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The Australian Medicines Terminology Overview

March 2013

Helen Pretty – Clinical Terminology, AMT Team Lead

John Barned – Clinical Terminology, Product Support Specialist

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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.

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.

eDiagnostics eDischarge eReferral eMedications Terminology

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• 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 approach required

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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

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“If you’re stumped, why not write an illegible prescription and hope the pharmacist comes up with something?”

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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)

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

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• 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:

• Prescribing

• Recording

• Reviewing

AMT overview

• Administering

• Supply – including dispensing

• Transfer of information

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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

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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

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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

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Fully Specified Name

amoxycillin (medicinal product) SCTID: 283875011000036114

How it all fits together

amoxycillin SCTID: 21415011000036100

Preferred Term

amoxycillin SCTID: 283876011000036119

Synonym amoxicillin * SCTID: 123456781000036100

* Synonyms currently not available in AMT

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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

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The AMT v3 Model

Identifies the Medicinal Products

Identifies the Trade Products

Containered Trade Product Pack

(CTPP)

Amoxil 500 mg capsule: hard, 20

capsules, blister pack

Trade Product Unit of Use

(TPUU)

Amoxil 500 mg capsule: hard, 1

capsule

Trade Product

(TP)

Amoxil

Medicinal Product

(MP)

amoxycillin

Medicinal Product Unit of Use

(MPUU)

amoxycillin 500 mg capsule

Medicinal Product Pack

(MPP)

amoxycillin 500 mg capsule, 20

Trade Product Pack

(TPP)

Amoxil 500 mg capsule: hard, 20

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.

AMT v3 Beta – Use Cases

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.

Use Case Focus

• 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

Prescribe and Dispense Use Case

Prescribing Use Case Goal - use of AMT as the source of the medicines terminology to support:

• Prescription (pack based prescribing) by an authorised prescriber (e.g. GP).

• Generation and exchange of information in a community-based model using an authorised dispenser (e.g. community pharmacy).

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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.

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).

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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.

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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

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• 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

Issues

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• 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!

Lessons learned

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AMT Roadmap 2012-2014

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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

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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

AMT Governance

AMT Support Group AMT Content Board

AMT Product Management Group

CTI Terminology Quality Group

NEHTA Clinical Terminology Governance

NEHTA Clinical Safety Unit

NEHTA Governance Bodies

IHTSDO

Provide operational oversight from a product, medicines & terminology perspective

Provide clinical, technical & jurisdictional health services advice

Endorse recommendations for clinical issues arising from AMTSG or AMTPMG

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For more information

• http://www.nehta.gov.au/connecting-australia/terminology-and-information/clinical-terminology/australian-medicines-terminology

• terminologies@nehta.gov.au

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For more information (cont.)

• View one of our recent videos: http://www.youtube.com/eHealthAus

• Or download a brochure: http://www.nehta.gov.au/media-centre/brochures

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Questions?