The NZF

• An independent resource providing healthcare professionals with clinically validated medicines information and guidance on best practice, enabling healthcare professionals to select safe and effective medicines for individual patients.

The NZF

• Developing a range of data sets aligned with SNOMED CT to support system interoperability to enable alerts and reminders

Problems in Health Care

• Patient Harm

• Unnecessary Care

• Waste

• Lack of Transparency

Problems in Health Care

Adverse events reported for 2012–13 include:

• 179 clinical management events, including delays in treatment, concerns about the accuracy of diagnoses, inadequate patient monitoring in hospital, and near misses

• 24 medication events, with 11 of these related to administration of an incorrectly prescribed drug or drug dose.

Making health and disability services safer—Serious Adverse Events report 2012–13 (HQSC)

Meaningful Objectives

• Improve quality, safety, efficiency and reduce disparities

• Engage patients

• Improve coordination of care

• Improve population health and interact with public health programs

Alerts & Reminders

• May reduce errors through timely information about– Indications– Contra-indications– Drug-Drug interactions– Appropriate dose ranges– Drug-Food interactions– Precautions for specific drug-disease combinations– Relevant abnormal laboratory test results (e.g. rising

creatinine levels)– Drug allergies

Alerts & Reminders

• Alerts and reminders must be– Specific– Useful– Timely

• Otherwise they will create noise that will be– Ignored– Overridden

• Clinicians override drug alerts 49% to 96% of the time

Alerts & Reminders

• Highest potential for reducing & preventing errors

• Difficult technology

– Labour intensive

– Still evolving

• Lack of CDS standards

SNOMED CT Integration

SNOMED CT Integration

SNOMED CT Integration

Shrimp Terminology Browser: SNOMED Clinical Terms Australian extension

Alert Examples—Indications

• Diagnosis: Acute Gout (SCTID: 24595009)

• Rx: Colchicine (SCTID 387413002)

Alert Examples—Contra-Indications

• Diagnosis: Acute gout (SCTID: 24595009)

• Rx: Colchicine (SCTID 387413002)

• Previous Clinical Finding: Sickle Cell Anaemia (SCTID 127040003)

Unintended Consequences

• Found that a widely used CPOE system facilitated 22 types of medication error risks from mis-design

JAMA. 2005 Mar 9;293(10):1197-203.

Summary

• The NZF can support system interoperability to enable alert and reminder development

• Alerts and reminders must be– Specific– Useful– Timely– Fully validated and tested

• Needs to be a collaborative approach to development