Stream: implementers
Topic: Drug Utilization Review
Ramakrishna Pratapa (Jun 24 2017 at 03:07):
Hi, Good evening, I am looking for a resource Drug Utilization Review (DUR) in FHIR. Can any one help. I checked DetectedIssue but I am not seeing all element I am looking. Can any one help.. Thank you, Ram
Eric Haas (Jun 24 2017 at 16:54):
@Melva Peters or @John Hatem ?
Melva Peters (Jun 24 2017 at 17:35):
@Ramakrishna Pratapa I believe the DetectedIssue resource is what you're looking for. If there are missing elements you can log a change request in GForge
Ramakrishna Pratapa (Jun 24 2017 at 17:59):
Melva, good morning, thank you for the response. Here is my thought process. Please kindly advise
DetectedIssue Fields based on FHIR:
"resourceType" : "DetectedIssue",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : { Identifier }, // Unique id for the detected issue
"status" : "<code>", // R! registered | preliminary | final | amended +
"category" : { CodeableConcept }, // Issue Category, e.g. drug-drug, duplicate therapy, etc.
"severity" : "<code>", // high | moderate | low
"patient" : { Reference(Patient) }, // Associated patient
"date" : "<dateTime>", // When identified
"author" : { Reference(Practitioner|Device) }, // The provider or device that identified the issue
"implicated" : [{ Reference(Any) }], // Problem resource
"detail" : "<string>", // Description and context
"reference" : "<uri>", // Authority for issue
"mitigation" : [{ // Step taken to address
"action" : { CodeableConcept }, // R! What mitigation?
"date" : "<dateTime>", // Date committed
"author" : { Reference(Practitioner) } // Who is committing?
}]
}
NCPDPD fields and the valid valies
1) Reason for Service Code
The valid values are :
DD = Drug-Drug Interaction
HD = High Dose
ID = Ingredient Duplication
TD = Therapeutic
These values can be mapped this field to FHIR DetectedIssue.category
2) Clinical Significance Code
Blank = Not Specified
1 = Major
2 = Moderate
These values can be mapped this field to FHIR DetectedIssue.severity
The following fields don't have proper mapping fields in FHIR based on what I am seeing.
3) Other Pharmacy Indicator
Ø = Not Specified
1 = Your Pharmacy
2 = Other Pharmacy in Same Chain
3 = Other Pharmacy
I am not sure what is the equivalent field in FHIR for the following
4) Previous Date of Fill
5) Quantity of Previous Fill
6) Database Indicator
Blank = Not Specified
1 = First Databank
7) Other Prescriber Indicator
Ø = Not Specified
1 = Same Prescriber
2 = Other Prescriber
8) dur FreeText Message
9) dur Additional Info
10) Clincal Sig Code
The link to the document is : https://www.txvendordrug.com/sites/txvendordrug/files/docs/manuals/drug-utilization-review.pdf
Also, All these fields can be repeatable. I feel if we can re-design the segment by adding a field similar to "implicated" which has an array the will provide all DUR data so that we can use this resource to accommodate all. I am not sure the intention is to use MedicationRequested.detectedIssue field ( it has one to many) and provide reference to the resources.
"implicated" : [{ Reference(Any) }], // Problem resource
Thank you for your help.
Ram
Last updated: Apr 12 2022 at 19:14 UTC
