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Building a National Medication Reference Terminology: VA Experience with NDF-RT Presented to HL7 Government SIG By Steven Brown & Michael Lincoln, Department.

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Presentation on theme: "Building a National Medication Reference Terminology: VA Experience with NDF-RT Presented to HL7 Government SIG By Steven Brown & Michael Lincoln, Department."— Presentation transcript:

1 Building a National Medication Reference Terminology: VA Experience with NDF-RT Presented to HL7 Government SIG By Steven Brown & Michael Lincoln, Department of Veterans Affairs In collaboration with NLM, FDA, NCI and Apelon

2 2 Why a Common Drug Reference Terminology? Improve use of drug information by single systems Improve sharing of drug information by adding semantic understanding to the syntax defined by HL7 messaging between systems

3 3 VA National Drug File (NDF) Centrally maintained file of drug products Distributed to 128 VA Medical Centers Incorporated into VistA Pharmacy Applications ~ 80,000 Entries Maintained and used via M Globals –VA Product File –VA Active Ingredient File More than a decade of experience…

4 4 NDF Uses Within VA National standard listing Local formularies mapped to NDF standard Interaction and Order Checking Consolidated Mail Outpatient Pharmacy –> 7 sites, 57 million prescriptions/year

5 5 NDF Product File Product Names –AMOXICILLIN 250MG/CLAVULANATE K 125MG TAB Form, Strength, Product Identifier Linked to: VA Drug Class : –AM052 penicillins, amino derivatives Linked to: Active Ingredients

6 6 NDF - Issues Maintenance –4000 NDC level edits per month –Done largely by hand Mapping local formularies to NDF –Manual process –Required for CMOP Decision Support – class based –CN101 Opioid Analgesics vs. CN103 Non-opioid analgesics

7 7 NDF Reference Terminology (RT) Enterprise Architecture project Goal – to evaluate the use of modern terminology techniques to increase functionality, improve quality and decrease costs

8 8 Rossi Mori First Generation Terminology Traditional Paper-Based Terminological Systems with lists of phrases and codes. –E.g. ICD9, CPT

9 9 Rossi Mori Second Generation Terminology Second Generation Terminology –Compositional terminological systems built according to a categorical structure and a cross- thesaurus with predefined values for each category. –E.g. LOINC

10 10 Rossi Mori Third Generation Terminology Reference Terminology – –A terminology where each term has a formal definition designed for data aggregation and retrieval. –Formal terminological systems represent concepts with symbols and rules that create a computable structured and coded system –e.g. SNOMED RT, NDF RT

11 11 Advantages of Formal Terminology Computer-based tools –Reduced Maintenance Costs 90% reduction in MED Maintenance effort –Reduced Mapping Effort 60% automated matches to formalized version of LOINC Comparable Data Supports Aggregation

12 12 Reference Terminology Creation Create a model of use case-based definitional attributes Create a reference hierarchy for each definitional attribute Define concepts using terms from reference hierarchies

13 13 Simplified NDF RT Model Active Ingredients Clinical Drug Chemical Structure Pharmacokinetics Therapeutic Use Mechanism of Action Strengths Dose Forms Route of Adm. (HL-7) National Drug Codes (NDCs) Database Links DKB Ids, CUIs, Mesh Structural ID Identity Key Gray = Chemical Green = Clinical Pink = Commercial Blue = Functional Yellow = External

14 14 Sample MoA Hierarchy Receptor Interactions Enzyme Interactions Transporter Agents Channel Agents ABC Transporters Organic Ion Transporters LST-1 Sialin Transporter

15 15 Sample Definition AMOXICILLIN 250MG/CLAVULANATE K 125MG TAB –Has_form: tablet –Has_active_ingredient: Amoxicillin Has_strength 250 mg Has_MoA: cell wall synthesis disruption –Has_active_ingredient: Clavulanate Has_strength 125mg

16 16 NDF RT Progress to Date NDF in terminology development tool Model Created Reference Taxonomies –Done: Route, Form, Strength, Structure –Under development : MoA, Physiologic Effect, Therapeutic Intent and Pharmacokinetics Concept Definition –Algorithmic initialization –Human review Input from NLM, HL7, FDA, NCI, Apelon

17 17 NDF RT – Next Steps Sample Applications demonstrating value Expand Project beyond VA –NLM, FDA, NCI, Regenstrief, ??? –Freely available to others for reuse

18 18 NDF RT Model Active Ingredients Clinical Drug Finished Dosage Form Product Packaged Product Kit Chemical Structure Class Pharmacokinetics Therapeutic Use Mechanism of Action Strengths Dose Forms Route of Adm. (HL-7) National Drug Codes (NDCs) Brand Names Database Links DKB Ids, CUIs Structural ID Identity Key Gray = Chemical Green = Clinical Purple = Commercial Blue = Functional Yellow = External Appearance


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