Mosaiq Drug Exposure

[dahealy]

Mosaiq Drug Mapping Problem: Mosaiq drug maps to RxNorm are not up-to-date and not used properly.

Example: Patient is administered the following drug: MQ_Drug_ID= 154**** MQ Drug Name= Atropine
Dose/Units/Route Administered 0.25 mg IVPush

Entries in MQ Drug Table for this Drug -- The IV Drug administered is mapped to an Oral drug with different dose... drg_id Drug_label Dose Route **154 Atropine 0.4 mg Oral**
1768 atropine 0.4 mg/mL Injection
3124 atropine 0 Injection

The IV Drug Administered is mapped to wrong RXNorm RXNorm code 1190692 = Atropine Sulfate 0.4 MG Oral Tablet

[dahealy]

Possible Solutions: 1) Remove RXNorm mapping from MQ Extracts 2) RS21 attempts again to map to a standard using name/dose/route 3) Analyze MQ data to determine how inaccurate MQ Mapping is

[mbernauer]

It would be great if we can find an alternate code for each of the drugs (e.g. NDC, GCN, etc) that doesn't suffer from the same issues as the RxNorm codes. If that's not possible then we'll need a single column that contains a concatenation of <generic_name> <brand> <strength> <dosage_form> where <generic_name> is actual generic name (e.g. Metoprolol succinate) and not drug class (e.g. Beta blocker) which seems to be what is currently in drug_generic_name

[isangil]

id go under the assumption that in mosaiq we do not have such standard codesets - even if we did, either they are not integrated correctly, and not used by our clinicians. I think it is time we strategize how to address the mappings using what we have. do we need to secure SME time? can we do a partial map, encode some rules based on the elements we have in mosaiq (route, dosage, drug name)? can we do a full custom mapping? etc.

[mbernauer]

@isangil can we meet with someone in pharmacy or one of the nurses to see if we can come up with an explanation why the RxNorm dosage form seems to conflict with the ordered route of administration in some cases (~ 8%). I suspect it may because pharmacy switches from IV to PO. There are several reasons where this may be a legitimate switch, for example shortage/cost of the IV dosage. Patients will be switched from IV to PO when anticipating to be discharged, not sure if this is as relevant in an ambulatory setting like the cancer center.

[dahealy]

Mike, I'm talking with one of our staff this morning to get a better understanding of how providers select drugs when they place orders. I'll also determine who the best source is to discuss this with if we need further clarification. Debbie

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From: Michael L. Bernauer @.> Sent: Friday, March 4, 2022 11:18 AM To: UNMCCC/CRIIS_Source_Extracts_for_OMOP @.> Cc: Debra A Healy @.>; Author @.> Subject: Re: [UNMCCC/CRIIS_Source_Extracts_for_OMOP] Mosaiq Drug Exposure (Issue #91)

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[mbernauer]

Thanks, Debbie!

Can we also schedule a conversation to discuss the measurements? I want to be sure that I'm not misclassifying urine and blood tests. Not sure if there's something within Mosaiq that will help us determine whether or not these labs are originating from uring or blood sample or if they may be a SME that we can chat with who might be able to help us out.

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From: dahealy @.> Sent: Monday, March 7, 2022 8:11 AM To: UNMCCC/CRIIS_Source_Extracts_for_OMOP @.> Cc: Michael Bernauer @.>; Comment @.> Subject: Re: [UNMCCC/CRIIS_Source_Extracts_for_OMOP] Mosaiq Drug Exposure (Issue #91)

[EXTERNAL]

Mike, I'm talking with one of our staff this morning to get a better understanding of how providers select drugs when they place orders. I'll also determine who the best source is to discuss this with if we need further clarification. Debbie

---

From: Michael L. Bernauer @.> Sent: Friday, March 4, 2022 11:18 AM To: UNMCCC/CRIIS_Source_Extracts_for_OMOP @.> Cc: Debra A Healy @.>; Author @.> Subject: Re: [UNMCCC/CRIIS_Source_Extracts_for_OMOP] Mosaiq Drug Exposure (Issue #91)

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[dahealy]

Discussed available drug data available for mapping with Mike on 3/7/22, Determined that RxNorm codes supplied by MQ query may not be accurate due to mapping complexities within MQ (MQ primarily maps to First DB (FDB). The DrugCodeMapping table maps multiple RxNorm codes to each FDB-MEDID. Also identified GNCSeq number as possible mapping code, but Mike indicated that this is not one of the standard vocabs used by RS21. We clarified that the data provided for drug exposure is from the Mosaiq Drug Administration table (PharmAdm) and so route, dosage, and units should be taken as the correct amounts administered. We will upload a file with concatenated Drug-Label, dosage-amount, units, and route. No changes made to RxNorm mapping. Further research required by RS21 for mapping given the available data.

[dahealy]

Drug-Exposure table contains administration amounts = 0.00. We believe they indicate that the drug was intended to be administered but conditions prevented that.