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The Future of NDC: The HL7 Perspective. James J. Cimino, M.D. Co-chair, HL7 Vocabulary Technical Committee Departments of Medicine and Medical Informatics Columbia University College of Physicians and Surgeons. Outline. HL7’s Needs Desiderata

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The future of ndc the hl7 perspective l.jpg

The Future of NDC:The HL7 Perspective

James J. Cimino, M.D.

Co-chair, HL7 Vocabulary Technical Committee

Departments of Medicine and Medical Informatics

Columbia University College of Physicians and Surgeons


Outline l.jpg
Outline

  • HL7’s Needs

  • Desiderata

    • Summary of 10+ years of research on controlled medical terminologies

    • Presented at IMIA Working Group 6, Jacksonville, FL, 1997

  • NDC and the Desiderata

  • HL7’s Perspective of NDC


Hl7 needs drug codes to l.jpg
HL7 Needs Drug Codes to...

  • transfer medication orders from an order entry system to a pharmacy

  • aggregate data from multiple sources

  • serves as grist for decision support engines

  • just about anything else you can imagine


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Drug Model Hierarchy

Packages

Medications

Drug Class

International Package Identifiers

Chemicals

is-a

Not-Fully-Specified Drug

is-a

Ingredient Class

is-a

Country-Specific Packaged Product

Clinical Drug

is-a

is-a

is-a

Ingredient

Composite Clinical Drug

Trademark Drug

is-a

is-a

Manufactured Components

Composite Trademark Drug


Drug model hierarchy5 l.jpg
Drug Model Hierarchy

Packages

Medications

Drug Class

International Package Identifiers

Chemicals

is-a

Not-Fully-Specified Drug

is-a

Ingredient Class

is-a

Country-Specific Packaged Product

Clinical Drug

is-a

is-a

is-a

Ingredient

Composite Clinical Drug

Trademark Drug

is-a

is-a

Manufactured Components

Composite Trademark Drug


Clinical drugs l.jpg
Clinical Drugs

  • Dosage form

  • Active ingredients

    • Chemical

    • Form Strength

      • Strength amount

      • Strength units

      • Volume

      • Volume units


Content l.jpg
Content

  • Needs to be complete

  • Needs to be up-to-date


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Concept Orientation

  • Unique identifiers associated with meaning

  • Name can change; meaning cannot

  • Nonredundant

  • Unambiguous

  • Codes can’t be reused


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Concept Permanence

  • Meaning doesn’t change

  • Never deleted


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Nonsemantic Identifiers

  • Don’t use names

  • Don’t use mnemonics

  • Don’t use hierarchical codes


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Polyhierarchy

  • Multiple classes for terms

  • Multiple views


Polyhierarchy12 l.jpg

Nonsteroidal Anti-inflammatory Medication

Glaxo Wellcome Products

Opiate Analgesic

Tablet

Aspirin Preparations

Codeine Preparations

Aspirin 325/Codeine 30mg Tablet

Polyhierarchy

Empirin #3


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Formal Definitions

  • Avoid misunderstanding of meaning

  • Allow detection of ambiguity and redundancy

  • Support multiple classification


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Formal Definitions

(Empirin #3:

(Ingredients:

( (Ingredient Aspirin) (Strength “325”) (Units milligrams) )

( (Ingredient Codeine) (Strength “30”) (Units milligrams) )

(Form: Tablet)

(Manufacturer: Glaxo Wellcome) )



Reject not elsewhere classified l.jpg
Reject “Not Elsewhere Classified”

  • Ambiguous (e.g., “Other Antibiotics”)

  • Semantic drift thwarts concept permanence


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Multiple Granularities

  • Different users need different abstractions


Multiple granularities18 l.jpg

Nonsteroidal Anti-inflammatory Medication

Aspirin Preparations

Aspirin 325/Codeine 30mg Tablet

Multiple Granularities

Empirin #3


Graceful evolution l.jpg
Graceful Evolution

  • Avoid:

    • Redundancy

    • Major name changes

    • Code reuse

    • Changed codes

  • Support:

    • Simple addition

    • Refinement

    • Minor name changes

    • Precoordination

    • Disambiguation

    • Obsolescence

    • Discovered redundancy


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NDC and the Desiderata

  • Content - timeliness and comprehensiveness

  • Concept orientation - done

  • Concept permanance - needs work

  • Nonsemantic identifiers - worst of both worlds

  • Polyhierarchy - may be beyond purview of FDA

  • Formal definitions - easily accomplished

  • Reject “NEC” - done (watch out for hierarchies)

  • Multiple granularities - as per polyhierarchy

  • Graceful evolution - editorial policy needed


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HL7’s Perspective

  • Need unique identifiers for:

    • Clinical (orderable) products

    • Dispensable products

    • Classes

    • Drug forms

    • Delivery routes

  • Need all these in a timely, high-quality form

  • Not all need come from FDA


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