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RxNavInterfaces to drug information sources

Lister Hill National Center for Biomedical CommunicationsBrown Bag Lunch Series

August 1, 2008

Olivier Bodenreider

Lister Hill National Centerfor Biomedical CommunicationsBethesda, Maryland - USA

Lister Hill National Center for Biomedical Communications 2

Acknowledgments

Stuart NelsonKelly Zeng

Lee PetersRamez Ghazzaoui

Lister Hill National Center for Biomedical Communications 3

Outline

RxNormDrug vocabulary integrationDrug vocabulary standardization

Visualizing drug information: RxNavProcessing drug information: RxNorm APIIntegrating drug information sourcesApplications

RxNorm

Overview

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Motivation

Exchange of information requires standardized names

Ordering drugsChecking interactionsInventory management

No standard naming conventions for drugsIntegrating drug vocabulariesUnique identifiers for drugsSpecify relations among drug entities

Drug vocabulary integration

RxNorm

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UMLS-like approach

9 source vocabulariesSynonymous names grouped into an RxNorm conceptUnique identifiers (RxCUI)RRF format

DifferencesRxNorm creates its own namesPrincipled use of names relationshipsLimited scope: drug names

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Source vocabularies in RxNorm

Gold Standard AlchemyMaster Drug Data Base (Medi-Span, Wolters Kluwer Health)

Multum MediSource LexiconMicromedex DRUGDEXFDA National Drug Code DirectoryFDA Structured Product LabelsNat’l Drug Data File (First DataBank Inc.)SNOMED Clinical Terms (drug information)Veterans Health Administration Nat’l Drug File

15

60

10

67

11

42

79

91*

12

(in thousands,as of July 2008)

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RxNorm concept

Acetaminophen

161

AcetaminophenParacetamolAPAPParacetamol productAcetaminophen (product)Acetaminophen (substance)Acetaminophen product

MMSL:5005SNOMEDCT:387517004SNOMEDCT:90332006NDDF:001605MTHSPL:362O9ITL9DMMSL:4119MMSL:d00049VANDF:4017513MMSL:4992MMSL:52845MTHFDA:50612UMLS: C0000970

SNOMED CT MeSHMultumNDDF…

Ingredient

Drug vocabulary standardization

RxNorm

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Normalization

Lexical levelConventions for representing strength, units, etc.

Structural levelGeneric vs. Brand names Atomic elements: Ingredient, Strength, Dose formCombinationsPrinciple set of relationships among the different types

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Normalization Lexical levelGS Digoxin 0.25mg/1mL Solution for injectionGS Digoxin 500mcg/2mL Solution for injectionMDDB 'Digoxin Inj 0.25 MG/MLMMSL digoxin 250 mcg/mL (0.25 mg/mL) injectable solutionMMSL Digoxin, 250 mcg/mL (0.25 mg/mL) injectable solutionMMX Digoxin 0.25 MG/ML Injection SolutionMTHFDA DIGOXIN 0.25 MG INTRAMUSCULAR INJECTION, SOLUTIONMTHFDA DIGOXIN 250 MCG INTRAMUSCULAR INJECTIONMTHFDA DIGOXIN 250 MCG INTRAVENOUS INJECTIONMTHSPL digoxin 0.25 MILLIGRAM In 1.0 MILLILITER INTRAVENOUS INJECTIONMTHSPL Digoxin 250 MICROGRAM In 1 MILLILITER INTRAVENOUS INJECTION, SOLUTIONNDDF DIGOXIN 250 mcg/mL INJECTION AMPUL (ML)NDDF DIGOXIN 250 mcg/mL INJECTION DISPOSABLE SYRINGE (ML)NDDF DIGOXIN@250 mcg/mL@INJECTION@AMPUL (ML)SNOMEDCT Digoxin 250micrograms/mL injection solution 2mL ampuleSNOMEDCT Digoxin 500micrograms/2mL injectionVANDF DIGOXIN 0.25MG/ML INJ[…] […]

