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RxNorm Extension - an OHDSI resource to represent international drugs
The purpose of this document is to define the process, rules and resulting structure of incorporating international drug vocabularies into an overall RxNorm-like system, called RxNorm Extension.
Drug vocabularies contain drug products and their components. Only about a third of these products are identical in the drug markets of individual countries or jurisdictions of a drug marketing approval agency. Even if the active ingredients are the same, they can differ in their Drug Strengths, Drug Forms, Brand Names, package sizes and manufacturers or distributors.
Therefore, these vocabularies need to be incorporated into the existing Drug Domain in such a way that all existing drugs and their components are correctly mapped, and the missing ones added as new concepts. This includes a life cycle for each Concept, allowing to generation, deprecation and update over time.
The processing script that follows these instructions can be found here.
General structure
The Drug Domain should be organized in a hierarchical structure described Drug Domain. This structure is based on RxNorm, which also forms the core of the content. RxNorm comprehensively describes the drug market in the United States. It may not contain products sold in the markets of other countries. It also does not contain US medical food or food supplement products.
This structure contains at a minimum (from bottom to top):
| Concept Class | Composed of |
|---|---|
| Branded Drug | Ingredients, their strength, form, brand name |
| Clinical Drug | Ingredient, their strength, form |
| Branded Drug Form | Ingredient, form, brand name |
| Clinical Drug Form | Ingredient, form |
| Branded Drug Component | Ingredient, strength, brand name |
| Clinical Drug Component | Ingredient, strength |
| Dose Form | Form |
| Brand Name | Brand name |
| Ingredient | Ingredient |
| Drug Class | Drug class |
It may optionally contain
| Concept Class | Composed of |
|---|---|
| Marketed Product | Ingredients, their strength, form, supplier (brand name and box size are optional) |
| Quantified Branded Drug Box | Ingredients, their strength, form, brand name, size and box size |
| Quantified Clinical Drug Box | Ingredients, their strength, form, size and box size |
| Branded Drug Box | Ingredients, their strength, form, brand name and box size |
| Clinical Drug Box | Ingredients, their strength, form and box size |
| Quantified Branded Drug | Ingredients, their strength, form, brand name, size |
| Quantified Clinical Drug | Ingredients, their strength, form, size |
| Branded Pack | Branded Drugs, their number (box size is optional) |
| Clinical Pack | Clinical Drugs, their number (box size is optional) |
| Supplier | Supplier |
Currently not supported in the Standardized Vocabularies:
| Concept Class | Composed of | Note |
|---|---|---|
| Precise Ingredient | Ingredient | Ingredient used instead; Precise Ingredients are mapped to Ingredients inside CONCEPT_RELATIONSHIP table |
| Multiple Ingredient | Ingredients | Single ingredients used instead |
| Dose Form Group | Dose Form | Explicit Dose Forms used instead; Dose Form Groups exist as Classification concepts and bear relation to standard concepts only inside native RxNorm vocabulary |
The Concepts are connected through hierarchical and lateral relationships.
Rules for adding Concepts
To add a Concept for which there is an existing equivalent:
- It should be recorded as a non-standard (source) Concept.
- It should be mapped through a “Maps to” relationship to its standard equivalent.
- All other relationships are optional and for QA and convenience. The standard Concept will take its place as the official representation.
To add a Concept that does not have an equivalent:
- It should be recorded as a standard Concept (standard_concept = 'S'), with the exception of Brand Names, which should be recorded as a non-standard Concepts.
- It should have hierarchical and lateral relationships in the same manner as RxNorm Concepts do.
- It should form relationship to relevant drug classes. The relationship_id of these relationship do not have to follow the RxNorm standard, as it differs for every drug class. Classes are most often defined for Ingredients, but some non-Ingredients may directly designate a Concept Class and “jump over” the Ingredient or even Drug Forms or Drug Components. They will be inferred automatically.
Units used in the strength determination are not added. They must be mapped to a Standard UCUM Concept instead. If a unit is not present in the UCUM vocabulary it has to be added.
Concepts from source vocabularies must be added following International drugs vocabulary implementation process.
documentation/international_drugs.1563802859.txt.gz · Last modified: 2019/07/22 13:40 by ekorchmar
