Stream: implementers
Topic: MedicationRequest.doNotPerform
Munish Jokhani (May 13 2021 at 15:24):
Hi , We are reviewing Medication Request resource for the UK FHIR Core. We are concerned that MedicationRequest.doNotPerform overlaps with MedicationRequest.status when status values are stopped or cancelled. Is there a specific use case for MedicationRequest.doNotPerform which is not covered by the status field? Thx
Jean Duteau (May 13 2021 at 15:43):
doNotPerform is used for systems that explicitly create records to either indicate that a patient should not take a specific medication or that they are instructing the patient to stop taking a medication.
the statuses of stopped or cancelled are used by systems that don't necessarily send specific requests for that but rather just change the status of the original request.
Munish Jokhani (May 14 2021 at 09:51):
Do you mean they persist/store the FHIR messages in the database when you say they "create records"? But for general FHIR messaging where systems have their own persistence layer, then status flag is enough?
Lloyd McKenzie (May 14 2021 at 14:05):
There are two different actions
- an order that said "please take this medication", which was subsequently updated to say "stop"
- an order that says "do not take this medication"
In the first case, you're revoking an authorization by changing the status on the order. In the second case, you're issuing a 'negative' order.
Munish Jokhani (May 18 2021 at 12:09):
@Lloyd McKenzie I understand the first use case that you can subsequently change your mind . I am not sure about the second use case, why issue an order when you don't want the patient to take the medication? Thx
Arianne van de Wetering (May 18 2021 at 12:22):
Munish Jokhani said:
Lloyd McKenzie I understand the first use case that you can subsequently change your mind . I am not sure about the second use case, why issue an order when you don't want the patient to take the medication? Thx
I suppose there could be an example when patients are using over the counter medication and you need them to stop (there never was an original MedicationRequest to update in that case, however there may be a MedicationUse statement). You could then issue a MedicationRequest (without a dispenseRequest of course) to say that you - as a professional - really don't want them to continue using this.
It is important to relate the MedicationUse with the MedicationRequest for which we have introduced a so called 'medication treatment' identification in The Netherlands. We add that identification to the MedicationRequest/MedicationDispense/MedicationUse instances (yes, we use an extension for that) to be able to relate them together, which really helps reconciliation in a landscape with distributed healthcare providers / systems all making decisions about the same medication treatment.
Lloyd McKenzie (May 18 2021 at 15:48):
You could also put an order in a patient's chart saying "No ACE Inhibitors" or something like that if there's a known issue and there's a concern that someone else might order one because it's part of protocol. It's similar to other "do not perform" orders. E.g. "Do not roll patient".
Vassil Peytchev (May 18 2021 at 19:03):
You could also put an order in a patient's chart saying "No ACE Inhibitors" or something like that if there's a known issue and there's a concern that someone else might order one because it's part of protocol.
Wouldn't Flag be more appropriate here? I am not sure that MedReq with doNotPerform will necessarily affect the ordering of the doNotPerform medication...
Lloyd McKenzie (May 18 2021 at 20:59):
Flag is the yellow sticky on the front of the folder. You still need the proper 'order'.
Jose Costa Teixeira (May 22 2021 at 11:39):
Negative orders are common. And they are still orders - they can be actioned or not, validated, updated, etc.
Lloyd McKenzie (May 22 2021 at 12:25):
Actioning a negative order is tough. "I did not provide this drug right now" is a statement you could make at any time, but it's not terribly useful to do so. (An order to not take a drug is distinct from a request to 'stop' an existing order.)
Last updated: Apr 12 2022 at 19:14 UTC
