Digital development: turning the vision into reality

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Digital development turning the vision into
reality

• Colin Macfarlane BNF

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Decision support services

• Interactions

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Decision support services

• Interactions
• Liver disease
• Renal impairment
• Pregnancy
• Breast-feeding

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Decision support services

• Contra-indications
• Allergies
• Side-effects
• Dose checking
• Ingredient doubling
• Therapeutic duplication
• Indication checking

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Contra-indications
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Contra-indications
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Contra-indications
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Medical record
BNF
Ontology
195967001
004391801
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Medical record
BNF
Ontology
Tea-tasters disease
56507008
004391801
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Clinical case studies

• BNF-interactive demo (CBCL)

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Clinical case study 1

• 34 yr lady with migraine headaches
• 4-month history, migraine not controlled by
  first-line measures

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Clinical case study 1

• Medical history
• 1988, mitral valve prolapse
• 2000, first pregnancy (went to term in 2001)
• 2001, transient ischaemic attack (TIA)
• 2004, second pregnancy (went to term in 2004)
• 2005 (1 week ago), non-gonococcal urethritis

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Clinical case study 1

• Medication history
• 2001, warfarin started following TIA
• 2000 2004, heparin throughout both pregnancies
  in place of warfarin
• Current medication
• Warfarin
• Erythromycin
• Paracetamol
• Domperidone

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Clinical case study 1

• Prescribing intention
• Eletriptan
• Problems
• Contra-indicated in TIA
• Interaction with erythromycin

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Clinical case study 1

• Prescribing intention
• Eletriptan
• Problems
• Contra-indicated in TIA
• Interaction with erythromycin
• Breast-feeding message

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Clinical case study 2

• 67 yr man with primary open-angle glaucoma of the
  left eye
• Ophthalmology out-pt clinic suggested timolol eye
  drops

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Clinical case study 2

• Medical history
• 1970, tea-tasters disease
• 1996, congestive cardiac failure
• 2005 (1 week ago), primary open-angle glaucoma of
  left eye

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Clinical case study 2

• Medication history
• 1996, bendrofluazide for heart failure
• 1997, frusemide in place of bendrofluazide
• 1998, lisinopril for heart failure not controlled
  by diuretics alone
• Current medication
• Furosemide 40mg each morning
• Lisinopril 20mg each morning

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Clinical case study 2

• Prescribing intention
• Timolol
• Problems
• Renal impairment message
• Contra-indicated in history of asthma
• Contra-indicated in uncontrolled heart failure

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see notes above
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Medical record
BNF
Ontology
Tea-tasters disease
56507008
004391801
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BNF-i / CSW Case Notes
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BNF-i / CSW Case Notes
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BNF-i / CSW Case Notes

• Interaction erythromycin increases plasma
  concentration of eletriptan (risk of
  toxicity)avoid concomitant use
• Contra-indicated for transient ischaemic attack

Eletriptan 20mg tablets 6
Tablets Eletriptan 40mg tablets 6
Tablets
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BNF-i / CSW Case Notes
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Drug alerts finding the solution

• Created drug ontology
• Delivering warnings securely