1. Webinar : An introduction to NHS dm+d and SNOMED CT UK Drug Extension
Introduction Slide: entitled Webinar : An introduction to NHS dm+d and SNOMED CT UK drug extension
There will be times in the Webinar where we will open up for any questions
Many of the slides in this presentation have explanatory Speaker’s Notes
NB some slides have ‘build’ animations. If you view them within Powerpoint in an ‘editing view whilst reading the notes (ie without actually running the presentation) then what you see on the screen may not correspond to what the notes are talking about.
For best results, print off the speaker’s notes and then run the presentation.
Ian Spiers
Pharmaceutical Terminology Specialist
Data Standards and Products

2. Contents History 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
Contents Slide – This slide gives a basic overview of the topics that will be covered in the presentation

3. Information: Paper to IT
Paper held Information
Electronically held Information
New Drugs New Drugs New Drugs
Discontinued Drugs Discontinued
Product Change Product Change
Price Change Price Change Price
Drug Name Change Drug Name
New Drugs New Drugs New Drugs
There have been major moves from paper information to IT but there is still a lot of information to cope with e.g. new drugs become available all the time. To help handle this information, dm+d provides a continually updated dictionary containing more than 180,000 drug concepts.
NHS dictionary of medicines and devices
(dm+d) has 188,527* drug concepts
HELP
*July 13th 2012

4. 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
In the UK in 1998 a statement identifying the need for a single medicines terminology was made in an NHS strategy document Information for Health.
The purpose was to help the NHS exploit the full power of information technology resulting in real improvements to healthcare.

5. Information for Health
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 Health
Section 3.22
There was a clear recognition in Information for Health (3.6) that this work
“is most sensibly done on a national basis”
 and it also emphasised the need to consolidate the development of all health information content standards within a single work programme.
The requirement for a national identifier for drug products in particular was reinforced by the Audit Commission report into medicines management in secondary care, A Spoonful of Sugar, which made the following recommendation
 “A standard national system for coding medicines across the NHS is required.”

6. 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)
The three dictionaries (PCDD, SCDD, MDD) combined to become the NHS dictionary of medicines and devices (dm+d)
The UK Standard Clinical Products Reference Source (UKCPRS) programme had 3 phases
Phase 1 covered the release of the Primary Care Drug Dictionary component
Phase 2 extended the use of the dictionary into secondary care with the inclusion of the Secondary Care Drug Dictionary
Further development of the NHS dm+d, Phase 3, is to cover the extension of the dictionary to include medical devices more related to secondary care e.g. Artificial hips (Not in the Drug Tariff). Those devices and appliances listed in the Drug Tariff are populated under the PCDD.
The three dictionaries (PCDD, SCDD, MDD) combined to become the NHS dictionary of medicines and devices (dm+d)
Currently the dictionary comprises 99.5% by volume of the items prescribed in Primary Care and the population of the Secondary Care element is continually expanding.
NHS Connecting for Health continue to work with the NHS Prescription Services on the development and maintenance of dm+d

7. 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
What the dm+d does NOT provide:
knowledge for decision support
application functionality
The dm+d is a dictionary containing unique identifiers and associated textual descriptions for medicines and medical devices.
So what does dm+d NOT provide?
It does not provide knowledge for decision support for example drug-drug interactions
It also does not provide application functionality – dm+d data provided but not any application software for using data is supplied

8. Use Cases Primary Care Secondary 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 has been developed for use throughout the NHS in both primary and secondary care
As you can see there are many use cases for dm+d:
most noteworthy are for prescribing, dispensing, administration and reimbursement as a means of uniquely identifying medicines and devices used in the diagnosis or treatment of patients
Improving Patient Safety is at the heart of all of the NHS IT initiatives. The National Patient Safety Agency (NPSA) has emphasised the importance of 'designing solutions that prevent harm'. Electronic prescribing and improved computer prescribing and dispensing systems have a vital part to play in reducing medication errors and transcription errors by providing clear, unambiguous, timely information.
There are many use case examples on the dm+d website that go into more detail.

9. dm+d 5-box data model
What are the dm+d concepts and how they fit in the 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
Virtual Medicinal Product (VMP) is an abstract concept representing the properties of one or more clinically equivalent Actual Medicinal Products, where clinical is defined as relating to the course of a disease.
This concept is known as the Virtual Medicinal Product (VMP) in dm+d

10. dm+d 5-box data model
Lets look at some more descriptions that include Paracetamol in the name
Paracetamol 500mg soluble tablets
Paracetamol 500mg capsules
Paracetamol 120mg suppositories
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
Virtual Medicinal Product (VMP) is an abstract concept representing the properties of one or more clinically equivalent Actual Medicinal Products, where clinical is defined as relating to the course of a disease.

