On-line Poisons Information in New Zealand: Current Status and Future Challenges On-line Poisons Information in New Zealand: Current Status and Future

On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:

Current Status and Future Current Status and Future ChallengesChallenges


Current Status and Future Current Status and Future ChallengesChallenges

Dr John S FountainNew Zealand National Poisons CentreDr John S FountainNew Zealand National Poisons Centre

On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:Current StatusCurrent Status

On-line Poisons Information On-line Poisons Information in New Zealand:in New Zealand:Current StatusCurrent Status

In 1997 it was recognised that the National Poisons Centre needed to improve its service provision

Key to this was access to a high quality poisons information resource

Poisindex® was reviewed as a possible source… but found lacking

Work was initiated to develop an in-house poisons information database

In 1997 it was recognised that the National Poisons Centre needed to improve its service provision

Key to this was access to a high quality poisons information resource

Poisindex® was reviewed as a possible source… but found lacking

Work was initiated to develop an in-house poisons information database

New ZealandNew ZealandNational Poisons CentreNational Poisons Centre


Inefficiencies existed within Inefficiencies existed within the Poisons Centre due to the Poisons Centre due to “down-time” between “down-time” between answering telephone callsanswering telephone calls

By working on TOXINZ By working on TOXINZ content during this period content during this period this time was gainfully this time was gainfully utilisedutilised

As time went by the database As time went by the database grew and in 1998 feed back grew and in 1998 feed back on quality of content was on quality of content was soughtsought

Inefficiencies existed within Inefficiencies existed within the Poisons Centre due to the Poisons Centre due to “down-time” between “down-time” between answering telephone callsanswering telephone calls

By working on TOXINZ By working on TOXINZ content during this period content during this period this time was gainfully this time was gainfully utilisedutilised

As time went by the database As time went by the database grew and in 1998 feed back grew and in 1998 feed back on quality of content was on quality of content was soughtsought



High demand from EDs for access to the CD-Rom lead its release to New Zealand hospitals in 2000

High demand from EDs for access to the CD-Rom lead its release to New Zealand hospitals in 2000





In 2002 TOXINZ, an Internet accessible version of the database, was developed and released, replacing the CD-Rom

In 2002 TOXINZ, an Internet accessible version of the database, was developed and released, replacing the CD-Rom

TOXINZ currently contains 165,000 listed chemicals, chemical products, pharmaceuticals, plants and hazardous creatures

Has three levels of access:First aid (free access)Primary Care (subscription)Full Management (subscription)

TOXINZ fundamentally changed the way poisons information is provided in New Zealand

TOXINZ currently contains 165,000 listed chemicals, chemical products, pharmaceuticals, plants and hazardous creatures

Has three levels of access:First aid (free access)Primary Care (subscription)Full Management (subscription)

TOXINZ fundamentally changed the way poisons information is provided in New Zealand

First First AidAid

Primary Primary CareCare

Full Full CareCare

Information Source

(2005-2006)

Percentage Use Weekly Monthly Yearly

TOXINZTOXINZ 87.187.1 1010 00ED protocols 4040 2020 4.34.3

Textbook 15.715.7 22.922.9 2.92.9

Other electronic 11.411.4 5.75.7 1.41.4

Telephone advice 2.92.9 15.715.7 4040

Poisindex® 00 00 00

Survey of Hospital Based TOXINZ Users(October 2005 – January 2006)

Survey of Hospital Based TOXINZ Users(October 2005 – January 2006)

(100 questionnaires to 15 hospitals with a 70% response rate)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

ENQUIRIES

1995-1996

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

YEAR

HOSPITAL ENQUIRIES

TELEPHONE

Impact on Hospital Enquiry NumbersImpact on Hospital Enquiry Numbers

A 79% decline in hospital telephone enquiries over 10 yearsA 79% decline in hospital telephone enquiries over 10 years

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

ENQUIRIES

1995-1996

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

YEAR

HOSPITAL ENQUIRIES

TOXINZ

TELEPHONE

Impact on Hospital Enquiry NumbersImpact on Hospital Enquiry Numbers

A 338% increase in total hospital enquiries over 10 yearsA 338% increase in total hospital enquiries over 10 years


Future ChallengesFuture Challenges


Future ChallengesFuture Challenges

Increasing Range of Substances:Increasing Range of Substances:

New chemical products are being marketedNew chemical products are being marketed

Increasing range of product trade namesIncreasing range of product trade names

New drugs are being developedNew drugs are being developed

Transfer of new organismsTransfer of new organisms

International use of TOXINZInternational use of TOXINZ

Future ChallengesFuture ChallengesFuture ChallengesFuture Challenges

Changing Nature of Medical Information:Changing Nature of Medical Information:

There is constant change in medical and, There is constant change in medical and, particularly, toxicological knowledgeparticularly, toxicological knowledge

Treatment regimens (e.g. decontamination Treatment regimens (e.g. decontamination procedures) are revised, new antidotes are procedures) are revised, new antidotes are developeddeveloped

Old methodologies are challenged and new Old methodologies are challenged and new approaches adoptedapproaches adopted


Database Resource Requirement

0

20

40

60

80

100

TIME

EFFORT

(

%

)

New Data

Maintenance

Future ChallengesFuture ChallengesFuture ChallengesFuture ChallengesDatabase MaintenanceDatabase Maintenance

It is easy to produce a database of medical It is easy to produce a database of medical toxicology informationtoxicology information

It is very difficult to maintain that dataIt is very difficult to maintain that data

What makes a superior poisons information What makes a superior poisons information database is its ability to be database is its ability to be

maintained/updatedmaintained/updated


Work smarter not harderWork smarter not hardere.g. develop innovative database systemse.g. develop innovative database systems

Engage in international co-operationEngage in international co-operatione.g. with other PICse.g. with other PICs

Obtain ongoing funding to continue Obtain ongoing funding to continue development of TOXINZdevelopment of TOXINZ


On-going funding is needed.On-going funding is needed.

