nlm show off your apps-08142011 - s3.amazonaws.com€¦ · your apps challenge [8/27/11] page: 2...

Submission to:

NLM Show Off Your Apps Innovative Uses Of NLM Information

08/27/2011 Contact: Josh Temkin : [email protected] Birali Hakizumwami: [email protected] Jim Horner: [email protected]

NLM Show Off Your Apps Challenge [8/27/11] Page: 2

NLM Show Off Your Apps Foreword: HTH Technologies is pleased to submit its entry for the NLM Show Off You Apps challenge as posted on challenge.gov. Our application demonstrates the power of using current and leading edge technologies available from the Open Source community to aggregate and integrate disparate databases and websites into a single user friendly and meaningful application. Utilizing over six disparate webservices, websites, and databases available from the National Library of Medicine (NLM), Food and Drug Administration (FDA), and National Cancer Institute (NCI), we have developed and deployed a web-‐based Drug and Drug Interaction research portal that is accessible from both desktop and mobile computing devices. Our application is available at http://drugs.hthtechnologies.com Introduction Individuals seeking to research information about the drugs that they are taking, including drug-‐drug interactions, have a myriad of available resources including both public and private websites and databases. For example, the National Library of Medicine (NLM) contains many useful and rich datasources of information about Drugs and Drug Interactions across multiple websites and multiple publically accessible web services. Other government agencies such as the Food and Drug Administration (FDA) and the National Cancer Institute (NCI) also provide complementary resources for people to research and gather information on pharmaceuticals as well. However, despite these many sources, there is no single place where a user can go to and perform a “global search” and receive a consolidated view across these sources in an easy-‐to-‐use and easy-‐to-‐understand interface. Our application and approach for the NLM Show Off Your Apps challenge addresses the key issue of providing a single, expandable site that aggregates drug and drug-‐interaction data in a simple-‐to-‐use, web-‐based application that is accessible from standard browsers as well as mobile devices. Our approach and deployed prototype for the NLM Challenge, demonstrates how disparate Drug Databases,


webservices, and online websites from the NLM, FDA, and NCI can be integrated through a single, open standards and extensible software platform to provide individuals with a single place to search and research drugs they are taking and check for interactions between them. Our application is accessible at: http://drugs.hthtechnologies.com Key Features of our Application: Our application was designed and built from the perspective of a patient or individual who is seeking information on the drugs they are taking. The use case that we have implemented starts with the premise that a user wants to build up a list of their current or proposed medications, learn about those medications, and ultimately determine if they could have interactions. The system would then warn the user that care providers should be contacted for further information. To start using our application, a user would open the url , http://drugs.hthtechnologies.com, from a web browser from their desktop or their mobile device such as an Android enabled phone, iPhone, or iPad. Depending on the device from which the application is launched, the user will be presented with one of the following views:

Figure 1A,1B Main View from Desktop and Mobile Device


Figure 1A shows the screen that the user will be presented if they launch the application from a desktop or laptop; Figure 1B shows the screen that a user would see from a mobile device. In both cases, mobile or desktop, the user will begin to use the application by starting to fill in , and ultimately search for drugs against our drug lookup service. This service utilizes the information published by the FDA in its Product and Package NDC database tables searching the entered text by the user against the proprietary and generic/brand name of the drug. As potential drugs that match the search criteria are found, the user is presented with a list. This is performed in real-‐time using the same principles and technology as Google search uses to bring up candidate queries when a users is searching the internet.

Figure 2A, 2B Searching View for Desktop and Mobile Devices

When the user finds the drug in the returned list they are looking for, the user then selects the drug from the returned list. At this point , the application begins a detailed search of the databases from NLM, FDA, and NCI to collect and summarize key information about the drug in the “Drug Listing of the Site”. This is performed asynchronously in the background, allowing the user to continue to add drugs to the list as shown in Figure 2A and 2B.


Figure 3A, 3B Detailed Drug Information View from Desktop and Mobile Devices

When data are returned containing the summarized information on these drugs, the user will see detailed information panes as depicted in Figure 3A,3B. As shown, the user has several options with the summarized information. Based on the information gathered, a user can (1) click over to DailyMed to see drug labels associated with the drug, (2) select Medline which brings up articles about the drug, or (3) view current information about the manufacturer, textual description, strength, form, and packaging details that has been gathered and summarized from RxTerms, RxNorm, FDA, and NCI.


