For standard OMOP Version 5 implementation, there is a vocabulary_id type of 'Drug Type' in CONCEPT table that includes codes such as : "randomized drug", "Prescription dispensed in pharmacy", "prescription dispensed through mail order", "prescription written", "medication list entry", "inpatient administration", and a few others. This code, as you mentioned below, is what is used in the drug_type_concept_id field in DRUG_EXPOSSURE.
The way I'd handle this if done in OMOP v5 is to add custom rows into the CONCEPT table for each of the categories below, and map to those. I would expand the surescripts dispensed to include dis-ambiguation between pharmacy and mail, then you can use the CONCEPT_RELATIONSHIP table to map the custom term with a relationship_id = 'is a' between the "SureScripts Pharmacy Dispensed" and "Prescription dispensed in pharmacy" as a standard OMOP term, which allows roll-up and use in other implementations but allows you to retain granularity in your local instance. I agree, PCOR doesn't seem to have the granularity at present to approximate the above solution. michael From: Russ Waitman [mailto:[email protected]] Sent: Monday, December 14, 2015 12:43 PM To: [email protected]; <[email protected]> Cc: Nathan Graham; Jiaxi Quan; Shawn N. Murphy; Lesley Curtis; Daniella Meeker; Matheny, Michael; Duke, Jon David; Patrick Ryan; Keith Marsolo; Michael Kahn; Charles Bailey; Abel N Kho; Klann, Jeffrey G.; Kevin Haynes; Grannis, Shaun J; Tamara McMahon Subject: Tagging for Surescripts fills, claims, and nulls with i2b2 modifiers and looking for OMOP/PCORnet analogs/harmonization Hi GPC-DEV, PCORnet, OMOP colleagues (I have met recently), and the i2b2 community, Nathan Graham, Jiaxi Quan, Tamara McMahon, and I are looking over the data that we're now getting from Surescripts into Epic here at KUMC. They turned on the feature here in the Spring and now we have 14.6 million events on 184,000 patients since May of 2014. As we look at the data, 3.4 million were marked as fills, 5.9 million as claims, and 5.3 million were null. In our data, nothing links back to a parent order in Epic. We're initially thinking of tagging these facts with a modifier. "SureScripts Dispensed" with then 3 sub-modifiers: "SureScripts Dispensed (Claim)" "SureScripts Dispensed (Fill)" "SureScripts Dispensed (Unknown)" (Note:I want to loop back with folks at Epic/Surescripts regarding what null means). PCORnetCDM We looked at the PCORnet CDM to see if there were any fields we need to load in CDM 2 or 3 related to attribution and CDM3 PRESCRIBING table has RX_BASIS RDBMS Text(2) SAS Char(2) 01=Dispensing 02=Administration NI=No information UN=Unknown OT=Other Basis of the medication order PCORnet But that really doesn't let you know if the source of the info was a fill or a claim. I know the SCILHS people are mapping to CDM 3 now https://github.com/hms-dbmi/i2b2-to-PCORNET-CDM but don't seem to see any source modifiers for i2b2 in SCILHS that cover how they are loading the PRESCRIBING.RX_BASIS field Jim Campbell in GPC had noted that the RX_BASIS field in the PCORnet CDM was inconsistent with the guidance on most EHR dispensing records. OMOP Now when we look at OMOP v5 https://github.com/OHDSI/CommonDataModel/blob/master/OMOP%20CDM%20v5.pdf It looks like they code the source of the med in a Drug_exposure table using the drug_type_concept_id drug_type_concept_id Yes integer A foreign key to the predefined concept identifier in the Standardized Vocabularies reflecting the type of drug exposure recorded. It indicates how the drug exposure was represented in the source data: as medication history, filled prescriptions, etc. But, I couldn't easily find a standard vocabulary used by OMOP that would specify the types of dispense record. I searched http://omop.org/VocabV4.5 for "fill" and didn't find anything. It seemed to mainly hold ATC and RxNorm which to my knowledge don't specify the terminology to attributing fill versus claim versus order, etc. If anyone has a standard vocabulary for OMOP that's commonly used, we'd ideally like to see if we can move in the direction of harmonizing the attribution of these medications facts. BTW, I presented the nominees for the PCORnet Data Committee and hope the names should be announced at the face to face PCORnet meeting Wednesday. So, stay tuned for more info on the PCORnet Data Committee shortly, Russ Waitman, PhD Director of Medical Informatics Assistant Vice Chancellor for Enterprise Analytics Associate Professor, Department of Internal Medicine University of Kansas Medical Center, Kansas City, Kansas 913-945-7087 (office) [email protected]<mailto:[email protected]> http://www.kumc.edu/ea-mi/ http://informatics.kumc.edu<http://informatics.kumc.edu/> http://informatics.gpcnetwork.org - a PCORNet collaborative
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