Digoxin 0.25 MG/ML Injectable Solution

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Normalization Structural level

Structural levelGeneric vs. Brand names Atomic elements: Ingredient, Strength, Dose formCombinationsPrinciple set of relationships among the different types

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Normalized form

Ingredient

Dose form

Strength

Ingredient

IngredientStrength Dose form

Strength

4mg/ml

Ingredient

Fluoxetine

Dose form

Oral Solution

Semantic clinical drug component

Semantic clinical drug

Semantic clinical drug form

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Generic vs. Brand

GenericIngredient(IN)Clinical drug form(SCDF)Clinical drug component(SCDC)Clinical drug(SCD)

BrandBrand name(BN)Branded drug form(SBDF)Branded drug component(SBDC)Branded drug(SBD)

tradename_of

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Relations among drug entities

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Relations among drug entities (revisited)

Ingredient

Cetirizine

C. Drug Component

Cetirizine 5MG

C. Drug Form

Cetirizine Oral Tablet

C. Drug

Cetirizine 5 MG Oral Tablet

Brand Name

B. Drug Component

Zyrtec

B. Drug Form

Cetirizine 5MG[Zyrtec]

B. Drug

Cetirizine Oral Tablet[Zyrtec]

Zyrtec 5 MG Oral Tablet

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RxNorm database

9 data sourcesGold Standard AlchemyMaster Drug Data BaseMultum MediSource Lex.Micromedex DRUGDEX FDA National Drug Code Directory FDA Structured Product LabelsNational Drug Data File Plus Source Vocabulary SNOMED Clinical Terms VA National Drug File

Content4,109 ingredients9,845 brand names

13,380 clinical drug comp.14,036 branded drug comp.18,245 clinical drugs14,769 branded drugs

8,193 clinical drug forms11,520 branded drug forms

104 dose forms

(as of July 1, 2008;excluding obsolete data)

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Recent changes

Generic/Branded PackCollection of drugs prescribed as one unit

Z-PAK = {6 (Azithromycin 250 MG Oral Tablet [Zithromax]) } Pack [Z-PAKS]

Nordette-28 ={21 (Ethinyl Estradiol 0.03 MG / Levonorgestrel 0.15 MG Oral Tablet) / 7 (Inert Ingredients 1 MG Oral Tablet) } Pack [Nordette 28 Day]

Triphasil-21 ={6 (Ethinyl Estradiol 0.03 MG / Levonorgestrel 0.05 MG Oral Tablet) / 10 (Ethinyl Estradiol 0.03 MG / Levonorgestrel 0.125 MG Oral Tablet) / 5 (Ethinyl Estradiol 0.04 MG / Levonorgestrel 0.075 MG Oral Tablet) } Pack [Triphasil 21 Day]

Active GPCK forms 217Active BPCK forms 279

Generic/Branded packsIngredient

C. Drug Component C. Drug Form

C. Drug

Brand Name

B. Drug Component B. Drug Form

B. Drug

B. PackG. Pack

Zithromax 250 MG Oral TabletAzithromycin 250 MG Oral Tablet

Z-PAK{6 (Azithromycin 250 MG Oral Tablet) } Pack

Azithromycin 250 MG Azithromycin Oral Tablet Azithromycin 250 MG[Zithromax]

Azithromycin Oral Tablet[Zithromax]

ZithromaxAzithromycin

Visualizing drug information

RxNav

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RxNav

Visualization and navigationRxNorm browserSpelling correctionSearch on names and codes (including proprietary)Standalone application

RxNorm database at NLMLocal RxNorm database

Drug information processingAPI to the RxNorm databaseWeb services

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RxNav demo

http://mor.nlm.nih.gov/download/rxnav/

Processing drug information

RxNorm Application Programming Interface

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RxNorm API

Made available in March 2008Based on Web Services

SOAPIndependent of any programming language

Used by RxNav and MyMedicationListEnable access to all information displayed in RxNavDocumentationhttp://mor.nlm.nih.gov/download/rxnav/

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List of functions 1/2

Housekeeping functionsgetRxNormVersion( )getIdTypes()getRelaTypes()getTermTypes()

Find RxNorm conceptsBy name: findRxcuiByString( searchString )By code: findRxcuiById( idType, id )Help: getSpellingSuggestions( searchString )

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List of functions 2/2

Get RxNorm concept propertiesgetRxConceptProperties( rxcui )getNDCs( rxcui )

Get RxNorm concept relationsBy rel.: getRelatedByRelationship( rxcui, rel-list )By type: getRelatedByType( rxcui, type-list )All: getAllRelatedInfo( rxcui )

Convenience functiongetDrugs( name )

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Documentation

Java

Coming up soon: Perl, .NET

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Implementation Perl client

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Implementation .NET client

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Coming up soon

Get proprietary information in a given sourceSubject to UMLS intellectual property restrictionsRequires a “ticket” (similar to UMLSKS API)Use cases

Access to exact names and codes in a given sourceSupport for mapping across drug vocabularies through RxNorm

– Code in Multum → code in First Data Bank

Multi-ingredient search

Integrating drug information sources

Link out

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FDA Standard product labels

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Coming up soon

Currently no clinical informationIn RxNormProcessable through RxNav

Textual information available through the links to DailyMedand MedlinePlus Drugs

Clinical information available in other sourcesE.g., MedlinePlus drugs, NDF-RTSoon to be integrated in RxNav

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MedlinePlus Drugs

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National Drug File Reference Terminology

Developed by the Veterans Health AdministrationPart of the VA clinical information systemNon-terminological information

Pharmacologic class (isa)Indications (may_treat, may_diagnose, may_prevent)Contraindications (drug_contraindicated_for)Mechanism of action (mechanism_of_action_of)Drug-drug interactions (contraindicated_with)Physiology (has_physiologic_effect)Metabolism (metabolic_site_of, metabolizes, pharmacokinetics_of)

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NDF-RT Examples

Cetirizinedrug_contraindicated_for Drug Allergymay_treat Rhinitis, Allergic, Perennialmay_treat Urticariahas_physiologic_effect Decreased Histamine Activity

Applications

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Applications

Terminology integration and standardization (RxNorm) enables interoperability and mapping across vocabulariesSpecific applications

Data integrationMedication reconciliationPersonal Health RecordE-prescribing / CPOECDA R2

[Zeng, AMIA 2008]http://mml.nlm.nih.gov/

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Quality control in RxNorm

Multiple equivalent paths between RxNorm entities

Ingredient

Cetirizine

C. Drug Component

Cetirizine 5MG

C. Drug Form

Cetirizine Oral Tablet

C. Drug

Cetirizine 5 MG Oral Tablet

consists of inverse isa

has ingredient has ingredient

getRelatedByRelationship( r, consists of ) ogetRelatedByRelationship( *, has ingredient)

?≡

getRelatedByRelationship( r, inverse isa) ogetRelatedByRelationship( *, has ingredient)

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Examples of application

Quality control in RxNorm: Results35,000 pairs of paths investigatedFew discrepancies detectedTypes of errors

Obsolete brand namesObsolete branded drug formsErroneous relations

Discrepancies reported to the RxNorm team

[Peters, AMIA 2008]

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Usage statistics

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References

RxNormhttp://www.nlm.nih.gov/research/umls/rxnorm/index.html

RxNav and RxNorm APIhttp://mor.nlm.nih.gov/download/rxnav/

MedicalOntologyResearch

Olivier Bodenreider

Lister Hill National Centerfor Biomedical CommunicationsBethesda, Maryland - USA

Contact:Web:

olivier@nlm.nih.govmor.nlm.nih.gov