Stream: implementers
Topic: MedicationRequest Category
Gayanjith Premalal (Jan 31 2019 at 21:56):
It seems to be there are 4 categories of medication requests, and they are inpatient, outpatient, community and discharge. When looking at the definitions, it makes sense. But when it comes to the real needs, do we really have to have this differentiation of 4 categories? Isn't it enough know whether the medication was administered (or to be administered) in a hospital setting or in an 'outside hospital' setting? In that case what would be a logical way to maintain a mapping?
At least it sounds like the following:
Inpatient and Outpatient = In a hospital setting
Community and Discharge = Outside a hospital setting
One example for this would be that the hospital has the complete responsibility of the medications which are to be administered in a hospital setting and the patient (or the guardian) has the responsibility for the medication which are to be administered at home or outside the hospital.
Grahame Grieve (Jan 31 2019 at 21:58):
note that list of 4 codes is just an example of how you might use MedicationRequest.category.
Grahame Grieve (Jan 31 2019 at 21:58):
the expectation is that you'd use whatever categories supported your workflow
John Silva (Jan 31 2019 at 22:18):
Yes, we had a use case that needed to use this category for other purposes but in STU3 this had a cardinality of 1 (if I remember right); at least in R4 we can use multiple categorizations for a med.
Gayanjith Premalal (Feb 01 2019 at 13:23):
But when populating FHIR resources, to make it interoperable, shouldn't we use some kind of a standard value set?
John Silva (Feb 01 2019 at 13:56):
@Gayanjith Premalal -- I'll not try to answer that but here's a different use case for MedicationRequest.category. If I have a clinical app that wants to organize MedReqs by pharmaceutical category then I could use the category property for this purpose maybe using a local (hospital specific) definition of this categorization or some standard's based pharmaceutical categorization. [The FHIR and Pharm experts here might suggest that this belongs in some other resource though, e.g. MedicationKnowledge, but if a system doesn't implement the MedKnowlegde resource ...]
https://www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162549.htm (US FDA's Pharmacologic Class)
https://www.drugs.com/drug-classes.html?tree=1
Lloyd McKenzie (Feb 01 2019 at 15:44):
The question is always "where can we get international consensus?". If we could be confident of getting agreement on a single set of categories across all types of pharmacy systems throughout the world, we'd definitely strive for that. If you think we can achieve more than the standard has thus far, feel free to submit a change request, but be aware that whatever value set we define must be useable (or at least mapable) everywhere.
John Silva (Feb 01 2019 at 18:40):
@Lloyd McKenzie As the Pham folks have stated elsewhere in Zulip, it is very unlikely to get an international standard on medications and categories for them because of country laws and regulations. (probably @Melva Peters or @Jose Costa Teixeira can answer this better). However, that's not to say that individual use cases can't use the MedRequest.category for their own purposes, (it seems FHIR allows this since the CodeableConcept is only an Example not a required one). So, by the same logic the CodeableConcept for "pharmaceutical categories" could be listed as an Example thereby not containing any implementation to use a specific coding here and any specific domain could constrain it to use a category defined in their realm (e.g. SPL in US Core).
Gayanjith Premalal (Feb 07 2019 at 09:21):
But if we use our own values to define the MedicationRequest.Category, then we will be creating an adverse impact on the interoperability (which is the main purpose for us to expose FHIR resources). In that case, "category" seems to be an attribute which is very vaguely defined, therefore might not be very usable in inter-system communication. For an example in our EHR we might use it to define whether the medication administration should happen in a hospital setting or not and may be in some other EHR, it will be used to define the exact hospital setting that the medication administration should take place (ex: outpatient clinic or in the surgery ward).
Jose Costa Teixeira (Feb 07 2019 at 12:55):
in some other EHR, it will be used to define the exact hospital setting that the medication administration should take place (ex: outpatient clinic or in the surgery ward).
if you mean "this should be performed at outpatient clinic X", then "category" is not what you are looking for.
If you mean "this should be performed at an authorized outpatient clinic" then it is the same problem as "whether it should happen in a hospital or not" but with different values
Danielle Friend (Feb 22 2019 at 16:47):
The medicationRequest (and medicationStatement) category elements has an un-resolvable URL for the system:
Page where this occurs: http://hl7.org/fhir/STU3/valueset-medication-request-category.html
" All codes from system http://hl7.org/fhir/medication-request-category "
If I hit that URL it doesnt exist (because the category element changed in R4)
If I click the link in the spec, it actually takes me here: http://hl7.org/fhir/STU3/codesystem-medication-request-category.html
So my question for the group is - in returning the medicationRequest.category.system element should the system read "http://hl7.org/fhir/medication-request-category" or "http://hl7.org/fhir/STU3/codesystem-medication-request-category.html"
Ken Sinn (Feb 22 2019 at 20:53):
My understanding is that the system URL would be "http://hl7.org/fhir/medication-request-category", with CodeableConcept.coding.version="3.0". Even though the URL doesn't resolve, it's still used as an identifier for that Code System.
In R4, the CodeSystem is defined by system URL = "http://terminology.hl7.org/CodeSystem/medicationrequest-category", but the html page is located at http://hl7.org/fhir/codesystem-medicationrequest-category.html. the system url does not always resolve.
Lloyd McKenzie (Feb 22 2019 at 21:07):
You'd only need to specify the version if the meaning of codes changed between version, which I don't think is the case here. We'll be updating things so that the system will resolve "soon" (next 6 months or so?)
Danielle Friend (Feb 22 2019 at 21:39):
That makes sense - thank you both!
Last updated: Apr 12 2022 at 19:14 UTC
