Transcript RxNorm_Tammy_Powell

RxNorm Overview
Tammy Powell
National Library of Medicine
National Institutes of Health
U.S. Department of Health and Human Services
[email protected]
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What is RxNorm?
 A set of names and codes used to represent drugs in
electronic medical records used for:
• E-prescribing
• Formulary
• Medication History
 Two sets of names:
• Drug compendia names
• RxNorm authorized names
 RxNorm Releases, Browser & API
• New web-based RxNAV Summer 2016
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‘Source’ data in RxNorm
 Intellectual property restrictions on proprietary data
• Free NLM license required to download regular RxNorm release
• Prescribable Content Subset: no license, no proprietary data
 Slight differences in what each source provides to NLM
• Brand names, National Drug Codes (NDCs), History data
 Can be used to navigate between sources
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NLM-authored data
 RxNorm content derived from data received from our
sources
 Devices, drug classes, radiopharmaceuticals out of scope
 Limited multi-vitamins
 Standalone non-commercial names and codes for
e-prescribing, formulary, and medication history
 RxNorm is the most complete set of drug data available
in the US
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Organizing the data
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RxNorm data sources/building blocks
Collection of commonly-used public and private drug vocabularies:
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VA: NDF-RT
FDA: Structured Product Label – SPL (DailyMed)
CMS Formulary Reference File (FRF/not released)
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Multum
First Data Bank
Micromedex
Medispan
Gold Standard
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SNOMED CT
Anatomical Therapeutic Chemical Classification System (ATC)
Drugbank – Fall 2016?
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Source names vs. normalized name
FLUOXETINE HCL 20 mg ORAL CAPSULE
FLUOXETINE HYDROCHLORIDE 20MG CAP
FLUOXETINE 20 MG ORAL CAP, GELATIN COATED
Fluoxetine 20 MG Oral Capsule
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RxNorm building blocks:
term types
 SCD: Center of the universe for RxNorm
• Ingredient + strength + dose form
• Fluoxetine 20 MG Oral Capsule
 SBD: SCD + Brand name
• Fluoxetine 20 MG Oral Capsule [Prozac]
• SY Prozac 20 MG Oral Capsule
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More RxNorm TTYs
 GPCK: Collection of SCDs
• {1 (1 ML Leuprolide Acetate 11.25 MG/ML Prefilled Syringe) / 90
(norethindrone acetate 5 MG Oral Tablet) } Pack
 BPCK: GPCK with a suffix
• {1 (1 ML Leuprolide Acetate 11.25 MG/ML Prefilled Syringe
[Lupron]) / 90 (norethindrone acetate 5 MG Oral Tablet) } Pack
[Lupaneta Pack 3-Month]
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Ingredient Term Types
SCD:
Acetaminophen 325 MG / Hydrocodone Bitartrate 10 MG Oral Tablet
 Ingredients (IN): Acetaminophen, Hydrocodone
 Precise IN (PIN): Hydrocodone Bitartrate
 Multiple Ingredients (MIN): Acetaminophen /
Hydrocodone
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Multiple levels of organization
SCD
SCDC
SCDF
SCDG
IN
Diazepam 5 MG Oral Tablet
Diazepam 5 MG
Diazepam Oral Tablet
Diazepam Pills
Diazepam
SBD
SBDC
SBDF
SBDG
BN
Diazepam 5 MG Oral Tablet [Valium]
Diazepam 5 MG [Valium]
Diazepam Oral Tablet [Valium]
Valium Pills
Valium
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How is RxNorm structured?
