Stream: implementers
Topic: Medication Request intent Order and Instance Order use
Pete Salisbury (Jan 18 2018 at 17:02):
Hi, in Medication Request the intent field has a valueset that includes order and instance-order. In the spec the examples the are given for the use of instance-order are all related to medication administration,
From Medication Request intent, instance-order - The request represents an instance for the particular order, for example a medication administration record.
From Request.intent, instance-order - An order created in fulfillment of a broader order that represents the authorization for a single activity occurrence. E.g. The administration of a single dose of a drug.
Would it be a correct use of FHIR to use instance-order to represent an issue of a repeat prescription by a GP? So if a GP Authorised a repeat prescription with 5 issues then there would be 5 Medication Requests with the intent set to instance-order that would represent the individual prescriptions.
Jose Costa Teixeira (Jan 18 2018 at 17:05):
from a prescription (medicationRequest, instance-order=order) that says "take this 3 times per day for 5 days",
instance-order is used to derive the 15 planned administrations "take this at 7 am on day 1", "take this at 3 pm on day 1"..." take this at 11pm on day 5"
Jose Costa Teixeira (Jan 18 2018 at 17:09):
so, repeat prescriptions should not be handled the way you are saying because that would mean that your prescription has intent=instance-order , which is not what is going to be recognized by another system (which expects prescriptions to be intent=order.
Jean Duteau (Jan 18 2018 at 17:17):
No, instance-order would rarely be used by a GP but if it was, it would be indicating the ordering of one specific administration that was covered by the drug. I do not totally understand your terminology "a repeat prescription with 5 issues", but the MedicationOrder resource allows for defining a prescription (with intent=order) that allows refills.
Lloyd McKenzie (Jan 18 2018 at 17:41):
What do you mean by "repeat prescription"?
Pete Salisbury (Jan 19 2018 at 08:48):
I guess Repeat prescription is a UK term. It is a prescription issued by a GP that means the patient can get further supplies of a medication without the patient having to see the doctor again. This may be for a limited number of occurrences ie. the GP may authorise for the medication to be supplied 5 times or perhaps until a certain date when it would be reviewed.
Jose Costa Teixeira (Jan 19 2018 at 09:05):
That is quite common. I would suggest the way to use it is using medicationrequest.DispenseRequest.
Jose Costa Teixeira (Jan 19 2018 at 09:05):
there you can say "this prescription is valid for 1 year" or "this prescription is valid for 5 refills"
Lloyd McKenzie (Jan 19 2018 at 15:54):
Agree with Jose. That would be a single order. The MedicationRequest.dispenseRequest would convey how many fills are authorized. If you wanted to initiate just a single fill, that would be handled by Task.
Jean Duteau (Jan 19 2018 at 16:14):
What they said. The MedicationRequest.DispenseRequest.numberOfRepeatsAllowed lets you specify how many fills beyond the first that you are authorizing.
Last updated: Apr 12 2022 at 19:14 UTC