11. dm+d 5-box data model In dm+d the VMPs Paracetamol 500mg tablets
Paracetamol 500mg soluble tablets
Paracetamol 500mg capsules
Paracetamol 120mg suppositories
are all associated with the higher level concept with the description
Paracetamol
This higher level concept is called a Virtual Therapeutic Moiety (VTM)
Virtual Medicinal Product (VMP) is an abstract concept representing the properties of one or more clinically equivalent Actual Medicinal Products, where clinical is defined as relating to the course of a disease.
 VTM usually have many associated VMPs.
A Virtual Therapeutic Moiety (VTM) is the abstract representation of the substance(s), formulated as a medicinal product, intended by an authorising health care professional for use in the treatment of the patient.
  Examples of Virtual Therapeutic Moieties:
Atenolol
Co-amoxiclav
Doxorubicin
Fluoruracil
Paracetamol + Metoclopramide
Each VTM also has a unique SNOMED CT identifier (Code) and a unique term (description)
e.g. Paracetamol SNOMED CT Code
As you can see one VTM may have many VMPs associated to it

12. Paracetamol 500mg Tablets
dm+d 5-box data model
VTM
Paracetamol
VMP
Paracetamol 500mg Tablets

13. dm+d 5-box data model
If we now look at the VMP : Paracetamol 500mg tablets
Many 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
As you can see one VMP may have many AMPs associated to it
An Actual Medicinal Product (AMP) is a single dose unit of a finished dose form (unless the product is presented as a continuous dosage form), attributable to an identified supplier that contains a specified amount of an ingredient substance.
Examples of Actual Medicinal Products:
Atenolol 100 mg tablets (Alpharma)
Tenormin 100 mg tablets (AstraZeneca)
Estracombi TTS patches (Novartis)
Augmentin 375 mg tablets (GlaxoSmithKline)
Doxorubicin 10mg/5ml solution for injection vials (Pharmacia)
Efudix 5% cream (ICN)
Aquadry Freedom sheaths mm (Coloplast)

14. Paracetamol 500mg Tablets
dm+d 5-box data model
VTM
Paracetamol
AMP
Panadol 500mg Tablets
VMP
Paracetamol 500mg Tablets

15. dm+d 5-box data model If 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)
16 tablet 2 x 8 tablets
Panadol 500mg tablets
(GlaxoSmithKline Consumer Healthcare)
12 tablet
Panadol 500mg tablets
(GlaxoSmithKline Consumer Healthcare)
32 tablet 4 x 8 tablets
AMPP similar to AMP except now has pack information.
An Actual Medicinal Product Pack (AMPP) is the packaged product that is supplied for direct patient use or from which AMPs are supplied for direct patient use.
Examples of Actual Medicinal Product Packs:
Atenolol 100 mg tablets (Alpharma) x 28 tablet
Tenormin 100 mg tablets (AstraZeneca) x 28 tablet
Estracombi TTS patches (Novartis) x 8 patches
Augmentin 375 mg tablets (GlaxoSmithKline) x 21 tablet
Doxorubicin 10mg/5ml injection solution vials (Pharmacia) x 1 vial (Pharmacia)
Doxorubicin 10mg/5ml injection solution vials (Pharmacia) x 5 vial (Faulding)
Efudix 5% cream (ICN) x 20g
Aquadry Freedom sheaths mm (Coloplast) x 30 device
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

16. dm+d 5-box data model dm+d 5-box data model
So the AMP :
Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare)
Can have many AMPPs
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
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
An Actual Medicinal Product Pack (AMPP) is the packaged product that is supplied for direct patient use or from which AMPs are supplied for direct patient use
AMPP similar to AMP except now has pack information.
AMP often have many associated AMPPs

17. dm+d 5-box data model VTM Paracetamol AMP VMP Panadol 500mg Tablets
Paracetamol 500mg Tablets
AMPP
Panadol 500mg Tablets 32 tablet 4x 8 tablets

