Transcript dm+d Webinar Aug 2012x

Webinar : An introduction to NHS dm+d
and SNOMED CT UK Drug Extension
Ian Spiers
Pharmaceutical Terminology Specialist
Data Standards and Products
Contents
History 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
Paper held
Information
Electronically held
Information
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
NHS dictionary of medicines and devices
HELP
*July 13th 2012
(dm+d) has 188,527* drug concepts
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 Health
Section 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
What the dm+d does NOT provide:
• knowledge for decision support
• application functionality
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
dm+d 5-box data model
What are the dm+d concepts and how they
fit in the 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
dm+d 5-box data model
Lets look at some more descriptions that include Paracetamol in the name
Paracetamol 500mg soluble tablets
Paracetamol 500mg capsules
Paracetamol 120mg suppositories
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 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
Paracetamol
This higher level concept is called a Virtual Therapeutic Moiety (VTM)
As you can see one VTM may have many VMPs associated to it
Each VTM also has a unique SNOMED CT identifier (Code) and a unique term
(description)
e.g. Paracetamol SNOMED CT Code 90332006
dm+d 5-box data model
VTM
Paracetamol
VMP
Paracetamol
500mg Tablets
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)
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
As you can see one VMP may have many AMPs associated to it
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
dm+d 5-box data model
VTM
Paracetamol
VMP
Paracetamol
500mg Tablets
AMP
Panadol 500mg
Tablets
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)
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 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
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
VTM
Paracetamol
VMP
Paracetamol
500mg Tablets
AMP
Panadol 500mg
Tablets
AMPP
Panadol 500mg
Tablets 32 tablet
4x 8 tablets
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
Paracetamol 500mg tablets 32 tablet
This higher level concept is called a
Virtual Medicinal Product Pack (VMPP)
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
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
VTM
Paracetamol
VMP
Paracetamol
500mg Tablets
dm+d 5 box model
AMP
Panadol 500mg
Tablets
Each concept has a
standard term
(description)
Each concept has a
SNOMED CT identifier
VMPP
Paracetamol
500mg Tablets
32 tablet
AMPP
Panadol 500mg
Tablets 32 tablet
4x 8 tablets
Relationships are not
defined they are implied
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 route populated 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
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 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.
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
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
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 Extension
VTM
Nifedipine
(product)
Defined Relationships
IS_A
VMP
Nifedipine 30mg
modified-release
tablets
(product)
IS_A
Has_VMP
VMPP
Nifedipine 30mg
modified-release
tablets 28 tablet
(product)
AMP
Adalat LA 30mg
tablets (Bayer Plc)
(product)
Has_AMP
IS_A
AMPP
Adalat LA 30mg
tablets (Bayer Plc)
28 tablet 2x14 tablets
(product)
SNOMED CT UK Drug Extension
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
If we look at all the different ‘types’ of AMPs with the brand Adalat in their
description we see the following
Trade Family
Adalat 10mg capsules (Bayer Plc)
Adalat (product)
Adalat 5mg capsules (Bayer Plc)
Adalat LA 20 tablets (Bayer Plc)
Adalat LA (product)
Adalat LA 30 tablets (Bayer Plc)
Adalat LA 60 tablets (Bayer Plc)
Adalat retard 10mg tablets (Bayer Plc)
Adalat retard
Adalat retard 20mg tablets (Bayer Plc)
(product)
Trade Family Group
Adalat
(qualifier value)
SNOMED CT UK Drug Extension
Trade Family
Adalat LA
(product)
VTM
Nifedipine
(product)
IS_A
Has_VMP
VMPP
Nifedipine 30mg
modified-release
tablets 28 tablet
(product)
Trade Family Group
Adalat
(qualifier value)
IS_A
IS_A
VMP
Nifedipine 30mg
modified-release
tablets
(product)
Has_TRADE_
Family_Group
AMP
Adalat LA 30mg
tablets (Bayer Plc)
(product)
Has_AMP
IS_A
AMPP
Adalat LA 30mg
tablets (Bayer Plc)
28 tablet 2x14 tablets
(product)
Additional Concept
Classes e.g. Trade Family
dm+d links to
SNOMED CT
Snomed® CT™ International
Release
etc etc
IS_A
cardiovascular drug
IS_A
NHS dictionary
of medicines
and devices
calcium channel blocking agent
IS_A
VMP
Nifedipine 30mg
modified-release tablets
(product)
VMPP
Nifedipine 30mg modifiedrelease tablets 28 tablet (product)
VTM
Nifedipine
(product)
AMP
Adalat LA 30mg tablets
(Bayer Plc) (product)
AMPP
Adalat LA 30mg tablets (Bayer Plc)
28 tablet 2x14 tablets (product)
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 about
SNOMED 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
VTM
VMP
VMPP
AMP
AMPP
added per week in dm+d
0 - 5 concepts
5 – 50 concepts
20 – 150 concepts
25 – 500 concepts
50 – 500 concepts
Total No. in dm+d (13/07/12)
2,286 concepts
15,589 concepts
22,683 concepts
68,988 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 Browser
http://www.ppa.org.uk/systems/pcddbrowserv2_3new/browser.jsp
• dm+d Helpdesk
– [email protected]
– 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.html
http://www.dmd.nhs.uk/issueslog/index.html
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
• 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