Guidance on designing drug-drug interactions

[akhilmalhotra]

We are looking for guidance on designing drug - drug interactions, based on the following use cases (selected examples) -

• If patient having warfarin and Anti-Tuberculosis Treatment started then shift to heparin
• Iron and calcium not to be prescribed to be taken at same time as they reduce each other’s effectivity.
• If Anti-Tuberculosis Treatment going on then patient should not be given Oral Contraceptive pills or warfarin

These examples are at a drug family level. We had a discussion around this in the Bahmni channel of OpenMRS talk. Our take from that discussion is -

1. We should add Drug family to OpenMRS metadata (as ConceptSet)
2. We should add existing drug concepts to aforementioned drug family(s) ConceptSet
3. We should write rules based on families irrespective of drug formulations

We have also come to know that WorldVistA has built a drug-drug-interaction dataset.

We would like to know the community’s opinion on these topics -

1. Discuss choice of using ingredients/drugs/families and the best ways to incorporate those in both the CIEL dictionary and in OpenMRS drug ordering
2. Where should we acquire standard Drug family/class information from (CIEL or otherwise)?
3. With our current dataset, is it alright to manually attribute drugs to Drug Family (as an example, should we model it such that we add drug concept to drug family concept set)
4. Should we be acquiring RxNorm as reference terms? If this has been done before, please do share your experience.

We had a discussion on DDIs in Bahmni channel here:

Drug-drug Interactions for Bahmni

As part of clinical decision support for Bahmni, we are working on building the functionality of Drug - Drug Interactions. To be able to provide the functionality out of the box with Bahmni, we want to standardise the rules for drug-drug interactions in a rules engine. We want to start off with a few examples first, test the MVP and then incrementally build the rules engine. We are thinking about the UX of the alerts and should be able to present the mock-ups soon. A few problems areas identif…

We want to gather opinion from a larger OpenMRS community and also request for a design call. @jthomas Please allot a slot as soon as it is available.

[jthomas (Jamie Thomas)]

Hi @akhilmalhotra. I’m looking into getting the right people on this call to provide guidance. Would Monday, February 22 or February 29 @ 4-5pm UTC work with your schedule?

[akhilmalhotra]

Hi @jthomas. Had a talk with Jonathan Teich, he is not available for the next two weeks. Since he is one of the key people for this conversation, if we can schedule the call for March 7, that would be great.

[jthomas (Jamie Thomas)]

Sure. Happy to schedule this for March 7th. Sounds like @jteich, @burke and @akanter (@4:30 UTC) can all participate.

[akhilmalhotra]

Thanks a lot @jthomas.

[jthomas (Jamie Thomas)]

@akhilmalhotra I re-read my response and wanted to make sure i am clear that jonathan and burke will be on the call @4pm UTC, andy will join @4:30pm UTC.

-Jamie

[akhilmalhotra]

Just using this platform to set context for the design call on March 7th.

Bahmni Requirements for DDIs -

• We have following examples
• If patient having warfarin and Anti-Tuberculosis Treatment started then shift to heparin
• Iron and calcium not to be prescribed to be taken at same time as they reduce each other’s effectivity.
• If Anti-Tuberculosis Treatment is going on then patient should not be given Oral Contraceptive pills or warfarin

We want to build the functionality incrementally i.e. start with a few examples and roll out the MVP. With time, we can keep adding examples to the rules database.

We are looking at a way to harness any available DDI databases.