A drug formulary file is a simple database of drugs, strengths, dose forms, routes, frequencies, and other fields detailing relevant features of a drug. Support for formulary files can be found in formulary decision support.
Pharmacy Information Systems (PIS) and Computerized Provider Order Entry (CPOE) systems have been in existence for 40 years. A basic element of PIS or CPOE applications is the.
Basic PIS and CPOE drug formulary files can be, and initially were, populated entirely locally at each site that implemented a PIS or CPOE. As PIS and now CPOE became more prevalent, and especially with the advent of clinical decision support within these systems, the local creation of an entire drug formulary file, including all the features needed for clinical decision support such as drug-drug and drug-allergy interaction checking, has become unfeasible.
Clinical decision support requires coded databases which allow automated cross referencing of tables which link drugs to other drugs which might react with each other, are duplicates, or where conflicts exist with allergies or other data elements such as labs. With the number of available drug agents in 2010, these databases are massive. An examination of the vendor-provided (First_DataBank) tables underlying the MedsManager (McKesson) PIS at one organization (PeaceHealth Southwest Medical Center, Vancouver, WA) yielded 1,291,248 coded drug interaction pairs in spring 2009. Individual sites generally do not have the resources to maintain such massive tables locally, and fortunately they do not have to.
Many commercial vendors such as First_DataBank, Multum, and MediSpan now provide database services which can be integrated into PIS and other products which involve medications (CPOE, Barcoded_Medication_Administration, etc). These databases provide the basis for entering drugs into the site-specific drug formulary file. They also provide the tables necessary for applications to cross reference drugs entered in to a PIS or CPOE system with other existing drugs which might interact or duplicate, with allergies existing on the patient profile, or with labs which might cause concern. Other features such as dose-range checking are also possible with these commercial databases.
With the benefits of these sevices come concerns over proprietary databases and their validation. As noted, the databases are enormous, and the contents are used to make important clinical and financial decisions. Litigation has resulted in some cases over concerns about data accuracy. There are also issues on compatibility/interoperability between applications using different proprietary databases. These issues could drive development of a government solution, perhaps building on the National Institutes of Health's terminology index RxNorm.
List of drug databases
- First DataBank
- Golden J. Assessing the First DataBank settlement: dramatic shake-up or status quo? Benefits Q. 2008;24(4):12-5.
Submitted by Gwendolyn B Moscoe