Evaluation of the NCPDP Structured and Codified Sig Format for E-Prescriptions

Published in: JAMIA, Journal of the American Medical Informatics Association, v. 18, no. 5, Sep. 2011, p. 645-651

Posted on RAND.org on January 01, 2011

by Harry H. Liu, Q. Burkhart, Douglas S. Bell

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OBJECTIVE: To evaluate the ability of the structure and code sets specified in the National Council for Prescription Drug Programs Structured and Codified Sig Format to represent ambulatory electronic prescriptions. DESIGN: We parsed the Sig strings from a sample of 20,161 de-identified ambulatory e-prescriptions into variables representing the fields of the Structured and Codified Sig Format. A stratified random sample of these representations was then reviewed by a group of experts. For codified Sig fields, we attempted to map the actual words used by prescribers to the equivalent terms in the designated terminology. MEASUREMENTS: Proportion of prescriptions that the Format could fully represent; proportion of terms used that could be mapped to the designated terminology. RESULTS: The fields defined in the Format could fully represent 95% of Sigs (95% CI 93% to 97%), but ambiguities were identified, particularly in representing multiple-step instructions. The terms used by prescribers could be codified for only 60% of dose delivery methods, 84% of dose forms, 82% of vehicles, 95% of routes, 70% of sites, 33% of administration timings, and 93% of indications. LIMITATIONS: The findings are based on a retrospective sample of ambulatory prescriptions derived mostly from primary care physicians. CONCLUSION: The fields defined in the Format could represent most of the patient instructions in a large prescription sample, but prior to its mandatory adoption, further work is needed to ensure that potential ambiguities are addressed and that a complete set of terms is available for the codified fields.

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