Objectives: RxNorm is a standardized nomenclature for clinical drug entities developed by the National Library of Medicine. In this paper, we audit relations in RxNorm for consistency and completeness through the systematic analysis of the graph of its concepts and relationships.
Methods: The representation of multi-ingredient drugs is normalized in order to make it compatible with that of single-ingredient drugs. All meaningful paths between two nodes in the type graph are computed and instantiated. Alternate paths are automatically compared and manually inspected in case of inconsistency.
Results: The 115 meaningful paths identified in the type graph can be grouped into 28 groups with respect to start and end nodes. Of the 19 groups of alternate paths (i.e., with two or more paths) between the start and end nodes, 9 (47%) exhibit inconsistencies. Overall, 28 (24%) of the 115 paths are inconsistent with other alternate paths. A total of 348 inconsistencies were identified in the April 2008 version of RxNorm and reported to the RxNorm team, of which 215 (62%) had been corrected in the January 2009 version of RxNorm.
Conclusion: The inconsistencies identified involve missing nodes (93), missing links (17), extraneous links (237) and one case of mix-up between two ingredients. Our auditing method proved effective in identifying a limited number of errors that had defeated the quality assurance mechanisms currently in place in the RxNorm production system. Some recommendations for the development of RxNorm are provided.