RxNorm Overview John Kilbourne MD National Library of Medicine kilbourj@mail.nlm.nih.gov

Topics Where does RxNorm data come from? Organizing the data A current issue we are addressing

Where does RxNorm data come from?

‘Source’ names: same or different?

Source names vs. normalized name “Ranitidine Hydrochloride 15 MG ORAL SYRUP” “Ranitidine Hydrochloride 16.8 MG ORAL SYRUP” “Ranitidine Hydrochloride 75 MG ORAL SOLUTION” Ranitidine 15 MG/ML Oral Solution (normalized name) SY: ranitidine 15 MG (ranitidine hydrochloride 16.8 MG) per ML Oral Solution SY: ranitidine 75 MG per 5 ML Syrup

RxNorm and its sources Free dataset published monthly (with weekly FDA adds) by NLM Also a browser and API access to the data Data sources aggregated and organized FDA: Structured Product Label – SPL (DailyMed) First Databank Multum MicroMedex Gold Standard Medi-Span VA: NDF-RT and VANDF SNOMED CT

Path of data for RxNorm

NLM-authored data RxNorm content determined by the source data Devices, drug classes, radiopharmaceuticals out of scope Standalone non-commercial names and codes for e-prescribing and other uses

Endorsement and use of RxNorm Center for Medicare and Medicaid Services (CMS) Formulary Reference File Clinical Quality Measures (CQMs), Meaningful Use Value Sets Office of the National Coordinator (ONC) Standard for medications and medication allergies Required for Electronic Health Record (EHR) certification National Council for Prescription Drug Programs (NCPDP) SCRIPT e-prescribing standard Formulary and Benefit standard Veterans Affairs – Department of Defense (VA-DoD)

Organizing the data

RxNorm building blocks: term types (TTYs) SCD: Center of the universe for RxNorm Ingredient + strength + dose form Azithromycin 250 MG Oral Tablet SBD: SCD + Brand name (BN) Azithromycin 250 MG Oral Tablet [Zithromax]

Packs GPCK: Collection of SCDs BPCK: GPCK with a suffix {6 (Azithromycin 250 MG Oral Tablet) } Pack {30 (Aspirin 325 MG Oral Tablet) / 30 (Pravastatin Sodium 20 MG Oral Tablet [Pravachol]) } Pack BPCK: GPCK with a suffix {6 (Azithromycin 250 MG Oral Tablet [Zithromax]) } Pack [Z-PAKS] {30 (Aspirin 325 MG Oral Tablet) / 30 (Pravastatin Sodium 20 MG Oral Tablet [Pravachol]) } Pack [Pravigard 325/20]

Multiple levels of description SCD Diazepam 5 MG Oral Tablet SCDC Diazepam 5 MG SCDF Diazepam Oral Tablet SCDG Diazepam Pills SBD Diazepam 5 MG Oral Tablet [Valium] SBDC Diazepam 5 MG [Valium] SBDF Diazepam Oral Tablet [Valium] SBDG Valium Pills BN Valium IN Diazepam

Counts of TTYs SCD 20,094 SBD 11,068 GPCK 413 BPCK 337 IN 9237 MIN 3848 PIN 2184

“One-to-many” issues Adenosine 3 MG/ML Injectable Solution Adenosine 3 MG/ML Prefilled Syringe 1 ML Adenosine 3 MG/ML Prefilled Syringe 2 ML Adenosine 3 MG/ML Prefilled Syringe 4 ML Adenosine 3 MG/ML Prefilled Syringe

Wrap-up RxNorm is derived from other drug data Drug classes, devices, radiopharmaceuticals out of scope Endorsed and used by CMS, ONC, NCPDP, VA, DoD RxNorm organized by ‘TTY’; SCD is the center of the universe; SCD, SBD, GPCK, BPCK can be administered

John Kilbourne MD kilbourj@mail.nlm.nih.gov Thank you John Kilbourne MD kilbourj@mail.nlm.nih.gov