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John Barned & Helen Pretty, nehta - National E-Health Transition Authority: The Australian Medicines Terminology (AMT) and Electronic Medication Management
 

John Barned & Helen Pretty, nehta - National E-Health Transition Authority: The Australian Medicines Terminology (AMT) and Electronic Medication Management

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John Barned, Product Lead, Medicines and Helen Pretty, Australian Medicines Terminology Lead, nehta - National E-Health Transition Authority delivered this presentation at the 2013 Electronic ...

John Barned, Product Lead, Medicines and Helen Pretty, Australian Medicines Terminology Lead, nehta - National E-Health Transition Authority delivered this presentation at the 2013 Electronic Medication Management conference. It is Australia’s only conference to look solely at electronic prescribing and electronic medication management systems. For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/emedmanagement

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    John Barned & Helen Pretty, nehta - National E-Health Transition Authority: The Australian Medicines Terminology (AMT) and Electronic Medication Management John Barned & Helen Pretty, nehta - National E-Health Transition Authority: The Australian Medicines Terminology (AMT) and Electronic Medication Management Presentation Transcript

    • The Australian Medicines Terminology Overview March 2013 Helen Pretty – Clinical Terminology, AMT Team Lead John Barned – Clinical Terminology, Product Support Specialist 1 National E-Health Transition Authority www.nehta.gov.au
    • NEHTA The National E-Health Transition Authority (NEHTA) is a company established by the Australian, State and Territory governments in 2005 to develop better ways of electronically collecting and securely exchanging health information. 2 National E-Health Transition Authority www.nehta.gov.au
    • NEHTA • Lead the uptake of eHealth systems of national significance; and coordinate the progression and accelerate the adoption of eHealth by delivering urgently needed integration infrastructure and standards for health information. • In 2013-14 NEHTA will continue to drive the national adoption and uptake of eHealth and support the Australian health sector’s transition to the effective use of eHealth. eHealth Solutions eDiagnostics eDischarge eReferral eHealth Foundations eMedications Identifiers Authentication Terminology Secure Messaging
    • National approach required • • • • Standards & specifications that offer semantic interoperability between disparate systems. Provide standard naming conventions. Avoids risks of duplication, avoidable expenditure & solutions that cannot integrate/scale across healthcare settings. Addresses specific priority clinical processes. Examples: • Medications Management • Discharge Summaries • Referrals National E-Health Transition Authority www.nehta.gov.au
    • Clinical challenge Clinical records: • Not only a record for the author • Essential to inform the next person in the care team Clinical safety risks of poor quality, ambiguous communication, e.g. prescribing, dispensing and administration errors. Difficult to establish a person’s medication history reliably and efficiently across the continuum of care. Desire to: • make systems more interoperable • improve data quality • improve ability to re-use information National E-Health Transition Authority www.nehta.gov.au
    • “If you’re stumped, why not write an illegible prescription National E-Health Transition Authority and hope the pharmacist comes up with something?” www.nehta.gov.au
    • Why Terminology? • Standardised and consistent terms • Unique identifiers to support communication between computer systems ensuring no loss of meaning • Foundation products to support National approach • Clinical uses via Systematized Nomenclature of Medicine Clinical Terms – Australian release (SNOMED CT-AU) • IHTSDO • Medicines via Australian Medicines Terminology (AMT) National E-Health Transition Authority www.nehta.gov.au
    • Clinical Terminologies Terminologies are: • • • Essentially large dictionaries of clinical terms Designed for clinical data capture and recording For use by humans and computers Terminologies are not: • • • A classification, e.g. ICD-10, ATC Designed for statistical reporting or resource uses A knowledge base
