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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. HL7’s Needs Desiderata

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The Future of NDC: The HL7 Perspective

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Clinical Drugs • Dosage form • Active ingredients • Chemical • Form Strength • Strength amount • Strength units • Volume • Volume units

  7. Content • Needs to be complete • Needs to be up-to-date

  8. Concept Orientation • Unique identifiers associated with meaning • Name can change; meaning cannot • Nonredundant • Unambiguous • Codes can’t be reused

  9. Concept Permanence • Meaning doesn’t change • Never deleted

  10. Nonsemantic Identifiers • Don’t use names • Don’t use mnemonics • Don’t use hierarchical codes

  11. Polyhierarchy • Multiple classes for terms • Multiple views

  12. Nonsteroidal Anti-inflammatory Medication Glaxo Wellcome Products Opiate Analgesic Tablet Aspirin Preparations Codeine Preparations Aspirin 325/Codeine 30mg Tablet Polyhierarchy Empirin #3

  13. Formal Definitions • Avoid misunderstanding of meaning • Allow detection of ambiguity and redundancy • Support multiple classification

  14. Formal Definitions (Empirin #3: (Ingredients: ( (Ingredient Aspirin) (Strength “325”) (Units milligrams) ) ( (Ingredient Codeine) (Strength “30”) (Units milligrams) ) (Form: Tablet) (Manufacturer: Glaxo Wellcome) )

  15. NEC

  16. Reject “Not Elsewhere Classified” • Ambiguous (e.g., “Other Antibiotics”) • Semantic drift thwarts concept permanence

  17. Multiple Granularities • Different users need different abstractions

  18. Nonsteroidal Anti-inflammatory Medication Aspirin Preparations Aspirin 325/Codeine 30mg Tablet Multiple Granularities Empirin #3

  19. Graceful Evolution • Avoid: • Redundancy • Major name changes • Code reuse • Changed codes • Support: • Simple addition • Refinement • Minor name changes • Precoordination • Disambiguation • Obsolescence • Discovered redundancy

  20. 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

  21. 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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