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Drug Vocabulary Integrationat the National Library of Medicine
Data and Tools
SPIM / INSERM URM S 872 – Eq. 20June 30, 2008
Olivier Bodenreider
Lister Hill National Centerfor Biomedical CommunicationsBethesda, Maryland - USA
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Outline
Drug vocabulariesDrug vocabulary integration: UMLSDrug vocabulary standardization: RxNormVisualizing drug information: RxNavProcessing drug information: RxNorm APIIntegrating drug information sourcesApplications
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Drug Vocabularies
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Drug vocabularies in the US
Gold Standard AlchemyMaster Drug Data Base (Medi-Span, Wolters Kluwer Health)
Multum MediSource LexiconMicromedex DRUGDEXFDA National Drug Code DirectoryFDA Structured Product LabelsNat’l Drug Data File (First DataBank Inc.)SNOMED Clinical Terms (drug information)Veterans Health Administration Nat’l Drug File
15
60
10
67
11
27
79
91
12
(June 2008)
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Drugs in SNOMED CT
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Drugs in SNOMED CT
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Drugs in MeSH
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Drugs in MeSH
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Drug vocabulary integration
Unified Medical Language System
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Source Vocabularies
143 source vocabularies17 languages
Broad coverage of biomedicine6M names1.5M concepts16M relations
Common presentation
(2008AA)
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Integrating subdomains
Biomedicalliterature
MeSH
Genomeannotations
GOModelorganisms
NCBITaxonomy
Geneticknowledge bases
OMIM
Clinicalrepositories
SNOMEDOthersubdomains
…
Anatomy
UWDA
UMLS
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Metathesaurus concept
Acetaminophen
C0000970
AcetaminophenAcetamide, N-(4-hydroxyphenyl)-AcetamidophenolAcetominophenACMPAPAPHydroxyacetanilideN-(4-Hydroxyphenyl)acetanilideN-Acetyl-p-aminophenolp-AcetamidophenolParacetamolp-Hydroxyacetanilide
Paracétamol - FrenchAzetaminophen - GermanAcetaminofene - ItalianHidroxiacetanilida - PortugueseПАРАЦЕТАМОЛ - RussianAcetaminofeno - Spanish
Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage.
SNOMED CT MeSHMultumNDDF…
PharmacologicSubstance
OrganicChemical
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Metathesaurus drug concepts
Semantic typesPharmacologic Substance 101,801
Antiparkinson AgentsVidarabine Phosphate
Antibiotic 3,592Kanamycin
Clinical Drug 165,378Afrin Nose Drops 0.05%Verapamil Oral Tablet [Calan]
270,000 concepts
(~21% of allMetathesaurus
concepts)
(2006AA)
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Metathesaurus relations
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Zyrtec in SemNav
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Drug vocabulary standardization
RxNorm
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Motivation
Exchange of information requires standardized names
Ordering drugsChecking interactionsInventory management
No standard naming conventions for drugsIntegrating drug vocabulariesUnique identifiers for drugsSpecify relations among drug entities
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Normalized form
Ingredient
Dose form
Strength
Ingredient
IngredientStrength Dose form
Strength
4mg/ml
Ingredient
Fluoxetine
Dose form
Oral Solution
Semantic clinical drug component
Semantic clinical drug
Semantic clinical drug form
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Generic vs. Brand
GenericIngredient(IN)Clinical drug form(SCDF)Clinical drug component(SCDC)Clinical drug(SCD)
BrandBrand name(BN)Branded drug form(SBDF)Branded drug component(SBDC)Branded drug(SBD)
tradename_of
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Relations among drug entities
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Relations among drug entities (revisited)
Ingredient
Cetirizine
C. Drug Component
Cetirizine 5MG
C. Drug Form
Cetirizine Oral Tablet
C. Drug
Cetirizine 5 MG Oral Tablet
Ingredient
B. Drug Component
Zyrtec
B. Drug Form
Cetirizine 5MG[Zyrtec]
B. Drug
Cetirizine Oral Tablet[Zyrtec]
Zyrtec 5 MG Oral Tablet
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RxNorm database
9 data sourcesGold Standard AlchemyMaster Drug Data BaseMultum MediSource Lex.Micromedex DRUGDEX FDA National Drug Code Directory FDA Structured Product LabelsNational Drug Data File Plus Source Vocabulary SNOMED Clinical Terms VA National Drug File
Content4,082 ingredients9,772 brand names13,299 clinical drug comp.13,938 branded drug comp.18,135 clinical drugs14,657 branded drugs8,134 clinical drug forms11,429 branded drug forms 102 dose forms
