Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug ExtensionIan SpiersPharmaceutical Terminology SpecialistData Standards and Products

ContentsHistory of NHS dm+d and Use Cases

dm+d 5 box data model

NHS standard

SNOMED CT UK Drug Extension

Release and dm+d website

Information: Paper to IT

*July 13th 2012

New Drugs New Drugs New Drugs

Discontinued Drugs Discontinued

Drug Name Change Drug Name

Price Change Price Change Price

New Drugs New Drugs New Drugs

Product Change Product Change

Paper held Information

Electronically held Information

NHS dictionary of medicines and devices

(dm+d) has 188,527* drug concepts HELP

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

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 HealthSection 3.22

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)

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

• knowledge for decision support• application functionality

What the dm+d does NOT provide:

Use CasesPrimary 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

dm+d 5-box data model

Take a look at the following description of tablets

Paracetamol 500mg Tablets

This concept description is made up of Name Strength Form

This concept is known as the Virtual Medicinal Product (VMP) in dm+d

What are the dm+d concepts and how they fit in the 5-box data model

dm+d 5-box data model

Paracetamol 500mg soluble tablets

Paracetamol 500mg capsules

Paracetamol 120mg suppositories

Lets look at some more descriptions that include Paracetamol in the name

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

dm+d 5-box data modelIn dm+d the VMPsParacetamol 500mg tabletsParacetamol 500mg soluble tabletsParacetamol 500mg capsulesParacetamol 120mg suppositories

Paracetamol

This higher level concept is called a Virtual Therapeutic Moiety (VTM)

Each VTM also has a unique SNOMED CT identifier (Code) and a unique term (description)e.g. Paracetamol SNOMED CT Code 90332006

are all associated with the higher level concept with the description

As you can see one VTM may have many VMPs associated to it

dm+d 5-box data model

VMPParacetamol

500mg Tablets

VTMParacetamol

dm+d 5-box data modelIf we now look at the VMP : Paracetamol 500mg tabletsMany 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)

When we add brand / supplier information to the description of a VMP we describe a concept known as the Actual Medicinal Product (AMP) in dm+d

Each AMP also has a unique SNOMED CT identifier (Code) and a term (description)

e.g. Paracetamol 500mg tablets (Aspar Pharmaceuticals Ltd) SNOMED CT Code 836511000001102

As you can see one VMP may have many AMPs associated to it

dm+d 5-box data model

VMPParacetamol

500mg Tablets

VTMParacetamol

AMPPanadol 500mg

Tablets

dm+d 5-box data modelIf 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)

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

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 modeldm+d 5-box data modelSo the AMP : Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare)

Can have many AMPPs

Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 12 tabletPanadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 16 tablet 2 x 8 tabletsPanadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets

Each AMPP also has a unique SNOMED CT identifier (Code) and a term (description)

e.g. Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 12 tablet SNOMED CT Code 1437511000001107

dm+d 5-box data model

AMPPPanadol 500mg Tablets 32 tablet

4x 8 tablets

VMPParacetamol

500mg Tablets

VTMParacetamol

AMPPanadol 500mg

Tablets

dm+d 5-box data model

Paracetamol 500mg tablets 32 tablet

This higher level concept is called a Virtual Medicinal Product Pack (VMPP)

Look at the following AMPPs

Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tabletsParacetamol 500mg tablets (Teva UK Ltd) 32 tablet 4 x 8 tabletsParacetamol 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 sizeThe only difference is that they are supplied by different companiesAll the above AMPPs are associated with the higher level concept with the description

dm+d 5-box data modelSo the VMPP : Paracetamol 500mg tablets 32 tablet

Can have many AMPPsPanadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tabletsParacetamol 500mg tablets (Teva UK Ltd) 32 tablet 4 x 8 tabletsParacetamol 500mg tablets (Aspar Pharmaceuticals Ltd) 32 tablet 4 x 8 tablets

