Does RxNorm work?

[PeteBoyd]

Does RxNorm integration work?

In OpenEMR 5.0.2 (patch 3) on Debian I copied RxNorm_full_07062020.zip to contrib/rxnorm/ and installed

In the Apache log I see the following, don’t know if these are an issue or not:

PHP Warning: file_get_contents(/tmp/RXNORM/scripts/mysql/Table_scripts_mysql_rxn.sql): failed to open stream: No such file or directory in …/library/standard_tables_capture.inc on line 93, referer: …/interface/code_systems/dataloads_ajax.php

PHP Warning: file_get_contents(/tmp/RXNORM/scripts/mysql/Load_scripts_mysql_rxn_unix.sql): failed to open stream: No such file or directory in …/library/standard_tables_capture.inc on line 97, referer: …/interface/code_systems/dataloads_ajax.php

PHP Warning: file_get_contents(/tmp/RXNORM/scripts/mysql/Indexes_mysql_rxn.sql): failed to open stream: No such file or directory in …/public_html/library/standard_tables_capture.inc on line 100, referer: …/interface/code_systems/dataloads_ajax.php

It appears to install OK

In Administration > Lists > Code Types > RXCUI I made it active and enabled for Drug

No medications can be found when using:
Patient demographics > Edit Medications > Add Medications > Coding > RXCUI Medication > Search.

I see mention of RxNorm integration being worked on but not completed back in 2013 but anything could have happened in the intervening years so wanted to check:

Integrating Rxnorm

bradymiller wrote on Tuesday, November 13, 2012: Hi, Beginning to work on integrating rxnorm drug database into OpenEMR. There’s still a long ways to go, but here’s the beginning (after you type three letters in the Add Presciption Name entry, it will start showing matches from the rxnorm drugs): http://github.com/bradymiller/openemr/commits/integrate-rxnorm Also likely will bring in a full jquery-ui codeset in to support the autocomplete (plan to use this in the code set searching also) and…

Thanks

[stephenwaite]

Thanks for the bug report @PeteBoyd, there’s something up with the handling of the zip archive and will fix it up.

[stephenwaite]

hi @PeteBoyd, the fix will be in the next patch

[PeteBoyd]

Many thanks @stephenwaite

[PeteBoyd]

@stephenwaite rather than continue to wait for the next release of OpenEMR, is it possible to get this RxNorm fix sooner by deploying the changed files – is that just a case of downloading library/standard_tables_capture.inc from github and deploying that?

[stephenwaite]

yes, the above link is for v5.0.2

[PeteBoyd]

Thanks @stephenwaite I deployed that file in OpenEMR 5.0.2 (patch 3) on Debian; cleared the entry in standardized_tables_track; did Administration > Other > External Data Loads > RxNorm > Install and appeared to install OK:

“Installed Release
Name: RXNORM
Revision: Standard
Release Date: 2020-07-06”

Administration > Lists > Code Types: RXCUI is automatically enabled for “Drug”

Administration > Lists > Code Types: RXCUI says “External: No” and there is no Rx to choose from in the drop-down list.

However I cannot find anything from RxNorm using:
Patient demographics > Edit Medications > Add Medications > Coding > RXCUI Medication > Search for: Salbutamol

I see nothing in the Apache error log.
Is there anything else I need to do or does this look like a continuation of the bug?
Thanks

[stephenwaite]

hi @PeteBoyd, there’s prob another issue related to the script reading the now loaded table.

[PeteBoyd]

If I can be of help in troubleshooting this further then please let me know. We’re eager to get RxNorm integrated. Thanks

[PeteBoyd]

I tested this again but with OpenEMR 5.0.2 Patch 4 and got the same results as above.

[PeteBoyd]

Is there any mechanism where by we can pay to have this issue focused on please?

[sjpadgett (Jerry P)]

You don’t need to pay Pete. I’ll see what I can do!

[stephenwaite]

should be working if you were able to load rxnorm (had to fix master just now @sjpadgett)

please see

Improve drug-drug interaction checking

which leads to
http://www.open-emr.org/wiki/index.php/Administration_Globals#Rx_NLM_Drug-Drug

[stephenwaite]

that’s for prescriptions, looks like there is a bug in Medications

[sjpadgett (Jerry P)]

@stephenwaite
Looks like we have the wrong code types. List has us using 109 for rxcui and rxnorm is importing as code type 110(Loinc)
umm, woops

[PeteBoyd]

Is there a diff available for this so that I can make the alteration myself please?

[hitechelp (David Martelle)]

We’re considering loading RxNorm, but not sure if it will work based on what we’re seeing here. Can someone please post a status update? (we run oemr v5.0.2(4) on Ubuntu 18.04)

[stephenwaite]

first go to Administration->Lists and choose Code Types and set RXCUI active
then go to Administration->Other->Native Data Loads and follow the instructions there to grab the file and then upload and install it
should now be able to add a medication by rxcui

[PeteBoyd]

Success!

As per what Stephen says above, there is a completely different method now in OpenEMR 5.0.2 Patch 4 of installing RxNorm. Now we use Administration > Other > Native Data Loads and not Administration > Other > External Data Loads; although the latter is still present.

Also, the instructions within OpenEMR now say to use the “Current Prescribable Content Monthly Release” where previously we used “RxNorm Full Monthly Release”.

The OpenEMR 5.0.2 Patch 4 release documentation only said “RxNorm import fixes”. Also note that the “Import RxNorm and SNOMED Tables” page at https://www.open-emr.org/wiki/index.php/Import_RxNorm_and_SNOMED_Tables still says to “Copy the zipped RxNorm database file into the ‘contrib/rxnorm’ directory … note you’ll need to get an account and that only the Full Monthly Releases currently work … In OpenEMR, go to Administration->Other->RxNorm in order to then install/upgrade the RxNorm database.” None of that now appears to be true.

On first installation using Administration > Other > Native Data Loads, I received this issue:
“POST Content-Length of 70740105 [70 MB] bytes exceeds the limit of 31457280 [30 MB] bytes in Unknown on line 0, referer: …/interface/super/load_codes.php”

I fixed this by increasing php.ini’s “post_max_size” from 30M to 80M.

I then used Administration > Other > Native Data Loads to upload again and got this so-called confirmation of success:
“LOAD SUCCESSFUL. Codes inserted: 0, replaced: 0”
However RxNorm still wasn’t available.

Administration > Other > External Data Loads still lists the prior installation of RxNorm:
“Installed Release
Name: RXNORM
Revision: Standard
Release Date: 2020-07-06”

I removed the record of that old installation using the following:
DELETE FROM standardized_tables_track WHERE name=“RXNORM”;

I installed RxNorm again using Administration > Other > Native Data Loads and got this confirmation of success:
“LOAD SUCCESSFUL. Codes inserted: 139890, replaced: 0”
Which looks more positive. And indeed RxNorm now appears to work fine.

Thank you

[hitechelp (David Martelle)]

Thank you Pete for your excellent post on how to make this happen!
We’re going to take a shot at it today!