18. dm+d 5-box data model Look at the following AMPPs
Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets
Paracetamol 500mg tablets (Teva UK Ltd) 32 tablet 4 x 8 tablets
Paracetamol 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 size
The only difference is that they are supplied by different companies
All the above AMPPs are associated with the higher level concept with the description
Paracetamol 500mg tablets 32 tablet
For every Actual Medicinal Product Pack (AMPP) there will exist a corresponding VMPP.
A Virtual Medicinal Product Pack (VMPP) is an abstract concept representing the properties of one or more quantitatively equivalent AMPPs.
Examples of Virtual Medicinal Product Packs:
Atenolol 100 mg tablets x 28 tablet
Generic Estracombi TTS patches x 8 patches
Co-amoxiclav 250mg/125mg tablets x 21 tablet
Doxorubicin 10mg/5ml solution for injection vials (Pharmacia) x 1 vial
Doxorubicin 10mg/5ml solution for injection vials (Pharmacia) x 5 vial
Fluorouracil 5% cream x 20g
Incontinence sheaths x 30 device
This higher level concept is called a
Virtual Medicinal Product Pack (VMPP)

19. dm+d 5-box data model
So the VMPP :
Paracetamol 500mg tablets 32 tablet
Can have many AMPPs
Panadol 500mg tablets (GlaxoSmithKline Consumer Healthcare) 32 tablet 4 x 8 tablets
Paracetamol 500mg tablets (Teva UK Ltd) 32 tablet 4 x 8 tablets
Paracetamol 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
A Virtual Medicinal Product Pack (VMPP) is an abstract concept representing the properties of one or more quantitatively equivalent AMPPs.
For every Actual Medicinal Product Pack (AMPP) there will exist a corresponding VMPP. A VMPP will have at least one AMPP and may have many AMPPs linked to it.
Often VMP has many associated VMPPs.

20. dm+d 5-box data model VTM Paracetamol 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
AMP
Panadol 500mg Tablets
VMP
Paracetamol 500mg Tablets
VMPP
Paracetamol 500mg Tablets
32 tablet
AMPP
Panadol 500mg Tablets 32 tablet 4x 8 tablets

21. dm+d 5-box data model
Each dm+d concept has additional information associated to it (Attributes)
e.g. VMP Paracetamol 500mg Tablets
Has the attribute of dose form populated with tablets
Has the attribute of route populated with oral
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
Associated to concepts are a number of attributes that give further information.
The above slide shows examples of some the attributes attached to the 5 concepts.
At VMP level attributes include ingredient, form, route and controlled drug status
At VMPP level there is information relating to the drug tariff and combination packs
At AMP level attributes include product availability, supplier, licensed route and excipients
AT AMPP level there is information relating to pack price, product prescribing i.e. dental formulary, appliance product information and reimbursement
Using attributes allows for a wealth of information to be associated to the dm+d concepts from ingredients to prescribing and reimbursement information
Some but not all of the attributes have SNOMED CT identifiers
For example, Dose form has a SNOMED CT code whereas pack price does not

22. Key dm+d documents dm+d Editorial Policy dm+d Data Model
dm+d Technical Specifications
The Editorial policy is very specific and shows the editorial principles on how dm+d concepts are populated. It is updated depending on decisions made by the governance structure. Changes to the editorial policy are made taking note of stakeholder consultations
dm+d data model: This document provides a detailed background and outline specification for the model structure and content of the NHS dictionary of medicines and devices (dm+d) covering primary care and secondary care elements.
dm+d Technical Specification: This document provides a technical specification which describes the structure and content of the downloadable XML release files of the NHS dictionary of medicines and devices (dm+d) covering both the primary and secondary care elements. It describes the form and the format of the files, how they can be accessed and how they need to be processed in order to create a useable database and ensure data integrity.
dm+d implementation guidance for both primary and secondary care are available on the dm+d website. The Implementation Guides are an aid to completing common tasks.
Implementation guidance for both primary and secondary care

23. NHS Standard SNOMED 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.
As you are probably aware SNOMED CT has now been approved as a Fundamental standard by the Information Standards Board.
SNOMED CT has been approved as a Fundamental Standard by ISB HaSC. The 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.
Therefore, whilst not yet mandated for specific business interchanges, any plans to introduce new electronic health record systems for individual patient care should include the provision to interchange SNOMED CT coded data instead of local or proprietary codes or those national codes which SNOMED CT is expected to replace (Read codes or Clinical Terms Version 3).
It is worth noting that within the notice there is reference to dm+d which states
Where pharmaceutical products are required to be represented then dm+d should be used.

