Gerry Hobson, R.Ph.
3200 Cherry Creek Drive South, Suite 300
Denver, Colorado 80209
My name is Gerry Hobson. I am the Manager of Research at Cerner Multum, a subsidiary of the Cerner Corporation. I am a pharmacist by training. My responsibilities at Cerner Multum encompass the management of our content creation processes. I appreciate this opportunity to testify and to provide our views on e-prescribing standards as set forth in the Medicare Prescription Drug, Improvement & Modernization Act to the National Committee on Vital and Health Statistics.
The Cerner Corporation is a leading supplier of clinical and management information and knowledge systems for healthcare organizations in the United States and abroad. We service more than 2,000 clients in the U.S. and around the world. These clients include integrated health delivery systems, community hospitals, ambulatory clinics, physician practices, health management organizations, blood banks, laboratories, and home health agencies.
Cerner Multum specializes in the creation, maintenance, and distribution of drug clinical information. Cerner Multum’s clients include the Cerner Corporation and many other private and public organizations. Over 2000 organizations, including electronic medical record system providers, physician offices, hospitals, insurance companies, and government organizations, license drug and drug product information from us. Cerner Multum’s drug terminology is a referenced vocabulary in standards produced by the National Council on Prescription Drug Programs (NCPDP) and is mapped to RxNorm terminology within the UMLS Metathesaurus.
We recognize a need for a national standard vocabulary for e-prescribing as exemplified by the RxNorm terminology for clinical drug nomenclature. Utilizing this terminology, individual suppliers of clinical drug information can be accurately mapped to a common drug nomenclature for use in e-prescribing, and electronic medical records.
As per our response to the Basic Requirements document, the National Council for Prescription Drug Programs, Inc (NCPDP) promulgation of data interchange standards for pharmacy provides the common standards necessary for transfer of pharmacy transaction related data.
I will now describe several features of the Cerner Multum drug database. Information on the prescribed drug within the medication history is a primary focus for the content which Cerner Multum creates:
Cerner Multum provides drug-drug interactions, based on current medical literature for all drugs in the vocabulary. No drug is released to a user unless this information is available. These interactions are fully referenced, and contain severity, action description, and management considerations.
Structured warnings and precautions are provided for drugs as delineated in package labeling and as documented by clinical evidence. These include “black box” warnings, and other precautions.
Dosage checking against patient weight and Dosage checking against patient age are both a component of Cerner Multum’s dose range checking functionality. Other patient attributes such as renal function, liver function, and condition being treated are also utilized per clinical documentation. Dosage ranges include FDA approved dosage and other dosages for non-FDA approved uses per clinical literature which is essential for pediatric dose range checking. The data is structured to utilize multiple levels of drug names for evaluating the dose range. These drug name levels provide dose range checking for clinician order entry systems where the actual drug product may not be identified as well as for dispensing systems where the drug product is identified.
Cerner Multum has information available to help determine lower cost drugs and therapeutic alternatives. We provide a complete categorization of drugs for therapeutic category interchange, a listing of drugs by indication, and pricing which can be used to derive this information for an end-user. Cerner Multum does not recommend specific therapies, but does provide literature based information to assist a prescriber in the choice of therapy.
Electronic transmittal of medical history information:
Cerner Multum provides drug allergy checking for all products included in our drug vocabulary. Each drug vocabulary vendor uses its own standards for including information on drug allergy that is unique to their vocabulary.
Cerner Multum provides drug to disease interaction checking. This check alerts the user when a medication is ordered on a patient having a disease for which the medication may be contraindicated or produce undesired effects.
Patient Safety is a major focus of Cerner Multum. We follow the Institute for Safe Medical Practices recommendations for drug representation, including “TALL MAN” names. We provide multiple clinical checks: dose range, drug interactions, food interactions, allergy, duplicate therapy, and patient specific dosage recommendations. Our prescription writer enhances patient safety by providing for the construction of clinically logical drug and prescription orders.
Quality of care enhancements are derived by making prescriptions more accurate. The vocabulary also can provide additional information on a drug based on the individual patient characteristics (such as age, weight, renal function, liver function, and condition being treated) making the information supplied specific to the patient being treated.
Efficiency is realized by a decrease in the amount of time needed to safely transmit, fill, and check prescription orders. Clinical checking at the point of clinician ordering minimizes the call back from the dispensing pharmacy.
To improve the facilitation of this clinical drug content for e-prescribing, Cerner Multum supports the steps the FDA is taking to enhance/improve their ndc drug product data. Efforts to make available the package insert in a structured database format would greatly enhance the retrieval and utilization of this data. A complete collection of ndcs would also enhance the process. This would improve patient safety, work flow efficiency, and enhance the quality of patient care.
In conclusion, I would like to reiterate our support of a national drug vocabulary that can be used to provide a standard mapping to drug content providers such as Cerner Multum.