Stream: implementers
Topic: Medication prescribed by a doctor and over-the-counter medic
Dongtu (Sep 19 2019 at 07:17):
I want to present 2 types of drug.
1. The drug is prescribed for treatment by a doctor in the hospital.
2. Over-the-counter medicines purchased at the drugstore
What Resource can I use in this situation?
I want to represent this information in malaria information. Can I present it in contained element of Condition Resources?
Philip Simonsen (Sep 19 2019 at 07:32):
This depends on the context the medication lives in. If it is just a definition of a medication then you can use the Medication resource. You'll probably need another resource to reference this Medication to a Condition unless you can use some extension for it
Dongtu (Sep 19 2019 at 07:36):
Can you give me an example?
Philip Simonsen (Sep 19 2019 at 07:41):
I don't really know your use case enough to give a good example, but I would assume you'd want to use something like a MedicationAdministration or MedicationStatement resource and have them refer to your Procedure. These resources can contain medication definitions in the form of codes, or they can contain a reference to a Medication resource.
Lloyd McKenzie (Sep 19 2019 at 12:41):
Generally you wouldn't use a 'contained' resource for something like this - if you know the patient, the drug and when, then you have enough information for a stand-alone record. ('contained' is for information that can't stand by its own).
The prescription would typically be MedicationRequest. Something purchased over-the-counter would typically be MedicationStatement.
Melva Peters (Sep 19 2019 at 12:48):
in R5 it will be MedicationUsage for over the counter medications (MedicationStatement has been renamed.
Brian Postlethwaite (Sep 19 2019 at 20:13):
So MedicationStatement has been renamed to MedicationUsage in R5?
Grahame Grieve (Sep 19 2019 at 20:13):
yes but as Product Director I'm going to ask the community to rule on whether this is a worthwhile change, and if they don't, I'll ask the committee to change it back
Jean Duteau (Sep 19 2019 at 21:01):
Why? The committee felt that the name better describes its scope and usage.
Grahame Grieve (Sep 19 2019 at 21:05):
indeed, the committee was clear about that. But this is a resource that has had a lot of use out in the community, and so I believe it's appropriate to ask the community whether the price of renaming is justified by the better clarity of the new name
John Silva (Sep 19 2019 at 22:41):
Yes, change for the sake of change ... Too bad we didn't have an alias mechanism in FHIR ;-)
Lloyd McKenzie (Sep 19 2019 at 22:51):
Essentially, the resource is being treated as FMM4+ which requires implementer consultation when making breaking changes
Grahame Grieve (Sep 19 2019 at 23:00):
we do have an alias mechanism but it sounds like you want more from it than it does
Dongtu (Sep 20 2019 at 01:16):
Thanks all,
I only care about drug names. Is there a way to display a list of drug names without using a lot of Medication Resource ?
Jose Costa Teixeira (Sep 20 2019 at 01:20):
@Dongtu what is your use case? can you describe what the user is supposed to be doing when you want to see that list of drug names?
Is it a list of drug names for a patient? a list of drugs they have in the formulary? it would help to have more information.
Dongtu (Sep 20 2019 at 01:26):
I am presenting malaria information, including information about drug names that have been used in the past. I don't want to use a lot of Medication Resources, just to get the name
Jose Costa Teixeira (Sep 20 2019 at 01:59):
so, for one patient?
Dongtu (Sep 20 2019 at 02:03):
That's right
Lloyd McKenzie (Sep 20 2019 at 02:20):
FHIR doesn't give you a whole lot of choice if you want to be consistent with how most systems represent that information. You could use CarePlan to represent multiple actions for a single Condition - but each would still be a separate action. And most systems would probably represent each in a separate resource.
Jean Duteau (Sep 20 2019 at 03:24):
Essentially, the resource is being treated as FMM4+ which requires implementer consultation when making breaking changes
Again why? It isn't FMM4, it is only FMM3.
Jean Duteau (Sep 20 2019 at 03:25):
Yes, change for the sake of change ... Too bad we didn't have an alias mechanism in FHIR ;-)
This comment is somewhat uncalled for. It definitely isn't change "for the sake of change". We didn't make the change lightly but we made it because the name was leading implementers to think it was something it wasn't.
Lloyd McKenzie (Sep 20 2019 at 03:30):
From a production usage perspective, it meets the criteria.
Jean Duteau (Sep 20 2019 at 03:32):
From a production usage perspective, it meets the criteria.
How so? And how do you and Grahame presume that when the workgroup doesn't agree?
Eric Haas (Sep 20 2019 at 04:48):
It’s a good thing that the community needs to be consulted. It means it’s being widely implemented. And we need to be sensitive to their perception of the name change value. I think we face a similar challenge with DocenentReference. The name is opaque but may be too expensive to change.
John Silva (Sep 20 2019 at 09:13):
@Jean Duteau - I didn't mean it disrespectfully. I'm just pointing out that from an 'outsider's perspective' (i.e. someone not involved with the committee's decision-making process) it seems like just a name change and thinking from the use case of product developers who now have existing code and stored data that needs to be changed with no (necessarily) perceived benefit from a FHIR application or server perspective. (Yes, I know if something is not FMM4 then developers need to assume or expect 'breaking changes' but that doesn't make it any easier.)
@Grahame Grieve - where is the FHIR alias mechanism defined? Is it being used?
Grahame Grieve (Sep 20 2019 at 10:12):
in StructureDefinition, you can assign other names. but we don't do much with the name, and it won't help operationally, only in terms of how the documentation is presented
Nick Radov (Sep 20 2019 at 15:35):
I don't want to use a lot of Medication Resources, just to get the name
There's nothing wrong with using a lot of Medication resources. Each resource is very small.
Peter Jordan (Sep 21 2019 at 22:52):
indeed, the committee was clear about that. But this is a resource that has had a lot of use out in the community, and so I believe it's appropriate to ask the community whether the price of renaming is justified by the better clarity of the new name
One highly-significant use being the International Patient Summary IG. Not to mention the fact that Medication Usage and Medication Administration are synonymous terms to some people.
Jean Duteau (Sep 21 2019 at 23:27):
It’s a good thing that the community needs to be consulted. It means it’s being widely implemented. And we need to be sensitive to their perception of the name change value. I think we face a similar challenge with DocenentReference. The name is opaque but may be too expensive to change.
Okay, except that Pharmacy has already consulted with the Pharmacy implementer community and they agreed on the name change, but I guess we'll wait to see what the bigger community has to say.
Grahame Grieve (Sep 21 2019 at 23:37):
Indeed. Note that I said that I'd ask the committee
Last updated: Apr 12 2022 at 19:14 UTC