Each VMPP also has a unique SNOMED CT identifier (Code) and a unique term (description)

e.g. Paracetamol 500mg tablets 32 tablet SNOMED CT Code 1064711000001107

dm+d 5-box data model

VMPPParacetamol

500mg Tablets 32 tablet

AMPPPanadol 500mg Tablets 32 tablet

4x 8 tablets

VMPParacetamol

500mg Tablets

VTMParacetamol

AMPPanadol 500mg

Tablets

dm+d 5 box model

Each concept has a standard term (description)

Each concept has a SNOMED CT identifier

Relationships are not defined they are implied

dm+d 5-box data modelEach dm+d concept has additional information associated to it (Attributes)

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

e.g. VMP Paracetamol 500mg Tablets Has the attribute of dose form populated with tabletsHas the attribute of route populated with oral

Key dm+d documents

dm+d Editorial Policy

dm+d Data Model

dm+d Technical Specifications

Implementation guidance for both primary and secondary care

NHS StandardSNOMED 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.

NHS Standarddm+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

Information StrategyThe 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

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

• Any questions?

Please put yourself on mute when not talking. Many Thanks.

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

SNOMED CT UK Drug ExtensionVTM

Nifedipine(product)

VMPNifedipine 30mg modified-release

tablets(product)

VMPPNifedipine 30mg modified-release tablets 28 tablet

(product)

AMPAdalat LA 30mg

tablets (Bayer Plc) (product)

AMPPAdalat LA 30mg

tablets (Bayer Plc) 28 tablet 2x14 tablets

(product)

IS_A

Has_VMP Has_AMP

IS_A

IS_A

Defined Relationships

SNOMED CT UK Drug Extension

If we look at all the different ‘types’ of AMPs with the brand Adalat in their description we see the following

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)

In the SNOMED CT UK Drug Extension new concept classes Trade family (TF) and Trade Family Group (TFG) have been added

These new concepts classes allow the grouping of branded products

Adalat (product)

Adalat LA (product)

Adalat retard (product)

Adalat (qualifier value)

Trade FamilyTrade Family Group

SNOMED CT UK Drug ExtensionVTM

Nifedipine(product)

VMPNifedipine 30mg modified-release

tablets(product)

VMPPNifedipine 30mg modified-release tablets 28 tablet

(product)

AMPAdalat LA 30mg

tablets (Bayer Plc) (product)

AMPPAdalat LA 30mg

tablets (Bayer Plc) 28 tablet 2x14 tablets

(product)

IS_A

Has_VMP Has_AMP

IS_A

IS_A

Additional Concept Classes e.g. Trade Family

Trade FamilyAdalat LA (product)

IS_A

Trade Family GroupAdalat

(qualifier value)

Has_TRADE_Family_Group

dm+d links to SNOMED CT

VMPPNifedipine 30mg modified-

release tablets 28 tablet (product)

AMPAdalat LA 30mg tablets

(Bayer Plc) (product)

AMPPAdalat LA 30mg tablets (Bayer Plc)

28 tablet 2x14 tablets (product)

VMPNifedipine 30mg

modified-release tablets(product)

VTMNifedipine(product)

calcium channel blocking agent

IS_A

cardiovascular drug

IS_A

etc etc

IS_ASnomed® CT™ International Release

NHS dictionaryof medicines and devices

Example of VTM in SNOMED CT UK Drug Extension

Virtual Therapeutic Moiety

Fully Specified Name

Preferred Term

Virtual Medicinal Products

SNOMED CT root node

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)

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

dm+d release on TRUD

SNOMED CT UK Drug Extension release on TRUD

SNOMED CT UK Drug Extension Editorial Policy

dm+d website

dm+d information

• dm+d Browserhttp://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

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.htmlhttp://www.dmd.nhs.uk/issueslog/index.html

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

Key Benefits

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

A recorded webinar can be found on the TRUD websiteunder UKTC Education and Training Resources as well asother webinars on SNOMED CT