I think maybe I'm not understanding your question ;-) ----- Original Message ----- From: "Nancy Anthracite" <[EMAIL PROTECTED]> To: <hardhats-members@lists.sourceforge.net> Sent: 2006-03-25 11:09 AM Subject: Re: [Hardhats-members] Pharmacy question: matching ingredients
> You are absolutely right that I am very interested. Do you have any objection > to my posting this on the Hardhats mailing list? > > On Saturday 25 March 2006 11:36, Bill Walton wrote: > Hi Nancy, > > Thought you might be interested in a couple of links I came across a while > back while looking into the drug interaction database question. > > Best regards, > Bill > > http://www.drugref.org/ > > http://www.e-mds.com/emds/prodserv/drugdb.html > > > ----- Original Message ----- > From: "Nancy Anthracite" <[EMAIL PROTECTED]> > To: <hardhats-members@lists.sourceforge.net> > Sent: 2006-03-25 9:42 AM > Subject: Re: [Hardhats-members] Pharmacy question: matching ingredients > > > I think that Mark Amundson's business will provide this service for those > > who > > > wish to purchase it. > > > > The whole question of drug interactions is an interesting one. There are > > databases one can purchase, but when it comes to implementing them, this > > is > > > an issue which virtually all medical records systems in large hospitals, > > particularly teaching hospitals, wrestle with. The severity of the > > interaction is rated by the company distributing the database, but I > > gather > > > the majority of the time there is not even close to unanimity of opinion > > about the advisability of using their rating system to generate an alert > > since the severity of the interaction does not always match the clinical > > importance of it. > > > > Since most systems that pop up an alert will expect an entry to explain > > the > > > over-ride, they don't want to harass their physicians with marginally > > helpful > > > alerts or alerts they do not feel rise to the level of necessitating this > > sort of added interaction. > > > > Generally there is a process established where folks can recommend alerts > > and > > > then there are one or more levels of review committees set up to determine > > what will go into the record system and also accept feedback and evaluate > > how > > > well they work. This is true for things other than drug interactions as > > well, such as reminders. > > > > As far as I know, the VA does its own interaction testing and own entries > > which involve an entry and a double check by a different person to be sure > > the orderable item file is correct. I don't know it for sure, but I > > suspect > > > there are committees like the ones I mentioned above at the VA. > > > > This whole question is a big one for the reasons Kevin has already cited > > and > > > especially because of VOE. VOE will go out the door with a drugs and > > interactions, but how will this be maintained? It was populated with an > > existing database, but will that continue? I am not aware of any plans to > > see that it will or of attempts being made to seek the cooperation of the > > VA > > > in doing it. That does not mean it hasn't happened. I just have not > > heard > > > about it. > > > > So I would guess that Mark's business prospects should be quite good. > > Let's > > > hope that he prices his services reasonably. > > > > On Saturday 25 March 2006 08:36, Kevin Toppenberg wrote: > > I have a question for the pharmacists on the message board: > > > > As I am processing the 280,000 entries in the FDA database, I am > > matching first by NDC. If that fails, I then have a drug that > > potentially needs to be added to the VA PRODUCT file. > > > > In order for the drug to work with drug-interaction testing later, the > > drug INGREDIENTS of the new addtion need to match with existing VistA > > ingredients. But here lies my problem. A great many drugs fail to > > match ingredients. > > > > Here is one example: > > > > FDA: ceftazidime pentahydride > > VistA: ceftazidime > > > > In this example, I feel fairly comfortable matching these. But if I > > make a rule that says, "if simple comparison doesn't match, then allow > > matching based on FIRST word only", then I worry that I will create a > > match between two ingredients that shouldn't be matched. > > > > So my question is: Is this worry valid? Are there ingredients where > > the second or third words DO MAKE A DIFFERENCE? > > > > Next, there are going to be new substances/ingredients that have been > > released by the FDA that have not previously been put into the VA > > PRODUCT file, or the INGREDIENTS file. For example, Spiriva > > (tiotropium), I don't know if this is in my VA PRODUCT file or not, > > but let's assume it is new enough that it is not already there. To > > add this as a new drug, I will need to add a new ingredient, > > TIOTROPIUM. > > > > But then what about the DRUG INTERACTIONS functionality? I haven't > > studied this part yet, but I assume there is a file somewhere that > > lists drug interactions and ingredients that cause them. If I don't > > have drug interaction data for new drugs, but do have it for old > > drugs, then providers will have a system that only works some of the > > time --> dangerous. In the VA system, I assume that new drugs are > > added one at a time by a pharmacist, on an as-needed basis. > > > > Question: Where do they get their information about drug interactions? > > There must be some database that they access, which should be > > continually updated. If so, is this a commercial product, or is it > > public and I could download it somewhere? > > > > I guess another option would be to simply add the new ingredients and > > then shut off the drug interaction system so that no warnings are > > generated (rather than just some of the time), and we would have the > > same situation as we do now, where doctors write prescriptions on > > paper and the pharmacist at the pharmacy fills the order (and *might* > > do some interaction checking). This is not a bad solution... > > > > Perhaps my work to automatically add missing drugs from the FDA > > database has been doomed from the start because there is not enough > > data there. (Other missing data is the maximum and minum doses, > > though I think our site can get by without this.) But frankly, the > > pharmacy system can't work if the doctors can't order ANY drug. And I > > feel I have established that we are not going to be able to tap into > > the up-to-date VA PRODUCT file maintained by the VA somewhere. And > > even this will not likely contain ALL the drugs (i.e. pediatric drugs, > > birth control tablets, labor & delivery drugs etc etc.) > > > > Your thoughts would be appreciated > > > > Kevin > > > > > > ------------------------------------------------------- > > This SF.Net email is sponsored by xPML, a groundbreaking scripting > > language > > > that extends applications into web and mobile media. Attend the live > > webcast > > > and join the prime developer group breaking into this new coding > > territory! > > > http://sel.as-us.falkag.net/sel?cmd=lnk&kid0944&bid$1720&dat1642 > > _______________________________________________ > > Hardhats-members mailing list > > Hardhats-members@lists.sourceforge.net > > https://lists.sourceforge.net/lists/listinfo/hardhats-members > > > > -- > > Nancy Anthracite > > > > > > ------------------------------------------------------- > > This SF.Net email is sponsored by xPML, a groundbreaking scripting > > language > > > that extends applications into web and mobile media. Attend the live > > webcast > > > and join the prime developer group breaking into this new coding > > territory! > > > http://sel.as-us.falkag.net/sel?cmd=lnk&kid=110944&bid=241720&dat=121642 > > _______________________________________________ > > Hardhats-members mailing list > > Hardhats-members@lists.sourceforge.net > > https://lists.sourceforge.net/lists/listinfo/hardhats-members > > ------------------------------------------------------- > This SF.Net email is sponsored by xPML, a groundbreaking scripting language > that extends applications into web and mobile media. Attend the live webcast > and join the prime developer group breaking into this new coding territory! > http://sel.as-us.falkag.net/sel?cmd=lnk&kid=110944&bid=241720&dat=121642 > _______________________________________________ > Hardhats-members mailing list > Hardhats-members@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/hardhats-members > > -- > Nancy Anthracite > > > ------------------------------------------------------- > This SF.Net email is sponsored by xPML, a groundbreaking scripting language > that extends applications into web and mobile media. Attend the live webcast > and join the prime developer group breaking into this new coding territory! > http://sel.as-us.falkag.net/sel?cmd=lnk&kid=110944&bid=241720&dat=121642 > _______________________________________________ > Hardhats-members mailing list > Hardhats-members@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/hardhats-members ------------------------------------------------------- This SF.Net email is sponsored by xPML, a groundbreaking scripting language that extends applications into web and mobile media. Attend the live webcast and join the prime developer group breaking into this new coding territory! http://sel.as-us.falkag.net/sel?cmd=lnk&kid=110944&bid=241720&dat=121642 _______________________________________________ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
