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

2. What is dm+d?

3. 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
dm+d is not:
A computer system
Decision support

5. 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.

6. Why is dm+d important?

7. 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.

8. 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 ) 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

9. 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

10. 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 we know most people won’t make it but you MUST have a plan in place to have it on your 12 month roadmap

11. 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

12. 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

13. 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

14. 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

15. What do you have to do?

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

17. 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….

18. 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

19. How will NHS Digital help?

20. 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

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

23. 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