Stream: implementers
Topic: Medication - alternating dose
Jose Costa Teixeira (Dec 14 2020 at 17:08):
How do we prescribe for an alternating dose, e.g. "1 tablet on day 1; 0,5 tablet day 2; do this for 2 weeks" ?
I think there are no examples for this, and we need to see how to use the dosage data type + timing for this.
@Isabelle GIBAUD this is your scenario, and we also need clarity for this in Belgium
Jose Costa Teixeira (Dec 14 2020 at 17:08):
We also need to do "red pill on day 1, blue pill on day 2"
Jean Duteau (Dec 14 2020 at 17:21):
I'm pretty sure you'd need to use multiple dosage instructions - one for each alternate with timing to say that it is every 2nd day.
Jose Costa Teixeira (Dec 14 2020 at 17:40):
how do we relate the second dosage instruction to the first?
How do we say "
- the first dosage instruction starts on day 1 ends on day 13
- the second dosage instruction starts on day 2 and ends on day 14
- the second dosage starts 1 day after the first take of the first dose, not after the entire dosage instruction"
?
Jose Costa Teixeira (Dec 14 2020 at 17:41):
(This was raised as an aspecty with insufficient clarity when we were migrating our existing standard to FHIR and I agree this needs guidance)
Jean Duteau (Dec 14 2020 at 17:55):
dosage instruction 1 - sequence 1, timing boundsPeriod - december 14 to 26, once per day every 2 days
dosage instruction 2 - sequence 1, timing boundsPeriod - december 15 to 27, once per day every 2 days
the sequence being the same for both instructions means that both dosages occur at the same time
Jose Costa Teixeira (Dec 14 2020 at 17:56):
we don't have fixed dates, we just have Day 1...
Jose Costa Teixeira (Dec 14 2020 at 17:57):
The actual dates depend on when the patient decides to start the treatment
Jose Costa Teixeira (Dec 14 2020 at 17:57):
(fixed dates is not a common thing in a prescription around here)
Jean Duteau (Dec 14 2020 at 17:58):
then use boundsRange 1 to 13 for Dosage1 and 2 to 14 for Dosage2
Jean Duteau (Dec 14 2020 at 18:00):
note: if the implementations don't convey this as structured dosage now, you might be better off just sending one dosage with text instructions.
Jose Costa Teixeira (Dec 14 2020 at 18:04):
Ok so for alternating dose we :
- both dosage sequences have the same value because they are concurrent
- bounds determine the actual start date AND the offset between the two
Jose Costa Teixeira (Dec 14 2020 at 18:06):
I understand we don't want to build anything too complex for less usual cases. This feels a bit strange but I don't see a better way.
If my understanding is correct, I Think we should freeze this as guidance.
#1 above is valid and should be straightforward, but #2 is meaningful guidance and should be captured, because it is not obvious
Jose Costa Teixeira (Dec 22 2020 at 10:17):
boundsRange = 1 day - does it mean start now? or start one day from now?
Lloyd McKenzie (Dec 22 2020 at 13:58):
It doesn't indicate a start
Jose Costa Teixeira (Dec 22 2020 at 15:19):
Does that mean "start on day 1" i.e. 0 days after the start (whatever "the start" is)?
Jose Costa Teixeira (Dec 22 2020 at 15:21):
that's how I would like to read it, but boundsRange is a SimpleQantity. "Day 1" is not really a quantity, is it?.
Just trying to get these semantics bulletproof before we issue guidance
Lloyd McKenzie (Dec 22 2020 at 19:53):
If you're specifying boundsRange, you're saying something like 10-15 days. The start date is unspecified.
Last updated: Apr 12 2022 at 19:14 UTC