(as of June2, 2008;excluding obsolete data)
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Recent changes
Generic/Branded PackCollection of drugs prescribed as one unit
Z-PAK = {6 (Azithromycin 250 MG Oral Tablet [Zithromax]) } Pack [Z-PAKS]
Nordette-28 ={21 (Ethinyl Estradiol 0.03 MG / Levonorgestrel 0.15 MG Oral Tablet) / 7 (Inert Ingredients 1 MG Oral Tablet) } Pack [Nordette 28 Day]
Triphasil-21 ={6 (Ethinyl Estradiol 0.03 MG / Levonorgestrel 0.05 MG Oral Tablet) / 10 (Ethinyl Estradiol 0.03 MG / Levonorgestrel 0.125 MG Oral Tablet) / 5 (Ethinyl Estradiol 0.04 MG / Levonorgestrel 0.075 MG Oral Tablet) } Pack [Triphasil 21 Day]
Active GPCK forms 213Active BPCK forms 276
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Generic/Branded packsIngredient
C. Drug Component C. Drug Form
C. Drug
Ingredient
B. Drug Component B. Drug Form
B. Drug
B. PackG. Pack
Zithromax 250 MG Oral TabletAzithromycin 250 MG Oral Tablet
Z-PAK{6 (Azithromycin 250 MG Oral Tablet) } Pack
Azithromycin 250 MG Azithromycin Oral Tablet Azithromycin 250 MG[Zithromax]
Azithromycin Oral Tablet[Zithromax]
ZithromaxAzithromycin
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Visualizing drug information
RxNav
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RxNav
Visualization and navigationRxNorm browserSpelling correctionSearch on names and codes (including proprietary)Standalone application
RxNorm database at NLMLocal RxNorm database
Drug information processingAPI to the RxNorm databaseWeb services
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RxNav demo
http://mor.nlm.nih.gov/download/rxnav/
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Processing drug information
RxNorm Application Programming Interface
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RxNorm API
Made available in March 2008Based on Web Services
SOAPIndependent of any programming language
Used by RxNav and MyMedicationListEnable access to all information displayed in RxNavDocumentationhttp://mor.nlm.nih.gov/download/rxnav/
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List of functions
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FindRxcuiByString
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GetRelatedByRelationship
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References
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Integrating drug information sources
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FDA Standard product labels
Drug vocabulariesMDDB http://www.medispan.com/Products/index.aspx?id=1Multum http://www.multum.com/DRUGDEX http://www.micromedex.com/products/drugdex/FDA NDC Dir. http://www.fda.gov/cder/ndc/NDDF Plus http://www.firstdatabank.com/knowledge_bases/nddf_plus/
Other vocabulariesMeSH http://www.nlm.nih.gov/mesh/SNOMED CT http://www.snomed.org/
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National Drug File Reference Terminology
Developed by the Veterans Health AdministrationPart of the VA clinical information systemNon-terminological information
Pharmacologic class (isa)Indications (may_treat, may_diagnose, may_prevent)Contraindications (drug_contraindicated_for)Mechanism of action (mechanism_of_action_of)Drug-drug interactions (contraindicated_with)Physiology (has_physiologic_effect)Metabolism (metabolic_site_of, metabolizes, pharmacokinetics_of)
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NDF-RT Examples
Cetirizinedrug_contraindicated_for Drug Allergymay_treat Rhinitis, Allergic, Perennialmay_treat Urticariahas_physiologic_effect Decreased Histamine Activity
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Applications
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Applications
Terminology integration and standardization (RxNorm) enables interoperability and mapping across vocabulariesSpecific applications
Data integrationMedication reconciliationPersonal Health RecordE-prescribing / CPOECDA R2
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Limitations
RxNorm: Limited coverage (out of scope)Over-the-counter drugsDietary supplementsDrugs vocabularies outside U.S. (e.g., ATC)
RxNavCoverage currently limited to drug names
RxNorm APIDisplay currently limited to RxNorm codes and strings
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References
Unified Medical Language System (UMLS)http://www.nlm.nih.gov/research/umls/Bodenreider O. (2004). The Unified Medical Language System (UMLS): Integrating biomedical terminology. Nucleic Acids Research; D267-D270.
RxNormhttp://www.nlm.nih.gov/research/umls/rxnorm/index.html
RxNav and RxNorm APIhttp://mor.nlm.nih.gov/download/rxnav/
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MedicalOntologyResearch
Olivier Bodenreider
Lister Hill National Centerfor Biomedical CommunicationsBethesda, Maryland - USA
Contact:Web: