a model for medication strengths
I have not looked too hard at these, but I would expect DV_PROPORTION and DV_INTERVALDV_PROPORTION to be the most common types to use, or else just two DV_QUANTIFIEDs in an archetype (the first one). I think, as Grahame noted, it will come down to where the balance lies between putting stuff in the information model vs ontology. But my initial impressions are that a simple information model (ala just a DV_PROPORTION, or interval of them) will be inadequate to represent the complexity of medication strengths and forms that are used in real products (in Australia). When it comes time to review the medication archetypes we should review this issue. I don't think I have enough expertise to progress this any further, though I will play around a bit more with the AMT to see if it has any insights.. Andrew
a model for medication strengths
* prEN ISO 11238: Structures and Controlled Vocabularies for Ingredients (substances) * prEN ISO 11239: Structures and Controlled Vocabularies for Pharmaceutical Dose Forms, Units of Presentation and Routes of Administration * prEN ISO 11240: Structures and Controlled Vocabularies for Units of Measurement Thanks Stefan, I think these 3 would be very relevant - does anyone know how far this work has progressed? Andrew
a model for medication strengths
Yes Andrew, I was at the last ISO WG6 meeting and have a copy of the latest drafts to go to a Committee Draft. Evelyn -Original Message- From: openehr-clinical-boun...@openehr.org [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Andrew Patterson Sent: Friday, 23 January 2009 2:16 PM To: For openEHR clinical discussions Subject: Re: a model for medication strengths * prEN ISO 11238: Structures and Controlled Vocabularies for Ingredients (substances) * prEN ISO 11239: Structures and Controlled Vocabularies for Pharmaceutical Dose Forms, Units of Presentation and Routes of Administration * prEN ISO 11240: Structures and Controlled Vocabularies for Units of Measurement Thanks Stefan, I think these 3 would be very relevant - does anyone know how far this work has progressed? Andrew ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
a model for medication strengths
prEN ISO 11238: Structures and Controlled Vocabularies for Ingredients (substances) - prEN ISO 11239: Structures and Controlled Vocabularies for Pharmaceutical Dose Forms, Units of Presentation and Routes of Administration prEN ISO 11240: Structures and Controlled Vocabularies for Units of Measurement These documents are under revision as Committee Drafts on WG 6 of ISO TC 215 and should be available with the new revisions on the ISO TC 215 shared point documents for revision by the Committee. In Edinburgh, in the last week of April, during the ISO TC 215 meeting these documents will be discussed. Since this a new work item a lot can change. Beatriz Andrew Patterson wrote: * prEN ISO 11238: Structures and Controlled Vocabularies for Ingredients (substances) * prEN ISO 11239: Structures and Controlled Vocabularies for Pharmaceutical Dose Forms, Units of Presentation and Routes of Administration * prEN ISO 11240: Structures and Controlled Vocabularies for Units of Measurement Thanks Stefan, I think these 3 would be very relevant - does anyone know how far this work has progressed? Andrew ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical Esta mensagem foi verificada pelo E-mail Protegido Terra. Atualizado em 22/01/2009
{Disarmed} Re: a model for medication strengths
Hi Andrew,
The dm+d medication model does contain these concepts and it was used as the
basis for constructing the
Australian Medicines Terminology (AMT) - Julie and Hugh (original authors of
dm+d)
came to Australia to help with this process.
The result (AMT) was handed to the Australian National eHealth Transition
Authority (NeHTA)
by a joint MSIA/DoHA working group over 4 years ago!
Since then NeHTA have simplified it and populated the structures at least for
PBS medications and are currently working on the rest
of the non-PBS medications
How much has been removed as part of the simplification I am unclear
You can access the AMT by going to the NeHTA Web site and registering for a
SNOMED licence (free for Australians).
You will then be able to download the AMT
Regards
Vince
Dr Vincent McCauley MB BS, Ph.D
CEO, McCauley Software Pty Ltd www.mccauleysoftware.com
President, Medical Software Industry Association www.msia.com.au
Vice Chair, HL7 Australia
p: +61298186493
f: +61298181435
- Original Message -
From: Paul Miller
To: For openEHR clinical discussions
Sent: Wednesday, January 21, 2009 6:31 AM
Subject: {Disarmed} Re: a model for medication strengths
Hi Andrew
The dm+d data model seems to me to provide some of this. From the dm+d data
model V2.3 from this page:
MailScanner has detected a possible fraud attempt from 195.97.218.30
claiming to be MailScanner warning: numerical links are often malicious:
http://195.97.218.30/dmd_download.htm
pharmaceutical strength
The amount of ingredient substance (as identified by the attribute ingredient
substance identifier or basis of strength substance identifier as indicated
above).
This attribute indicates the quantity of the substance per defined unit of
measure in the Virtual Medicinal Product (e.g. one tablet, one ml) measured by
weight or volume per unit or concentration. An ingredient may be present
without a strength.
Pharmaceutical strength has 4 components, where a strength is provided the
strength value numerator (SVN) and strength value numerator unit (SVNU) are
mandatory. Strength value denominator (SVD) and strength value denominator
unit (SVDU) are used to fully express 'per' strengths.
EXAMPLES:
Paracetamol 500mg tablets
Ingredient SVNSVNUSVDSVDU
Paracetamol 500 mg
Paracetamol 250mg/5ml oral suspension
Ingredient SVNSVNUSVDSVDU
Paracetamol 50 mg 1 ml
Hydrocortisone 1% cream
Ingredient SVNSVNUSVDSVDU
Hydrocortisone 10 mg 1g
would suggest a good starting point, perhaps?
--
Dr Paul Miller
Scotland, UK
Tel: +44 (0) 7711-346-928
2009/1/20 Karsten Hilbert Karsten.Hilbert at gmx.net
On Tue, Jan 20, 2009 at 11:48:17PM +1100, Andrew Patterson wrote:
Now I realise this is pretty complex - for instance these are
some of the medication strengths strings listed for some Australian
medications..
0.3mg/mL (0.03%)
0.4mg-10.0mg-2.0mg/mL
0.54g-1.28g/10mL
0.375mg
1% w/w
1 Million KIU/100mL
10 dose
100mcg/capsule
Well, basically, strength should be amount per amount.
Sometimes (as in the examples given above) there is assumed
knowledge involved, say, how many drops are in a milliliter.
So, with each of the strength indications one needs to
provide an algorithm and appropriate factors with which to
reduce it to a normalized form. That way it can be made
computable. Note that the above do not seem to all mean
quite the same things.
Those factors and algorithms could well be encapsulated into
dedicated classes as you suggested.
Karsten
--
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E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
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a model for medication strengths
Thank you all for your comments on this, specific responses below Diego: I agree that UCUM might be a useful within a model - however, I just don't think a single PQ covers the scope of strengths that I am seeing in use in Australian medications (they become a lot more complex). Karsten: Well, basically, strength should be amount per amount. Sometimes (as in the examples given above) there is assumed knowledge involved, say, how many drops are in a milliliter. So, with each of the strength indications one needs to provide an algorithm and appropriate factors with which to reduce it to a normalized form. That way it can be made computable. I agree that this is useful, but this normalization is even beyond what I require (though would be the obvious phase 2!). I just need a simple model that lets me literally store the strength designations for common medications in a way that is more controlled.. (my use of the word computable was maybe too strong) So I need to be able to represent that there is a medication called Aluminium Hydroxide/Magnesium Hydroxied/Simethicone that is sold as either a a tablet 200mg/200mg/20mg or in a liquid form 200mg-200mg-20mg/5mL Preferably the model would prevent storage of incorrect data - dressings would require an 'area' measure, injections would require 'mass' / 'volume' measures, tinctures would only allow percentages etc. Ampoules are sometimes measured as percentages, sometimes ratios, sometimes mass/volume. The model would need to cope with the fact that sometimes tablets have multiple medical ingredients and so it must be able to store N masses etc I need this to be controlled so that I can do things like display them in a uniform manner (do I put - between components of a tablet, or / as in the example). I don't know what the answers are but without some formalization I know that we'll all do it different in an _uncontrolled_ way. I know that there are some national efforts to put medications in terminology (dm+d, AMT etc) and if all this information is in the terminology then perhaps we don't need any strength modelled in the medication archetypes? We just point to a single term that says what the exact medication trade product is, and the strength is implicit from that? Note that the above do not seem to all mean quite the same things. Yes - I was just cutting and pasting various in use strengths from a whole bunch of australian medications. There appears to be rougly 1000 different strengths in use (i.e. if we say 0.1mg/mL is different to 0.2mg/mL). The computer scientist in me wants to bring order to this universe - surely we can get this down to under 100 documented strength types InjectionStrength XXmg / YYmL or XXmg[] / YYmL CapsuleStrength XXmg or XXg or XXmcg etc Paul: I will look into dm+d modelling a bit - thanks for the tip. I have been using the AMT (which is its Australian counterpart) but it doesn't seem to have the concepts you mentioned. Andrew
{Disarmed} Re: a model for medication strengths
The dm+d medication model does contain these concepts and it was used as the basis for constructing the How much has been removed as part of the simplification I am unclear Thanks Vince - this question arose because I was trying to do some mappings into the AMT - the simplified version (as of 1.10) doesn't seem to be populated with any of these concepts (thought the accompanying UML diagram does seem to indicate the relationships may exist). I guess it may be a case of waiting till some of this data appears in the AMT (I imagine actually getting the medication themselves listed is NEHTAs first priority) Andrew
a model for medication strengths
Hi Andrew, I have not looked too hard at these, but I would expect DV_PROPORTION and DV_INTERVALDV_PROPORTION to be the most common types to use, or else just two DV_QUANTIFIEDs in an archetype (the first one). - thomas beale Andrew Patterson wrote: I was wondering if anyone had any experience or knowledge of a useable model for storing computable medication strengths (and medications forms etc)? Now I realise this is pretty complex - for instance these are some of the medication strengths strings listed for some Australian medications.. 0.3mg/mL (0.03%) 0.4mg-10.0mg-2.0mg/mL 0.54g-1.28g/10mL 0.375mg 1% w/w 1 Million KIU/100mL 10 dose 100mcg/capsule However I actually think that it would be possible to construct a way of modelling most of these in a regular manner (certainly if we leave the really hard/obscure ones to the side it should be possible to cover the _majority_ of medications). It doesn't even have to be a particularly clever model - I mean it could have 50+ distinct classes each covering a different style of medication strength/form with no clever OO hierarchy or anything, and surely it would be better than doing everything as a string? I would presume that this is the type of thing they do at HL7, but whereas I can find models for how medication components and ingredients relate etc it seems that strengths and forms are just strings?? From the openehr end, there is some attempt in the medication archetypes to put it in a computable form but I'm not sure the archetypes are at all complete yet - they have a Strength Per Dose Unit as a mass unit, and a Dose Unit as a terminology value but this does not seem to be adequate to me. Is there any published work that looks at this problem that can help us flesh out the medication archetypes? The nearest paper I could find in this area was http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=516250 Andrew ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical -- *Thomas Beale Chief Technology Officer, Ocean Informatics http://www.oceaninformatics.com/* Chair Architectural Review Board, /open/EHR Foundation http://www.openehr.org/ Honorary Research Fellow, University College London http://www.chime.ucl.ac.uk/ * *
a model for medication strengths
I was wondering if anyone had any experience or knowledge of a useable model for storing computable medication strengths (and medications forms etc)? Now I realise this is pretty complex - for instance these are some of the medication strengths strings listed for some Australian medications.. 0.3mg/mL (0.03%) 0.4mg-10.0mg-2.0mg/mL 0.54g-1.28g/10mL 0.375mg 1% w/w 1 Million KIU/100mL 10 dose 100mcg/capsule However I actually think that it would be possible to construct a way of modelling most of these in a regular manner (certainly if we leave the really hard/obscure ones to the side it should be possible to cover the _majority_ of medications). It doesn't even have to be a particularly clever model - I mean it could have 50+ distinct classes each covering a different style of medication strength/form with no clever OO hierarchy or anything, and surely it would be better than doing everything as a string? I would presume that this is the type of thing they do at HL7, but whereas I can find models for how medication components and ingredients relate etc it seems that strengths and forms are just strings?? From the openehr end, there is some attempt in the medication archetypes to put it in a computable form but I'm not sure the archetypes are at all complete yet - they have a Strength Per Dose Unit as a mass unit, and a Dose Unit as a terminology value but this does not seem to be adequate to me. Is there any published work that looks at this problem that can help us flesh out the medication archetypes? The nearest paper I could find in this area was http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=516250 Andrew
a model for medication strengths
Why don't create a PQ object and assign to its units UCUM as terminology name and the desired units to the code? Here is a list of the UCUM units list http://www.hl7.de/download/documents/ucum/ucumdata.html 2009/1/20 Andrew Patterson andrewpatto at gmail.com: I was wondering if anyone had any experience or knowledge of a useable model for storing computable medication strengths (and medications forms etc)? Now I realise this is pretty complex - for instance these are some of the medication strengths strings listed for some Australian medications.. 0.3mg/mL (0.03%) 0.4mg-10.0mg-2.0mg/mL 0.54g-1.28g/10mL 0.375mg 1% w/w 1 Million KIU/100mL 10 dose 100mcg/capsule However I actually think that it would be possible to construct a way of modelling most of these in a regular manner (certainly if we leave the really hard/obscure ones to the side it should be possible to cover the _majority_ of medications). It doesn't even have to be a particularly clever model - I mean it could have 50+ distinct classes each covering a different style of medication strength/form with no clever OO hierarchy or anything, and surely it would be better than doing everything as a string? I would presume that this is the type of thing they do at HL7, but whereas I can find models for how medication components and ingredients relate etc it seems that strengths and forms are just strings?? From the openehr end, there is some attempt in the medication archetypes to put it in a computable form but I'm not sure the archetypes are at all complete yet - they have a Strength Per Dose Unit as a mass unit, and a Dose Unit as a terminology value but this does not seem to be adequate to me. Is there any published work that looks at this problem that can help us flesh out the medication archetypes? The nearest paper I could find in this area was http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=516250 Andrew ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical -- Diego Bosc? Tom?s diebosto at fis.upv.es yampeku at gmail.com Grupo IBIME Instituto ITACA - Universidad Polit?cnica de Valencia Acceso B Edificio 8G Camino Vera s/n 46022 VALENCIA (Spain) tel: +34 963 875 277 http://ibime.upv.es
a model for medication strengths
On Tue, Jan 20, 2009 at 11:48:17PM +1100, Andrew Patterson wrote: Now I realise this is pretty complex - for instance these are some of the medication strengths strings listed for some Australian medications.. 0.3mg/mL (0.03%) 0.4mg-10.0mg-2.0mg/mL 0.54g-1.28g/10mL 0.375mg 1% w/w 1 Million KIU/100mL 10 dose 100mcg/capsule Well, basically, strength should be amount per amount. Sometimes (as in the examples given above) there is assumed knowledge involved, say, how many drops are in a milliliter. So, with each of the strength indications one needs to provide an algorithm and appropriate factors with which to reduce it to a normalized form. That way it can be made computable. Note that the above do not seem to all mean quite the same things. Those factors and algorithms could well be encapsulated into dedicated classes as you suggested. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
{Disarmed} Re: a model for medication strengths
Hi Andrew The dm+d data model seems to me to provide some of this. From the dm+d data model V2.3 from this page: http://195.97.218.30/dmd_download.htm pharmaceutical strength The amount of ingredient substance (as identified by the attribute ingredient substance identifier or basis of strength substance identifier as indicated above). This attribute indicates the quantity of the substance per defined unit of measure in the Virtual Medicinal Product (e.g. one tablet, one ml) measured by weight or volume per unit or concentration. An ingredient may be present without a strength. Pharmaceutical strength has 4 components, where a strength is provided the strength value numerator (SVN) and strength value numerator unit (SVNU) are mandatory. Strength value denominator (SVD) and strength value denominator unit (SVDU) are used to fully express 'per' strengths. EXAMPLES: Paracetamol 500mg tablets *Ingredient SVNSVNUSVDSVDU* Paracetamol 500 mg Paracetamol 250mg/5ml oral suspension *Ingredient SVNSVNUSVDSVDU* Paracetamol 50 mg 1 ml Hydrocortisone 1% cream *Ingredient SVNSVNUSVDSVDU* Hydrocortisone 10 mg 1 g would suggest a good starting point, perhaps? -- Dr Paul Miller Scotland, UK Tel: +44 (0) 7711-346-928 2009/1/20 Karsten Hilbert Karsten.Hilbert at gmx.net On Tue, Jan 20, 2009 at 11:48:17PM +1100, Andrew Patterson wrote: Now I realise this is pretty complex - for instance these are some of the medication strengths strings listed for some Australian medications.. 0.3mg/mL (0.03%) 0.4mg-10.0mg-2.0mg/mL 0.54g-1.28g/10mL 0.375mg 1% w/w 1 Million KIU/100mL 10 dose 100mcg/capsule Well, basically, strength should be amount per amount. Sometimes (as in the examples given above) there is assumed knowledge involved, say, how many drops are in a milliliter. So, with each of the strength indications one needs to provide an algorithm and appropriate factors with which to reduce it to a normalized form. That way it can be made computable. Note that the above do not seem to all mean quite the same things. Those factors and algorithms could well be encapsulated into dedicated classes as you suggested. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20090120/ea467d08/attachment.html
