Talk about dumb. Sorry for doing that. On Saturday 25 March 2006 12:09, Nancy Anthracite wrote: 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
