Transcript Modeling Clinical Drug Terms

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
Packages
Medications
Drug Class
Chemicals
International
Package Identifiers
is-a
Not-Fully-Specified Drug
Ingredient
Class
is-a
Country-Specific
Packaged Product
Clinical Drug
is-a
Ingredient
is-a
is-a
Trademark Drug
is-a
Manufactured
Components
is-a
Composite
Clinical Drug
is-a
Composite
Trademark Drug
Drug Model Hierarchy
Packages
Medications
Drug Class
Chemicals
International
Package Identifiers
is-a
Not-Fully-Specified Drug
Ingredient
Class
is-a
Country-Specific
Packaged Product
Clinical Drug
is-a
Ingredient
is-a
is-a
Trademark Drug
is-a
Manufactured
Components
is-a
Composite
Clinical Drug
is-a
Composite
Trademark 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
Valium 5mg Tablet
Tablet
Diazepam
^5^mg
Tylenol #3
Tablet
Acetaminophen
^325^mg
Chloral Hydrate Syrup Syrup
Ingredient 2
Codeine
^30^mg
Chloral Hydrate
100.000000^mg^1.000000^ml
Descriptions from Vendors
Set
A
B
C
D
E
Mapped
358
459
605
405
566
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
-
None
642
541
395
395
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
A
B
C
D
E
B
C
D
E
340 358 326 357
452 361 449
393 554
392
Pairwise Comparisons
Set
A
B
C
D
E
3982
B
C
D
E
340 358 326 357
452 361 449
393 554
392
{
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
Conversion
After
Conversion
Components:
Ingredients
Strength
Units
Volume
Volume Units
5507
4337
4337
4337
4337
3607 (65%)
374 (9%)
1845 (43%)
1054 (24%)
2319 (53%)
4337 (79%)
3262 (75%)
2964 (68%)
3754 (87%)
3486 (80%)
Overall:
Each Ingred
All Ingred
Dose Form
Complete Drug
4337
3982
3982
3982
0 (0%)
0 (0%)
645 (16%)
0 (0%)
2773 (64%)
2519 (63%)
2859 (72%)
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
-
Pairwise Complete Matches
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%
-
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)
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
SODIUM FLUORIDE^1.100000^MG^^
TABLET|
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
Tablet
Sodium Fluoride
1.1 MG
Tablet
is-a
Chewable
Tablet
A
is-a
Sodium Fluoride
1.1 MG
Chewable Tablet
B
C
D
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
PROPRANOLOL HYDROCHLORIDE^80.0000^MG^^
CR|
D:: |PROPRANOLOL HYDROCHLORIDE^80 MG|CAPSULE CR|
PROPRANOLOL HYDROCHLORIDE^80^MILLIGRAM(S)^1^EACH
E:: |PROPRANOLOL HCL TABS CR, 80MG|TABLET
HYDROCHLORIDE^80.000000^MG^^
CR|PROPRANOLOL
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
A
D
Terbutaline
Sulfate
0.2mg/ACT
Aerosol
is-a
B
C
E
Terbutaline
Sulfate
0.2mg/ACT
Inhaled Aerosol
is-a
Inhaled Dermal
Aerosol Aerosol
Triamcinolone
Acetonide
0.147mg/GM
Aerosol
A
is-a
Triamcinolone
Acetonide
0.147mg/GM
Dermal Aerosol
C
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 Solution
AMPUL
DROPS
INFUS. BTL
INJECTION
IRRIGATION
SOLUTION
IV SOLN.
KIT
PIGGYBACK
PLAST. BAG
SKIN TEST
SOLUTION
SYRUP
VIAL
ELIXIR
INJ REPOSITORY
INJECTION
INJECTION TYPE
INJECTION IVPB
KIT
LIQUID
SOLUTION
SUSPENSION
CONCENTRATE
INJECTION
KIT
NEBU
OIL
SOLUTION
SYRUP
DROPS, OPHTHALMIC
(NON-SYSTEMIC)
INJECTION
IRRIGATION
SOLUTION
KIT, INJECTION
(SYSTEMIC)
SOLUTION FOR
DROPS, OTIC
SOLUTION FOR
INHALATION...
SOLUTION
OPHTMALMIC…
SOLUTION, ORAL
(SYSTEMIC)
SOLUTION, OTIC
SOLUTION, TOPICAL,
DERMAL
SYRUP
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