Stream: implementers
Topic: Compound medications
Brendan Keeler (Feb 15 2022 at 22:19):
Crossposting from #medications since it only has 144 members and this has 20k.
https://chat.fhir.org/#narrow/stream/179249-Medication/topic/Compound.20Medications
Brendan Keeler (Feb 15 2022 at 22:20):
NCPDP is a standard for medication dispenses we pull from outpatient pharmacies. We want to encode this data back into FHIR format properly. We’ve done so for “normal” medications already.
Compound medications are trickier. We see something like this:
Brendan Keeler (Feb 15 2022 at 22:20):
Brendan Keeler (Feb 15 2022 at 22:20):
In order to represent the compounded medication, we must use the FHIR Medication resource as a contained resource. Here’s an example compounded Medication:
Brendan Keeler (Feb 15 2022 at 22:20):
{
"resourceType": "Medication",
"id": "med0319",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: med0319</p><p><b>form</b>: Ointment <span>(Details : {SNOMED CT code '385101003' = 'Ointment', given as 'Ointment'})</span></p><blockquote><p><b>ingredient</b></p><p><b>item</b>: Salicyclic Acid (substance) <span>(Details : {SNOMED CT code '387253001' = 'Salicylic acid', given as 'Salicyclic Acid (substance)'})</span></p><p><b>strength</b>: 5 g<span> (Details: UCUM code g = 'g')</span>/100 g<span> (Details: UCUM code g = 'g')</span></p></blockquote><blockquote><p><b>ingredient</b></p><p><b>item</b>: Hydrocortisone (substance) <span>(Details : {SNOMED CT code '396458002' = 'Hydrocortisone', given as 'Hydrocortisone (substance)'})</span></p><p><b>strength</b>: 1 g<span> (Details: UCUM code g = 'g')</span>/100 g<span> (Details: UCUM code g = 'g')</span></p></blockquote><blockquote><p><b>ingredient</b></p><p><b>item</b>: White Petrolatum (substance) <span>(Details : {SNOMED CT code '126066007' = 'White petroleum', given as 'White Petrolatum (substance)'})</span></p><p><b>strength</b>: 94 g<span> (Details: UCUM code g = 'g')</span>/100 g<span> (Details: UCUM code g = 'g')</span></p></blockquote></div>"
},
"form": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "385101003",
"display": "Ointment"
}
],
"text": "Ointment"
},
"ingredient": [
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "387253001",
"display": "Salicyclic Acid (substance)"
}
]
},
"strength": {
"numerator": {
"value": 5,
"system": "http://unitsofmeasure.org",
"code": "g"
},
"denominator": {
"value": 100,
"system": "http://unitsofmeasure.org",
"code": "g"
}
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "396458002",
"display": "Hydrocortisone (substance)"
}
]
},
"strength": {
"numerator": {
"value": 1,
"system": "http://unitsofmeasure.org",
"code": "g"
},
"denominator": {
"value": 100,
"system": "http://unitsofmeasure.org",
"code": "g"
}
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "126066007",
"display": "White Petrolatum (substance)"
}
]
},
"strength": {
"numerator": {
"value": 94,
"system": "http://unitsofmeasure.org",
"code": "g"
},
"denominator": {
"value": 100,
"system": "http://unitsofmeasure.org",
"code": "g"
}
}
}
]
}
Brendan Keeler (Feb 15 2022 at 22:21):
It’s not clear how we map the quantity into the Medication. For instance, this:
Brendan Keeler (Feb 15 2022 at 22:21):
<CompoundIngredientsLotNotUsed>
<CompoundIngredient>
<CompoundIngredientItemDescription>PLO flowable Pluronic Lecithin Organogel</CompoundIngredientItemDescription>
<ItemNumber>
<Code>00395013501</Code>
<Qualifier>ND</Qualifier>
</ItemNumber>
</CompoundIngredient>
<Quantity>
<Value>82.9</Value>
<CodeListQualifier>87</CodeListQualifier>
<QuantityUnitOfMeasure>
<Code>C48155</Code>
</QuantityUnitOfMeasure>
</Quantity>
</CompoundIngredientsLotNotUsed>
Brendan Keeler (Feb 15 2022 at 22:21):
Seems to say that 82.9 grams (C48155 stands for grams) of PLO flowable Pluronic Lecithin Organogel were used, but that feels like an amount and not a strength.
Brendan Keeler (Feb 15 2022 at 22:21):
Anyone know how to encode this properly? Is FHIR not able to do compound medications properly?
John Moehrke (Feb 15 2022 at 22:22):
Brendan Keeler said:
Crossposting from #medications since it only has 144 members and this has 20k.
https://chat.fhir.org/#narrow/stream/179249-Medication/topic/Compound.20Medications
bad idea... those 144 understand medication... all you have done is make the 20k-144 see your message.
Brendan Keeler (Feb 15 2022 at 22:24):
I disagree? There's a chance someone in the 20k might know? Heck, I'll post it on Twitter too if a wider audience means I might find someone who knows and responds
Jean Duteau (Feb 15 2022 at 22:38):
Brendan Keeler said:
Anyone know how to encode this properly? Is FHIR not able to do compound medications properly?
Ha ha, I posted my comments on your Medication thread just as you crossposted, so you needed to wait 5 more minutes for an answer! :grinning_face_with_smiling_eyes: We have multiple systems able to do compound medications just fine. You have a built-in ratio in your representation Xg/100g so I'm not sure what the ultimate problem is. As I said in the first thread, R5 medication has added Quantity and CodeableConcept to the ingredient strength to allow for things that weren't ratios (eg. 5%) or to say QS (as much as is needed). You can backport the new options into R4 with an extension of you need.
Last updated: Apr 12 2022 at 19:14 UTC
