Automate Medical Coding With WHODrug Koda
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WHODrug Koda, developed by Uppsala Monitoring Centre (UMC), is an automated coding service, which uses artificial intelligence (AI) to automate the coding of drug names and ATC selections, improving consistency and operational efficiency. It can also be used to accelerate dictionary upgrades, including the transition from WHODrug B2 format to B3. Through API (Application Programming Interface) web services, the coding engine can be integrated with custom or off-the-shelf drug safety, medical coding, or data management systems. In this webinar, Perficient and UMC discussed WHODrug Koda and how you can integrate it into your medical coding activities.
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Automate Medical Coding With WHODrug Koda
- 1. Automate Medical Coding With WHODrug Koda
- 2. 2 Tom Hogan Chief OperatingOfficer Who We Are AN INTRODUCTION TO We’re a global digital consultancy transforming how the world's leading enterprises and biggest brands connect with customers and grow their businesses. With Perficient, you get experience and expertise, speed and agility, and a healthy dose of pragmatism to drive your business forward.
- 3. 3 ~4,500 Colleagues WE ARE Global in Our Delivery We have office locations across North America and fully owned global and domestic delivery centers around the world. Allentown, PA Ann Arbor, MI Atlanta, GA Boston, MA Bozeman, MT Cedar Rapids, IA Charlotte, NC Chicago, IL Columbus, OH Dallas, TX Denver, CO Detroit, MI Fairfax, VA Fargo, ND Houston, TX Irvine, CA Lafayette, LA Milwaukee, WI Minneapolis, MN New York, NY San Francisco, CA Seattle, WA St. Louis, MO Toronto, ON Washington, D.C. North America Latin America Mexico City, Mexico Medellin, Colombia Bogota, Colombia Cali, Colombia Chennai, India Nagpur, India Bangalore, India India Hangzhou, China China Oxford, UK Novi Sad, Serbia Europe
- 4. 4 AT-A-GLANCE Perficient Profile Alliance partnerships with major tech vendors Multiple vendor & industry tech and growth awards Global delivery centers in China, India and Latin America Dedicated solution practices 35 Global Locations $565M 2019 Revenue 1997 Founded in ~4,500 Colleagues ~90% Repeat Business Rate PRFT Public, NASDAQ
- 5. 5 Industry Expertise Our experience in the life sciences industry empowers us to help companies discover, develop, and manufacture products that help people feel better and live longer. We also help them enhance their customer experience and achieve operational excellence. I NDUSTRY Life Sciences 30+ of the world's leading public pharmaceutical, biotechnology, and medical device companies count on us . We helped a pharmaceutical giant transform the way it performs its medical coding activities. Project Spotlight DigitalTechnologyStrategy Clinical Safety
- 6. 6 Caroline Halsey Director, Life Sciences Caz.Halsey@Perficient.com Damon Fahimi Product Manager, Uppsala Monitoring Centre Damon.Fahimi@who-umc.org Today’s Speakers
- 7. 77 Agenda • WHODrug Global and Drug Coding • An Introduction to WHODrug Koda • Why use Koda • Methods of Using Koda • Perficient Koda Interface - Prototype • Use Cases • How to Find Out More
- 8. 8 Uppsala Monitoring Centre & WHODrug Global Productname Drugcode ActiveIngredient(s) ATC ASPIRIN [ACETYLSALICYLIC ACID] 00002701004 Acetylsalicylic acid A01AD, Other agents for local oral treatment B01AC,Platelet aggregation inhibitors excl. heparin M02AC,Preparations with salicylic acid derivatives N02BA, Salicylic acid and derivatives WHODrugGlobal
- 9. 9 The Challenges of Structuring Drug Data Staffing Drug coding requires highly skilled, educated and trained staff IncreasingVolumes Both long-term and short-term demands Quality& Consistency Dynamic nature of drug coding. How to keep consistency in coding teams? Tools & Processes Dependencies on tools & synonym lists not delivering optimal support for drug coding
- 10. 10 What if… ...drug coding staff could spend their time only on the most relevant cases? …a more significant part of the drug coding could be automated, thereby helping cope with both short- and long-term peaks? …UMC could gather know-how from the industry and, with the help of technology, increase drug coding consistency? …there was a plug-in to current processes and tools, enhancing drug coding? Project goal: Find an intelligent approach to automating drug coding using machines and efficiently using the human brain when needed
