Stream: implementers
Topic: MedicationStatement.status
Rick Geimer (Apr 27 2016 at 16:37):
Quick question about medication status:
http://hl7-fhir.github.io/medicationstatement.html
Is there a reason why "on hold" is not present? Speaking to several clinicians they state that on hold is a valid status (i.e. stop this med temporarily until tomorrow's surgery is completed).
Ewout Kramer (Apr 27 2016 at 17:03):
Hi Rick, I think this is bevause MedicationStatement is not a workflow-type of resource like MedicationOrder or MedicationAdministration (which both have on-hold). The Statement is a statement by for example the Patient that he has been/is using medication. So "on-hold" is pretty meaningless for such a statement. Or as the spec says:
There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise.
Rick Geimer (Apr 27 2016 at 17:04):
But if you look at MedicationStatement as representative of a documented med list, on hold is a valid current status.
Rick Geimer (Apr 27 2016 at 17:05):
A patient could certainly state "I was on this med, but my doctor said to stop it until X date because of Y".
Josh Mandel (Apr 27 2016 at 17:09):
I agree with @Rick Geimer . Seems like a perfectly valid example of statement.
Melva Peters (Apr 27 2016 at 17:14):
Pharmacy WG has been reviewing the statuses of all resources - I would suggest you add a tracker item. There is a way to say that the medication statement is active but that the patient did not take - the exemplar value set is weak at the moment but could be strengthened to add codes such as "admitted to hospital" or "surgery".
Rick Geimer (Apr 27 2016 at 17:23):
I'll add the tracker
Rick Geimer (Apr 27 2016 at 17:24):
Sad that the current binding of MedicationStatement.status is required :(.
Rick Geimer (Apr 27 2016 at 17:43):
http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=9901
Rick Geimer (Apr 27 2016 at 17:43):
Added
Lloyd McKenzie (Apr 27 2016 at 17:43):
You could model it as status of "active" with an extension conveying the "suspended" nuance if you wished.
Rick Geimer (Apr 27 2016 at 17:44):
I agree that's the work around for now, but long term the clinicians I have spoken to say that on-hold is pretty common, and an extension approach seems insufficient.
Lloyd McKenzie (Apr 27 2016 at 17:45):
I think it's a granularity question. How time-specific is a medication statement expected to be?
Lloyd McKenzie (Apr 27 2016 at 17:45):
Will be an interesting discussion within the Pharmacy WG.
Rick Geimer (Apr 27 2016 at 17:46):
Agreed. Maybe a topic for the clinical connectathon to discuss as well.
Rick Geimer (Apr 27 2016 at 17:48):
Note: in C-CDA this is represented as "suspended".
Rick Geimer (Apr 27 2016 at 17:49):
So maybe that's the better term vs. "on-hold".
Ewout Kramer (Apr 27 2016 at 17:53):
Will be an interesting discussion within the Pharmacy WG.
Yes. it be interesting to see whether if you need to communicate that you have suspended taking medication at some time for some reason, you'd also have a use to record when you continued. And what happens if you stop/continue multiple times.
Rick Geimer (Apr 27 2016 at 18:56):
I'm thinking about this from a document perspective (as usual). If I need to create a document bundle that accurately represent the patient's med list today, and the patient currently has a medication that is on hold, how to I encode it?
Rick Geimer (Apr 27 2016 at 18:57):
If I had on hold or suspended as a code in MedicationStatement.status, I would just replace that MedicationStatement when the status changed.
Rick Geimer (Apr 27 2016 at 18:58):
(i.e. a PUT on the resource, versioning it).
Lloyd McKenzie (Apr 28 2016 at 04:41):
Well, one possibility is to mix statements and orders - because "on hold" generally relates to orders. Though I suppose there may be circumstances where it's driven by patient choice.
David Hay (Apr 28 2016 at 04:43):
you could have a medication statement indicating that you usually take aspirin - but it is on hold for an operative procedure...
Lloyd McKenzie (Apr 28 2016 at 04:44):
That probably would have been ordered though.
David Hay (Apr 28 2016 at 04:46):
but if the statement was part of the patients 'usual meds', you need to do something with it...
Grahame Grieve (Apr 28 2016 at 06:15):
this seems extra hard to me - if a medication order can be suspended, how can a statement about what medications a patient is on not include 'I'm on a medication that is suspended'
David Hay (Apr 28 2016 at 07:34):
'cause I usually take aspirin, but my surgeon told me to stop for the week before my operation... I'll take it again once my operation is done.
Richard Kavanagh (Apr 28 2016 at 11:59):
I'm still puzzled why we bake these kind of things into a code within the resource. If we get the list wrong, there are local variances or systems choose to use terminology for this - it just adds complications.
Michelle (Moseman) Miller (Apr 29 2016 at 16:09):
We struggle with MedicationStatement frequently because it can be a mix of derived information (from the MedicationOrder itself) and explicit patient compliance statements (e.g. whether the patient is taking the ordered/OTC med or not).
We based our current mappings on the January WGM meeting discussion with Pharmacy WG where the following table was defined as part of a discussion around http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=8010
MedicationStatement.status + MedicationStatement.wasNotTaken = meaning
Active + T = Not currently taking
Completed + T = Not taken in the past
Intended + T = No intention of taking
Active + F = Taking, but not as prescribed
Active + F = Taking
Intended + F = Will be taking (not started)
Completed + F = Taken in past
In Error + N/A = In Error
As such, for any MedicationStatement derived from an on-hold MedicationOrder, our current logic looks like:
- Active + wasNotTaken = T (if we believe the patient previously took the med before being suspended)
- Intended + wasNotTaken = F (if we believe the patient didn't previously take the med before being suspended)
Richard Townley-O'Neill (Sep 15 2016 at 01:59):
I'm troubled by the value "entered-in-error" in MedicationStatement.status.
The definition of status implies that this is the status of use of the medicine, not the status of the MedicationStatement record.
"A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed."
However the binding suggests this is about the record : A coded concept indicating the current status of a MedicationStatement."
And the values are about the use of the medicine, except for one (entered-in-error), which is about the record.
I think that there are two concepts here that should not be blended. The data element should be renamed from "status" to "useStatus", the value "entered-in-error" should be removed and, if required, a new data element should be added to capture "entered-in-error". It might be boolean or a coded.
Grahame Grieve (Sep 15 2016 at 09:43):
or, more simply, the definition could be amended a little. Is there any point in having both a status and 'entered-in-error'?
Richard Townley-O'Neill (Sep 16 2016 at 01:02):
There are two concepts here. One is the status of the use of the medication and the other is the status of the statement. Putting both two concepts into the one data element is always a bad idea.
How will "entered-in-error" be used?
One case is is to update a resource instance to say that it is a mistake.
Another case is to include in a list of records that were entered, some sort of history.
On the current design this will overwrite the original status of active/intended/completed etc. If it is worth keeping the original record at all it might be worth keeping knowledge of the original status. That suggests that an extra data element is required, if it is worth saying "entered-in-error" at all.
Grahame Grieve (Sep 16 2016 at 23:03):
is it worth keeping? why? I didn't see any actual reason in what you wrote.
Melva Peters (Sep 17 2016 at 16:26):
I suggest that a tracker item be added and assigned to Pharmacy so that a discussion can be held.
Richard Townley-O'Neill (Sep 19 2016 at 06:28):
Now in tracker at http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12011
Last updated: Apr 12 2022 at 19:14 UTC