    • AMT overview • A medicines terminology developed in the same way as SNOMED CT • Delivers standardised identification of brand (trade) products and equivalent generic medicines along with associated components Identifies all commonly used medicines in Australia and can be implemented in clinical information systems to support: • Administering • Prescribing • Supply – including dispensing • Recording • Transfer of information • Reviewing 9 National E-Health Transition Authority www.nehta.gov.au
    • What is included in AMT? • • • • Majority of Registered items from the TGA’s Australian Register of Therapeutic Goods Many Listed items from the Register PBS dressings, diagnostics and nutritional supplements Provision to include non-approved therapeutic goods, e.g. SAS items National E-Health Transition Authority www.nehta.gov.au
    • Medicines terminology or medicines information? • • • • There is a wide range of knowledge about medicines that is not included in a medicines terminology Terminology information must always necessarily be ‘true’ Knowledge information may change over time Knowledge can be linked to product descriptions through the terminology National E-Health Transition Authority www.nehta.gov.au
    • Terminology or Information? • Product name, e.g. Panadol  • Clinical indication  • Pack size  • Strength  • Dose Form  • Unit of use  • Adverse reaction  • Relationships between concepts  • Availability  • • • • • • • • • • Synonyms  Identifier code  Drug interaction  Allergy class  Dose  Generic name, e.g. Paracetamol  Contraindication  Subsidy  Container  Price  National E-Health Transition Authority www.nehta.gov.au
    • How it all fits together Fully Specified Name amoxycillin (medicinal product) SCTID: 283875011000036114 Preferred Term amoxycillin amoxycillin SCTID: 283876011000036119 SCTID: 21415011000036100 Synonym amoxicillin * SCTID: 123456781000036100 * Synonyms currently not available in AMT National E-Health Transition Authority www.nehta.gov.au
    • AMT Status • Monthly releases, version 2 data model • Transition from current version 2 model to version 3 model underway • Based on stakeholder feedback • Simplification of model to allow easier implementation • Beta release – 4 February 2013 National E-Health Transition Authority www.nehta.gov.au
    • The AMT v3 Model Identifies the Medicinal Products Identifies the Trade Products Medicinal Product Trade Product (MP) (TP) amoxycillin Amoxil Medicinal Product Unit of Use (MPUU) amoxycillin 500 mg capsule Trade Product Unit of Use (TPUU) Amoxil 500 mg capsule: hard, 1 capsule Medicinal Product Pack Containered Trade Product Pack (MPP) (CTPP) amoxycillin 500 mg capsule, 20 Amoxil 500 mg capsule: hard, 20 capsules, blister pack Trade Product Pack (TPP) Amoxil 500 mg capsule: hard, 20 National E-Health Transition Authority www.nehta.gov.au
    • AMT v3 Beta – Use Cases What are they? • Clinical scenarios defining how AMT can be used • However feedback indicated: • AMT implementation guidance against clinical use cases had been lacking. • Use cases at the time didn’t provide context Aim of developing use cases for v3 Beta: • Improve understanding of how AMT may be used in different clinical situations • Assist vendors in developing against defined use cases.
    • Use Case Focus Initial focus: • To support vendors and NEHTA initiatives (e.g. PCEHR) where the majority of development activity is occurring. This includes: • General Practitioners (GP) and Specialists using pack based prescribing. • Community Pharmacist dispensing (pack based) • Transfer of information between GP Prescribing and Community Pharmacist Dispensing. • Further use case development will prioritise those supporting electronic medications management and the AMT Roadmap, e.g. dose based prescribing.
    • Prescribe and Dispense Use Case • Puts use of AMT in context • Illustrates interactions between Prescribe and Dispense Use Cases • Includes messages and logical data flows to illustrate the use of the AMT
    • Prescribing Use Case Goal - use of AMT as the source of the medicines terminology to support: • Prescription (pack based prescribing) by an • Generation and exchange of authorised information in a community-based prescriber model using an authorised dispenser (e.g. GP). (e.g. community pharmacy).
