In general I handle this via the active ingredients as well, but try to use RXNORM's MIN (multi-ingredients) vs multiple single ingredients (IN). So for something like Folic acid / Vitamin D combinations, I would add the MIN (if it wasn't already there) and map to that.
The problem with the multiple single ingredients is that if you query for a single ingredient ... say Folic acid, you don't necessarily want the people taking the combination. As for your example .. I'm assuming the only active ingredient is the Chemo infusion, I'd map to that alone. Lori From: Russ Waitman [mailto:[email protected]] Sent: Monday, November 28, 2016 3:11 PM To: Dan Connolly <[email protected]>; Phillip Reeder <[email protected]>; [email protected]; Nathan Graham <[email protected]> Cc: Phillips, Lori C. <[email protected]>; members <[email protected]> Subject: RE: Mapping Medication Mixtures 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]<mailto:[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. The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance HelpLine at http://www.partners.org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail.
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