- 11. 11 The Result: WHODrug Koda – Born in 2019 Verbatim + Route* + Indication* * If available Drug Name Coding ATC Selection
- 12. 12 Example
- 13. 13 Machine Learning Applied How? For What? TrainingData? Supervised machine learning via logistical regression Primarily ATC code selection, but also drug name coding Millions of data points from VigiBase Trainingdata Input A → Output A Input B → Output A Input C → Output B Prediction Non-trainingdata Input D → Output A More than 500,000 “classes” of drug names Around 1400 “classes” of ATC codes
- 14. 14 VigiBase: An Invaluable Asset for Training • Training data is key! • VigiBase used to train and update WHODrug Koda + millions of additional data points Coded in WHODrug Global Drug name ATC code and text Acetazolamide S01EC, Carbonic anhydrase inhibitors Acetazolamide S01EC, Carbonic anhydrase inhibitors Acetazolamide C03, Diuretics Acetazolamide N03AX, Other antiepileptics Unprocessed Data Verbatim Route Indication Acetasolamide Oral Cataract surgery Acetazolamide tablet 250mg Unknown Retinitis central Acetazolamide Oral Secondary hypertension Acetazolamide Oral Seizure
- 15. 15 “Only” Machine Learning – Not Enough Built-in CodingRules Spell Checks and Algorithms Know-how and Controlled Feedback Loops Following the latest regulatory expectations and best practices for WHODrug coding Making sense of the data Systemic (foundational) Dynamic (supplementary) Examples of drug verbatims Naphazoline (naphcon) 0.1% ophthalmic solution sodium fluoride (prevident5000 booster plus) 1.1% dental paste ERELSA TABLETS 50MG Pharmacists and medical expertise at UMC and feedback from users
- 16. 16 Average Results With External Data Drugname coding ATC Selection ≈ 95%of all drug namescoded* *High certainty: 80%; Lower certainty: 15%; Uncoded: 5% ≈ 100% selected** **High certainty: 80%; Lower certainty: 20% What about the precision for the predictions? ≈ 99%*** ***Based on high certainty predictions For an example;please see: Herrgårdet al., 2020. Assessment of Machine Learning Methods in Coding of Concomitant Medications in Clinical Trials.Abstract for the 2020 PhUSE Connect USA 2020. https://www.phusewiki.org/docs/2020%20US%20Connect%20Florida/Presentations/ML/Final%20Papers/ML13%20pdf.pdf
- 17. 17 How to Access WHODrug Koda WEB APPLICATION For evaluations / smaller studies API Allowing implementation within current processes
- 18. 18 UMC and Perficient • Perficient is licensed and approved by UMC for integrating WHODrug Koda into medical coding tools • Contact UMC for general questions about WHODrug Koda • Contact Perficient for questions about our services https://www.who-umc.org/whodrug/whodrug-portfolio/whodrug-koda/
- 19. 19 Why Use Koda Koda can support medical coding in various scenarios: • Assigning drug codes only • Assigning drug codes and preferred ATC codes based on indication • Recoding / refreshing WHODrug encoded data • Up-versioning to a more recent version • Up-versioning from B2 to B3 format Koda is already trained • Time, effort, and volume of data required to train an AI system is significant • Koda is already trained and ready to use
- 20. 20 Methods of Using Koda Two ways to use Koda: 1. Upload / download data through Koda UI on UMC website • Requires manual process of data extraction and bringing coding results back into source data • Koda UI is currently used by UMC customers 2. Upload / download data through UMC Koda webservice API • Allows direct integration of Koda functionality into coding process • Requires technical knowledge of webservice integration into systems
- 21. 21 Perficient Koda Interface – Prototype Perficient has built a prototype of a generic Oracle interface to the Koda webservice API • Consists of a table for drug data to be coded and some programming objects • Oracle-based • Requirements: • Oracle 11 or above • UMC security certificates installed • Open network connection from DB server to UMC server • Additional custom adapter required for each specific source system (medical coding system, PV system, etc.)
