Evaluating the implementation of RxNorm in ambulatory electronic prescriptions.
OBJECTIVE
RxNorm is a standardized drug nomenclature maintained by the National Library of Medicine that has been recommended as an alternative to the National Drug Code (NDC) terminology for use in electronic prescribing. The objective of this study was to evaluate the implementation of RxNorm in ambulatory care electronic prescriptions (e-prescriptions).


METHODS
We analyzed a random sample of 49 997 e-prescriptions that were received by 7391 locations of a national retail pharmacy chain during a single day in April 2014. The e-prescriptions in the sample were generated by 37 801 ambulatory care prescribers using 519 different e-prescribing software applications.


RESULTS
We found that 97.9% of e-prescriptions in the study sample could be accurately represented by an RxNorm identifier. However, RxNorm identifiers were actually used as drug identifiers in only 16 433 (33.0%) e-prescriptions. Another 431 (2.5%) e-prescriptions that used RxNorm identifiers had a discrepancy in the corresponding Drug Database Code qualifier field or did not have a qualifier (Term Type) at all. In 10 e-prescriptions (0.06%), the free-text drug description and the RxNorm concept unique identifier pointed to completely different drug concepts, and in 7 e-prescriptions (0.04%), the NDC and RxNorm drug identifiers pointed to completely different drug concepts.


CONCLUSIONS
The National Library of Medicine continues to enhance the RxNorm terminology and expand its scope. This study illustrates the need for technology vendors to improve their implementation of RxNorm; doing so will accelerate the adoption of RxNorm as the preferred alternative to using the NDC terminology in e-prescribing.
Surescripts LLC, Clinical Quality, Arlington, VA, USA ajit.dhavle@surescripts.com.
Ajit A
AA
Dhavle
Surescripts LLC, Clinical Quality, Arlington, VA, USA.
Stacy
S
Ward-Charlerie
Midwestern University, Pharmacy Administration, Glendale, AZ, USA.
Michael T
MT
Rupp
National Library of Medicine, Medical Subject Headings (MeSH), Bethesda, MD, USA.
John
J
Kilbourne
CVS Health, Patient Safety and Quality Assurance, Woonsocket, RI, USA.
Vishal P
VP
Amin
Surescripts LLC, Clinical Quality, Arlington, VA, USA.
Joshua
J
Ruiz
D055695:Electronic Prescribing; D006801:Humans; D009317:National Library of Medicine (U.S.); D062245:RxNorm; D014481:United States; D018875:Vocabulary, Controlled
E-Prescribing; NDC; RxNorm; electronic prescriptions; quality