Cerner Multum - National Committee on Vital and Health Statistics

Lexical Foundationcategorization∞∞Drug_id Generic drug concept amoxicillin, ibuprofen,1ceftazidime, propoxyphene∞MMDC Generic formulation concept amoxicillin 500 mg oral capsule,1ceftazidime 1 gm/50ml IV solution∞NDC Packaged drug product Amoxil (amoxicillin) 500 mg oralcapsule, bottle of 30, nonunit-dosed, from SKB

Lexical Foundationcategorization∞∞Drug_id1ConceptserythromycinNamesdrug_name (synonym_id)erythromycinerythromycin ethylsuccinate∞MMDC1∞NDCerythromycin ethylsuccinate200 mg oral table, chewableEryPed (erythromycinethylsuccinate) 200 mg oral tablet,chewable bottle of 40, SouthwoodErythromycin Ethylsuccinateerythromycin lactobionateerythromycin ethylsuccinate 200 mgoral tablet, chewableErythromycin ESErythromycin BaseEryPedgentamicin

Lexical Foundationcategorization∞∞Drug_id1∞MMDC1erythromycinerythromycin ethylsuccinate200 mg oral table, chewable• dose range check•patient ed• smart scripts• CSA classification• J-codes•etc…∞NDCEryPed (erythromycinethylsuccinate) 200 mg oral tablet,chewable bottle of 40, Southwood

Comparison<strong>Multum</strong> Lexicon• 17 tables• Minimal data set• Available under no-feelicense agreement,downloadable on the web• > 5700 licenseesVantage Rx Database• 144 tables• Everything in the <strong>Multum</strong>Lexicon, and a lot more– Update tables/changedates– Expanded synonymy– Clinical content (referentialinformation, DUR alerts,etc….)• Available under a for-feelicense• > 150 paying clients (notincluding <strong>Cerner</strong> clients)

<strong>Multum</strong> TodayContent Adopted by <strong>Cerner</strong> Clients and More than150 Additional Prestigious Organizations– EMR/HIS Suppliers• Eclipsys• EPIC• Electronic HealthcareSystems– Hospital Enterprises• CareGroup• Baylor Health System– Pharmacy SystemSuppliers• PDX• PharmNet– Web Portals• WebMD• HealthSouth.com• DiscoveryHealth.com– Resellers• Adam• Mosby• Softwatch– PBMs• Medco Health

VantageRx Database

Concept PermanenceWe respectfully disagree with conclusion of the evaluation• Obsolete drugs and their identifiers are retained in the <strong>Multum</strong> Lexiconand VantageRx Database• Obsolete drug products are explicitly marked as obsolete (with the dateon which the drug products became obsolete)• Obsolescence in the <strong>Multum</strong> system “trickles up” according specificrules (NDC to MMDC to drug_id to category id)• <strong>Multum</strong> concept identifiers (i.e. NDC, MMDC, drug_id, etc…) areunique• <strong>Multum</strong> concept identifiers (i.e. NDC, MMDC, drug_id, etc…) are notreused• <strong>Multum</strong> concept identifiers (i.e. NDC, MMDC, drug_id, etc…) do notchange in meaning (if there is a need to “change meaning”, a code isretired and a new concept code is added)• <strong>Multum</strong> drug names are also explicitly marked as obsolete (but stillretained)• Record level controls exist for each modified record…and tablescontaining these controls are available to licensees of the <strong>Multum</strong>Lexicon and VantageRx Database for their inspection and use

Concept PermanenceBaycol as a Simple Example

Baycol (cervistatin)

Baycol (cervistatin)

Baychol (ML)

Baycol (VRxDB)

Baycol (VRxDB)

Concept Permanence• We believe the <strong>Multum</strong> Lexicon providesan excellent example of conceptpermanence in a large-scale healthterminology system• We are asking the committee to reconsiderits findings regarding concept permanenceand the <strong>Multum</strong> Lexicon

A Proposal

Background• For years <strong>Cerner</strong> has publicly advocated the creation of acentral code-assigning authority for drugs and drugproducts.• We believe the continued use of disparate, generallyproprietary, drug terminology systems is a potential threatto the safety of individual patients and to the public healthAND limits the ability of care providers, payers, and othersto perform their work efficiently, effectively, and safely.• For the same general reasons the Federal government issponsoring and subsidizing use of SNOMED-CT, webelieve that the Federal government (FDA) should establishand maintain drug terminology standards and code sets.

Assumptions• Creation of a drug terminology standard is expensive andtime consuming.• Multiple well-developed drug terminology systems exist.• FDA should profit from the experience of commercialvendors of drug information systems and select one as astarting point.

Our Proposal• FDA should invite proprietary drug information providers tocontribute drug terminology data in an open-source fashion.• <strong>Cerner</strong> will make the complete VantageRx Databaseavailable for evaluation by FDA (or other appropriateFederal agency).• FDA may determine what tables, fields, and data etc… itmay need in order to achieve the goal of creating a nationaldrug terminology standard and code set.• <strong>Cerner</strong> will provide to FDA any tables, fields, and dataselected by FDA for use by the FDA and US public under a“liberal open-source agreement”*.*unlimited right for FDA to distribute, redistribute, use, andmodify data

Benefits of Proposal• Creates a fast-track and low-cost path to a comprehensivenational standard.• Encourages multiple vendors to participate and contributeto a standard code set via an open, transparent process.• Facilitates interoperability (all drug vendors will have accessto the selected data).