John Kilbourne

Normalized names for clinical drugs: RxNorm at 6 years.

OBJECTIVE In the 6 years since the National Library of Medicine began monthly releases of RxNorm, RxNorm has become a central resource for communicating about clinical drugs and supporting interoperation between drug vocabularies. MATERIALS AND METHODS Built on the idea of a normalized name for a medication at a given level of abstraction, RxNorm provides a set of names and relationships based on 11 different external source vocabularies. The standard model enables decision support to take place for a variety of uses at the appropriate level of abstraction. With the incorporation of National Drug File Reference Terminology (NDF-RT) from the Veterans Administration, even more sophisticated decision support has become possible. DISCUSSION While related products such as RxTerms, RxNav, MyMedicationList, and MyRxPad have been recognized as helpful for various uses, tasks such as identifying exactly what is and is not on the market remain a challenge.

Building a Standards-Based and Collaborative E-Prescribing Tool MyRxPad

MyRxPad is a prototype application developed at the National Library of Medicine that helps prescribers lower some of the e-prescribing adoption barriers and encourages an early positive experience of e-prescribing. We envision a practitioner-patient collaborative approach towards e-prescribing: patients play an active role in their healthcare by maintaining up-to-date and accurate medication lists. Prescribers make well-informed and safe prescribing decisions based on personal medication records contributed by patients. In the paper, we discuss the development of MyRxPad, a vehicle for collaborations with patients using MyMedicationList. Integration with personal medication records in the context of e-prescribing is thus enabled. An early version of MyRxPad is available at http://rxp.nlm.nih.gov.

Building a standards-based and collaborative e-prescribing tool: MyRxPad

MyRxPad is a prototype application developed at the National Library of Medicine that helps prescribers lower some of the e-prescribing adoption barriers and encourages an early positive experience of e-prescribing. We envision a practitioner-patient collaborative approach towards e-prescribing: patients play an active role in their healthcare by maintaining up-to-date and accurate medication lists. Prescribers make well-informed and safe prescribing decisions based on personal medication records contributed by patients. In the paper, we discuss the development of MyRxPad, a vehicle for collaborations with patients using MyMedicationList. Integration with personal medication records in the context of e-prescribing is thus enabled. An early version of MyRxPad is available at http://rxp.nlm.nih.gov.

Evaluating the implementation of RxNorm in ambulatory electronic prescriptions.

OBJECTIVE RxNorm is a standardized drug nomenclature maintained by the National Library of Medicine that has been recommended as an alternative to the National Drug Code (NDC) terminology for use in electronic prescribing. The objective of this study was to evaluate the implementation of RxNorm in ambulatory care electronic prescriptions (e-prescriptions). METHODS We analyzed a random sample of 49 997 e-prescriptions that were received by 7391 locations of a national retail pharmacy chain during a single day in April 2014. The e-prescriptions in the sample were generated by 37 801 ambulatory care prescribers using 519 different e-prescribing software applications. RESULTS We found that 97.9% of e-prescriptions in the study sample could be accurately represented by an RxNorm identifier. However, RxNorm identifiers were actually used as drug identifiers in only 16 433 (33.0%) e-prescriptions. Another 431 (2.5%) e-prescriptions that used RxNorm identifiers had a discrepancy in the corresponding Drug Database Code qualifier field or did not have a qualifier (Term Type) at all. In 10 e-prescriptions (0.06%), the free-text drug description and the RxNorm concept unique identifier pointed to completely different drug concepts, and in 7 e-prescriptions (0.04%), the NDC and RxNorm drug identifiers pointed to completely different drug concepts. DISCUSSION The National Library of Medicine continues to enhance the RxNorm terminology and expand its scope. This study illustrates the need for technology vendors to improve their implementation of RxNorm; doing so will accelerate the adoption of RxNorm as the preferred alternative to using the NDC terminology in e-prescribing.