

  34. 4 Key Points aboutSNOMED CT UK Drug Extension • dm+d information forms the basis of the SNOMED CT UK Drug Extension • Not all dm+d information is used (e.g. Price) • Additional concept classes and information are added (e.g. Trade Family) • Defines relationships between concepts (only implied in the dm+d XML)

  35. Release Schedule • dm+d data updated and released weekly in XML format Number of medicine and device concepts typically added per week: Concept type added per week in dm+d Total No. in dm+d (13/07/12) VTM 0 - 5 concepts 2,286 concepts VMP 5 – 50 concepts 15,589 concepts VMPP 20 – 150 concepts 22,683 concepts AMP 25 – 500 concepts 68,988 concepts AMPP 50 – 500 concepts 78,981 concepts Total 188,527 concepts • SNOMED CT UK Drug Extension released every 4 weeks • Both released via the TRUD website and FTP site • Technology Reference Data Update Distribution Service (TRUD) • www.uktcregistration.nss.cfh.nhs.uk

  36. dm+d release on TRUD

  37. SNOMED CT UK Drug Extension release on TRUD

  38. dm+d website

  39. dm+d information • dm+d Browser http://www.ppa.org.uk/systems/pcddbrowserv2_3new/browser.jsp • dm+d Helpdesk • nhsbsa.dmdenquiries@nhs.net • 0845 850 0001 • In-Demand - is a web based system which provides pharmaceutical companies the facility to submit their product information changes and prices directly to the NHS Business Services Authority https://indemand.medicines.org.uk/login/default.aspx?ReturnUrl=%2fDefault.aspx

  40. Governance and Issues • Information on dm+d governance structures, issues process and the current issues log can be found on the dm+d website: http://www.dmd.nhs.uk/dmdgovernance/index.html http://www.dmd.nhs.uk/issueslog/index.html

  41. Key Benefits NHS dm+d • Stable, well defined national dictionary that is freely available • published editorial policy and stringent governance process for change control • continually updated and released weekly • dm+d concepts have unique SNOMED CT identifiers and associated textual descriptions • Allows unambiguous recording of medicines and devices for prescribing, dispensing, administration and reimbursement • Enables unambiguous electronic data transfer SNOMED CT UK Drug Extension • Contains dm+d concepts with defined relationships to the international terminology SNOMED CT, allows international interoperability • New concept classes : Trade Family and Trade Family Group supports brand prescribing and enhanced allergy recording

  42. Any questions? Please put yourself on mute when not talking. Many Thanks. A recorded webinar can be found on the TRUD website under UKTC Education and Training Resources as well as other webinars on SNOMED CT

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