Implementing the NHS dictionary of medicines and devices (dm+d) presented by Jo Goulding Head of Pharmacy Terminology Implementation

What is dm+d?

What is dm+d? dm+d is: Text – standardised UNIQUE description for each entry The human readable bit Code – SNOMED CT The computer readable bit Paracetamol 500mg tablets 322236009 dm+d is not: A computer system Decision support

dm+d links to SNOMED CT SNOMED® CT™ International Release etc etc SNOMED® CT™ International Release IS_A cardiovascular drug IS_A NHS dictionary of medicines and devices calcium channel blocking agent IS_A VTM Nifedipine (product) VMP Nifedipine 30mg modified-release tablets (product) VMPP Nifedipine 30mg modified- release tablets 28 tablet (product) AMP Adalat LA 30mg tablets (Bayer Plc) (product) AMPP Adalat LA 30mg tablets (Bayer Plc) 28 tablet 2x14 tablets (product) dm+d is designed to interact with SNOMED CT – dm+d is the SNOMED CT UK drug extension) All identifiers for the core concept classes (VTM, VMP, VMPP, AMP, AMPP) are SNOMED CT concept identifiers. VTM and VMP may have core (international release) SCT identifiers (where there is an international equivalent) VMPP, AMP , AMPP will always have UK namespace identifiers. All five boxes sit at the bottom of the SNOMED CT Pharmaceutical / biologic product hierarchy with the VTM and VMP acting as the bridge between the UK namespace and international release. VTM and VMP may exist anywhere in the world. VMPP, AMP and AMPP are specific to the UK and thus should not and never will sit in the International Release.

Why is dm+d important?

Why dm+d – historical drivers The 1998 Government White Paper ‘Information for Health’ noted: “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”   The UK Clinical Products Reference Source (UKCPRS) programme was initiated to deliver a terminology to address this lack of standardisation dm+d is the product of the UKCPRS programme The product output from the UKCPRS project, the NHS dictionary of medicines and devices (dm+d), is designed to bring significant business benefits over existing terminologies, such as reducing ambiguity in providing for selection of product terms by clinicians, the ability to transfer coded data between systems without translating data between different coding systems, and reduced cost of maintenance of multiple code sets.

Why dm+d – current context ‘The Power of Information’ (May 2012) “At the moment different areas of the health and care system use different coding terminologies – this means that information cannot flow around the system well……..all relevant systems should use the same terminology to exchange coded information; SNOMED CT, adapted to fit all necessary uses, is the appropriate terminology to base this on. Similarly, to allow drugs to be consistently referenced, systems will consistently use the electronic drugs dictionary (dm+d)” ‘The Power of Information’ published in May 2012 sets a ten-year framework for transforming information for the NHS, public health and social care through the publication of information standards which will allow information to flow around the (care) system more effectively. The Power of Information’ (The Department of Health's information strategy http://informationstrategy.dh.gov.uk/ ) states that to allow information to flow around the (care) system well all systems should use the same terminology. For medicines information this terminology will be the NHS dictionary of medicines and devices, dm+d For clinical information SNOMED CT Both of these terminologies are maintained by ISD Terminology Services – Pharmacy and Clinical business units respectively

National Information Board National Information Board (NIB) - ‘Personalised Health and Care 2020: A Framework for Action’ “The NIB endorses the move to adopt a single clinical terminology – SNOMED CT – to support direct management of care, and will actively collaborate to ensure that all primary care systems adopt SNOMED CT by the end of December 2016; the entire health system should adopt SNOMED CT by April 2020” (p30-31) Noting that SNOMED CT includes dm+d

dm+d – the NHS Standard ISB 0052 Dictionary of Medicines and Devices (dm+d) The Standards primary purpose is to support interoperability. Therefore 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 and descriptions when transferring information Implementation Date 30th June 2017 Standard is still applicable (moving to SCCI) ISB 0052 – 30th June 2017 - we know most people won’t make it but you MUST have a plan in place to have it on your 12 month roadmap

The Carter Context – supporting Hospital Transformation Recommendation 3 Recommendation 3(a) – HPTP planning and governance Recommendation 3(b) – clinical pharmacy and infrastructure services Recommendation 3(c) – Electronic prescribing and medicines administration Recommendation 3(d) – Accurate coding of medicines Recommendation 3(e) – Top 10 drug saving opportunities Recommendation 3(g) – Medicines stock-holding and supply chain

The Carter Context – supporting Hospital Transformation Recommendation 3 Recommendation 3(a) – HPTP planning and governance Recommendation 3(b) – clinical pharmacy and infrastructure services Recommendation 3(c) – Electronic prescribing and medicines administration Recommendation 3(d) – Accurate coding of medicines Recommendation 3(e) – Top 10 drug saving opportunities Recommendation 3(g) – Medicines stock-holding and supply chain

The Carter Context – supporting Hospital Transformation Recommendation 3 Recommendation 3(a) – HPTP planning and governance Recommendation 3(b) – clinical pharmacy and infrastructure services Recommendation 3(c) – Electronic prescribing and medicines administration Recommendation 3(d) – Accurate coding of medicines Recommendation 3(e) – Top 10 drug saving opportunities Recommendation 3(g) – Medicines stock-holding and supply chain

The Carter Context – supporting Hospital Transformation Recommendation 3 Recommendation 3(a) – HPTP planning and governance Recommendation 3(b) – clinical pharmacy and infrastructure services Recommendation 3(c) – Electronic prescribing and medicines administration Recommendation 3(d) – Accurate coding of medicines Recommendation 3(e) – Top 10 drug saving opportunities Recommendation 3(g) – Medicines stock-holding and supply chain

What do you have to do?

Current Landscape Primary Care EPS, GP2GP, SCR Good dm+d coverage ISB 0052 compliance

Current Landscape Primary Care Secondary Care EPS, GP2GP, SCR Good dm+d coverage ISB 0052 compliance Secondary Care No programmes Poor coverage (polite) Not a hope….

dm+d in Secondary Care There is a long way to go in Secondary Care Small steps – being here today is a good first step NIB, NHSE, Hospital Transformation Beginning to define requirements What do you have to do? Think – are you dm+d ready? Talk to your Pharmacy IT lead or the PBTG Speak to your suppliers Get dm+d on your roadmap

How will NHS Digital help?

Pharmacy Terminology Implementation Small team - we have to be realistic with what we can achieve, and how we set about to achieve it Same as that used for Primary Care Direct liaison with Central initiatives and drivers Working with system suppliers Implementation guidance Educational materials to support implementers and front line staff

Information sources General enquiries – nhsbsa.dmdenquiries@nhs.net. Implementation queries – information.standards@nhs.net dm+d website dm+d Browser dm+d download - TRUD dm+d education materials Current resources on TRUD for download New portal arriving soon

dm+d Webinars – coming soon….. Webinars already developed and ready to be released once site agreed: Downloading dm+d and SNOMED CT UK Drug Extension files from TRUD BSA dm+d Browser In development: The NHS dictionary of medicines and devices - A brief introduction to dm+d, what it is and why we need it Planned: dm+d model dm+d or SNOMED CT Drug Extension? dm+d Standard