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Evaluation of a Proposed Method for Representing Drug Terminology James J. Cimino, Timothy J. McNamara, Terri Meredith, Carol A. Broverman, Karen C. Eckert. Drug Terminology Efforts in HL7. Need for medication terms Much source data generated by pharmacy systems - PowerPoint PPT Presentation
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Evaluation of a Proposed Method for Representing Drug Terminology
James J. Cimino, Timothy J. McNamara, Terri Meredith, Carol A. Broverman,
Karen C. Eckert
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
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
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
is-a
is-a
is-a
is-a
is-a
Chemicals
MedicationsPackages
Composite Clinical Drug
is-a
Composite Trademark Drug
is-a
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
is-a
is-a
is-a
is-a
is-a
Chemicals
MedicationsPackages
Composite Clinical Drug
is-a
Composite Trademark Drug
is-a
Clinical Drug
Clinical Drugs
• Dosage form
• Active ingredients– Chemical
– Form Strength• Strength amount
• Strength units
• Volume
• Volume units
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
Sample Selection
• 71,000 NDC Codes
• 1000 selected at random (1.4%)
• Many are obsolete
Descriptions from Vendors
Name Form Ingredient 1 Ingredient 2
Valium 5mg Tablet Tablet Diazepam ^5^mg
Tylenol #3 Tablet Acetaminophen Codeine ^325^mg ^30^mg
Chloral Hydrate Syrup Syrup Chloral Hydrate 100.000000^mg^1.000000^ml
Descriptions from Vendors
Set Mapped
A 358
B 459
C 605
D 405
E 566
A B C D E None
- 340 358 326 357 642
340 - 452 361 449 541
358 452 - 393 554 395
326 361 393 - 392 395
357 449 554 392 - 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.
Pairwise Comparisons
Set B C D E
A 340 358 326 357
B 452 361 449
C 393 554
D 392
E
Pairwise Comparisons
Set B C D E
A 340 358 326 357
B 452 361 449
C 393 554
D 392
E
{3982
Comparisons
• Dosage Form: 3982
• Ingredient (number and match): 5507
• Dose Strength (dose, units, volume, volume units): 4337
• Overall: 3982
Dosage Form Matching
• TAB = TABLET
• LIQUID ORAL LIQUID
• 111 Dosage form synonyms
Ingredient Matching
• HCl vs. Hydrochloride
• Salt vs. Base
• Inclusion of form or route
• Mention of animal source
Dose Strength Matching
• Standard format (000050000 vs. 500.00)
• Normalization of units (GM vs. MG)
Dose Units Matching
• Standard abbreviations
• Normalization of units (GM vs. MG)
• Missing values
• Inclusion of concentration information
• MG vs. %
Dose Volume Matching
• Not given
• Different numeric formats
• Defaults (0 and 1)
• Different volumes ( per 1ml vs per 5ml)
Dose Volume Units Matching
• Not given
• “Each”
• Different abbreviations
Overall Matching
• Form matches
• Same number of ingredients
• Each ingredient matches on chemical and all four other parameters
Overall Matching
Total Before After Conversion Conversion Components: Ingredients 5507 3607 (65%) 4337 (79%) Strength 4337 374 (9%) 3262 (75%) Units 4337 1845 (43%) 2964 (68%) Volume 4337 1054 (24%) 3754 (87%) Volume Units 4337 2319 (53%) 3486 (80%)
Components:
Overall: Each Ingred 4337 0 (0%) 2773 (64%) All Ingred 3982 0 (0%) 2519 (63%) Dose Form 3982 645 (16%) 2859 (72%) Complete Drug 3982 0 (0%) 2128 (53%)53%
Pairwise Comparisons
Set A B C D E
A - 340 358 326 357
B 340 - 452 361 449
C 358 452 - 393 554
D 326 361 393 - 392
E 357 449 554 392 -
Set A B C D E
A - 59% 45% 48% 52%
B 59% - 54% 63% 62%
C 45% 54% - 46% 48%
D 48% 63% 46% - 58%
E 52% 62% 48% 58% -
Pairwise Complete Matches
Example of MismatchGUAIFENESIN 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^MLGUAIFENESIN^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)
Example of Mismatch
BUMEX INJECTION|0.25|MG|INJ-SOL
AMPUL
BUMETANIDE^00000000.250^MG^0001.000^ML
INJECTION
SODIUM CHLORIDE, IV USE^0.850000^%^^
BUMETANIDE, INJECTABLE^0.250000^MG^1.000000^ML
INJECTION
BUMETANIDE^0.25^MG^1^ML
SOLUTION
BUMETANIDE^0.2500^MG/ML^^
SOLUTION
BUMETANIDE^0.25^MILLIGRAM(S)^1^MILLILITER(S)
Example of Mismatch
RECOMBIVAX HB ADULT FORMULATION INJECTION|10|MCG|INJ-SUS
VIAL
HEPATITIS B VIRUS VACCINE^00000010.000^MCG^0001.000^ML
INJECTION
HEPATITIS B SURFACE ANTIGEN^10.000000^MCG^1.000000^ML
INJECTION
HEPATITIS B VACCINE-RECOMBINANT^10^MCG^1^ML
INJECTION
HEPATITIS B VIRUS VACCINE RECOMBINANT^10.0000^MCG/ML ^^
SOLUTION
HEPATITIS B VACCINE RECOMBINANT^10^MICROGRAM(S)^ 1^MILLILITER(S)
Focus on Dosage Form
• 3982 comparisons
• 111 synonyms
• 72% match rate
• What went wrong?