Figure 4A, 4B Drug List Screen with Button to Launch Drug Drug Interaction Checking Service from Desktop and Mobile Devices

After a user has built up a drug list of more than 2 drugs, a button will appear in the Drug Listing segment of the page allowing them to check to see if there are drug interactions between any drugs in the built up list Figure 4A, 4B.

Figure 5A, 5B Drug Interaction Result Screen for a found result for both Desktop and Mobile Devices

When the user clicks the search for drug interactions, a search is performed against the NDF-‐RT services and the results are returned and displayed as demonstrated in


Figures 5A and 5B. If no interactions are found based on the information returned from NDF-‐RT, then the site displays a no interactions found messages as shown in Figures 6A and 6B.

Figure 6A,6B Text Shown to User when no Drug Drug Interaction has been found from the NDF-RT Service for both Desktop and Mobile Devices

Removing Drugs From the List If a user has entered a drug by mistake or is no longer taking a drug previously added he can remove the drug from the listing by clicking on the Red “X” icon on the drug within the listing table. Printing and Emailing Information Once a user is satisfied with the built up list of drugs and information returned on drug interactions, he has the option of printing the data or emailing it by using these standard functions on their web browser. Implementation Details Of the many available datasources for drug and drug interaction data available from the NLM, FDA, and NCI, we have implemented and integrated the following as part of our application and submission to the NLM Challenge.


Agency Webservice/Database Usage National Library of Medicine (NLM)

RxNorm REST service Used to find drug information based on RXCUI such as label information and other details as available from the APIs of this service

RXTerm REST service Used to fill in drug information not found in the RxNorm service

NDF-‐RT REST service Used to search for drug-‐drug interactions based on users selection of drugs

DailyMed Provided as a link within the full details of a drug to retrieve the associated drug product labels

Medline Provided as a link for articles and additional information for a specified drug

RSS Feed Latest Drug Label Updates from DailyMed are displayed in the Desktop version of the site

Food and Drug Administration (FDA)

NDC Product and Package Databases

Utilized as source for searching drugs and gathering specific information in the drug and packages including NDC codes for a particular drug

RSS Feeds for MedWatch, What’s New Drugs, Recalls

Desktop/Internet version displays readable RSS Feeds for the users to get the latest news on drugs from the FDA

National Cancer Institute (NCI) LexBigEVS version 6.0

Webservice Utilized to get more information on a selected drug including a textual description of the drug

Use of Technology One of the key features of our application is that it utilizes technology such as HTML5 that allows for a single deployment to work across multiple platforms and devices. While this is not the only way to deploy or develop user interfaces against


our aggregation services, this approach meets the need to support multiple platforms including both mobile and desktop application required by this challenge. Quality and Accuracy As part of the development of our application, we tested for quality and accuracy using drug data that we found to be available in all or some of the resources. We linked all data across database sources through unique identifiers such as RxCUI, NDC Code, UMLSCUI, and NUI codes across the various databases. We performed tests both manually through willing beta testers as well as performed automated tests through our Continuous build server. Our tests looked for accuracy of the data retrieved and aggregated to make sure that data that we were linking and retrieving corresponded to the correct drug and drug interaction data from these sources. As part of our testing methodology, we developed and deployed a Continuous Integration stack using the Atlassian product line to manage our defects, source repository, automated builds, and unit testing. Impact on Potential Users Usability Our design and approach for the desktop and mobile versions of our deployed application focused on creating recognizable icons, flows, and usage patterns that a user familiar with basic internet searching and mobile application usage would recognize. Search Scheme Our solution provides a standard search bar that behaves and acts like a search bar on Google, Yahoo, or other standard search sites. Users who are familiar with search based tools like these should have no difficultly with the concept of entering in a drug, picking a result, and adding it to the drug list Recognizable icons For any icons and graphics we used in describing drugs, Medline articles, or interaction warnings, we researched common icons that would be both visually appealing and recognizable with drug type data. Examples of these icons include pill shapes for drug labels, the Medline icon for Medline articles, and warning labels


for drug drug interactions that differentiate “Severe” and “Moderate” based on the information returned from the NDF-‐RT service Simple Logical Layout Our website hides the complexity of the data merges, queries, and other complexities required to gather all of the information across these sites into a simple three step website and process for users to follow. The flow and logic is consistent across both the mobile and desktop applications and does not require special training for a user to flip between using the mobile and desktop versions of the application. The flow presents information in a top down format ,starting with the search bar, to collection of the built up drug list, to the display of results for drug interactions. This represents the logical progression of using the site from searching to building up drug lists, to finding interactions. Innovative Design As previously discussed, our application and approach performs the task of integrating disparate Government resources on drug and drug interactions into a single set of services. Utilizing the latest available, and common open source standards such a RESTful Web Services, Java, and HTML5 with Javascript, we were able to accomplish the goals of this challenge while meeting the requirement of supporting both desktop and mobile application deployments in support of end users. Our user interface is innovative because it simplifies the complexity of using all of the data sources we have combined into a simple three step process that is both logical and easy to navigate. Some key specifics of our use of technology

-‐ HTML 5 allows our solution to render and act both as a mobile enabled application as well as a desktop solution without the need to develop specific application in iOS or Android.

