Open Medication Datasets

In our quest for CCHIT Oncology Certification, we will also be required to be CCHIT Ambulatory EHR certified. This Ambulatory certification has a good amount of overlap with the Meaningful Use requirements, including most of the medication/allergy/drug interaction requirements. I have spent many hours going through medication datasets trying to find the right combination that will give us what we need. This post serves as both a recap of my research for documentation but will hopefully provide a good starting point for others looking for open datasets for medications and allergies.

 

General medication list requirements include:

1.Keeping  a dataset of prescribable  medications. This list must include at a minimum drug name, generic name, dose, strength and route. This list should be comprehensive and concise enough to provide the prescriber with a terse, yet complete list of medication options.

2. A mechanism for documenting current and past medications and keeping that list up to date.

3. A way for providers to add new prescriptions and send them to the pharmacy as (non-faxed) eRx.

4. A way to provide information on any drug interactions.

5. The ability to create CCD/CDA documents for continuation of care.

6. The ability to accept continuation of care documents from other facilities.

7. Not cost a fortune.

 

Given the above requirements, two fundamental notions must be captured in the medications dataset: The drug list and a list indicating drug interactions.

 

Many of the proprietary medication datasets (FDB, Medi-span, etc.) are not open and I am sure they are not cheap.  There are no prices on their website which makes me weary of their pricing strategy. I don’t have time or energy to negotiate pricing and worry about whether I got a good deal.

 

There are open alternatives, the main one being RxNorm.  This dataset is very comprehensive and is freely available. however, it is more of a translation device between other datasets than a terse, canonical list of medicines.  RxNorm is constructed by collating medicines from many sources, FDA, VA, Gold Standard, SNOMED-CT, even the proprietary medications are linked.  Because of the vast breadth of this RxNorm, it is not immediately suitable for fast data entry.

 

This is why Kin-Wah Fung of the Lister Hill National Center for Biomedical Communications, NLM has led the effort to create RxTerms. RxTerms is a curated list of drugs derived from information in RxNorm and is designed for efficient provider data entry. The medication names are distinct, concise and include the required information for prescribing. And each medication or concept in RxTerms links to corresponding concepts in RxNorm. Here is a great demo of their work.

However, RxTerm was not designed to directly provide drug interaction data.

 

For medication interaction data, we will be using the NDF-RT dataset, created and maintained by the U.S. Department of Veterans Affairs, Veterans Health Administration (VHA). This dataset is linkable to both RxNorm and RxTerm and is also freely available.

The queries will be a bit cumbersome but all of the needed data is there. You can try the demo of this interaction mapping at the RxMix site.

 

With these two datasets, RxTerms and NDF-RT, we will be able to provide concise lists of medications to our providers, check drug interactions and transmit and receive continuation of care documents to and from external providers or HIEs.

 

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5 Responses to “Open Medication Datasets”

  1. Cindy Says:

    This looks like a great plan!

  2. vishalicious Says:

    Hi, great blog! I work for a small EMR for nursing homes and its wonderful to read your experiences developing Ankhos. Did you end up using RxNorm and NDF-RT for your system, or did MDToolbox supercede what you were working on?

    • Nick Orlowski Says:

      Yes, we ended up using RxNorm. There have been a lot of improvements from UMLS since then including a new API that helps to understand their content. The main thing we have had to outsource has been medication interaction data. RxNorm does have interaction data now, but our clinicians were not happy with the quality of it. MDToolbox works very well with RxNorm.

      • vishalicious Says:

        Thanks! That’s very helpful. Regarding the medication interaction data, what was it that the clinicians didn’t like?

        In our industry, most of the bigger vendors are using First Databank. I don’t know their pricing, but I assume its high – I do mean to call them and find out.

        Have you looked at First Databank, and if so, do you know how it compares with MDToolbox? I know RxNorm uses data from First Databank as one of its sources.

  3. Nick Orlowski Says:

    MDToolbox does provide APIs for drug searching, but we keep an implementation of RxNorm on our servers for speed. I can’t speak to proprietary systems. As far as interactions data, it is not as clear cut as some of the commercial providers’ warnings. ePocrates comes to mind as having simple, easy to understand warnings. It also seems that some contraindications are present in some data sets, while missing in others. There doesnt seem to be a central authority for them, implying that to get complete coverage, you’d need to subscribe to many. NDF-RT used to have the interaction data but discontinued it for 2015.

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