Sorry I missed it.

Nathan: could be we likely have some similar situations here but would have to 
see.

I would have to look at detailed examples but ideally the primary active chemo 
or drug would be mapped to RxNorm.

-          At Vanderbilt when we were doing formulary management across the 
pharmacy system and CPOE, we'd identify the active ingredients that would 
trigger decision support.

-          So if it's one active, I'd just map to that and ignore the fillers.

-          But if it's a custom compound of two or more, I'd map to two i2b2 
observations.  It's kind of wonky as we mainly now have those parent child 
relationships for just the modifiers.

I wonder if others have already tread this path outside our network like Lori 
Phillips at Partners,

Russ


From: Dan Connolly
Sent: Monday, November 28, 2016 12:33 PM
To: Phillip Reeder; [email protected]; Russ Waitman; Nathan Graham
Subject: RE: Mapping Medication Mixtures

Russ, did you notice this message? I wonder if it got lost in the shuffle while 
you were at AMIA.

We discussed it in last week's call and there were a few ideas, but if you have 
anything to add, please let us know.

Likewise, Nathan, is this issue familiar to you at all?

--
Dan
________________________________
From: 
[email protected]<mailto:[email protected]> 
[[email protected]] on behalf of Phillip Reeder 
[[email protected]]
Sent: Thursday, November 17, 2016 2:09 PM
To: [email protected]<mailto:[email protected]>
Subject: Mapping Medication Mixtures
We found that some of our ordered medications are not mapped by GCN to rxnorm 
using the shared mapping script.  It turns out that these medications are 
actually mixtures of medications that use a mixture template to order them.  
The data for what is actually in the med order ends up in the order_medmixinfo 
table.  For example:
"XXX Chemo Infusion" from the medication order turns out to be "XXX Chemo 
Solution" + "Overfill Volume for IV Infusions" + "Sodium Chloride 0.9% IV".

We have a simple generic code associated with the primary medication but I'm 
not seeing how to convert get that to an RXNorm Code. The "XXX Chemo Solution" 
does map to RXNorm.  But the ingredients in the template associated with the 
medicine id also can change over time.  In the case above, the template went 
from 2 to 3 ingredients at some point. I believe the filler was added to the 
mix.  But that indicates that they are not static templates which further 
complicates the mappings process.

I'm considering using the simple generic code to find another similar 
medication and then taking it's ingredients for my mapping.  Another 
alternative would be to use the medmixinfo to create 3 new observations in i2b2 
which represent the 3 components of the mixture.

Has anyone else looked at this?

Phillip


________________________________

UT Southwestern


Medical Center



The future of medicine, today.


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