 Relationships connect RXCUIs
• SCD has_tradename SBD
• BPCK contains SCD consists_of SCDC has_ingredient IN
• SBD has_doseform DF
 RXCUIs have associated attributes
• NDCs
• Marketing Category
• Labeler
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Codes in RxNorm
• RXCUI
• NDC
• UNII
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RxNorm Concept Unique Identifier
(RxCUI)
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Created by NLM
All Concepts within RxNorm
Authoritative and Complete
RXCUI Stability
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National Drug Codes (NDCs)
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Issued by the manufacturer
Represents Drug at the Package Level
No centralized list
RxCUI can have > 1 NDC
Only 1 RxCUI for a Given NDC
RxNorm reconciles conflicts
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Unique Ingredient Identifiers (UNIIs)
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Assigned to Ingredients
UNII Codes come from the FDA
Primarily from the SPL Data
SPL labels do not have the complete set of UNII
codes
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Need for prescribable names
• Levothyroxine sodium 0.1 MG Oral Tablet
• apraclonidine 5 MG/ML Ophthalmic Solution
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{7 (Ethinyl Estradiol 0.035 MG / Norethindrone 0.5 MG Oral
Tablet) / 7 (Ethinyl Estradiol 0.035 MG / Norethindrone 0.75 MG
Oral Tablet) / 7 (Ethinyl Estradiol 0.035 MG / Norethindrone 1
MG Oral Tablet) } Pack [Ortho-Novum 7/7/7 21 Day]
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Need for prescribable names
• Levothyroxine sodium 0.1 MG Oral Tablet
• Levothyroxine sodium 100 MCG Oral Tablet
• apraclonidine 5 MG/ML Ophthalmic Solution
• Apraclonidine 0.5 % Ophthalmic Solution
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{7 (Ethinyl Estradiol 0.035 MG / Norethindrone 0.5 MG Oral Tablet) / 7
(Ethinyl Estradiol 0.035 MG / Norethindrone 0.75 MG Oral Tablet) / 7
(Ethinyl Estradiol 0.035 MG / Norethindrone 1 MG Oral Tablet) } Pack
[Ortho-Novum 7/7/7 21 Day]
• ORTHO-NOVUM 7/7/7 21 Day Pack
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Dailymed/SPL Editing Process
 How long after a new drug is approved will it appear in
RxNorm?
 Create 2 types of strings from the Dailymed Labels
• Drug Products (DP)
• SU – Substance
 Loaded into the RxNorm Editing Database 5 Days a
week
 Part of the Weekly & Monthly RxNorm Release
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SPL Example Uptravi
 Marketing Start Date/FDA Approval 12/21/2015
 RxNorm Received the data from the label on 01/05/2016
 RxNorm had 10 strings from this label including:
• SU: Selexipag
• DP: SELEXIPAG 1600 ug ORAL TABLET, COATED
[UPTRAVI]
 New form created on January 5th & Released January
13th
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How do I access RxNorm data?
http://www.nlm.nih.gov/research/umls/rxnorm/
 Monthly zip file*
• Weekly updates for newly added FDA drug labels
 Current Prescribable Content subset zip file
 APIs – RxNorm, prescribable subset
*Requires a (free) UMLS license to access
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Endorsement and use of RxNorm
 Centers for Medicare and Medicaid Services (CMS)
• Medicare Part D Model Guidelines (FRF)
• Clinical Quality Measures, Meaningful Use Value Sets
 Office of the National Coordinator (ONC)
• Standard for medications and medication allergies
• Required for Electronic Health Record certification
 National Council for Prescription Drug Programs (NCPDP)
• SCRIPT e-prescribing standard
• Formulary and Benefit standard
 Veterans Affairs – Department of Defense (VA-DOD)
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Philosophy and Approach
 Active engagement with stakeholders
• Source vocabulary providers
• End users
• Federal agencies
 Limited scope (names and codes for drugs)
 Actual use in clinical systems
 Simplicity of the model
• And flexibility to meet use cases
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Wrap-up
 RxNorm is a set of names and codes for E-prescribing,
formulary management, medication history
 RxNorm content determined by the data we receive from
our sources
 RxNorm organized by ‘TTY’; SCD is the center of the
universe, SBD, GPCK, BPCK
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Thank you
DailyMed Jamboree
September 27th, 2016
Tammy Powell
[email protected]
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