united kingdom clinical products reference source

United Kingdom Clinical United Kingdom Clinical Products Reference Products Reference

SourceSourceDictionary of medicines+devices

DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust& Hon Treasurer, SCATA

UKCPRSUKCPRS

dm+d

DR ANTHONY MADDEN Consultant Anaesthetist North Bristol NHS Trust& Hon Treasurer, SCATA

dm+ddm+d

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

project• Demo

Information for Health 1998Information 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.”


“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.”


“is most sensibly done on a national basis, but must engage the relevant stakeholders…..”.

The m of dm+d began in late 2000

• 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

Why is it needed?Why is it needed?

• 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 provideWhat the Dictionary will provide

• knowledge for decision support

• application functionality

What the Dictionary will What the Dictionary will NOTNOT provideprovide

dm+ddm+d


project• Demo

PhasesPhases

• 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?

The m in dm+dThe m in dm+d

Use Cases - mUse 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

VMPVirtual Medicinal

Product

VMPPVirtual Medicinal

Product Pack

AMPPActual Medicinal

Product Pack

VirtualProduct

Ingredient &Strength

CombinationPack Content

Pack Size Pack Price

AMPActual Medicinal

Product

ActualProduct

Excipient

Supplier

VTMVirtual

TherapeuticMoiety

NHS dm+d High LevelConceptual Model -

Medicines

Drug Form

Unit DoseForm


AMDActual Medical

Device

VMDVirtual Medical

Device

VMDPVirtual Medical

Device Pack

AMDPActual Medical

Device Pack

DeviceMaterial

Information



Non-DefiningDimensionInformation

Supplier

VTDVirtual

TherapeuticDevice

NHS dm+d High LevelConceptual Model - Medical

Devices

DefiningDimensionInformation

DefiningCharacteristic

Information


Non-DefiningCharacteristic

Information

VBPVirtual Blood

Product

BloodProduct

Component

ABPActual Blood

Product

PreparationProcess

VBTMVirtual BloodTherapeutic

Moiety

NHS dm+d High LevelConceptual Model - Bloodand Blood Components

Virtual Medicinal Product

Actual Medicinal Product Pack

Virtual Medicinal Product Pack

Actual Medicinal Product

Virtual Therapeutic Moiety





Virtual Therapeutic Moiety SNOMED CT

& Decision Support UK

Namespace

Relationship to Relationship to SNoMedCTSNoMedCT

• Directed acyclic graph structure• Is_a (manifestation of)

• Object – Attribute – Value triples•Object-HAS-Value





Virtual Therapeutic Moiety SNOMED CT


Namespace






What the doctor prescribes

What the Pharmacy buys when stocks run low

What the Pharmacy dispenses

What the patient swallows

Therapeutic decision

SNOMED CT


Namespace






e.g. atenolol 100mg tablets

What the doctor prescribes

e.g. atenolol 100mg tablets (Alpharma)

e.g. Atenolol 100 mg tablets x 28 tablet


e.g. Atenolol 100 mg tablets (Alpharma) x 28 tablet

What the Pharmacy dispenses

What the patient swallows

e.g. atenolol


SNOMED CT


Namespace






What the anaesthetist wants to give


What the Pharmacy supplies

What the anaesthetist actually gives


SNOMED CT


Namespace






e.g. atracurium injection 10mg/ml

What the anaesthetist wants to give

e.g. atracurium 25mg in 2.5 ml (Glaxo Smith Kline)

e.g. atracurium 25mg in 2.5 ml – 5 ampoule packs


e.g. atracurium 25mg in 2.5 ml (Glaxo Smith Kline) – 5 ampoule pack

What the Pharmacy supplies

What the anaesthetist actually gives

e.g. atracurium


SNOMED CT


Namespace

VMPVirtual Medicinal

Product

VMPPVirtual Medicinal

Product Pack

AMPPActual Medicinal

Product Pack

VirtualProduct

Ingredient &Strength



AMPActual Medicinal

Product

ActualProduct

Excipient

Supplier

VTMVirtual

TherapeuticMoiety

NHS dm+d High LevelConceptual Model -

Medicines

Drug Form

Unit DoseForm


dm+ddm+d


project• Demo

The d in dm+dThe d in dm+d

Recent project - 4 domains•Anaesthesia•Cardiology•Orthopaedics•Blood product transfusion

Project reports by 31 Mar 05


Recent project - 4 meetings

• 6 Dec 04• 17 Jan 05• 21 Feb 05• 14 Mar 05


Recent project – 4 representatives

•Chris Barham – AAGBI• Tom Clutton-Brock – RCoA• Tony Madden – SCATA•Andrew Norton – IOTA

• [Roger Tackley – SNOMED]

Scope - dScope - d

‘Equipment’• Power source

needed• Not disposable!• Cost £k• Capital• Record output

‘Devices’• No power

source• Disposable

(reusable)• Cost p or £• Revenue• Record use

High level uHigh level use case - dse 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 - dDetailed 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

Virtual Medical Device

Actual Medical Device Pack

Virtual Medical Device Pack

Actual Medical Device

Virtual Therapeutic Device

SNOMED CT


Namespace






What you ask the ODP for

What the ODPs order when stocks run low

What the Supplies Dept. actually orders

What the ODP gives you & you actually use


SNOMED CT


Namespace






e.g. standard type #3 LMA


e.g. standard type #3 Portex disposable LMA

e.g. a box of standard type #3 LMAs


e.g. a box of standard type #3 LMAs from Portex




SNOMED CT


Namespace

AMDActual Medical

Device

VMDVirtual Medical

Device

VMDPVirtual Medical

Device Pack

AMDPActual Medical

Device Pack

DeviceMaterial

Information



Non-DefiningDimensionInformation

Supplier

VTDVirtual

TherapeuticDevice

NHS dm+d High LevelConceptual Model - Medical

Devices

DefiningDimensionInformation

DefiningCharacteristic

Information


Non-DefiningCharacteristic

Information






e.g. standard type #3 LMA


e.g. standard type #3 Portex disposable LMA

e.g. a box of standard type #3 LMAs


e.g. a box of standard type #3 LMAs from Portex




dm+ddm+d


project• Demo

DemoDemo

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

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

SummarySummary

ConclusionConclusion

• 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

united kingdom clinical products reference source

Documents

farthe d

nhs policythe story

clinical messagingwhat

medical devices

dispensing information

recent projectdemodm

scatadm dhow

unique id of medicines