How can this be justified when we are How can this be justified when we are already funded to provide a telephone already funded to provide a telephone

enquiry service with access to enquiry service with access to experienced poisons information experienced poisons information

specialists and clinical toxicologists?specialists and clinical toxicologists?

We need to show that TOXINZ is a We need to show that TOXINZ is a necessary addition to the current necessary addition to the current

serviceservice

We need to show that TOXINZ is a We need to show that TOXINZ is a necessary addition to the current necessary addition to the current

serviceservice


Disruptive innovationDisruptive innovation

Technological convergenceTechnological convergence

Technological paradigm shiftTechnological paradigm shift


We can Apply Business Concepts:We can Apply Business Concepts:


A term describing a technological innovation, product, or service that uses a "disruptive" strategy, rather than a "revolutionary" or "sustaining" strategy, to overturn the existing dominant technologies or status quo products in a market


Bower JL, Christensen CM. Disruptive Technologies: Catching the Wave. Harvard Business Review 1995; January-February: 43-53.

Internet accessible poisons informationInternet accessible poisons information

Is a disruptive innovationIs a disruptive innovation

Created from other disruptive innovations e.g.:Created from other disruptive innovations e.g.:Desk top computersDesk top computersDatabase softwareDatabase softwareInternetInternet




Examples of Disruptive InnovationsExamples of Disruptive Innovations

““Desk top” ComputerDesk top” ComputerMainframe ComputerMainframe Computer


Valve RadioValve Radio Transistor RadioTransistor Radio

Examples of Disruptive InnovationsExamples of Disruptive Innovations

http://en.wikipedia.org/wiki/Image:Regency_transistor_radio.jpg

Bower JL, Christensen CM. Disruptive Technologies: Catching the Wave. Harvard Business Review 1995, January-February 1995. 43-53.




Disruptive innovations do not need to meet high Disruptive innovations do not need to meet high level requirements to satisfy the initial consumers level requirements to satisfy the initial consumers

(e.g. telephonic specialist clinical toxicology advice).(e.g. telephonic specialist clinical toxicology advice).

Once adopted, the product will evolve to meet Once adopted, the product will evolve to meet successively higher user demands.successively higher user demands.

Eventually, the disruptive innovation will replace the Eventually, the disruptive innovation will replace the incumbent technology.incumbent technology.


Hacklin F, Raurich V. Implications of technical convergence on innovation trajectories: the case of ICT industry. International Journal of Innovation and Technology Management 2005; 2 (3); 313-330.

Disruptive innovationDisruptive innovationTechnological convergenceTechnological convergence

Technological convergence is the trend of Technological convergence is the trend of technologies to merge into new technologies technologies to merge into new technologies that bring together a myriad of media.that bring together a myriad of media.

CameraCamera TelephoneTelephone

Technological ConvergenceTechnological Convergence

CameraphoneCameraphone


Information StorageInformation Storage(patient information)(patient information)

Information CollectionInformation Collection(laboratory results)(laboratory results)


ComputerComputer



Patient InformationPatient Information Poisons InformationPoisons Information


Watts M, Fountain J, Reith DM, Herbison P. Clinical utility of an electronic poisons information and clinical decision support tool. Int J Med Inform 2003; 71: 3-8.

Fountain JS, Reith DM, Watts M. Comparison of CD-Rom and Internet access to clinical information. Int J Med Inform 2005; 74: 769-777.

Clinicians prefer to access poisons information via a computer than a telephone and access that information more often


Dosi G. Technological paradigms and technological trajectories: a suggested interpretation of the determinants of technical change. Research Policy 1982; 11: 147-62.

Disruptive innovationDisruptive innovationTechnological convergenceTechnological convergenceTechnological paradigm shiftTechnological paradigm shift

Certain technologies are identified and developed to provide a product or service. Overtime emergent technologies displace these paradigms producing a technology paradigm shift.


Dr WhoDr WhoWilliam HartnellWilliam Hartnell

(1963 - 1966)(1963 - 1966)


Dr WhoDr WhoSylvester McCoySylvester McCoy

(1987 - 1996)(1987 - 1996)


Dr WhoDr WhoSylvester McCoySylvester McCoy

(1987 - 1996)(1987 - 1996)


Dr WhoDr WhoDavid TennantDavid Tennant

(2005 -)(2005 -)


Dr WhoDr WhoDavid TennantDavid Tennant

(2005 -)(2005 -)



Technological convergenceTechnological convergence

Technology paradigm shiftTechnology paradigm shift

If our Poisons Centre wishes to If our Poisons Centre wishes to meet the needs of Health meet the needs of Health

Professionals we must provide Professionals we must provide an Internet accessible an Internet accessible

database of high qualitydatabase of high quality


Documents

On-line Poisons Information in New Zealand: Current Status and Future Challenges On-line Poisons Information in New Zealand: Current Status and Future