Examination of Dosage Forms
• Compare use of each form, in each source, with use in other sources for corresponding medications
• Look for irregularities in source
• Look for 100% agreement
• When not 100% agreement, look at hierarchical subsumption
Irregularities in Sources
NDC: 0000153144|FLUORITAB TABLETS CHEWABLE CHERRY|1.1|MG| TAB CHEW|100|BOT:
A:: |FLUORITAB 0.5MG TABLET CHEW^SODIUM FLUORIDE| CHEWABLE TABLET|SODIUM FLUORIDE^00000000.500^MG ^0000.000^
B: |FLUORITAB CHERRY TABS CHEW, 0.5MG|CHEWABLE TABLET| SODIUM FLUORIDE^1.100000^MG^^
C: |SODIUM FLUORIDE CHEW TAB 1.1 MG (0.5MG F)|CHEWABLE TABLET|SODIUM FLUORIDE^1.1000^MG^^
D: ||TABLET|SODIUM FLUORIDE^0.5^MG^^
Near Misses and the Hierarchy
ASodium Fluoride1.1 MGChewable TabletB
C
D
Tablet
ChewableTablet
is-a
is-a
Sodium Fluoride1.1 MGTablet
Irregularities in Sources
NDC: 0000014889|PROPRANOLOL HYDROCHLORIDE EXTENDED RELEASE CAPSULES|80|MG|CAP ER|100|BOT
A: ||CAPSULE CR|PROPRANOLOL HYDROCHLORIDE^80^MG^^
B: |PROPRANOLOL 80MG CAPSULE SA^PROPRANOLOL HCL| CAPSULE CR|PROPRANOLOL HCL^00000080.000^MG^0000.000^
C:: |PROPRANOLOL HCL CAP CR 80 MG|CAPSULE CR| PROPRANOLOL HYDROCHLORIDE^80.0000^MG^^
D:: |PROPRANOLOL HYDROCHLORIDE^80 MG|CAPSULE CR| PROPRANOLOL HYDROCHLORIDE^80^MILLIGRAM(S)^1^EACH
E:: |PROPRANOLOL HCL TABS CR, 80MG|TABLET CR|PROPRANOLOL HYDROCHLORIDE^80.000000^MG^^
Example of 100% Agreement
A: LOTION: 1: LOTION|
B: LOTION: 1: LOTION|
C: LOTION: 1: LOTION|
D: LOTION: 1: LOTION|
E: LOTION: 1: LOTION|
Example of 100% Agreement
A: TABLET CR: 14: TAB E REL|TAB FC ER
B: TABLET CR: 6: TAB FC ER|TAB SUG CO|
C: TABLET CR: 9: TAB FC ER|TAB E REL|
D: TABLET CR: 14: TAB E REL|TAB FC ER|TAB FC|
E: TABLET CR: 7: TAB FC ER|TAB E REL|
Example of <100% Agreement
A: AEROSOL: 2: INHALANT|AEROSL SPR|
B: AEROSOL: 1: INHALANT|
C: AEROSOL: 1: INHALANT| SPRAY, TOPICAL, DERMAL: 1: AEROSL SPR|
D: AEROSOL: 2: INHALANT|AEROSL SPR|
E: AEROSOL: 1: INHALANT|
Handling Ambiguity
Aerosol
InhaledAerosol
is-a
DermalAerosol
A
Triamcinolone Acetonide0.147mg/GMAerosol
A
Terbutaline Sulfate0.2mg/ACTAerosol
D
Terbutaline Sulfate0.2mg/ACTInhaled Aerosol
C
E
B
C
Triamcinolone Acetonide0.147mg/GMDermal Aerosol
is-a is-a
Example of Subsumption
Aerosol ():A(AEROSOL) D(AEROSOL)
Inhaled Aerosol (INHALENT):B(AEROSOL) C(AEROSOL)
E(AEROSOL)
Dermal Aerosol (AEROSL SPR): C(SPRAY TOPICAL, DERMAL)
No Solution for SolutionAMPULDROPSINFUS. BTLINJECTIONIRRIGATION SOLUTIONIV SOLN.KITPIGGYBACKPLAST. BAGSKIN TESTSOLUTIONSYRUPVIAL
ELIXIRINJ REPOSITORYINJECTIONINJECTION TYPEINJECTION IVPBKITLIQUIDSOLUTIONSUSPENSION
DROPS, OPHTHALMIC (NON-SYSTEMIC)INJECTIONIRRIGATION SOLUTIONKIT, INJECTION (SYSTEMIC)SOLUTION FOR DROPS, OTICSOLUTION FOR INHALATION...SOLUTION OPHTMALMIC…SOLUTION, ORAL (SYSTEMIC)SOLUTION, OTICSOLUTION, TOPICAL, DERMALSYRUP
CONCENTRATEINJECTIONKITNEBUOILSOLUTIONSYRUP
Discussion
• Matching is still far from perfect
• Not surprising, given lack of standards for attribute values
• Next steps
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
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
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
