Post on 14-Jan-2016
On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:
Current Status and Future Current Status and Future ChallengesChallenges
On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:
Current Status and Future Current Status and Future ChallengesChallenges
Dr John S FountainNew Zealand National Poisons CentreDr John S FountainNew Zealand National Poisons Centre
On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:Current StatusCurrent Status
On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:Current StatusCurrent Status
In 1997 it was recognised that the National Poisons Centre needed to improve its service provision
Key to this was access to a high quality poisons information resource
Poisindex® was reviewed as a possible source… but found lacking
Work was initiated to develop an in-house poisons information database
In 1997 it was recognised that the National Poisons Centre needed to improve its service provision
Key to this was access to a high quality poisons information resource
Poisindex® was reviewed as a possible source… but found lacking
Work was initiated to develop an in-house poisons information database
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
Inefficiencies existed within Inefficiencies existed within the Poisons Centre due to the Poisons Centre due to “down-time” between “down-time” between answering telephone callsanswering telephone calls
By working on TOXINZ By working on TOXINZ content during this period content during this period this time was gainfully this time was gainfully utilisedutilised
As time went by the database As time went by the database grew and in 1998 feed back grew and in 1998 feed back on quality of content was on quality of content was soughtsought
Inefficiencies existed within Inefficiencies existed within the Poisons Centre due to the Poisons Centre due to “down-time” between “down-time” between answering telephone callsanswering telephone calls
By working on TOXINZ By working on TOXINZ content during this period content during this period this time was gainfully this time was gainfully utilisedutilised
As time went by the database As time went by the database grew and in 1998 feed back grew and in 1998 feed back on quality of content was on quality of content was soughtsought
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
High demand from EDs for access to the CD-Rom lead its release to New Zealand hospitals in 2000
High demand from EDs for access to the CD-Rom lead its release to New Zealand hospitals in 2000
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
New ZealandNew ZealandNational Poisons CentreNational Poisons Centre
In 2002 TOXINZ, an Internet accessible version of the database, was developed and released, replacing the CD-Rom
In 2002 TOXINZ, an Internet accessible version of the database, was developed and released, replacing the CD-Rom
TOXINZ currently contains 165,000 listed chemicals, chemical products, pharmaceuticals, plants and hazardous creatures
Has three levels of access:First aid (free access)Primary Care (subscription)Full Management (subscription)
TOXINZ fundamentally changed the way poisons information is provided in New Zealand
TOXINZ currently contains 165,000 listed chemicals, chemical products, pharmaceuticals, plants and hazardous creatures
Has three levels of access:First aid (free access)Primary Care (subscription)Full Management (subscription)
TOXINZ fundamentally changed the way poisons information is provided in New Zealand
First First AidAid
Primary Primary CareCare
Full Full CareCare
Information Source
(2005-2006)
Percentage Use Weekly Monthly Yearly
TOXINZTOXINZ 87.187.1 1010 00ED protocols 4040 2020 4.34.3
Textbook 15.715.7 22.922.9 2.92.9
Other electronic 11.411.4 5.75.7 1.41.4
Telephone advice 2.92.9 15.715.7 4040
Poisindex® 00 00 00
Survey of Hospital Based TOXINZ Users(October 2005 – January 2006)
Survey of Hospital Based TOXINZ Users(October 2005 – January 2006)
(100 questionnaires to 15 hospitals with a 70% response rate)
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
ENQUIRIES
1995-1996
1996-1997
1997-1998
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
YEAR
HOSPITAL ENQUIRIES
TELEPHONE
Impact on Hospital Enquiry NumbersImpact on Hospital Enquiry Numbers
A 79% decline in hospital telephone enquiries over 10 yearsA 79% decline in hospital telephone enquiries over 10 years
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
ENQUIRIES
1995-1996
1996-1997
1997-1998
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
YEAR
HOSPITAL ENQUIRIES
TOXINZ
TELEPHONE
Impact on Hospital Enquiry NumbersImpact on Hospital Enquiry Numbers
A 338% increase in total hospital enquiries over 10 yearsA 338% increase in total hospital enquiries over 10 years
On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:
Future ChallengesFuture Challenges
On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:
Future ChallengesFuture Challenges
Increasing Range of Substances:Increasing Range of Substances:
New chemical products are being marketedNew chemical products are being marketed
Increasing range of product trade namesIncreasing range of product trade names
New drugs are being developedNew drugs are being developed
Transfer of new organismsTransfer of new organisms
International use of TOXINZInternational use of TOXINZ
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Changing Nature of Medical Information:Changing Nature of Medical Information:
There is constant change in medical and, There is constant change in medical and, particularly, toxicological knowledgeparticularly, toxicological knowledge
Treatment regimens (e.g. decontamination Treatment regimens (e.g. decontamination procedures) are revised, new antidotes are procedures) are revised, new antidotes are developeddeveloped
Old methodologies are challenged and new Old methodologies are challenged and new approaches adoptedapproaches adopted
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Database Resource Requirement
0
20
40
60
80
100
TIME
EFFORT
(
%
)
New Data
Maintenance
Future ChallengesFuture ChallengesFuture ChallengesFuture ChallengesDatabase MaintenanceDatabase Maintenance
It is easy to produce a database of medical It is easy to produce a database of medical toxicology informationtoxicology information
It is very difficult to maintain that dataIt is very difficult to maintain that data
What makes a superior poisons information What makes a superior poisons information database is its ability to be database is its ability to be
maintained/updatedmaintained/updated
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Work smarter not harderWork smarter not hardere.g. develop innovative database systemse.g. develop innovative database systems
Engage in international co-operationEngage in international co-operatione.g. with other PICse.g. with other PICs
Obtain ongoing funding to continue Obtain ongoing funding to continue development of TOXINZdevelopment of TOXINZ
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
On-going funding is needed.On-going funding is needed.
