Current Status and Future Challenges

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Nov 7, 2013 (3 years and 9 months ago)

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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

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

New Zealand

National Poisons Centre

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



First Aid

Primary
Care

Full
Care

Information
Source

(2005
-
2006)

Percentage Use

Weekly

Monthly

Yearly

TOXINZ

87.1

10

0

ED protocols

40

20

4.3

Textbook

15.7

22.9

2.9

Other electronic

11.4

5.7

1.4

Telephone advice

2.9

15.7

40

Poisindex
®

0

0

0

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
E
N
Q
U
I
R
I
E
S
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 Numbers

A 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
E
N
Q
U
I
R
I
E
S
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 Numbers

A 338% increase in total hospital enquiries over 10 years

On
-
line Poisons Information
in New Zealand:

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 Resource Requirement
0
20
40
60
80
100
TIME
E
F
F
O
R
T
(
%
)
New Data
Maintenance
Future Challenges

Database Maintenance

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

Disruptive innovation



Technological convergence



Technological paradigm shift

Future Challenges

We can Apply Business Concepts:

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


Future Challenges

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

Internet accessible poisons information


Is a disruptive innovation



Created from other disruptive innovations e.g.:

Desk top computers

Database software

Internet

Future Challenges

Disruptive innovation

Future Challenges

Examples of Disruptive Innovations

“Desk top” Computer

Mainframe Computer

Future Challenges

Valve Radio

Transistor Radio

Examples of Disruptive Innovations

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

Future Challenges

Future Challenges

Disruptive innovation

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

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 innovation

Technological convergence


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


Camera

Telephone

Technological Convergence

Cameraphone

Technological Convergence

Information Storage

(patient information)

Information Collection

(laboratory results)

Technological Convergence

Computer

Technological Convergence

Technological Convergence

Patient Information

Poisons Information

Technological Convergence

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

Future Challenges

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

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.

Technological paradigm shift

Dr Who

William Hartnell

(1963
-

1966)

Technological paradigm shift

Dr Who

Sylvester McCoy

(1987
-

1996)

Technological paradigm shift

Dr Who

Sylvester McCoy

(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

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

Future Challenges