How to store ordered, prescribed, dispensed and administered drugs in DRUG_EXPOSURE table. How to distinguish them

[jiawei-qian]

How to store ordered, prescribed, dispensed and administered drugs in DRUG_EXPOSURE table. How to distinguish them

CDM or THEMIS convention?

CDM

Table or Field level?

Table

Is this a general convention?

Yes

Summary of issues

1. In OHDSI Forum, many people asked how to store ordered, prescribed, dispensed and administered drugs in DRUG_EXPOSURE table if they have these data?
2. How to distinguish these different drug records in DRUG_EXPOSURE table if all loaded
3. Are these different provenance drug records duplicate/overlapping in DRUG_EXPOSURE table

Summary of answer

1. Christian and Patrick said we should store all the drug records into DRUG_EXPOSURE table
   (Christian: https://forums.ohdsi.org/t/prescribed-and-dispensed-drugs-in-the-drug-exposure-table/10997/29
   Patrick: https://forums.ohdsi.org/t/which-is-the-best-choice-drug-type-concept-id-in-drug-exposure-table-cdm-v-4-0/394/8)

2. Use the drug_type_concept_id field to distinguish these drug records
   (Patrick: https://forums.ohdsi.org/t/which-is-the-best-choice-drug-type-concept-id-in-drug-exposure-table-cdm-v-4-0/394/8
   Christian: https://forums.ohdsi.org/t/drug-type-concept-id-values-from-drug-exposure-table-what-do-they-represent-is-there-overlap/12143/2
   Melanie: https://forums.ohdsi.org/t/drug-exposure-entity/7893/3)

3. If we use the drug_type_concept_id field, we can distinguish these different provenance drug records. It will be OK (and encouraged) to have these different perspectives for the same drug exposure. When we build DRUG_ERA records, these records will be combined together if they are the same patient having the same ingredient during the same duration.
   (Patrick: https://forums.ohdsi.org/t/which-is-the-best-choice-drug-type-concept-id-in-drug-exposure-table-cdm-v-4-0/394/9)

Additional: Christian mentioned that Clair is at it (updating the CDM documentation of the description of drug exposure definition). Because Chris Knoll said the current description of drug exposure is not correct. It should also consider situation that the drug is not really exposed to patient.

Related links

OHDSI Forum: https://forums.ohdsi.org/t/which-is-the-best-choice-drug-type-concept-id-in-drug-exposure-table-cdm-v-4-0/394/8
OHDSI Forum: https://forums.ohdsi.org/t/prescribed-and-dispensed-drugs-in-the-drug-exposure-table/10997/29
OHDSI Forum: https://forums.ohdsi.org/t/drug-exposure-entity/7893
OHDSI Forum: https://forums.ohdsi.org/t/drug-type-concept-id-values-from-drug-exposure-table-what-do-they-represent-is-there-overlap/12143
OHDSI Forum: https://forums.ohdsi.org/t/if-we-have-order-information-and-administration-information-for-drugs-should-we-bring-in-both-rows/21109

Other comments/notes

There is another CDM issue OHDSI/Themis#131 created by me. It is about how to store the cancelled order drug records (due to system reason) into DRUG_EXPOSURE table. In that issue, the cancelled order records are suggested not to store into DRUG_EXPOSURE table because it is not happened.
However, in this CDM issue, Christian and Patrick said we can store ordered, prescribed, dispensed and administered drugs. Thus, need to have better consideration for CDM issue OHDSI/Themis#131 (cancelled order is caused by system which means order is not happened).

[MelaniePhilofsky]

The drug_type_concept_id stores the provenance (order, administer, etc.) of where these data are found in the source system. I believe this is well documented here: https://ohdsi.github.io/CommonDataModel/cdm54.html#drug_exposure
@clairblacketer Thoughts?
Themis issue #131 is about the status of an ordered medication and will be answered separately.