    • Prescribing Examples The AMT will support pack based prescribing such as: • Prescribed for the first time (new): antibiotics, oral medicines, injections, topical preparations, combination pack, modified release medicines etc. • Prescribed for repeat prescription (repeats): long term medicines etc. • Prescribed for re-supply of prescription: long term medicines, inhaler, anticoagulant, eye drops, tablets, etc. • Prescribed for administration in clinics: vaccines etc. National E-Health Transition Authority www.nehta.gov.au
    • Dispensing Use Case Goal - use of AMT to support: • • • • Documentation of pack based dispensing by an authorised dispenser. Generation and exchange of information using AMT to dispense medicines. Dispensing of pack based prescriptions by an authorised dispenser (e.g. community pharmacist). Generation and exchange of information involving an authorised prescriber (e.g. GP).
    • Dispensing Examples The AMT will support pack-based dispensing such as: • Dispensed for the first time (new): antibiotics, oral medicines, injections, topical preparations, combination pack, modified release medicines etc. • Dispensed for repeat prescription (repeats): long term medicines etc. • Dispensed for re-supply of prescription: long term medicines, inhaler, anticoagulant, eye drops, tablets, etc. National E-Health Transition Authority www.nehta.gov.au
    • AMT Implementations • • • • • • • DOHV – Cerner/Multum implementations in four Health Services PharmCIS (Pharmaceutical Benefits) NPS – internal application Pharmhos Merlin CSC iPharmacy – capacity to include AMT IDs MTS Medication Technologies Browsers - CSIRO, Federation Health, Montage National E-Health Transition Authority www.nehta.gov.au
    • Issues • • • • • • • • Content coverage - gap items Complementary medicines Special Access Scheme (SAS) Total parenteral nutrition solutions, clinical trial medication, extemporaneous products Synonyms, dosage form inconsistencies – between TGA Register of Therapeutic Goods and clinical practice Dose based prescribing Product availability Decision support National E-Health Transition Authority www.nehta.gov.au
    • Lessons learned • • • • • • Scope out requirements for use cases • Ensures appropriate concept is used • Mapping considerations - maintenance Understand the clinical environment, limitations of the clinical system, e.g. search capabilities Understand the limitation of the medicines terminology including what is does/does not include Ongoing maintenance – monthly releases Validation / Conformance / Compliance of implementation Communicate, communicate, communicate! National E-Health Transition Authority www.nehta.gov.au
    • AMT Roadmap 2012-2014 National E-Health Transition Authority www.nehta.gov.au
    • Pharmaceutical Benefits Scheme and the AMT • • • • Pharmaceutical Consolidated Information System (PharmCIS) Implements AMT as part of database PBS monthly data releases include AMT concept IDs and descriptions Online PBS schedule includes AMT descriptions National E-Health Transition Authority www.nehta.gov.au
    • Alignment with National programmes Message structure for electronic transfer of prescriptions • Information models supporting • Discharge summaries, e-Referrals, Shared Health Summaries • Personally Controlled E-Health Record (PCEHR) and associated prescribing and dispensing repositories • National E-Health Transition Authority www.nehta.gov.au
    • AMT Governance NEHTA Clinical Terminology Governance Provide operational oversight from a product, medicines & terminology perspective NEHTA Governance Bodies AMT Product Management Group AMT Support Group AMT Content Board CTI Terminology Quality Group Provide clinical, technical & jurisdictional health services advice Endorse recommendations for clinical issues arising from AMTSG or AMTPMG NEHTA Clinical Safety Unit IHTSDO
    • For more information • • http://www.nehta.gov.au/connectingaustralia/terminology-and-information/clinicalterminology/australian-medicines-terminology terminologies@nehta.gov.au National E-Health Transition Authority www.nehta.gov.au
    • For more information (cont.) • View one of our recent videos: http://www.youtube.com/eHealthAus • Or download a brochure: http://www.nehta.gov.au/mediacentre/brochures National E-Health Transition Authority www.nehta.gov.au
    • Questions? 32 National E-Health Transition Authority www.nehta.gov.au