The San goes live with AMT for drug allergies

The Sydney Adventist Hospital (SAH) has gone live with an updated version of its SNOMED-enabled allergies list that includes mapped brand and generic names for medications through the Australian Medicines Terminology (AMT).

SAH, also affectionately known as The San, first instituted an allergies pick-list based on SNOMED-CT AU within its electronic medical record SanCare in 2011. Previously, about 90 per cent of allergies information was entered as free text, as nurses and clerical staff had difficulty finding the right description.

Following the introduction of SNOMED-CT AU, the amount of coded allergy data improved from about 10 per cent to over 60 per cent. Both clinicians using the EMR as well as patients who were using the hospital's pre-admission module eAdmissions were managing to code their allergies through the list, which meant reports were then able to be integrated into the hospital's dietetics system CBORD and its MetaVision ICU system.

The hospital then discovered that the remaining 40 per cent of allergies that were still being entered as free text were predominantly drug-related, so it began a two-year process, working with NEHTA, to institute a version of the AMT.

According to SAH's project manager for health informatics, John Sanburg, it is now hoped that levels of allergies entered as code will rise to over 90 per cent. Mr Sanburg said the hospital had created its own drug-allergy list but it was not “heavy duty” enough, so NEHTA guided it in the direction of the AMT.

“If a patient comes in and says they are allergic to Panadeine, which is paracetamol plus codeine, the patient wouldn't know if it was the paracetamol or the codeine that they were allergic to,” Mr Sanburg said.

“If they say they are allergic to codeine that's all very well, but there are about 70 different trade names of codeine on the market. We don't want to list 70 so we have to select the most common. What we have done is mapped the trade and the generic together so we define the same thing.”

The hospital still encourages the clinicians to enter some form of free text in the EMR via a comments section if they think it's necessary. It also plans to do a problems/co-morbidities list along similar lines.

“If someone says I've had a CVA or I had a stroke or I had a cerebral vascular accident, they are all the same thing," Mr Sanburg said. "We have to map it all back to the same common code so that whatever the clinician puts in, it has to lead everyone back to the same source.”

The hospital's health information management section and its medical records manager, Lucy White, also worked on the project, conducting an audit of how many different forms there were that could record allergies, along with the medication chart. They found there were potentially 49, Mr Sanburg said.

“We have tried to rationalise that and cut it down. Now they have one common allergy form that they call the MR00 and that stays in the front of the notes. That gets reconciled when a patient is discharged, but the staff can add to that throughout the episode of care and health information management can add that to the electronic system.

“The allergy is added to the patient's medical record number (MRN) so that it is coded in a way that when a patient comes back, that same allergy will appear.”

Through eAdmissions, which SAH developed in association with Sydney firm EpiSoft, about 30 per cent of pre-admissions forms are now being filled out by the patients themselves before they come to hospital. eAdmissions has the same ability to code their allergies through a patient-friendly list that is then linked to the main allergies list, Mr Sanburg said.

“Likewise with food, if they have an anaphylactic reaction to nuts or something, they would choose that and that will come across to our system and will also go across to CBORD, which is our diet module, and because it's all coded you can interface it nicely.”

For food and contrast allergies, it is using severity levels, he said.

“With the food side of things – and we worked closely with dieticians about this – it is listed as an intolerance or an allergy, and it defaults to whatever the most common one is. The user has the ability to override that, but it gives the dietician some better understanding of the allergy as there are different degrees.”

Data about contrast allergies is sent to the Agfa radiology information system, and the clinician or the patient can note the degree of severity in terms of mild, moderate or severe.

“That helps radiology to have a better understanding. For example, if you came in as a patient and had a mild reaction to a contrast, they might give you some antihistamine and push through it. If you had anaphylactic reaction to the contrast they wouldn't even go there. That whole degree of severity is important to radiology because they can medicate you, push through and persist with the test.”

Mr Sanburg said the two-year process has been a challenge, and while he is yet to crunch the numbers on uptake by clinicians, the anecdotal feedback has been very positive.

“We are looking forward to seeing that 60 per cent rise right up to about 90 per cent,” he said.

Posted in Australian eHealth

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