How would you describe Vademecum Internacional and the services it offers?
VademecumInternacional was founded in Spain more than 53 years ago with the objective of supplying pharmacological information to healthcare professionals in printed format. The company is part of the leading medication information group in the world,UBMMedica, which has long-established brands such as Vidal, MIMS and Vademecum. Today we supply medication reference information in structured electronic format to over 3500 hospital centers across 4 continents. We are integrated with the principal health information technology systems and so provide standardized operations for administrative and clinical medication-handling processes. We are based in Sao Paolo and have clients in Mexico, Honduras and Chile; Latin America has become VademecumInternacional’s main driver of growth.
How did a group made up of brands with a strong local identity (in domestic European markets) expand internationally?
Having been involved in IT for over 20 years and as the undisputed leader in traditional markets, the UBM group plays a key role in new models for European healthcare provision: we are involved in the EPSOS and PSIP therapeutic standardization and insurance Projects.
At the beginning of the last decade, our long-term technological partners (digital health solution providers), in searchof medication databases that could provide an alternative to existing North American ones (which aren’t suited to the non-US market and are in English), asked us to collaborate with them on internationalization.
The group then took 2 key decisions: to offer multilingual solutions (Spanish, Portuguese, English and French) and to link to clinical information based on the evidence of local products in each market following simple guidelines: localization and relevance/concision of information for inclusion in these systems.
How do you adapt the information provided from very different markets to make it international?
Firstly, to internationalize and optimize structural costs, the group has centralized production/maintenance of clinical data in France. Simultaneously, VademecumInternacional processes sourcing/treatment/updates of non-clinical information (pharmaceutical presentations, the laboratories that sell the medications, product identification, administrative information…) for different Latin American countries. This organization (which is very powerful and dynamic) offers several advantages in addition to a reduction in costs to the customer: the nucleus of evidence-based clinical information (EBM) is continually updated (when for example a new side-effect caused by a medication is discovered in one of the countries that feeds the international database, the doctors who prescribe the medication with the same composition as that country will benefit from said warning). Furthermore, although the creation of a list of medications with certain attributes is within the capabilities of many entities, the maintenance of a structured database of virtual medicinal products(VMP) linked to local products and alerts supporting clinical decisions (CDS) requires a world market to achieve the economies of scale that ensure that our customers will receive not only the maintenance of information about a product but also that the development of the product will be followed.
In “Old Europe” private and public investment is now almost exclusively limited to the implementation of more efficient solutions that provide significant and measurable savings. In Latin America, many countries are making the effort to establish and generalize an e-health model that requires the implementation of a medication and clinical support database in a structured, standardized manner. In both areas, healthcare authorities, insurers and healthcare providers need interoperable information about medications.
How do you generate a structured and standardized database?
UBMMedica’s more than 20 years of experience integrating with different software providers has allowed us to form a clear idea of how to code and structure our database to make it 100% integrated and interoperable. This shows in the everyday work of our production team linking our information to its corresponding international terminology. With the support of ‘multi-terminological’ databases (connection from the Vidal Unified Multilingual Thesaurus to UMLSdatabases), all our information is indexed. We use normalized interoperable international codes (taxonomy based on hierarchically structured semantic thesauruses [synonyms, derivatives]): CIE 9, 10 and 11, ATC, LOINC, EDQM, Mesh, Icpc2, SNOMED-CT… and from the point of view of treatment of concepts/denomination of medications, we work with different levels of VMP, AMP and AMPP.
How do you connect the database to the Electronic Health Record (EHR)?
Without a connection to a medication database and CDS, an Electronic Health Record will be unlikely to reduce medication costs or provide quality health statistics. Furthermore, when the success of technological facilities depends more on human factors (resistance to change, slowing down of processes compared to the paper era) than the technologies themselves, it should offer clear benefits in exchange, such as time savings for the user and increased patient safety.
The DB / EHR connection not only improves patient safety (and in concrete cases avoids lethal errors) but it also provides healthcare professionals with essential information for their clinical practice which is not easy to find and especially not very accessible from their workflow. For example, a connected system, in addition to providing and registering the side-effects of a prescription, will only show information relevant to the patient in question, and will provide replacement medications in accordance not only with the structure/stock/guidelines of the center but also the physio-pathological state of the patient.
In an overall context of cost reduction, measurement of ROI and improvement in the health of patients, DB / EHR connection accentuates the benefits of investment in the Electronic Health Record (EHR). Direct advantages include:
- For the healthcare professional: avoiding the many medication errors that occur everyday across the world and reducing the pressure on care as more information is made available in less time.
- For administrators (Private Entities): To attract the best healthcare professionals, private actors should provide added value, service and safety in IT and clinical processes. Furthermore, as patients are increasingly well informed, centers which have made investments in the quality of care will set themselves apart from the competition.
- For the patient: knowing that your treatment has been evaluated according to your Physio-pathological parameters and that the risk of reactions between medications has been reduced gives an impression of the value and quality of the service you have received.
Why is it important for healthcare centers and professionals to have a tool that prevents patient medication errors?
Errors in the prescription of a determined medication to a patient are too common in the day to day work of healthcare professionals across the world. Different studies in different countries show this to be true. For example, a study carried out for the National Health Service (NHS) in the United Kingdom calculated that an approximate average of 60 patients die every day due to a fatal error in the medication prescribed.
Similarly in Spain, a study by the Ministry of Health into adverse medication-related events found that 9.3% of hospital stays were due to serious adverse reactions to medication with prescription-related errors being the most common cause of these, at 30%.
In New Zealand, the Health Ministry estimates that every year around 5000 patients suffer medication errors. Of these, patients 150 end up dying and over 400 suffer permanent disability as a result of errors made regarding their medication. Finally, in the United States it is calculated that medication errors affect 1.5 million people every year. 400,000 of those affected are hospitalized at a cost of 3.5 billion dollars in additional medical costs.
A database providing pharmacological knowledge and clinical decision support makes for a safer prescription process without medication errors as well as guaranteeing greater control over purchases and thus savings to the Public or Private Healthcare System.
