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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

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
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
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
drug model hierarchy
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
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
Clinical Drugs
  • Dosage form
  • Active ingredients
    • Chemical
    • Form Strength
      • Strength amount
      • Strength units
      • Volume
      • Volume units
content
Content
  • Needs to be complete
  • Needs to be up-to-date
concept orientation
Concept Orientation
  • Unique identifiers associated with meaning
  • Name can change; meaning cannot
  • Nonredundant
  • Unambiguous
  • Codes can’t be reused
concept permanence
Concept Permanence
  • Meaning doesn’t change
  • Never deleted
nonsemantic identifiers
Nonsemantic Identifiers
  • Don’t use names
  • Don’t use mnemonics
  • Don’t use hierarchical codes
polyhierarchy
Polyhierarchy
  • Multiple classes for terms
  • Multiple views
polyhierarchy12

Nonsteroidal Anti-inflammatory Medication

Glaxo Wellcome Products

Opiate Analgesic

Tablet

Aspirin Preparations

Codeine Preparations

Aspirin 325/Codeine 30mg Tablet

Polyhierarchy

Empirin #3

formal definitions
Formal Definitions
  • Avoid misunderstanding of meaning
  • Allow detection of ambiguity and redundancy
  • Support multiple classification
formal definitions14
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
Reject “Not Elsewhere Classified”
  • Ambiguous (e.g., “Other Antibiotics”)
  • Semantic drift thwarts concept permanence
multiple granularities
Multiple Granularities
  • Different users need different abstractions
multiple granularities18

Nonsteroidal Anti-inflammatory Medication

Aspirin Preparations

Aspirin 325/Codeine 30mg Tablet

Multiple Granularities

Empirin #3

graceful evolution
Graceful Evolution
  • Avoid:
    • Redundancy
    • Major name changes
    • Code reuse
    • Changed codes
  • Support:
    • Simple addition
    • Refinement
    • Minor name changes
    • Precoordination
    • Disambiguation
    • Obsolescence
    • Discovered redundancy
ndc and the desiderata
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
hl7 s perspective
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