- 22. 22 WHODrug Koda Interface Source System YOUR COMPANY WHODrug Koda Encoded drug or suggested drug Drugs to be coded CustomAdapter Drugs to be coded Encoded drug or suggested drug
- 23. 23 Example Workflow Step 1 – Table With Uncoded Data Line Drug Route Indication Code ATC Comments 1 Paracetamol Entry with single ATC code 2 Aspirin Oral Anti-coagulant Entry with 4 ATC codes from 4 different classes 3 Aspirin Thrombosis Entry with 4 ATC codes from 4 different classes 4 Aspirin thrombose Entry with 4 ATC codes from 4 different classes 5 Aspirin Thrombosis prophylaxis Entry with 4 ATC codes from 4 different classes 6 Aspirin Headache in the morning Entry with 4 ATC codes from 4 different classes 7 Artificial tears Drops Non-unique entry including an umbrella term 8 A b c Another entry ABC exists 9 ibuprofen headache Entry with some ATCs not very distinctive (e.g. two from M class) 10 Vitamins Non-unique drug name (one regular entry and one umbrella term) 11 x37ytc12 Non-existing entry 12 sebcur Unique name which was non-unique in older versions 13 sebcur [salicylic acid] Non-unique entry as in older version 14 sebcur salicylic acid Concatenation of name with ingredients
- 24. 24 Example Workflow Step 2 - Interface Execution 1. Transformationof datato be coded intoKodaformat (JSON) {"WhoDrugVersionShortName":"GLOBALB3Sep19","UsePreferredBaseRule":"true","UseGenericRule":"true","Description":"ClientJob ID = 13774594","DrugsToCode":[{"Id":13774573,"Verbatim":"paracetamol","Route":null,"Indication":"headache"},{"Id":13774574,"Verbatim":"aspirin","Route":"oral","Indication":"anti- coagulant"},{"Id":13774575,"Verbatim":"aspirin","Route":null,"Indication":"thrombose"},{"Id":13774576,"Verbatim":"aspirin","Route":null,"Indication":"thrombosis"},{"Id":13774577,"Ver batim":"aspirin","Route":"oral","Indication":"thrombosis prophylaxis"},{"Id":13774578,"Verbatim":"aspirin","Route":null,"Indication":"headachein the morning"},{"Id":13774579, "Verbatim":"acetylsalycilicacyd","Route":null,"Indication":null},{"Id":13774580,"Verbatim":"aspirin50mg","Route":null,"Indication":null},{"Id":13774581,"Verbatim":"ab c","Route":null, "Indication":null},{"Id":13774582,"Verbatim":"artificaltears","Route":"drops","Indication":null},… 2. CreateHTTPSconnection to Kodawebservice API using UMCsecurity certificates, senddata, andget a response {"Id":"db7a0032-3656-4736-864e-d0d75495d8b6","Description":"ClientJob ID = 13774594","WhoDrugVersionLongName":"WHODRUGGLOBAL B3 September 1, 2019","WhoDrugVersionShortName":"GLOBALB3Sep19","UsePreferredBaseRule":true,"UseGenericRule":true,"EncodingJobStatus":"Finished","QueuedDateUTC":"2020-01- 31T16:29:56.1800000Z","StartedDateUTC":"2020-01-31T16:29:56.6400000Z","FinishedDateUTC":"2020-01-31T16:30:02.3500000Z","NoOfRecords":21,"CodingItem“ :[{"Id":"13774573","Verbatim":"paracetamol","Route":null,"Indication":"headache","EncodedDrug":{"Tradename":"PARACETAMOL","Ingredients":["Paracetamol"],"DrugCode":"000200 