United Kingdom Clinical Products Reference Source

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United Kingdom Clinical Products Reference Source

• Dictionary of medicinesdevices

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

• dmd

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

• How it all began - NHS policy
• The story so far
• The d in dmd - the recent project
• Demo

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dmd

• How it all began - NHS policy
• The story so far
• The d in dmd - the recent project
• Demo

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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.

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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.

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Information for Health 1998

• is most sensibly done on a national basis, but
  must engage the relevant stakeholders...
• The m of dmd began in late 2000

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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

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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

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What the Dictionary will NOT provide

• knowledge for decision support
• application functionality

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dmd

• How it all began - NHS policy
• The story so far
• The d in dmd - the recent project
• Demo

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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?

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The m in dmd
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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

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Virtual Therapeutic Moiety
Virtual Medicinal Product
Actual Medicinal Product
Actual Medicinal Product Pack
Virtual Medicinal Product Pack
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Virtual Therapeutic Moiety
SNOMED CT Decision Support
UK Namespace
Virtual Medicinal Product
Actual Medicinal Product
Actual Medicinal Product Pack
Virtual Medicinal Product Pack
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Relationship to SNoMedCT

• Directed acyclic graph structure
• Is_a (manifestation of)
• Object Attribute Value triples
• Object-HAS-Value

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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
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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
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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
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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
Actual Medicinal Product Pack
Virtual Medicinal Product Pack
What the Pharmacy buys when stocks run low
What the Pharmacy dispenses
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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
Actual Medicinal Product Pack
Virtual 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
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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
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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
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dmd

• How it all began - NHS policy
• The story so far
• The d in dmd - the recent project
• Demo

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The d in dmd

• Recent project - 4 domains
• Anaesthesia
• Cardiology
• Orthopaedics
• Blood product transfusion
• Project reports by 31 Mar 05

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The d in dmd

• Recent project - 4 meetings
• 6 Dec 04
• 17 Jan 05
• 21 Feb 05
• 14 Mar 05

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The d in dmd

• Recent project 4 representatives
• Chris Barham AAGBI
• Tom Clutton-Brock RCoA
• Tony Madden SCATA
• Andrew Norton IOTA
• Roger Tackley SNOMED

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Scope - d

• Equipment
• Power source needed
• Not disposable!
• Cost k
• Capital
• Record output

• Devices
• No power source
• Disposable (reusable)
• Cost p or
• Revenue
• Record use

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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

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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

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SNOMED CT Decision Support
Virtual Therapeutic Device
UK Namespace
Virtual Medical Device
Actual Medical Device
Actual Medical Device Pack
Virtual Medical Device Pack
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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
Actual Medical Device Pack
Virtual Medical Device Pack
What the ODPs order when stocks run low
What the Supplies Dept. actually orders
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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
Actual Medical Device Pack
Virtual 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
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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
Actual Medical Device Pack
Virtual 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
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dmd

• How it all began - NHS policy
• The story so far
• The d in dmd - the recent project
• Demo

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Demo

• C\Program Files\Blue Wave\dmd Demo Browser for
  Anaesthetic Devices\dmd Browser for Anaesthetic
  Devices.exe

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Summary

• dmd
• 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

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Conclusion

• 5 box model for drugs seems to work for devices
  (as defined)
• We havent broken the model!
• Now up to NPfIT/C4H
• Watch this space