24. NHS Standard dm+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
What is the dm+d Standard?
The purpose of the Standard is to ensure that diverse clinical systems can effectively 'talk' to one another by using a common coded language for the transfer of medicines information between such systems. dm+d provides this 'common language' by the provision of its unique identifiers (codes) and associated textual descriptions.
How to comply with the Standard
IT systems must be able to output and receive dm+d codes where there is a need to transfer information electronically about medicines used in the care of a NHS patient from one system to another and the system must be able to 'translate' the identifier and display the associated human readable textual description. The Full standard will require the use of SNOMED CT identifiers specified in dm+d for electronic communication and transfer of information about medicines and medical devices used in the care of a patient.
When to comply with the Standard
Health and Care Organisations, System Suppliers and Pharmaceutical companies must comply by 30th June 2017
Consideration however should be given to implementing this Standard prior to this date when there are major updates taking place to existing systems or new procurements are undertaken with system suppliers

25. Information Strategy
The 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
Also worth noting is the Department of Health Information strategy published in May 2012
The Strategy document makes specific reference to the use of SNOMED CT and dm+d
It recommends the use of dm+d for coded information where IT systems reference medicines
The document stresses that Standardising on a single set of identifiers means that IT systems will be able interoperate more easily and that information can be more readily shared
This enforces the ethos of recording once for multiple purposes and to reduce the multiple recording burden

26. 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
dm+d consists of a 5-box data model VTM, VMP, VMPP, AMP, AMPP. It is designed for both primary and secondary care. dm+d concepts and some attributes use SNOMED CT concept identifiers.

27. Any questions? Please put yourself on mute
when not talking. Many Thanks.
Please put yourself on mute when not talking. Many Thanks

28. 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
Why do we produce SNOMED CT UK Drug extension
Well dm+d and SNOMED CT have a different structure and release format
All relationships in dm+d are implied ie. not defined (as we saw on previous slides)
dm+d is released weekly in a XML format whereas SNOMED CT is released as flat text files
The SNOMED CT UK Drug Extension is produced to provide links from the top of the SNOMED CT hierarchy down to the dm+d concepts
So What is SNOMED CT UK Drug extension ?
Well, it is mainly a technical transform which utilises some but not all information from dm+d
The 5 dm+d concepts are carried across and some of the dm+d attributes but not all, for example, pricing information is not present in the SNOMED CT UK drug extension
The SNOMED CT UK drug extension also defines relationships between concepts and has additional concept classes, I will cover this in more detail in the next few slides
It is also Released every 4 weeks

29. SNOMED CT UK Drug Extension
VTM
Nifedipine
(product)
Defined Relationships
IS_A
VMP
Nifedipine 30mg modified-release tablets
(product)
AMP
Adalat LA 30mg tablets (Bayer Plc)
(product)
IS_A
Concepts have SNOMED descriptions and relationships
Here we have another example of a drug in the five box model, nifedipine . This drug is used mainly to treat angina and blood pressure.
The VMP in this instance is Nifedipine 30mg modified-release tablets
It has a AMP Adalat LA 30mg tablets
The VMPP and AMMP represent the 28 tablet packs
So as you can see we have the 5 concepts from dm+d but Now they have defined relationships
For example, the AMP ADALAT LA 30mg tablets has the relationship IS_A to the VMP Nifedipine 30mg modified-release tablets 28 tablet, ie the AMP is a child of the parent VMP
Has_VMP
Has_AMP
VMPP
Nifedipine 30mg modified-release tablets 28 tablet
(product)
AMPP
Adalat LA 30mg tablets (Bayer Plc)
28 tablet 2x14 tablets
(product)
IS_A

30. SNOMED CT UK Drug Extension
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
If we look at all the different ‘types’ of AMPs with the brand Adalat in their description we see the following
Trade Family
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)
Trade Family Group
Adalat (product)
A Trade Family (TF) is the abstract conceptual representation of a brand group of related actual medicinal products without representation of any attributes of individual products of that brand group (i.e. dose form, presentation strength, flavour). One TF have one or more AMPs associated.
Trade Family Group (TFG) : This qualifier value concept allows for Trade Family products sharing a common root Trade Family name to be grouped. Trade products grouped under this concept may or may not share the same active ingredients. One TFG have many TFs associated.
Concept class representing ‘brand name’ (brand VTM equivalent) populated and the following use cases identified to support its addition : To support the recording of medication history, Care pathways/protocols, Allergy/Intolerance, Post Co-ordination – Secondary care product description/selection, Pick List Production.
Adalat LA (product)
(qualifier value)
Adalat
Adalat retard
(product)

