I have manged to register to obtain copies of rxnorm and snomed ct. I am sort of confused about what they are needed for and if they are necessary. There are a number a versions of each of them and new and old formats etc. The notes I can find in the wiki are pretty vague on their use and seem to indicate you need the full international versions. These are huge files coming to like 750 mb between them, so I thought I would ask about them before cluttering up the database and making a bigger backup burden.
Hi,
At this point, the rxnorm and snomed tables can be imported, however, they have not been integrated into the software yet(ie. not yet used in meds and dx codes). So, would rec waiting if concerned about the size of database backups.
-brady
Since these databases come with their own installation/maintenance packages , does it not make sense to interface with them either as external MySQL database(s) or better yet as web service(s)?
These huge (and relatively complex) tables are unlikely to be modified or localized by any installations. So in case of recovery it will be better to reinstall / recreate them. They are however very useful in interpreting inbound textual data from sources like AllScripts.
Quick question here if anybody knows offhand. If do a mysql dump on OpenEMR with these rxnorm and snomed tables, how much bigger do they make the file?
brady, i have icd-10, snomed and rxnorm installed on 4.1.1, the mysqldump backup file size is over 1.5gb. it is a fresh install, very small amount of patient data.
Thanks for reporting that,
That sounds about what I would expect. The icd10 stuff is relatively small. It is the snomed and rxnorm that are very large.
-brady OpenEMR
The Wikipedia article did a better job describing Snomed CT than the Snomed official website. It appears that Snomed identifiers, 8 to 11 numbers, are glorified ICD and CPT codes. Physicians use codes to get paid for services rendered. Here in the US, Medicare and the other insurance carriers require ICD and CPT codes, not Snomed codes. In a clinical setting what is the practical application of the Snomed codes? It is not going to put food on the table. The collection of ICD and CPT codes that I use for billing is so tiny, I rarely have to look them up because I know most of them by heart. In my practice, it would not make sense to incorporate Snomed codes.
Prescribing is fairly easy with the Allscripts Integration via the Grease Monkey add-on. In Ophthalmology we have only a handful of drugs to contend with. Even in Internal Medicine, do you need a database of all the pharmaceuticals out there?
Except in a research environment why would clinicians need an additional database of 1.5 GB? With Windows operating systems, the more stuff you have, the greater the chance of incompatibilities and thus the greater the chance of a crash. Do you want to backup every day stuff that you don’t need or use?
(Had to edit the named link above. Thanks a bunch, Brady, for the brilliant Edit button and much improved search engine!!! Pimm would like the Delete button,too, thank you in advance.)
Only 30% of downloads are from the US. MU2 requires use of SNOMED and RXNORM. That being said, there are several options to consider here to improve this:
Provide the option of placing the reference tables (ICD9,ICD10,SNOMED,RXNORM) into a separate database, which is something I am guessing the vendors that use multisite will begin to think about (the code that searches these things are very centralized and modular, so it would not be tough to support this).
Have the backup script not backup the reference tables (these are standardized references tables, so likely to not need to be backed up; ie. could simply reinstall them as part of restore procedure).
Likely lots of ither options I have not thought of.
BTW, although I’d like to take credit for the edit button, all I did was click a button on sourceforge to migrate our project to this new format (I spent maybe just two hours on the migration dealing with the repository changes and the administration permissions, which were very different from the old software; otherwise all the work was done by sourceforge )
Salutations Brady ( we, old folks, are idiosyncratic),
Please provide a CMS reference for the Snomed & Rxnorm mandate in Stage 2 Meaningful Use. I did a quick perusal of the Stage 2 webpages at CMS, looking at the Toolkit, Specification Sheets and the Comparison Table between Stages 1 and 2 but nothing obvious about the requirement of Snomed & Rxnorm. Most of it involved higher percentages for each of the “hoops” we have to jump through. What is the ostensive purpose of this requirement other than to make us sigh and roll our eyes? (Now I am really sounding like a crabby old curmudgeon).
I realize that we, here in the US, are behind the times in regards to coding. Sweden and the Netherlands began to use ICD-10 codes in the 1990’s and even China has implemented it before we did.
Irrespective of whether you clicked 1 button or 100 buttons, we are tickled pink about the Edit link. I agree, SourceForge rocks.
Thanks, Brady, for the Federal Register file. The Patient Protection and Affordable Care Act with its 2000 pages was a walk in the park compared to this .pdf file. At least the PPACA was double spaced with fat margins. I skimmed the first 30 pages. Those pages expressed a preference for Snomed and Rxnorm but it was not quite a mandate.
With ever decreasing Medicare reimbursements and increasing regulatory burdens, it will force old folks to retire earlier and the younger physicians to refuse Medicare patients.
Unfortunately for myself, I still enjoy the practice of Medicine, so I will learn to use Snomed & Rxnorm. Fortunately for me, I will need just a sprinkling of each to continue the practice Ophthalmology.
I believe that anywhere SNOMED is needed can actually be fulfilled with ICD-10 instead, and given that ICD-10 is going to be a requirement for billing, rather than try to adapt to both SNOMED and ICD-10, an easier and acceptable solution will be to learn ICD-10 codes.
If memory serves, it took about 5 years before we had to switch to the 5010 format for electronic claims submission. If I am lucky, I may reach the age for Reqired Minimum Distribution (I will be put out to pasture) before the full implementation of SNOMED and RXNORM.
The transition to ICD-10 next October 1st should be relatively painless for us with our little collection of codes. This converter will help ease the way.
The ICD-10 import process loads “General Equivalence Mappings” created by the National Center for Health Statistics into OpenEMR tables already. However, like the current state of RXNORM, no code in OpenEMR actually takes advantage of those tables.
I can envision a number of potential ways to further simplify the ICD-9 to ICD-10 process that is integrated into the existing billing workflow instead of having to leave OpenEMR to go to icd10data.com. How to fund such a project is an unsolved issue.
The zipped files for the most current edition of ICD-9 codes is about 1 MB. ICD-10 is 3 times larger. Having the whole kit and kaboodle and using more than one code per claim will not increase reimbursement. Importing codes manually is rather unsophisticated, while importing the database en masse probably gives colleagues a sense of security.
I am of the school that less is more. How often does the average American medical practice code for Schistosomiasis, let alone remember what it is, except for a vague notion that it’s some kind of strange tropical disease?
Non sequitor #2
The Pope has been petitioned to grant sticky posts. No pronouncement in that regard from the Vatican yet. At least it was not an unequivocal “NO!”. The response seemed to indicate that the Delete link may be coming soon. (This reads like a message from the Delphi Oracle.)
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