01001","AtcCode":"N02BE","SuggestedAtcs":[]},"SuggestedDrugs":[],"CodingPath":"DirectHit"},{"Id":"13774574","Verbatim":"aspirin","Route":"oral","Indication":"anti- coagulant","EncodedDrug":{"Tradename":"ASPIRIN[ACETYLSALICYLICACID]","Ingredients":["Acetylsalicylicacid"],"DrugCode":"00002701004","AtcCode":"B01AC", "SuggestedAtcs":[]},"SuggestedDrugs":[],"CodingPath":"NonUniqueByIndication"},{"Id":"13774575","Verbatim":"aspirin","Route":null,"Indication":"thrombose","EncodedDrug":{"Tradena me":"ASPIRIN[ACETYLSALICYLICACID]","Ingredients":["Acetylsalicylicacid"],"DrugCode":"00002701004","AtcCode":"N02BA","SuggestedAtcs":[]},"SuggestedDrugs":[]… 3. Parseresponse fromKodaformat(JSON) and updatedatatable
- 25. 25 Example Workflow Step 3 – Table Contains Coded Data Line Drug Route Indication Code ATC Comments 1 Paracetamol 00020001001 N02BE ATC provided as drug has only one ATC code 2 Aspirin Oral Anti-coagulant 00002701004 B01AC ATC code correct 3 Aspirin Thrombosis 00002701004 B01AC ATC code correct 4 Aspirin thrombose 00002701004 N02BA Wrong ATC (indication misspelled) 5 Aspirin Thrombosis prophylaxis 00002701004 B01AC ATC code correct 6 Aspirin Headache in the morning 00002701004 N02BA ATC code correct 7 Artificial tears Drops No code as non-unique,but list of suggested drugs as expected 8 A b c 00256502021 No ATC code as no indication 9 ibuprofen headache 00109201001 No ATC code, but 2 suggested ATC codes from M class 10 Vitamins No code as non-unique.Returns 2 suggested drugs as expected, one of which is an umbrella term 11 x37ytc12 Uncoded as expected 12 sebcur 00021201106 No ATC code as no indication 13 sebcur [salicylic acid] 00021201106 Entry from old WHODrug version correctly coded although no longer non-unique in new version 14 sebcur salicylic acid No encoded drug code, but single suggested drug code, which is correct
- 26. 26 Potential Interface Use Possible integrations of an Oracle-based interface could include: • Argus Safety • Connect Koda as WHODrug interactive coding webservice to Argus Product screen • Integrate WHODrug coding via Koda into custom case save procedure • Oracle TMS • Auto-create unapproved VTAs for coding omissions which have been sent to Koda We are prototyping an Oracle-based approach. The integration of Koda with other source systems can be explored.
- 27. Questions?
- 28. 28 Caroline Halsey Director, Life Sciences Caz.Halsey@Perficient.com Damon Fahimi Product Manager, Uppsala Monitoring Centre Damon.Fahimi@who-umc.org Thank You
Editor's Notes
- My name is Caroline Halsey, I am a Director in the Life Sciences Business Unit at Perficient. I have 20 years experience in the pharmaceutical industry including: Clinical data management Project & program management Process design & system implementation Computer system validation For the past few years I have been focussed on medical coding processes and systems. Today I am here to describe about how you could integrate the UMC’s WHODrug Koda coding engine into your coding process via its webservice API and I am pleased to be joined by Damon Fahimi from the UMC to discuss this.
