Stream: implementers
Topic: MedicationRequest.category question
Floyd Eisenberg (Jan 21 2020 at 19:09):
FHIR R4 MedicationRequest.category contains two concepts - community and discharge. CQI believes that discharge was added for their use case - I.e., for medications ordered for the patient to take at home after discharge. However, previously, Pharmacy committee suggested that we use "community" since the orders is written for the patient to take at home. We need clarification.
Jose Costa Teixeira (Jan 21 2020 at 19:18):
this is an example binding so I guess/hope it says "there is no strict guidance on these codes and their meaning and implications".
Jose Costa Teixeira (Jan 21 2020 at 19:22):
If the use case is a hospital system, this case is obviously a "discharge", there's no need to project the remainder of the workflow (where this may be happening) into the request. But depends on the use. In some implementations you may simply have inpatient/community.
Jose Costa Teixeira (Jan 21 2020 at 19:23):
Is there a need to make any stronger guidance here?
Floyd Eisenberg (Jan 21 2020 at 19:27):
The issue is that the definition of "community" seems to encompass the "written to be taken at home ---- as in after discharge" and it is broader because it is also covering medications written to take at home from the ambulatory setting. Discharge is for meds to be taken at home but more restricted to the discharge setting. The challenge is that in writing electronic clinical quality measures, we feel there is some overlap and we want to be sure the implementers are clear.
Jose Costa Teixeira (Jan 21 2020 at 19:54):
Discharge Prescriptions does overlap with "Prescriptions dispensed in a community pharmacy", I think.
This overlap is not a bad thing, is it?
Melva Peters (Jan 21 2020 at 20:15):
There is definitely an overlap between discharge and community. The attribute can be used for any kind of grouping - pharmacy included the exemplar value set for "where the medication is expected to be consumed or administered" . Originally, we had inpatient, outpatient and community, but have since added discharge. I really think that this attribute needs to be reviewed and the value set updated to make it less confusing. If we're trying to represent (in the example) where the medication is to be consumed - then I think it should be inpatient, outpatient and community only as values. Discharge is confusing. I'm going to add a JIRA issue. @Floyd Eisenberg you can add your comments about your use case to that issue once it is created. We can only have 1 exemplar value set, but we could provide other examples of how this could be used in the attribute it self.
Floyd Eisenberg (Jan 21 2020 at 20:19):
Thanks Melva. I think discharge may have "sneaked in" because of CQI's comments but I definitely think community covers the use case without discharge.
Jose Costa Teixeira (Jan 21 2020 at 20:20):
FWIW, I think overlap is not a bad thing. We have hierarchical codes everywhere. But agree with clarification of the examples we give in implementation.
Melva Peters (Jan 21 2020 at 20:23):
Here's the JIRA issue: FHIR-25555 - https://jira.hl7.org/browse/FHIR-25555
Last updated: Apr 12 2022 at 19:14 UTC
