Stream: implementers
Topic: Medication Classification
Shubham Sharma (Sep 01 2020 at 11:48):
Hi All, While trying to model for Medication resource. We are looking for appropriate place to put Drug Classification.
As there is no category/class kid of property on Medication, has some one come up with some extension for same.
Lloyd McKenzie (Sep 01 2020 at 15:43):
@Melva Peters
Melva Peters (Sep 01 2020 at 15:45):
There is an attribute on MedicationKnowledge and not on Medication. Can you please explain your use case? We kept medication pretty simple for the purposes of prescribing, dispensing, administering of medications.
Shubham Sharma (Sep 02 2020 at 14:43):
Thanks @Melva Peters , Use case is mapping prescription / current medications using MedicationRequest / MedicationStatement resource. There we need give some classification/categorization of medication like it is analgesic or it is an chemotherapy agent or it is controlled drug some thing like those to give a general intimation on a medicine.
Melva Peters (Sep 02 2020 at 14:48):
There is a category attribute on MedicationRequest, MedicationUsage, MedicationDispense and MedicationAdministration that can be used to categorize the type of each of the resource instances. I'm not sure if you currently have this information on your prescriptions and other records or not.
Shubham Sharma (Sep 02 2020 at 17:29):
But there can only be one category and that is used to specified inpatient|outpatient as per specification.
John Silva (Sep 02 2020 at 17:55):
In R4 MedicationRequest.category was changed to 0..*. -- I think I had asked for this change a year or so ago and it got in! :-)
Melva Peters (Sep 02 2020 at 18:30):
Yes, in R4 it was changed to 0..*. The Category is intended to provide a way to provide the type of medication request or usage. We provide an exemplar value set but it is exemplar only. The description for the attribute in R4 says: "Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient))." This is an example only. In the Current Build, the description has been updated to: "Indicates the grouping or category of medication request (for example, drug classification like ATC, where meds would be administered, legal category of the medication.)."
Jose Costa Teixeira (Sep 02 2020 at 20:28):
Category of medication is not the same as category of the request / usage / administration
Jose Costa Teixeira (Sep 02 2020 at 20:30):
One may imply the other (i.e. narcotic product may imply a certain category of request). But I don't think medicationrequest.category should be the place to put classificiations like ATC or similar
Melva Peters (Sep 02 2020 at 20:47):
We've had implementers ask for this and that's why it was changed to support multiple categories and classification is one kind.
Jean Duteau (Sep 02 2020 at 20:49):
Although I personally agree with you Jose, we had multiple implementers ask for this (like Shubham does in this thread), so we bowed to the implementer community and allowed them to send it in the category.
Jose Costa Teixeira (Sep 02 2020 at 22:20):
you mean medication category goes into request category?
Jose Costa Teixeira (Sep 02 2020 at 22:22):
if you need to add a category for the requested medication, that would be a "medicationCategory" attribute. We should not endorse misusing fields.
Jose Costa Teixeira (Sep 02 2020 at 22:36):
I just re-read Melva's description and I do think the clarification makes the boundary very fuzzy. It should be clear - i.e. ATC code is not a medication request category. It is a medication category.
Lloyd McKenzie (Sep 02 2020 at 22:55):
I don't think it's a mis-use. The reality is that if a prescription prescribes a regulated medication, then it becomes a 'regulated' prescription, so reflecting that in MedicationRequest.category isn't an invalid use. In some cases, the prescription might be for a complex compound, where one of the ingredients is restricted. You don't want receivers to have to dig through the whole recipe to determine whether there are special rules around how the prescription gets handled.
Shubham Sharma (Sep 03 2020 at 04:13):
Only thing i see is since attribute is more of a Medication, either we may need to replicate it on other Resources like MedicationStatement, MedicationAdministration, MedicationDispense (i mean allowing multiple categories in these resources,, which requires change in FHIR) <OR> making MedicationReqeust reference available always, which seems to bit tricky specially if information is exchanged between two systems.
Last updated: Apr 12 2022 at 19:14 UTC
