Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension Ian Spiers Pharmaceutical...
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Transcript of Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension Ian Spiers Pharmaceutical...
Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension
Ian Spiers
Pharmaceutical Terminology Specialist
Data 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– [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.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