Drug-Drug , Drug-Allergies cross checking +

OpenEMR Development
1

sapiens110 wrote on Monday, October 05, 2015:

Hi,

They should have an edit option for the title of the post!

Drug-Drug , Drug-Allergies cross checking + other stuff:

I was crawling around the forums and got a bit confused in this matter and would like some clarification since I’m a techie guy. I need to know if this is a part of MUII and is coming up or Rxnorm might be an option here.

I saw Visolve,NewCorp and ZH are working on it but don’t know which are closer to the finish line.

We are intrested in any past module and work about the following:

1- An up to date database with Generic drug names ( cause some countries only use this and it’s kind of a unified medicine language as brand names vary in each country) so this can be imported into a table of the database and be used while using the prescription module. ( similar to an interface when you enable inventory and the drug is added their and the system suggest drugs (demanded)

2- The database must have drug-drug and drug-allergy checks. Warning must pop up if any interaction is going to happen. (demanded). Not sure if Rxnorm has this.

3- An integaration with problem list or ICD codes so if a problem is entered, drugs related to that case is suggested to physician. Now this is quite hard to accomplish but a module to enter this manually as configuration of the system is nice. Each facility can enter their own,with their responsibily and knowing it’s not a decision maker for them and finally no disclaimer needed! ( It’s a plus)

4- CAMOS module,prescription module and inventory must be in sync at all times (demanded)

5- Later on, this can be mapped to a MAR system. So if a physician adds a prescription with all the checks above via CAMOS or prescription, this gets to a Administration record with reminders and logging so the person in charge can actually administer the drug to the patient ( for a semi in-patient facility) ( It’s a plus)

Trying to solve a couple of problems can actually make it complicated but thoughts and steps are appreciated and team work with official OpenEMR support teams is possible.

I also found these but not sure if they’re still being worked on and is acctually what we need.
http://sourceforge.net/p/openemr/discussion/202506/thread/b41bcde6
https://sourceforge.net/p/openemr/discussion/202506/thread/b41bcde6

Have a nice day!

2

tmccormi wrote on Monday, October 05, 2015:

All of the things that related to Drug/Drug and Drug Allergies (in the USA )are done via the interface to New Crop for MU1 and MU2. This requires a subscription to NewCrop via one of vendors. Medical Information Integration or ZH Heatlhcare, there are some others now too.

–Tony

3

fsgl wrote on Monday, October 05, 2015:

E-Prescribing was a requirement of MU1 & continues to be so in MU2.

A free alternative to a paid subscription is E-Prescribe with Allscripts, which will fulfill needs 1- 3. Diagnoses rather than ICD codes are used for 3. Allscripts is only available in the U.S.

4 & 5 are future CAMOS refinements which, if donated back to the Project, will be appreciated.

4

sapiens110 wrote on Wednesday, October 07, 2015:

Tony,
Thank you for the clarification. What database are Newcorp/ZH using?I’m sure they do check drug names and interactions againts a db. Can this be obtained anywhere? Probably ZH can clarify on this. We’re not trying to null any paid service that is financially reasonable to vendors,this will only help physicians do their prescribing easier and smarter when E-Prescription is not an option.

fsgl,
The reason why I mentioned this is to have this in house not a third party subscription. This can be used anywhere outside the USA as well and offline. The E-Prescribe is not what we’re intrested in. We need this so physicians can be helped and reduce interactions thats all. We are currently working on the 4&5 which will be later released under GPL. What we are lacking and need help with, is the database with those checks said above. If we can get those( even paid), we’ll come back to the community with all the above enhancements.

Have a nice day!

5

yehster wrote on Wednesday, October 07, 2015:

http://www.newcroprx.com/

Newcrop is the point of integration for all of the “good stuff,” including the database for drug-drug interaction.

http://www.newcroprx.com/what-we-do

It looks like Newcrop ultimately uses Lexicomp

http://www.wolterskluwercdi.com/

6

fsgl wrote on Wednesday, October 07, 2015:

Sounds like a very laudable project, which our colleagues abroad will value greatly. Offline & in-house will be prized features in developing countries.

The Dispensary Module is a good place to start. I think the online formulary was not working properly when I last looked.

Peruse the University of Washington School of Pharmacy or contact UMM.

If memory serves, Medicare, the National Health Service of Australia provides a database of generic name of drugs to their physicians.

Perhaps someone will give you a sizable discount if they are aware that yours is an open source endeavor. Educational and governmental instutitions should have goals other than profit.

7

fsgl wrote on Wednesday, October 07, 2015:

Two more resources: FDA & Canada’s Drug Product Database.

If not exactly what you want, hopefully one out of the 5 links will be a good “Sherpa” to point the way.

8

tmccormi wrote on Thursday, October 08, 2015:

Lexicomp is quite expensive, we (Dr Bowen and I) started to do our own full eRX direct with SureScripts (long ago) and decided the cost of the database alone (about $80K per year if I remember) made that impossible.

Open databases exist, like RxNorm, but the logic to do reliable, safe and certified drug/drug drug/allergy would be cost prohibitive. Plus the responsible entity, in this case OEMR.org would need liablity insurance in the extreme, I bet.

There may be halfway steps, like using a SAAS service for the drug/drug drug/allergy part but keeping the drug name database local. Managing the many, many updates to that very large table is also an issue.

–Tony

9

sapiens110 wrote on Wednesday, October 14, 2015:

Hi,

Newcorp/Lexicomp and UMM are not an option as they all use Wolters Kluwer and they are like Tony said, “expensive”.

Called University of Washington. They developed their own and are working on a licensing model but don’t have it for people like us today. What they use it for is to license it to pharmaceutical companies and charge an annual licensing fee from $5,000/yr. to $40,000/yr. And they don’t allow releasing it under GPL.

We need to hear back from Medscape and drug product now. Any more resources would be appreciated before we start building on open dbs.

This will be released under GPL if we are not bound by the database we get our hands on.

10

yehster wrote on Wednesday, October 14, 2015:

Drug-drug interaction data is expensive because there are liability concerns, and for that reason it is unlikely you are going to find anything significantly cheaper than what you are encountering.

11

fsgl wrote on Wednesday, October 14, 2015:

Because RxNorm is a compilation of other databases, look under the 3rd FAQ, especially VA, FDA & CMS for other possible leads.

If OEMR.org is concerned about liability, integration with OpenEMR is called into doubt. Your project may have to exist as a stand-alone application.

It is not necessary for the application to list every new specialty/chemotherapeutic pharmaceutical; just the the ones in every day practice.

Our colleagues abroad are not likely to prescribe meds such as Solvaldi at US$1000 per pill. Probably not even the generic, Hepcvir, at US$600 per course, for most of their patients.

Solvaldi’s price tag is almost as bad as the 5600% increase of Daraprim for the treatment of Toxoplasmosis.

12

aethelwulffe wrote on Friday, October 16, 2015:

Kind of makes you want to stay away from cat litter, hunh? I think that speeding tickets should go towards funding Daraprim for all bad drivers…at least 56% of the people on the road.

13

fsgl wrote on Friday, October 16, 2015:

As a result of public outrage, Turing was forced to revert to $13.50; but Sulfadiazine at $6.69 (30 tabs) is equally effective with less side effects.

Increasingly everything about pharmaceuticals, the markets can no longer bear.