On-line Poisons Information in New Zealand Current Status

On-line Poisons Information in New Zealand: Current Status and Future Challenges Dr John S Fountain New Zealand National Poisons Centre

On-line Poisons Information in New Zealand: Current Status

New Zealand National Poisons Centre 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 Zealand National Poisons Centre Inefficiencies existed within the Poisons Centre due to “down-time” between answering telephone calls By working on TOXINZ content during this period this time was gainfully utilised As time went by the database grew and in 1998 feed back on quality of content was sought

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

New Zealand National Poisons Centre In 2002 TOXINZ, an Internet accessible version of the database, was developed and released, replacing the CDRom

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 Aid

Primary Care

Full Care

Survey of Hospital Based TOXINZ Users (October 2005 – January 2006) Information Source (2005 -2006) Percentage Use Weekly Monthly Yearly TOXINZ 87. 1 10 0 ED protocols 40 15. 7 11. 4 2. 9 0 20 22. 9 5. 7 15. 7 0 4. 3 2. 9 1. 4 40 0 Textbook Other electronic Telephone advice Poisindex® (100 questionnaires to 15 hospitals with a 70% response rate)

Impact on Hospital Enquiry Numbers TELEPHONE A 79% decline in hospital telephone enquiries over 10 years

Impact on Hospital Enquiry Numbers TOXINZ TELEPHONE A 338% increase in total hospital enquiries over 10 years

On-line Poisons Information in New Zealand: Future Challenges

Future Challenges Increasing Range of Substances: New chemical products are being marketed Increasing range of product trade names New drugs are being developed Transfer of new organisms International use of TOXINZ

Future Challenges Changing Nature of Medical Information: There is constant change in medical and, particularly, toxicological knowledge Treatment regimens (e. g. decontamination procedures) are revised, new antidotes are developed Old methodologies are challenged and new approaches adopted

Future Challenges Database Maintenance

Future Challenges It is easy to produce a database of medical toxicology information It is very difficult to maintain that data What makes a superior poisons information database is its ability to be maintained/updated

Future Challenges Work smarter not harder e. g. develop innovative database systems Engage in international co-operation e. g. with other PICs Obtain ongoing funding to continue development of TOXINZ

Future Challenges On-going funding is needed. How can this be justified when we are already funded to provide a telephone enquiry service with access to experienced poisons information specialists and clinical toxicologists? We need to show that TOXINZ is a necessary addition to the current service

Future Challenges We can Apply Business Concepts: Disruptive innovation Technological convergence Technological paradigm shift

Future Challenges Disruptive innovation 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.

Future Challenges Disruptive innovation Internet accessible poisons information Is a disruptive innovation Created from other disruptive innovations e. g. : Desk top computers Database software Internet

Future Challenges Examples of Disruptive Innovations Mainframe Computer “Desk top” Computer

Future Challenges Examples of Disruptive Innovations Valve Radio Transistor Radio

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

Future Challenges Disruptive innovations do not need to meet high level requirements to satisfy the initial consumers (e. g. telephonic specialist clinical toxicology advice). Once adopted, the product will evolve to meet successively higher user demands. Eventually, the disruptive innovation will replace the incumbent technology.

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

Technological Convergence Camera Telephone

Technological Convergence Cameraphone

Technological Convergence Information Storage (patient information) Information Collection (laboratory results)

Technological Convergence Computer

Technological Convergence Patient Information Poisons Information

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

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

Technological paradigm shift Dr Who William Hartnell (1963 - 1966)

Technological paradigm shift Dr Who Sylvester Mc. Coy (1987 - 1996)

Technological paradigm shift Dr Who Sylvester Mc. Coy (1987 - 1996)

Technological paradigm shift Dr Who David Tennant (2005 -)

Technological paradigm shift Dr Who David Tennant (2005 -)

Future Challenges Disruptive innovation Technological convergence Technology paradigm shift

Future Challenges If our Poisons Centre wishes to meet the needs of Health Professionals we must provide an Internet accessible database of high quality