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Drug naming standard for electronic health records enhanced

Data contributed by First DataBank improves utility of drug vocabulary produced by NIH

The RxNorm standard clinical drug vocabulary produced by the National Library of Medicine (NLM) now contains more accurate and complete connections between National Drug Codes (NDCs) and standard nonproprietary names of medications recommended for use in electronic health records (EHRs).

It also includes, for the first time, First DataBank's set of NDCs. First DataBank is a provider of drug databases that are widely used in the health care industry.

NDCs are product identifiers assigned by manufacturers and packagers of drugs in the United States. They are published on medication labels and packages and are often used in pharmacy inventory control and in dispensing and billing for drugs. If a single manufacturer issues the same medication in packages of different sizes (25 tablets, 50 tablets, etc.), each size has a different NDC. If more than one manufacturer produces the same medication, each assigns different NDCs.

In contrast, the RxNorm vocabulary creates standard names and identifiers for the combinations of ingredients, strengths, and dose forms (such as Aspirin 325 MG Oral Tablet) that exist in drugs marketed in the United States. This is the information doctors typically include when they write a prescription because they often can't know the specific product that will be used to fill it. All medication products that contain the same active ingredients, the same strengths, and the same dose forms have the same RxNorm standard name. This standard name is connected to other information in RxNorm that can be used within EHR systems to improve patient safety.

Accurate and complete connections between NDC product codes and RxNorm standard names and identifiers have many potential uses within an individual patient's EHR. These include the use of an NDC on a medicine bottle to speed standard data entry or to trigger an alert written in the RxNorm standard that could prevent a medication error.

At present, there is no single source that contains the NDCs for all medications currently marketed in the United States. RxNorm has included NDCs provided by the Food and Drug Administration, the Department of Veterans Affairs, and the Multum and Gold Standard drug information sources for a number of years. Starting with the Feb. 7, 2011 release, RxNorm now includes a revised, filtered version of the NDC data that segregates obsolete NDCs from those currently in the marketplace. It also includes, for the first time, First DataBank's set of NDCs, which are widely used in the health care industry.

"The RxNorm standard clinical drug vocabulary is the result of great collaboration between NLM, the FDA, the VA, and commercial drug information providers, as illustrated by this latest submission from First DataBank," said NLM Director Donald A.B. Lindberg.

Stuart Nelson, M.D., creator of RxNorm, also welcomed the new content. "We believe that this represents an important addition which improves RxNorm's quality and its usefulness in medication data entry, clinical decision support, and many activities, such as outcome and comparative effectiveness studies that rely on the ability to identify groups of patients who have taken the same medications," he said.

"First DataBank is pleased to help make the RxNorm standard vocabulary more useful to health care providers and patients," said Thomas R. Bizzaro, R.Ph., vice president for health policy and industry relations. "We are committed to enabling safe, high quality patient care and believe that comprehensive and up-to-date health data standards contribute to that goal."

Douglas Fridsma, M.D., Ph.D., head of Standards and Interoperability within the Office of the Nation al Coordinator for Health Information Technology applauded First DataBank's expanded contribution to RxNorm. "This is a great example of the private sector taking action to ensure that health data standards have the coverage they need to support meaningful use of electronic health records, including robust clinical decision support and efficient health information exchange."

In a recently published study sponsored by the Centers for Medicare & Medicaid Services and performed by the RAND Corporation and others, RxNorm was found to have entries for essentially all of the drugs in a sample of 19,743 ambulatory e-prescriptions (electronic prescriptions for patients seen in clinics or physician offices). Some e-prescriptions in the study sample failed to match automatically to an NDC in RxNorm, however. The inclusion of the First DataBank NDCs is likely to eliminate this gap.

For more information about RxNorm, visit http://www.nlm.nih.gov/research/umls/rxnorm/index.html.

The National Library of Medicine (NLM) is the world's largest library of the health sciences and collections, organizes and makes available biomedical science information to scientists, health professionals and the public. For more information, visit the website at www.nlm.nih.gov.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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