How can this be justified when we are How can this be justified when we are already funded to provide a telephone already funded to provide a telephone
enquiry service with access to enquiry service with access to experienced poisons information experienced poisons information
specialists and clinical toxicologists?specialists and clinical toxicologists?
We need to show that TOXINZ is a We need to show that TOXINZ is a necessary addition to the current necessary addition to the current
serviceservice
We need to show that TOXINZ is a We need to show that TOXINZ is a necessary addition to the current necessary addition to the current
serviceservice
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Disruptive innovationDisruptive innovation
Technological convergenceTechnological convergence
Technological paradigm shiftTechnological paradigm shift
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
We can Apply Business Concepts:We can Apply Business Concepts:
Disruptive innovationDisruptive innovation
A term describing a technological innovation, product, or service that uses a "disruptive" strategy, rather than a "revolutionary" or "sustaining" strategy, to overturn the existing dominant technologies or status quo products in a market
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Bower JL, Christensen CM. Disruptive Technologies: Catching the Wave. Harvard Business Review 1995; January-February: 43-53.
Internet accessible poisons informationInternet accessible poisons information
Is a disruptive innovationIs a disruptive innovation
Created from other disruptive innovations e.g.:Created from other disruptive innovations e.g.:Desk top computersDesk top computersDatabase softwareDatabase softwareInternetInternet
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Disruptive innovationDisruptive innovation
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Examples of Disruptive InnovationsExamples of Disruptive Innovations
““Desk top” ComputerDesk top” ComputerMainframe ComputerMainframe Computer
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Valve RadioValve Radio Transistor RadioTransistor Radio
Examples of Disruptive InnovationsExamples of Disruptive Innovations
Bower JL, Christensen CM. Disruptive Technologies: Catching the Wave. Harvard Business Review 1995, January-February 1995. 43-53.
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Disruptive innovationDisruptive innovation
Disruptive innovations do not need to meet high Disruptive innovations do not need to meet high level requirements to satisfy the initial consumers level requirements to satisfy the initial consumers
(e.g. telephonic specialist clinical toxicology advice).(e.g. telephonic specialist clinical toxicology advice).
Once adopted, the product will evolve to meet Once adopted, the product will evolve to meet successively higher user demands.successively higher user demands.
Eventually, the disruptive innovation will replace the Eventually, the disruptive innovation will replace the incumbent technology.incumbent technology.
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Hacklin F, Raurich V. Implications of technical convergence on innovation trajectories: the case of ICT industry. International Journal of Innovation and Technology Management 2005; 2 (3); 313-330.
Disruptive innovationDisruptive innovationTechnological convergenceTechnological convergence
Technological convergence is the trend of Technological convergence is the trend of technologies to merge into new technologies technologies to merge into new technologies that bring together a myriad of media.that bring together a myriad of media.
CameraCamera TelephoneTelephone
Technological ConvergenceTechnological Convergence
CameraphoneCameraphone
Technological ConvergenceTechnological Convergence
Information StorageInformation Storage(patient information)(patient information)
Information CollectionInformation Collection(laboratory results)(laboratory results)
Technological ConvergenceTechnological Convergence
ComputerComputer
Technological ConvergenceTechnological Convergence
Technological ConvergenceTechnological Convergence
Patient InformationPatient Information Poisons InformationPoisons Information
Technological ConvergenceTechnological Convergence
Watts M, Fountain J, Reith DM, Herbison P. Clinical utility of an electronic poisons information and clinical decision support tool. Int J Med Inform 2003; 71: 3-8.
Fountain JS, Reith DM, Watts M. Comparison of CD-Rom and Internet access to clinical information. Int J Med Inform 2005; 74: 769-777.
Clinicians prefer to access poisons information via a computer than a telephone and access that information more often
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Dosi G. Technological paradigms and technological trajectories: a suggested interpretation of the determinants of technical change. Research Policy 1982; 11: 147-62.
Disruptive innovationDisruptive innovationTechnological convergenceTechnological convergenceTechnological paradigm shiftTechnological paradigm shift
Certain technologies are identified and developed to provide a product or service. Overtime emergent technologies displace these paradigms producing a technology paradigm shift.
Technological paradigm shiftTechnological paradigm shift
Dr WhoDr WhoWilliam HartnellWilliam Hartnell
(1963 - 1966)(1963 - 1966)
Technological paradigm shiftTechnological paradigm shift
Dr WhoDr WhoSylvester McCoySylvester McCoy
(1987 - 1996)(1987 - 1996)
Technological paradigm shiftTechnological paradigm shift
Dr WhoDr WhoSylvester McCoySylvester McCoy
(1987 - 1996)(1987 - 1996)
Technological paradigm shiftTechnological paradigm shift
Dr WhoDr WhoDavid TennantDavid Tennant
(2005 -)(2005 -)
Technological paradigm shiftTechnological paradigm shift
Dr WhoDr WhoDavid TennantDavid Tennant
(2005 -)(2005 -)
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges
Disruptive innovationDisruptive innovation
Technological convergenceTechnological convergence
Technology paradigm shiftTechnology paradigm shift
If our Poisons Centre wishes to If our Poisons Centre wishes to meet the needs of Health meet the needs of Health
Professionals we must provide Professionals we must provide an Internet accessible an Internet accessible
database of high qualitydatabase of high quality
Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges