Keith What my researchers want most is exposure data documenting treatment events and the time frame of exposure. It is not clear to me yet whether dosing data is important to research planning but certainly start and end dates and probably doses or frequency of administration are likely important. CDMV31.PROCEDURES as designed can only document a time series of administration events as NDC codes or record the beginning or end date of an infusion if it lasts more than 24 hours. CDMV31.PRESCRIBING has more detail to offer as to start and end dates for treatment planning as well as dosing data but is intentional only, cannot document administration and must be reported as RxNORM codes for any hope of nteroperation.
At Nebraska, and I hope SCILHS, we have our i2b2 metadata organized so that NDC package codes can be indexed to their RxNORM semantic clinical drugs but I suspect many do not. For the use case of identifying treatment exposure, I think the CDM is splitting the extracted pharmaceutical data into separate tables that fragment the events and codify them with two different schemes for which we do not offer a simple translation. In my opinion, as a documentation of treatment exposure, CDMV31.PROCEDURES is less than optimal. Jim From: Marsolo, Keith [mailto:keith.mars...@cchmc.org] Sent: Tuesday, April 18, 2017 10:51 AM To: Campbell, James R <campb...@unmc.edu> Cc: Laura Qualls <laura.qua...@duke.edu> Subject: Re: Medication orders, dispense and admin events Jim, We may not have been entirely clear on the call, and we can try to work on the language. What we were trying to say is that if a site has evidence of medication administration in their procedure orders, then those events should end up in the PROCEDURES table. For example, if an infusion is billed as a procedures, that event would be in the PROCEDURES table. We wouldn’t have all of the metadata that you would associate with an administration/infusion, but we would know that the event occurred. That’s what we were getting at. We do NOT want people to load their native medication administration records into the PROCEDURES table. I realize it’s a bit nuanced. We’ll definitely work on clarifying things. Keith On Apr 18, 2017, at 8:28 AM, Campbell, James R <campb...@unmc.edu<mailto:campb...@unmc.edu>> wrote: Keith If you check the notes from the ?third call you hosted, discussion on the PROCEDURES table concluded that medication administration events could be stored there…a surprise to me. At any rate, GPC is simply trying to achieve consensus on where to store medication events. For right now, and based upon your response, I am concluding: ORDERS(Inpatient, clinic and prescriptions) • CDMV31.PRESCRIBING DISPENSE EVENTS(Inpatient and community pharmacy) • CDMV31.DISPENSING ADMINISTRATION EVENTS(Inpatient, clinic) •CDMV31.PROCEDURES You further caution us to record events indexed to the most specific level of clinical detail: NDC codes for dispense and administration events and RXNORM SBD and SCD (or I assume BPCK or GPCK) for orders. Have I interpreted you correctly? At Nebraska we have our metadata organized so that we can aggregate by ingredient for searches, but do not store events at that level. Jim From: Marsolo, Keith [mailto:keith.mars...@cchmc.org] Sent: Friday, April 14, 2017 1:50 PM To: Campbell, James R <campb...@unmc.edu<mailto:campb...@unmc.edu>> Cc: Laura Qualls <laura.qua...@duke.edu<mailto:laura.qua...@duke.edu>> Subject: Re: Medication orders, dispense and admin events Jim, Sorry for the very delayed response. This week got away from me. You can end up looking at this from a couple of different angles. If you are an investigator, and want to research on chemotherapy treatments, you can look at the available tables that may contain medications and decide which to investigate. For chemotherapy, that’d probably be PROCEDURES and PRESCRIBING. It’s likely that an institution would have data in one of those tables, or both, depending on their source system. If you’re approaching the problem as an ETL programmer (which is what I think you’re asking), then it’s a different question. Given chemotherapy data, where do I put it in the CDM? Assuming that the chemotherapy treatments look something like medication administration data, I think we’d want the orders to be put into the PRESCRIBING table. Right now, we don’t really have a place to store the administration event itself, but that’s something we hope to address in the next version of the CDM. In the antibiotic study, the main challenge was getting network partners to map their data to the right level of RxNorm. The preference is to use a more inclusive term level, like Semantic Branded Drug (SBD) or Semantic Clinical Drug (SCD). I understand that storing by ingredient can make the ontology more straightforward, but it greatly complicates any downstream analysis. So my recommendation would be to store the SBD or SCD RxCUI as part of the observation (perhaps as a modifier) even if you use ingredient as a concept code. That way there isn’t any loss of analytic utility when it comes time to populate the CDM. I’m copying Laura in case she’d like to add anything. Keith On Apr 4, 2017, at 1:08 PM, Campbell, James R <campb...@unmc.edu<mailto:campb...@unmc.edu>> wrote: Keith From the Data characterization calls with DRNOC a couple weeks back, I took away to a confusing discussion within GPC about how we are deploying medications in CDMV3+. In particular, you noted that medication administration events were to be expected in PROCEDURES in NDC codes but orders are in PRESCRIBING (at least ambulatory) in RXNORM and dispense events in DISPENSING with NDC. Discussing this with our Cancer workgroup, they have a requirement for tracking chemotherapy treatments and are asking for advice on standardization of deployment. We are organiuzing our i2b2 medication metadata from NLM by ingredient (RXNORM) and subsuming all clinical formulations (RXNORM) and packaging (NDC) in a tree structure with top level organization by VA drug classes. I understand you are involved in a national antibiotic study and ask if you can provide some advice or direct me to guidance from PCORI/Sentinel about how we should be planning our i2b2 deployment of medication events. Jim The information in this e-mail may be privileged and confidential, intended only for the use of the addressee(s) above. Any unauthorized use or disclosure of this information is prohibited. If you have received this e-mail by mistake, please delete it and immediately contact the sender. The information in this e-mail may be privileged and confidential, intended only for the use of the addressee(s) above. Any unauthorized use or disclosure of this information is prohibited. If you have received this e-mail by mistake, please delete it and immediately contact the sender. The information in this e-mail may be privileged and confidential, intended only for the use of the addressee(s) above. Any unauthorized use or disclosure of this information is prohibited. 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