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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
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