Business Benefits of the Use of the NHS dm+d, and How to Realise Them

1. Business Benefits of the Use of the NHS dm+d, and How to Realise Them Julie James Blue Wave Informatics

2. Outline: • Key Benefits of dm+d in Clinical Use • Key Behaviours of dm+d in Clinical Systems • Building a Requirements Specification for Implementation of dm+d in Clinical Systems • Support for Implementation of dm+d in Clinical Systems

3. Information for Health; 1998 • The successful development of the EPR and EHR requires a common coded clinical vocabulary to facilitate reliable and accurate electronic communication of clinical information 3.16 • To support the clinical process we need electronic communication of drug information for individual patient care and secondary/other purposes. To achieve this a common electronic register of clinical products is required to support • Electronic Healthcare Records • Clinical Electronic Data Interchange (such as ETP) • Decision support • Stock control • Costing • Adverse drug reaction reporting • Performance Management • Different care delivery systems 3.22

4. The UKCPRS dm+d Vision A Single Comprehensive Electronic Dictionary of Medicinal Products (and Personal Medical Devices) to support Clinical Care across all sectors of the Health Service

5. The dm+d model – illustrative conceptual model

6. Key Benefits of dm+d in Clinical Use - 1 • Standard electronic identifiers for medicines for use in the EHR (the NCRS/PSIS) “the common clinical vocabulary” – no need for translation Reduced risk of misinterpretation of retrieved information

7. Key Benefits of dm+d in Clinical Use - 2 • Standard descriptors for medicines and associated concepts for use in all sectors of healthcare • Adrenaline acid tartrate 1:1000 intravenous injection 10ml syringe • Adrenaline 10mg/10ml Syringe • Adrenaline 1mg/ml IV Injection 10ml PF Syringe • Adrenaline 10mg/10ml (1:1000) Injection PF Syringe • Epinephrine 10mg/10ml Injection IV Syringe • Adrenaline 10mg Shock Syringe Reduced risk of error in medicine selection for clinical use (prescribing, dispensing, administration)

8. Key Benefits of dm+d in Clinical Use - 3 • Standard Identifiers and Descriptors for electronic clinical communication • ETP • Discharge medication Reduced risk of misinterpretation Reduced risk of error by removing need for re-keying of information, plus time saving for staff

9. Key Benefits of dm+d in Clinical Use - 4 • Standard Identifiers and cohesive structured supporting information for decision support e.g. Active ingredient information expressed consistently to support dose checking applications Safer medicines use • Integration with SNOMED-CT e.g. Active ingredient information links to the “chemical entity” branch of SNOMED-CT to support recording and retrieval of allergy information Safer medicines use

10. Key Benefits of dm+d in Clinical Use - 5 • Integration with the Supply Chain, through the AMPP concept class, supports • Process automation e.g. robotic dispensing • Product recall Improved efficiency in medicines use

11. Key Benefits of dm+d in Clinical Use - 6 • Standard electronic identifiers for medicines for use across all sectors of healthcare supports • Clinical governance e.g. identification of items regularly involved in safety incidents • Medicines Management e.g. identification of items regularly used in less than optimal dosages • MedicinesSafety e.g. identification of new ADRs Improved safety and efficiency in medicines use

12. Key Behaviours of dm+d in Clinical Systems 1 Clinical systems should implement dm+d so as to deliver the business benefits to the clinical community • Display of dm+d descriptors for concepts e.g. Filgrastim 48million units/1.6ml solution for injection vials Adrenaline 500microgram/0.5ml (1 in 1,000) solution for injection ampoules • Use of dm+d “Short Names” e.g. for labelling, when screen or paper real estate is a scarce commodity • Transmission of dm+d identifiers on all clinical communications e.g. for ETP, discharge medication information

13. Key Behaviours of dm+d in Clinical Systems 2 Clinical systems should implement dm+d so as to deliver the business benefits to the clinical community • Correct use of the relationships between concepts e.g. the brand-generic links • Correct use of the dm+d structure: it is not “hierarchical” e.g. for “alphabetic” pick list presentation, do not use a VTM  VMP  AMP type pattern (rather, build an aggregate alphabetic list of appropriate concepts) What else should be added to this list?

14. Building an Implementation Requirements Specification • The UKCPRS/NHS dm+d Programme are currently working on the production of detailed guidance for clinical system suppliers to support implementation of dm+d in application functionality • This will harmonise with the system testing and accreditation that will be required for NCRS Compliance

15. Support for Implementation ? • The UKCPRS/NHS dm+d Programme are committed to providing support for implementation of dm+d • This will be offered using a variety of processes, including: • Documentation, with worked examples • Conformance criteria • Technical liaison • Help desk etc. What do you need? When do you need it?