31. SNOMED CT UK Drug Extension
Trade Family
Adalat LA (product)
Trade Family Group
Adalat
(qualifier value)
VTM
Nifedipine
(product)
Has_TRADE_
Family_Group
IS_A
IS_A
Additional Concept Classes e.g. Trade Family
VMP
Nifedipine 30mg modified-release tablets
(product)
AMP
Adalat LA 30mg tablets (Bayer Plc)
(product)
IS_A
Concepts have SNOMED descriptions and relationships
A Trade Family (TF) is the abstract conceptual representation of a brand group of related actual medicinal products without representation of any attributes of individual products of that brand group (i.e. dose form, presentation strength, flavour). One TF have one or more AMPs associated.
Trade Family Group (TFG) : This qualifier value concept allows for Trade Family products sharing a common root Trade Family name to be grouped. Trade products grouped under this concept may or may not share the same active ingredients. One TFG have many TFs associated.
Concept class representing ‘brand name’ (brand VTM equivalent) populated and the following use cases identified to support its addition :To support the recording of medication history, Care pathways/protocols, Allergy/Intolerance, Post Co-ordination – Secondary care product description/selection, Pick List Production.
Has_VMP
Has_AMP
VMPP
Nifedipine 30mg modified-release tablets 28 tablet
(product)
AMPP
Adalat LA 30mg tablets (Bayer Plc)
28 tablet 2x14 tablets
(product)
IS_A

32. 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)
This slide shows how dm+d now links up to The Snomed CT International Release
At the bottom you have the 5 dm+d concepts
And as you can see in this case, the VTM nifedipine, has a parent of calcium channel blocking agent, which is a child of cardiovascular drug in the SNOMED CT International release, which will then link up all the way to the top of the SNOMED CT hierarchy
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)

33. Example of VTM in SNOMED CT UK Drug Extension
Virtual Therapeutic Moiety
Fully Specified Name
Preferred Term
Looking at the SNOMED CT UK drug extension in a Browser
In this example you can see Gabapentin has a relationship, IS_A anticonvulsant, IS_A CNS drug, IS_A pharmaceutical / biological product, IS_A SNOMED CT Concept (root). So a defined relationship all the way to the SNOMED CT Concept (root).
Note the many VMP’s that are children of the VTM. C= SNOMED CT International Release concept. M = SNOMED CT UK Drug Extension concept.
Now has Fully specified name and Preferred term.
gabepentin (product) = Fully specified name – in the product hierarchy
gabapentin = Preferred term
Within the SNOMED CT UK Drug Extension the current dm+d derived description for the concept classes of VTM, VMP, VMPP, AMP and AMPP becomes the Preferred Term so a change to the dm+d terms would cause the Preferred Term to be updated.
A dm+d realm description subset is produced and released as part of the SNOMED CT UK Extension data to enable suppliers to identify the correct term for use in interfaces for dm+d implementations . Implementations can identify the dm+d derived term as the preferred term.
Virtual Medicinal Products
SNOMED CT root node

34. 4 Key Points about SNOMED 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)
dm+d isn’t a subset of the UK Drug Extension – they are intersects.

35. 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 concepts 2,286 concepts
VMP – 50 concepts 15,589 concepts
VMPP – 150 concepts 22,683 concepts
AMP – 500 concepts 68,988 concepts
AMPP – 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)
Release schedule described in slide
The weekly release of dm+d means that up to date product information and codes on drugs are always available
Also to note this is a full release so implementers can use as frequently/infrequently as they want.

36. dm+d release on TRUD So on the NEW TRUD Website
Under NHS Dictionary of Medicines and Devices (clicking on left hand downloads) gives the following display
NHSBSA dm+d file And NHSBSA dm+d supplementary file

37. SNOMED CT UK Drug Extension release on TRUD
SNOMED CT UK Drug Extension Editorial Policy
So on the NEW TRUD Website
Under NHS SNOMED releases (clicking on left hand downloads) gives the following display

38. dm+d website
dm+d website is a very useful site and holds a lot of information

39. dm+d information dm+d Browser dm+d Helpdesk In-Demand
dm+d Helpdesk
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

40. Governance and Issues
Information on dm+d governance structures, issues process and the current issues log can be found on the dm+d website:

41. Key Benefits NHS dm+d SNOMED CT UK Drug Extension
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

42. Any questions? A recorded webinar can be found on the TRUD website
Please put yourself on mute
when not talking. Many Thanks.
A recorded webinar can be found on the TRUD website
under UKTC Education and Training Resources as well as
other webinars on SNOMED CT