Dr Malcolm Partridge, Director of Pharmacy, Derby City General Hospital, UK.
The British National Formulary (BNF) has been available on CD-ROM for some time now. The BNF is continually reviewed and updated every 6 months and volume 33 of the current format was made available in March 1997 along with the electronic version. In summary, the eBNF is currently exactly that - a graphics based CD-ROM of the paper version offering no obvious advantage to the usual audience of pharmacists, doctors and nurses who need rapid access to drug information data whilst decision making at the bedside. One has the feeling at times whilst scanning through the various options that because the BNF is essentially a database that there must have been a "keeping-up" derived obligation to produce it on CD-ROM and that a clarity of purpose in doing so is lacking.
There are, however, other potential audiences such as students and possibly the public generally who might choose to browse more leisurely through the eBNF as a library resource. in this context the opportunity to "cut" and "paste" articles for review or project work is extremely useful and in this context the eBNF offers many of the general advantages of CD-ROM such as some customising for annotating text and adding bookrnarks, References, are not included for the researcher or drug information pharmacist and rarely does the eBNF offer more than an exact transcription of the paper version. Adding references to advice, doses and information given would be a reasonably easy development, assuming the information to be well researched, and this would be well received by the professions.
The eBNF is an incomplete version of the paper BNF there being no DPF, NPF, Index of Manufacturers, and Yellow card information. Section 9 - relating to additional labelling, warnings etc. is also absent. The graphic pages are also accessed separately which if one is trying to manage paracetamol overdose interpretation is most unhelpful. The clarity of these graphics is also not good.
In our hospital we challenged the eBNF to a contest with the paper version. Six routine daily therapeutic questions were put to two pharmacists -one for each source. The paper BNF accessed the information first on every occasion for the practical answer that was required. The most common problem encountered was lack of hot links between keywords. This would have made all the difference on a number of occasions. "What is the dose of clonidine in migraine" was a good illustration of this. It must be remembered that the paper BNF is carried in the pockets of many clinical pharmacists and junior medical staff and is available for answers immediately at the bedside. A pocket notebook version of EBNF is a must, therefore, for the future although a readable type face for all the information may be difficult to achieve. Is there a version planned for the Psion, Nokia or equivalents?
We found the fastest way to access information was to use the contents view box, often entering only 2-3 characters was sufficient to find expected target words which was impressive.
To the professional familiar with daily use of the paper version of the BNF, the EBNF has very much the feel of an evolving asset. The potential place of such a resource as a framework. for computer prescribing, drug interaction scanning, automatic additional labelling and advice in dispensing, hot linking to in-depth detailed referenced information, perhaps linked to Martindale - the Extra Pharmacopoeia or to comparative drug reviews and costs such as the Drugs and Therapeutics Bulletin (both of which are already available on CD-ROM) or to the MeReC bulletin makes the future for development. of the eBNF exciting. These ideas would be a major leap forward in comparison to current practice. But don't hold your breath. Such developments, whilst clearly technically possible now, are beyond the resource of most health institutions. I fear also that a significant time lapse is required before the culture of the health professional's prescribing atid administration enviroment will be ready for such automation.
The priority for further development of the eBNF must he the establishing of a good network of hot links to important key words e.g. dose, posary data, interactions, conditions, trade names, group coupons etc.
'l'o be fair, the editors make clear through the "help" dialogues that they do see that the future of the eBNF will be in "intelligent decision qupport and as a prescribing tool linking to patient, records" and they must be encouraged to develop and prepare for this goal as an inevitable long term outcome of the venture. W'hen this is achieved there is no question that the eBNF will have come into its own and will be as Pharmacists talk of - New Millennium Age. I'm also certain that a pocket version of all this will be here in the not too-distant future - such developments seern inevitable. There are many healthcare professionals who just can't wait!
The opinions expressed are those of the author and colleagues and not the institution in which they work.
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Correspondence to:
Director of Pharmacy Derby City General Hospital, Uttoxeter Road,