Drug coding in Wales. Robin Burfield Health Solution Wales. 13th February 2002

Transcription

1 Drug coding in Wales Robin Burfield Health Solution Wales 13th February 2002

2 How Wales in organised National Assembly for Wales Health Solutions Wales Prescribing Services Unit (PSU) Hospital Pharmacy Team supports Welsh EDS Pharmacy system 15 Trusts - Pharmacy systems 11 Welsh EDS 1 JAC/Welsh EDS 1 JAC/Ascribe 2 None

3 Origins and Requirements a need for comparative information on medicines covering Primary and Secondary care in Wales prescribing and dispensing Prescribing Services Unit (PSU) produce data on drug usage in Primacy care Asked by the Assembly to include Hospital Pharmacy data into the PSU data analyse the drug data from secondary care link it to the primary care data

4 Problem needs a common drug code scheme No common drug codes Apply the codes to the existing data no resource to add the drug code to the local drug files Maintain the codes Solution Out-source it

5 Drug coding system Single coding system Covering all medicines, devices and appliances Levels Drug, Product and Pack Used across the whole of the NHS in Wales Primary and Secondary care Common drug coding scheme bought-in Common drug codes - master drug file Apply the new drug codes to the existing hospital data Maintain the codes Supplier selected - ASC - Signing contract

6 PCDD design

7 Drug codes - secondary care Drug name Omeprazole Drug name, dose form, strength Omeprazole E/C capsules 20mg Stock record - location and unit of issue Dispensary, 28 day pack Supply record - brand, supplier and packsize Losec, AAH, 28 day pack

8 Composite data model

9 The Medusa Project What is it? Build a data warehouse contains highish-level summary data individual drug and pack level summarised by month, directorate and Trust locality covering purchase and issue data Access via the Intranet A range of displays, graphs and reports Single selection criteria - applies to all reports 2 drugs groups - single drug, group of drugs or all drugs 2 Hospital groups - single hospital, benchmarking club or all hospitals

10 The Medusa Project How does it work? Drug files extracted from each Hospital Pharmacy system Downloaded to HSW and consolidated with PSU drug files Drug files sent to the drug code supplier return their master drug file match each record in our drug files to their master drug file return our drug files with the new drug code added HSW build database holding the master drug file supplied mapping tables that map local drug codes to the master drug file

11 The Medusa Project How does it work? Each month, purchase and issue (and drug) files are extracted from each Hospital Pharmacy system downloaded to HSW and consolidated with PSU data HSW add the files to the data warehouse mapping the drug codes to the master drug file using the mapping files

12 The Medusa Project How does it work? New drugs and unmapped drugs are loaded but not mapped to the master drug file files of new and unmapped drugs are prepared and sent to the supplier for coding Supplier adds the new drug code and returns the files The mapping amendments are added to the database The un-coded drug records are re-matched

13 The Medusa project How does it work? There will always be some drug records that remain unmatched clinical trials, non-drug items New drug codes will not (initially) be held on the Pharmacy system No local coding of drugs No local resource required to code drugs

14 The Medusa project Phased approach Phase 1 - June 2002 BNF chapter 1 Hospital and PSU Sample displays and reports Phase 1 review Phase 2 - December 2002 BNF chapters 2-15 More displays and reports Phase 3 and beyond

15 The Medusa system Benefits - Validation Spelling - drug name, dose form, strength, packsize, etc. BNF code checking and half yearly updates Code updating - AAH link, PIP, EAN and UKCPRS EDI ordering and invoicing via Mediate Price checking - AAH and Unichem price lists Trust mergers drug file mergers Validation and update files will be sent back with the local drug code local checking but updated automatically

16 The Medusa system Benefits - Information Support the information needs of the National Assembly, Health Authorities, Local Health Groups and NHS Trusts Monitor prescribing volume and cost Review cost pressures Monitor prescribing changes, trends and performance Clinical Governance and clinical audit requirements Expand to cover Skillmix, Benchmarking, Dispensing Errors and IV Drug Guide Delivers targets in Prescribing TaF Report and draft National IM&T Development Plan (NIDP)

17 Potential Uses of the data Comparison of data across Primary and Secondary care Comparison of prescribing and dispensing costs Analysis of the influence of secondary care on primary care prescribing and vice versa Unified drug budgets across sectors held by LHGs/LHBs Hospital data fed across into the PIAS system Comparison of purchasing volumes and costs between Trusts Comparison of issue volumes and costs down to directorate or consultant team level between Trusts

18 Potential Uses of the data Analyse and monitor the actual usage and costs of drugs against the following initiatives: National and local formularies and Prescribing Strategies National Service Frameworks (NSFs) Health Improvement Plans (HIPs) Performance Indicators Monitor the cost of the introduction of new drug therapies NICE guidance Forewarning of prescribers starting to use a new drug Monitoring the cost of increasing expenditures

19 The Medusa system Benefits - Messaging Electronic transfer of prescriptions (ETP) loop The prescription data can be transferred from the GP to the Community Pharmacist The endorsed prescription data can be transferred from the Community Pharmacist to PSU for pricing No ETP pilot in Wales Primary - Secondary care loop The patient s medication history can be transferred to the Trust on demand The patient s medication history, as amended during the patient s stay in hospital, can be transferred to the GP and Community Pharmacist on discharge

20 Electronic Health Record (EHR) loop Between GPs, Community Pharmacists and Hospitals for the notification and updating of patient medication changes Underpin a unified health record (EHR) shared by doctors and pharmacists across primary and secondary care Supporting seamless care to allow the transfer of medication information to all clinical professional as they require it subject to security and privacy restrictions and underpin the Electronic Health Record Clearing house for patient medication data

21 All-Wales Drug Contracting loop Identify drugs for inclusion in the tendering process Early warning of new drugs and drugs with increasing usage Monitor usage against the volume contracted for Monitor compliance with the contract by Trusts Monitor contract enhancements to the All-Wales contract and other local agreements Quantify the value of savings realised by the All-Wales contracting process Price comparisons and purchasing benchmarking Automatic updating of Hospital databases with the Regional contract changes

22 Why will it work in Wales Data model is simple Drug codes at two levels not four - Product and Pack Implementation issues are resolved No local coding UKCPRS implemented on release Costs Set-up and implementation cost is low Software funding review after Phase 1 Timescales - Full implementation by December 2002