-‐ Webservices that we have built to do the mining and correlation of drug data that is presented in the portal can be reused by other applications. RESTful interfaces using JSON formatted data present the data in a format that can be consumed by web applications or full client side apps for Droid or iOS.

Platform Neutrality Our solution is platform agnostic, any HTML 5 capable browser can access our website and utilize the functions of search, add, and retrieval of information. This


technology has enabled our application to be developed and deployed once making it available to be used everywhere by anyone with access to the Internet. Extensibility The design of our application follows a Model View Controller pattern, where the user interface for both the mobile and desktop views are separated from the logic that performs the integration and aggregation of data. This means that the webservices we have deployed can be utilized by other applications and integrated into many other applications for other users beyond what we have put together as part of the NLM Challenge. As an example, the RESTful services that we have developed could be integrated with an Electronic Healthcare Record in which the patients’ current medication list is gathered and sent to the service to check for drug interactions. Other examples could be that the services could be embedded into native mobile applications such as a fully deployed Android or iOS app. These applications could be developed to take advantage of hardware specific capabilities not available to an HTML5 application, such as taking pictures of pills and expanding the search capability to search for the medication based on the picture taken (image search) or as part of a mobile personal health record that the patient collects and maintains on their device. Integration of other Data Sources Our application and more specifically our platform and webservices are designed to be able to incorporate and aggregate data from many different data sources. For the NLM Challenge we demonstrated this through the integration of disparate sources from FDA, NLM and NIH as examples. In the future, the types of data we integrate and summarize through the Restful services could be easily expanded. Some immediate sources that we have identified are the PillBox API for retrieving Pill Images and Toxnet which contains other information on the drugs not available in the sources we did integrate. Each site contains their own API, utilizing one or more of the identifiers of RXCUI, UMLSCUI, NUI , UNII, NDC, etc that can be used as an integration point for pulling and linking together available information. In addition to these sources, customized research and/or proprietary databases could also be incorporated to expand the offering and types of information available to the user seeking information on drugs and drug interactions. In the drug interaction area, the services could be expanded to include information on drug-‐>herbal/over the counter/vitamins and supplements information, drug -‐>food, and drug-‐>laboratory interactions if this information is available. These special cases of drug interaction data allow patients to research information and understand how the foods they eat, or supplements they take, could interact or affect lab values.


Overall the integration and summarization points are endless, and the design that we have put together allows for the integration of multiple data sources to be accomplished in a manner that is repeatable and can be accomplished quickly. Section 508 Accessibility and usability are key items in making software useful to people with disabilities. In support of this need, we have designed our pages to be used by screen readers such as JAWS by setting the tab order, and alt-‐text fields for all labels, images, and flows. This allows a screen reader to read the content to a user taking advantage of these tools in accessing our site. Overall Observations of the Datasources Throughout the course of developing this project, we kept a backlog of items and integration challenges we faced. Some of the key items we noted that can effect the performance of our application are the following:

1) Not all of the databases and datasources update their content at the same time. This can lead to one database being out of synch with the others, leading to information not being found or retrievable using standard identifiers. A key example is in our ability to get the textual description of a drug from the NCI Metathesaurus where we use either the NUI or UMLSCUI from the RxNorm or NDF-‐RT webservices to query this resource for the textual description. In certain cases, we found that the UMLSCUI returned from RxNORM was considered “obsolete” by NCI and no definition was returned.

2) When translating data between RxNORM api’s and the NDF-‐RT database, we found that not every RxCUI translates directly to a NUI, and in those cases we had to find either the Base Node RxCUI or Generic RxCUI to improve the ability to get a NUI for finding drug interactions.

About Us Founded in 2011, HTH Technologies provides IT Consulting Services to its clients seeking to integrate disparate systems within their organization. HTH specializes in Health IT solutions, Data Standards, SOA, Mobile, and web based solutions and provides these services to both Federal and Commercial companies.

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