1. HL7 Drug Name Coordination Efforts James J. Cimino, M.D. Columbia University

2. Drug Terminology Efforts in HL7 Need for medication terms Much source data generated by pharmacy systems Pharmacy knowledge base vendors are exploring ways to place their terminologies in the public domain Vocabulary TC convened meetings to explore ways of collaborating

3. Disclaimer Nothing is a balloted standard yet TC has not yet proposed a formal model TC has not yet proposed a plan of action TC is still defining scope and goals

4. Drug Terminology Modeling Some agreement on the concept of a "clinical drug" More-specific terms Less-specific terms Dosage forms Routes

5. Clinical Drugs Active ingredients Dosage form

6. Trademark Drugs Trademark Active ingredients Dosage form

7. Manufactured Components Inactive ingredients Dispensing and Inventory Manufacturer (may not be the same as supplier) Active ingredients Dosage form Trademark

8. Drug Model Hierarchy Drug Class Not-Fully-Specified Drug Clinical Drug Trademark Drug Manufactured Components Ingredient Class International Package Identifiers Country-Specific Packaged Product Ingredient is-a Chemicals Medications Packages Composite Clinical Drug is-a Composite Trademark Drug is-a

9. Drug Model Hierarchy Drug Class Not-Fully-Specified Drug Trademark Drug Manufactured Components Ingredient Class International Package Identifiers Country-Specific Packaged Product Ingredient is-a Chemicals Medications Packages Composite Clinical Drug is-a Composite Trademark Drug is-a Clinical Drug

10. Clinical Drugs Dosage form Active ingredients –Chemical –Form Strength Strength amount Strength units Volume Volume units

11. Experiment Can model allow for interoperability? –Single terminology vs. –Mapping between terminologies Select random sample of drug terms Obtain descriptions from terminology developers Compare description components Examine overall match rate

12. Sample Selection 71,000 NDC Codes 1000 selected at random (1.4%) Many are obsolete

13. Descriptions from Vendors NameForm Ingredient 1 Ingredient 2 Valium 5mg TabletTablet Diazepam ^5^mg Tylenol #3Tablet AcetaminophenCodeine ^325^mg^30^mg Chloral Hydrate SyrupSyrup Chloral Hydrate 100.000000^mg^1.000000^ml

14. Descriptions from Vendors SetMapped A 358 B 459 C 605 D 405 E 566 A B C D E None -340358326357642 340 - 452361449541 358452 - 393554395 326361393 - 392395 357449554392 - 434 Overall, 367 terms were not represented in any set, 71 appeared in only one set, 77 appeared in exactly two sets, 83 appeared in three sets, 91 appeared in four, and 311 terms appeared in all five terminologies.

15. Pairwise Comparisons Set B C D E A 340358326357 B 452361449 C 393554 D 392 E

16. Pairwise Comparisons Set B C D E A 340358326357 B 452361449 C 393554 D 392 E { 3982

17. Comparisons Dosage Form: 3982 Ingredient (number and match): 5507 Dose Strength (dose, units, volume, volume units): 4337 Overall: 3982

18. Dosage Form Matching TAB = TABLET LIQUID  ORAL LIQUID 111 Dosage form synonyms

19. Ingredient Matching HCl vs. Hydrochloride Salt vs. Base Inclusion of form or route Mention of animal source

20. Matching Other Components Dose Strength Matching Dose Units Matching Dose Volume Matching Dose Volume Units Matching

21. Overall Matching Form matches Same number of ingredients Each ingredient matches on chemical and all four other parameters

22. Overall Matching 53%

23. Pairwise Comparisons Set A B C D E A - 340358326357 B340 - 452361449 C358452 - 393554 D326361393 - 392 E357449554392 -

24. Set A B C D E A - 59%45%48%52% B59% - 54%63%62% C45%54% - 46%48% D48%63%46% - 58% E52%62%48%58% - Pairwise Complete Matches

25. Example of Mismatch GUAIFENESIN AC LIQUID|10;100|MG/5ML;MG/|LIQUID SYRUP| GUAIFENESIN^00000000.000^^0000.000^ CODEINE PHOSPHATE^.^^.^ LIQUID| CODEINE PHOSPHATE^2.000000^MG^^ GUAIFENESIN^20.000000^MG^1.000000^ML LIQUID, ORAL (SYSTEMIC)| CODEINE PHOSPHATE^10^MG^5^ML GUAIFENESIN^100^MG^5^ML LIQUID| CODEINE PHOSPHATE^10.0000^MG/5ML^^ GUAIFENESIN^100.0000^MG/5ML^^ SYRUP| CODEINE PHOSPHATE^10^MILLIGRAM(S)^5^MILLILITER(S) GUAIFENESIN^100^MILLIGRAM(S)^5^MILLILITER(S)

26. Example of Mismatch RECOMBIVAX HB ADULT FORMULATION INJECTION|10|MCG|INJ-SUS HEPATITIS B VIRUS VACCINE HEPATITIS B SURFACE ANTIGEN HEPATITIS B VACCINE-RECOMBINANT HEPATITIS B VIRUS VACCINE RECOMBINANT HEPATITIS B VACCINE RECOMBINANT

27. Discussion Matching is still far from perfect Not surprising, given lack of standards for attribute values Next steps

28. Discussion: Next Steps Define some rules for each field Select new random sample Find subset with good overlap across terminologies Submit descriptions of new subset

29. Discussion: New Rules Dose forms: separate translation step Ingredients: –Right number –Specific chemical entity –Identifiers (UMLS?) –Don’t mix in route or concentration Strengths: –Conversion algorithms –Rules for defaults –Don’t mix route or concentration with strength

30. Conclusions Glass half empty: –How can we do automated translation of patient data? –Can drug order transfers and decision support be safe? Glass half full: –No attempt yet to standardize attribute terminology –Most translation was much better than 50% –Just getting started –Better than what we do now