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In looking how to integrate drug classifications in our research and clinical databases the following came to mind.

Public domain drug classification is a real issue.  Many medical databases need and want drug classifications.  With the move to national standards, there will be winners and losers in various codification schemes.  There is little question that RxNorm codes are and will be the national coding standard for clinical drugs moving forward.  That leaves the issue what will be the drug classification standard.

The Am Soc of Health System Pharmacy (ASHP) has developed Am Formulary Hospital System (AFHS) classification system.  They have RxNorm codes mapped to AHFS therapeutic categories at a ridiculous price quote of $50K.  That being totally absurd, the price did go down to $25K per year.  Let me explain why this is equally absurd.  I believe that ASHP views this coding as an asset to sell versus an asset to leverage and give them position in a new market.  This thinking locks ASHP out of being a player in drug nomenclature and risks AFHS category codes to be obsolete.   If ASHP would make this more available (free or low cost), it would gain a wider adoption (both AFHS and RxNorm).   Standard organizations are looking for a publicly available code set for drug classifications.  ASHP, by offering their code set to the standards bodies could become a real player in the drug nomenclature market.   By having the code set in every db (if it became the Standard) the potential would be to (up) sell other items of value, such as Infobutton links and other drug information.   I am wondering what is more valuable to an organization: Their code set in every medical database in the country or a few paying customers?

This is basic marketing in a Web world.  Recently Monty Python put all of there material up on YouTube for free.  Conventional marketing would suggest that, they can not give that away, it cost them a lot to produce that content.  This is exactly ASHP’s response to the suggestion of giving away the RxNorm-AHFS Categories. What really happen was that the sales of Monty Python DVD’s increased 23,000%. 

While DVD’s and drug categories are not the same thing, the concept of marketing exposure is.  My perception is that AHFS is not exactly in a growth mode.  They need some exposure and infusion of something to keep it going.   Becoming a player in the almost certain RxNorm explosion could put them on the map in this market.  Other aspects of AFHS surely could be repositioned in such a marketing strategy.

A few paying customers of AFHS category codes may soon be history as well.  Recently it came to my attention that with a few SQL statements you can link RxNorm to the VA drug classification system, which is essentially a modified FirstDataBank classification.   An effort is underway to publish this and bring this simple solution to standard organizations. Admittedly this classification is not as elegant as AFHS, but free versus $25,000/yr?  That decision is easy.

With the large push for interoperability nomenclature standards as part of the ONCHIT agenda the effort to establish nomenclature standards are already moving at an accelerated pace.  Should AFHS category codes not be the standard, there is no incentive for any organization to adopt them as part of a database.  This has noting to do with the quality and everything to do with the delivery.  We all could learn something from Monty Python.