RxNorm Provides Template for Improving CPOE Interoperability

Oct 27, 2016 2:15:00 PM · by David Kushan

RxNorm has transformed the pharmacy industry by helping to standardize drugs according to specific codes. RxNorm codes are essentially naming conventions that were devised so that pharmacists can know which codes are related to which drug through a unified coding system.

About RxNorm

RxNorm was developed in the early 2000s as an experiment in modeling clinical drugs in the Unified Medical Language System. The project approached clinical drug representation in a series of steps, beginning by defining a Semantic Normal Form (SNF) to represent clinical drugs.

This SNF served to normalize every active ingredient, strength, unit of measurement, and dosage form for a given clinical drug preparation. This SNF was then used to establish a standardized set of generic ingredient names, units, and dose forms that could be used in implementing standard names for drugs.

A widely implemented, standardized practice, RxNorm has normalized names for clinical drugs and links those names to the drug vocabularies used in pharmacy management and drug interaction software. This standardization has made it easy for pharmacists to know exactly what a drug was and what it was for, simply by being able to read its particular code.

RxNorm and the Challenge for CPOE

Computerized physician order entry (CPOE) is another facet of EHR related to pharmacy. CPOE makes it easier for medical practitioners to prescribe drugs to patients by making it possible for them to do it digitally. Unlike the old paper, fax, or phone system for prescribing drugs, CPOE is instant, more accurate, and less error-prone.

The problem with CPOE is, that unlike RxNorm, it’s not standardized. So the way drugs are prescribed can vary from hospital to hospital. Complicating matters even further is that it can often vary within the same hospital, as order systems vary from department to department. This is an oft-cited pain point among pharmacists.

These shortcomings in terms of CPOE interoperability are made all the more stark in the face of the great strides we’ve seen made with adoption of RxNorm codes over the past decade.

While CPOE is undeniably useful, in order to take the next step in terms of maximizing its efficacy, CPOE needs similar standardization along the lines of what RxNorm has. Adapting the same sort of standardization as we’ve seen with RxNorm would minimize instances of CPOE interoperability, making the platform a more useful, agile tool for pharmacists.

Precedent for Tackling Interoperability Issues

Finding such interoperability solutions is nothing new to pharmacy. Prior to the establishment of NCPDP (National Council for Prescription Drug Programs) standards used in the retail pharmacy setting, there were problems with interoperability between retail pharmacy systems, adjudication of pharmacy claims, and integration with pharmacy benefit managers (PBMs).

The adoption of not only RxNorm but also SNOMED (Systematized Nomenclature of Medicine) for standardizing drug transactions, routs, and SIGs (drug administration directions and frequencies) enabled systems to communicate with each other without requiring data translation and conversion tables in the interface.

This was a significant development that addressed what had been considerable interoperability challenges and led to a notable increase in efficiency among retail pharmacies.

The Way Forward

Standardization and technology in pharmacy have improved dramatically in the past half-decade and it would be an exaggeration to say we are in the dark ages. But there is still a long way to go.

The good news is that it’s far from too late to improve CPOE’s implementation. And thankfully, with the success of RxNorm, there is a clear example and proof that standardization is possible within the pharmacy industry.

While the transition isn't always easy, the changes happening in the pharmacy space are leading to a bright future. Download our "How Pharmacy Informatics are Evolving to Improve Patient Care" eBook for more information.

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