[CQM-419] For allergy observation NDFRT and UNII productCoded should RXCUI "integrated" in RxNorm be used? Created: 02/25/13 Updated: 08/14/13 Resolved: 08/14/13 |
|
| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | Guidance |
| Type: | Terminology | Priority: | Major |
| Reporter: | George Robinson (Inactive) | Assignee: | Rob McClure |
| Resolution: | Answered | Votes: | 1 |
| Labels: | None | ||
| Contact Name: | George Robinson |
| Contact Email: | grobinson@fdbhealth.com |
| Contact Phone: | 3175717390 |
| Institution/Name: | FDB |
| Guidance required: | Guidance for proper population of AllergyObservation QRDA productCoded |
| Solution: | The MU value sets currently do not include medication class concepts, but as is noted in the question, the expectation is to use NDFRT concepts to identify these classes. Even though ONC has stated that RXNORM is the preferred code system for reactants, it has become clear that for drug classes, the proper code system identifier to the expected NDFRT concepts is the NDFRT NUI (NDFRT Unique Identifier) and the NDFRT code system OID. Therefore your option 2 is preferred. |
| Tracker Notification: |
Duc Nguyen (Inactive), Kevin Larsen (Inactive), Maria Michaels (Inactive), Steve Emrick (Inactive)
|
| Description |
|
I’m seeking clarification on a debate regarding compilation of the “productCoded” element of the Allergy Observation when the source of the code which has been “integrated” within RxNorm spans FDA UNII (SAB = MTHSPL) or NDFRT on the behalf of one of our customers. One side supports use of the RXCUI, regardless of the code’s source (in keeping with ONC medication allergy constraint of "RxNorm for Medication Allergy", the other side supports use of the RXCUI only when the code spans the source vocabulary of RxNorm (more in keeping with HL7 C-CDA and QRDA specifications). FDB provides both the external code and the RXCUI to our customers within our cross-references. Here are a couple of examples: Patient drug allergy is to “amoxicillin”… amoxicillin spans the RxNorm precise ingredient “Amoxicillin”… I would expect this representation of the productCoded: <code code=”723” displayName = “Amoxicillin” Patient drug allergy is to “Penicillins” … spanning NDFRT N0000011281 “Penicillins” which is integrated in RxNorm with RXCUI 7986 Option 1 – Use RXCUI assigned to the NDFRT Code <code code=”7986” displayName = “Penicillins” Option 2 – use the NDFRT Code and NDFRT OID, as the code does not span an RXNORM value with a SAB (source vocabulary) of “RXNORM <code code=”N0000011281” displayName = “Penicillins” For the Penicillins example, which method is more consistent with ONC/CMS intent? Secondly, would the first option fail NIST validation? |
| Comments |
| Comment by George Robinson (Inactive) [ 04/30/13 ] |
|
I know it is confusing. RxNorm has a "duality" - it is a repository for multiple vocabularies; each code and its term integrated into RxNorm and assigned an RXCUI representative of its unique meaning. "RxNorm" is also a vocabulary source... when RXNORM is references as the source vocabulary, the "Code" and the "RXCUI" are identical. A vocabulary code which has been integrated within RxNorm is identified by its "code," its "source vocabulary" (SAB) and the RXCUI of which it has been integrated into RxNorm with. Certain vocabulary concepts (i.e., NDF-RT class concepts) are "integrated" within RxNorm but are not part of the RxNorm source vocabulary itself. NDFRT N0000011281 "Penicillins" has been integrated within RxNorm with an RXCUI of 7986. However, no record can be found within RxNorm where the source vocabulary is "RXNORM" for 7986. ONC specifies the use of "RxNorm" for "medication allergens"... does this imply the exclusive use of RxNorm the vocabulary, or the broader use of other vocabularies "integrated" within RxNorm (i.e., FDA UNII, VA NDF-RT)... secondly, if it implies the broader use of other vocabularies, we then need to adhere to HL7 v3 constraints for code and code system expression. I believe the intent of the HL7 pairing of "code" and "codesystem" (OID) is to attribute the source vocabulary responsible for the creation of the code. If this is the case, the proper presentation of "Penicillins" within the HL7 C-CDA would be to use the NDF-RT code "N0000011281" and its object identifier "2.16.840.1.113883.3.26.1.5". Alternatively, folks may take the position that the RXCUI could be sent along with the object identifier for RXNORM... however, if the recipient of the message would attempt to find an RXNORM "vocabulary" record for that RXCUI, they would not find a match. George A. Robinson, RPh www.fdbhealth.com Please join us at the FDB Customer Seminar Register Now! Early bird discount ends June 5th Follow us on Twitter and LinkedIn |
| Comment by Julia Skapik (Inactive) [ 04/30/13 ] |
|
George, Can you clarify for Rob what you are asking? Thanks, |
| Comment by Rob McClure [ 03/05/13 ] |
|
I'm a bit unclear on the exact question being asked, as well as the exact meaning of the word "span" in this context, but as to the choice of using NDF-RT identifiers or RXCUI identifiers for productCoded, I believe the answer should be RXCUI. Of note, RXCUI identifiers for all general pharmacologic class "collector" concepts like "Penicillins" is still not completed. We will need to get additional input on what is in the NIST validator. |