Stream: implementers
Topic: Definitions of Medicinal Products
Jose Costa Teixeira (Oct 21 2018 at 18:11):
I have seen good discussions and progress on the resources but perhaps now is the time to ask:
We have a few resources to convey "the relevant characteristics of a medicinal product".
Some resources for the top regulators, some resources for the clinical world.
Some resources aligned to IDMP, others not focused on that.
Jose Costa Teixeira (Oct 21 2018 at 18:12):
Out there, we will have variance. How is FHIR going to support it?
Jose Costa Teixeira (Oct 21 2018 at 18:14):
how do we support the several levels/concepts of medication? For one country, the top level is "generic" but for another it will be "active substance".
Jose Costa Teixeira (Oct 21 2018 at 18:17):
- RxNorm has 2 levels IIRC
- IDMP has several levels (4 concepts, but one of them has several levels)
- DCI / ICD has not levels, but just substances (and is still a target for national prescription)
- Countries have levels of granularity that can be Generic , Brand , Package, etc. this is not a small set.
They are all useful.
Jose Costa Teixeira (Oct 21 2018 at 18:23):
in a related problem we had, we defined a master information set, and all concepts of medication definition were projected onto that set.
In other words, we had a "medicinal product attribute set" from which we could select a couple of attributes to define a Pharmaceutical Product, or a substance, or a branded product... This resolved the issue.
Jose Costa Teixeira (Oct 21 2018 at 18:27):
To achieve the same flexibility in FHIR, I would start with soething like the MedicationKnowledge resource and define profiles .
Jose Costa Teixeira (Oct 21 2018 at 18:30):
.. and for discussion: This approach could also overlap with the Regulatory resources which could be a profile (e.g. a Pharmaceutical Product is a Medication Definition for which Substance, Strength, Dose Form... are mandatory, medicinal Product is one where Manufacturer, brand... are identified..."
Jose Costa Teixeira (Oct 21 2018 at 18:32):
I know this will get interesting when looking at medicinal products that have two pharmaceutical products (e.g. oral contraceptives, or packages that have different types of antibiotics for a given schedule) but i just wanted to launch the need:
Jose Costa Teixeira (Oct 21 2018 at 18:33):
IDMP is one of the great things that happened in this topic, and we must support it, and provide a bridge to all the other "medicinal product definitions" that exist in local regulatory jurisdictions, or inside a given hospital, or inside the context of a given insurance plan...
Jose Costa Teixeira (Oct 21 2018 at 18:36):
I personally am inclined towards a "master" resource that can be profiled, rather than several resources with specific purposes, so that real implementations do not have the problems I had.
I don't know what the solution should be. @Rik Smithies , @Melva Peters will know how /whether / when this can be discussed.
Melva Peters (Oct 21 2018 at 18:57):
@Jose Costa Teixeira there is a joint project with Pharmacy and BR&R discussing these resources and working on harmonizing to a common medication model. Calls are scheduled through BR&R and are Thursday at 10am Eastern every 2 weeks at this point (next one is November 1st). There is a stream created for discussion related to this topic. https://chat.fhir.org/#narrow/stream/152-BRR--.20Pharmacy.20Common.20Medication.20Model
Jose Costa Teixeira (Oct 21 2018 at 18:59):
Ah great. Thanks Melva
Dion McMurtrie (Oct 22 2018 at 06:03):
I've thought about this quite a bit too @Jose Costa Teixeira and it does seem a bit awkward at present. It seems FHIR currently has 3 concepts of medications -
- Medication - used for instance resources in prescribe/dispense...etc events
- MedicationKnowledge - used to provide reference and definitional information about medicines, e.g. from terminology
- "Medication Definition" resources - appear to be a FHIR rendering of IDMP
I've spent time working on STU3 representing terminology definitions using Medication because I started before MedicationKnowledge existed. For my use case there were many required extensions to Medication to support what I wanted to do. You can see the latest results at https://medserve.online
Perhaps moving to MedicationKnowledge will resolve some of these extensions (I'm yet to do that analysis), but both Medication and MedicationKnowledge have this strange (to me) modelling with respect to "units" (like a tablet) versus packages (like a bottle of tablets) and the resulting consequence of being able to represent nonsense.
The "Medication Definition" resources are much more detailed in their modelling, separating out this concept clearly, but are also much more detailed than the use case I've got - I want to provide AMT and other medicines terminology content via an easy to consume API, and FHIR makes a pretty good candidate for this.
So I'm really interested where this goes, but I agree something that is probably more maximal than MedicationKnowledge (maybe split it in two first) and then profiled for various use cases makes sense...but that's just my thought.
I'd be interested to sit in on that discussion if possible...
Melva Peters (Oct 22 2018 at 15:19):
@Dion McMurtrie there is a separate stream for this work https://chat.fhir.org/#narrow/stream/152-BRR--.20Pharmacy.20Common.20Medication.20Model
Last updated: Apr 12 2022 at 19:14 UTC