- Damon will introduce WHODrug coding and WHODrug Koda, then I will discuss how it could be used and what we are working on at Perficient to enable integration of Koda into medical coding processes
- As you have heard, Koda can help you with your daily drug coding business, but it can also help to recode data by upgrading your WHODrug version or even your WHODrug format. For example, when recoding a study from B2 to B3 a large number of terms may no longer code. Submitting those terms to WHODrug Koda could dramatically reduce the manual effort of recoding. One of the main challenges in the use of AI in medical coding is the time, effort and volume of data required to train the AI system. With WHODrug KODA the training has already been done for you."
- We’ve heard from Damon, one way to use Koda is via uploading and downloading data through the Koda UI, but it is also possible to fully integrate it into your systems by using the Koda webservice Application Programming Interface. Now, using webservice APIs is not always straightforward, as you have to deal with technicalities like transforming data, generating network traffic, security cerificates etc. It would simplify integration if you had an additional interface level available, which hides all the technical bits. Some of my Perficient colleagues have built a prototype of such an interface, and this is what I’d like to talk about today. I’ll give an overview of the design, usage and possible integration and let you know how to find out more if you are interested
- In order to build such an interface we needed first to decide on a platform, and we have chosen Oracle. This choice was kind of arbitrary, and of course you could build a similar interface on any other platform. This prototype consists basically of a table which contains the drug data to be coded and mimics the source application plus some programming objects in PL/SQL, which interact with the webservice API right out of the database. The only system requirement is that you have Oracle version 12 or higher, and you need to have the UMC certificates installed and an open network connection from your database to the UMC server. No further infrastructure is needed.
- Here you can see the designed workflow. The source system or application sends the drugs to be coded via the custom adapter to the interface. The interface converts the data into the format expected by the Koda application and calls the Koda webservice API It then gets back the response from Koda with coding information, parses the response and updates the drug data with the coding information in the source system. Triggering the interface could of course be an automated process, e.g. a regular batchjob or automated execution if the table of drugs has been updated. This design actually hides all the technical complicated bits from the end user or end application.
- Now lets have a look at a real example. The columns with blue heading here reflect data which is exchanged with Koda. Initially the drug table contains drug verbatims, some of them with route and / or indication. Now we trigger the interface.
- The interface now Transforms the data into Koda format Builds the network connection and send data to Koda Gets the response in Koda format Parses the response Puts coding information back into the source table This is the part that nobody wants to deal with as it looks like this <trigger animation>
- This is what the table looks like after the interface execution. The interface has updated the code and ATC code column with some values. Please note that here you can only see the encoded information, the comments column shows some information on suggested drugs if available. Lets have a look at a few examples in more detail... Line 1 is paracetamol, which is correctly coded to its drug code and ATC code although no indication was provided. This is because Paracetamol has only one ATC code. Lines 2 to 6 are some records with Aspirin, which has 4 ATC codes from 4 different classes, so is fairly distinctive. For correctly spelled indications the drug code and ATC is always correct, for the misspelled indication in line 4 the ATC code is incorrect. Line 7 to 11 are some examples where we have tried non-unique drugs, non-existing names, umbrella terms, drugs with multiple ATC codes from the same class etc. All codes which were provided were as expected and correct. Suggested information is also as expected and correct. Of special interest are lines 12 to 14, which is an example on how you could use Koda for a version or format upgrade. The tradename SEBCUR was non-unique in a previous WHODrug version and became unique in a more recent version. Koda is able to correctly encode or suggest the code from the current version if you pass in the tradename with ingredients attached as it was stored in the previous version.
- Such an Oracle based interface could be potentially integrated with any Oracle based system, for example Argus Safety, where you could use it for coding during case entry, or for coding during case save. Or you could integrate it with Oracle TMS, where you could for example auto-create non-approved VTAs for coding omissions which you send to Koda and where Koda returns a code. As already mentioned, this prototype is currently Oracle based, but could be explored for other platforms as well, so please don’t go away with the iompression that this would only work if you use Argus and TMS.
- Seed Question: Will this interface only work for Oracle-based systems? Response: the prototype interface is Oracle based, but with the appropriate custom adapter, in principle, any source system could be used.