Stream: implementers
Topic: MedicationStatement - use of reasonNotTaken
Pramod Dematagoda (Mar 27 2017 at 00:16):
We have a scenario where a medication that is prescribed to a patient could be stopped because:
1) The patient has an allergic reason to it
2) The patient improved before the medication was finished
Would it be possible to represent this information under MedicationStatement.reasonNotTaken given that in both the scenarios mentioned above the patient could have actually been taking the medication?
Lloyd McKenzie (Mar 27 2017 at 05:02):
reasonNotTaken is not the same as reasonStopped. For now, that would be an extension, though you could try making the case for it to be added to core. In either case, submitting a change request would be a good idea.
Grahame Grieve (Mar 27 2017 at 05:14):
that's not obvious to me. "I don't take this medication because it gives me hives" - hard to imagine that as anything by a 'reasonNotTaken'. @Melva Peters @Scott Robertson @John Hatem may have opinions
Pramod Dematagoda (Mar 27 2017 at 23:22):
Ideally we would use the reasonNotTaken field, but the only concern with doing this is that the FHIR spec seems to imply that setting MedicationStatement.notTaken to true (DSTU2), which must be done in order to use reasonNotTaken, means that the patient had never taken the medication in the past which is not necessarily the case.
Eric Haas (Mar 28 2017 at 00:50):
MedicationStatement.status is used and has a stopped status. notTaken is different - you didn't take the meds at all. It would be reasonable to supply a reason why the meds were stopped ( e.g., got better ) in the note element or make or an extension.
Michelle (Moseman) Miller (Mar 28 2017 at 17:11):
I agree that MedicationStatement,reasonNotTaken shouldn't be used. It has an invariant that says it is only applicable when MedicationStatement.taken=no -- meaning the med was not taken.
In DSTU2, we (Cerner) had implemented a stopped reason using the MedicationOrder.reasonEnded (with MedicationStatement referencing the MedicationOrder).
However, in STU3, the MedicationRequest.reasonEnded was replaced by the "eventHistory" structure, which was originally going to be a backbone element with status, action, date/time, practitioner, and reason, but then "eventHistory" morphed into the reference to Provenance. Personally, I would have preferred it to be inline in the resource instead of relying on Provenance.
Last updated: Apr 12 2022 at 19:14 UTC
