RxNorm concept missing from ATHENA

[LynxMaxim]

Dear reader

We are trying to understand why the following concepts from RxNorm cannot be found in ATHENA.
Example RXCUIs: 284635, 214317

It seems that it was a conscious decision to leave them out, as my spotchecks show that none of these type of concepts (combination of drug ingredients) are present in ATHENA. However, I do not understand why.

Could someone explain the reasoning for leaving out these concepts?
Maybe we could also see if in a future update they could be included somehow?

Cheers
Maxim

PS: I'd be glad to explain further why this is causing us some issues :)

[pbr6cornell]

It would be helpful to hear your usecase, but just as a quick confirmation, In my vocabulary, I see RxCUI 214317= OMOP concept Id 36029913 = name 'Bisoprolol / Hydrochlorothiazide'. I cannot find RxCUI 84635 in RxNav or the OHDSI vocabularies, so wondering if you have a typo there.

[LynxMaxim]

Apologies, I indeed accidentally deleted a character. The issue is now updated to reflect the correct code. (284635)
I still cannot find the ATHENA concept_id for this one, is it just me? ;)

I need to structure my thoughts a bit further on the topic, I might come back with our use case soon!

[don-torok]

@LynxMaxim You are more likely to get a response if you move your question to one of the forums rather than here in github issues.

[cgreich]

@LynxMaxim:

There are two issues.

Issue #1 is that you are giving us an example of an RXCUI that actually doesn't exist. Can you give us the correct one?

Issue #2 is how you get the best RxNorm concepts based on your incomplete data. The vocab team has a mechanism for doing that. Please provide your data and we can figure out the best mapping.

[LynxMaxim]

Issue #1: I believe I provided the correct RXCUI (after correction). I'll share the link to RxNav this time: https://mor.nlm.nih.gov/RxNav/search?searchBy=String&searchTerm=fluticasone%20%2F%20salmeterol

Isseu #2: I moved the topic to the forum. https://forums.ohdsi.org/t/drug-domain-rxnorm-why-are-concepts-for-multiple-ingredient-non-standard/16621. Is there any documentation on this mechanism? (I'm assuming it is rule based).

[Alexdavv]

Issue #1: I believe I provided the correct RXCUI (after correction). I'll share the link to RxNav this time: https://mor.nlm.nih.gov/RxNav/search?searchBy=String&searchTerm=fluticasone%20%2F%20salmeterol

@hardhouse Can you please confirm it's not in the UMLS source we use?

[hardhouse]

@Alexdavv we don't use UMLS in RxNorm, and this concept is in the sources: select * from sources.rxnconso where sab = 'RXNORM' and rxcui='284635'. But it has tty='MIN', which we don't use in load_stage https://github.com/OHDSI/Vocabulary-v5.0/blob/master/RxNorm/load_stage.sql#L164

[Alexdavv]

But it has tty='MIN', which we don't use in load_stage

Here we do. But why is it rxnatomarchive rather than a regular source?

[mik-ohdsi]

Hi @hardhouse , I understand we added MIN support here. With the restriction that we do not allow them to be standard. This particular RXCUI (284635) seems not to have made it. Do we understand why?

[hardhouse]

hi @mik-ohdsi , because in that commit we are using rxnatomarchive, not rxnconso

[mik-ohdsi]

Hi @hardhouse - could you prepare an analysis that explains why we use rxnatomarchive over rxnconso in this case and how we still could get all proper MINs included?

[hardhouse]

@mik-ohdsi hi, analysis is impossible, because it was the decision of @ekorchmar and @cgreich. But technically, of course, there are no problems, i can add additional concepts from rxnconso to that INSERT

[mik-ohdsi]

@hardhouse - it would be great if we could get a rundown of our options how we can combine rxnatomarchive and rxnconso to achieve better coverage of MINs? Maybe also try to find out why some MINs are not in rxnatomarchive / how are those different to the ones that we can find in both tables?

[cgreich]

This is part of #470 and therefore closed.

[mik-ohdsi]

not quite @cgreich - as there were MINs missing. New logic has been introduced but has not been fully implemented as there was no RxNorm refresh since.

[mik-ohdsi]

Hi @LynxMaxim - we have added the missing MINs to the recent vocabulary release. Can you check if you find everything you need? And if you do, please close the issue!