Stream: implementers
Topic: Medicine Augmentation
Mithilesh gupta (Nov 08 2017 at 06:47):
(deleted)
Mithilesh gupta (Nov 09 2017 at 10:05):
In Psychiatry often an antidepressant is prescribed with an SSRI like (lithium + SSRI).
And the result of this on the patient is noted in terms of side effect, Body response etc.
we have a similar requirement, Where we want to track the patient's response to a medicine Augmentation.
I cannot find any way of representing this in FHIR.
The medication statement can take only 1 medication and the two medicines we have will surely not go in as ingredients.
Please help me map this.
Jose Costa Teixeira (Nov 09 2017 at 11:49):
I'm not sure whether i understadn correctly, but do you need to make a statemetn about two medicines?
Jose Costa Teixeira (Nov 09 2017 at 11:50):
if so, you can have a medicationStatement with child statements, where the child statements are each medication
Jose Costa Teixeira (Nov 09 2017 at 11:51):
look at partOf
Jose Costa Teixeira (Nov 09 2017 at 11:52):
medicationStatement 1.1 and medicationStatemetn 1.2 can be partOf medicationStatement 1
Lloyd McKenzie (Nov 09 2017 at 12:35):
If you want to order two meds simultaneously and treat them as a single order, you can also use RequestGroup which lets you specify timing, conditionality and other co-occurrence constraints
Mithilesh gupta (Nov 09 2017 at 12:55):
@Jose Costa Teixeira That was exactly what I was looking for. Thanks!
Samm Anderegg (Nov 10 2017 at 20:37):
We're running into a similar issue. For a combination drug (i.e. ledipasvir/sofosbuvir), we're struggling on how do represent the dose. We DO NOT want to get down to the product level (e.g. ledipasvir 90mg/sofosbuvir 400mg oral tablet) within Medication Statement for several reasons. We DO want to maintain the combination structure of the medication, because ledipsavir does not exist alone outside of the ledipasvir/sofosbuvir combination. We're using the RxNorm MIN to represent the code for ledipasvir/sofosbuvir, but when representing the doseQuantity, we can only use 1 value as a decimal. Any suggestions?
Lloyd McKenzie (Nov 11 2017 at 11:39):
The dose would just be "1 tablet". The ingredient strengths are built into the product - and if desired could be exposed using Medication.ingredient
Jose Costa Teixeira (Nov 11 2017 at 11:42):
dose is indeed the amount the patient took, not the composition.
Jose Costa Teixeira (Nov 11 2017 at 11:43):
medication.ingredient provides the possibility to define the content.
Jose Costa Teixeira (Nov 11 2017 at 11:44):
btw, i think "ingredient" is misleading. Should be rather "content" or something, no?
Jose Costa Teixeira (Nov 11 2017 at 11:44):
Ingredient is too specific. We may want to support cases other than the chemical composition of a drug.
Lloyd McKenzie (Nov 11 2017 at 11:45):
Can you provide an example Jose?
Jose Costa Teixeira (Nov 11 2017 at 11:48):
antibiotic cocktails.
Jose Costa Teixeira (Nov 11 2017 at 11:49):
contraceptives that contain different substances in a same box
Jose Costa Teixeira (Nov 11 2017 at 11:51):
infusions (althgouhgh these can actually be called "ingredients" - depending how far we stretch the definition of our term "ingredient" (wink) )
Jose Costa Teixeira (Nov 11 2017 at 11:52):
http://www.mydr.com.au/medicines/cmis/nexium-hp7-combination-pack
Jose Costa Teixeira (Nov 11 2017 at 11:54):
https://www.drugs.com/dosage/ethinyl-estradiol-norgestrel.html
Lloyd McKenzie (Nov 11 2017 at 11:56):
Contraceptive would be Medication.package.content
Lloyd McKenzie (Nov 11 2017 at 11:57):
Infusions would certainly be ingredients as would antibiotic cocktails
Lloyd McKenzie (Nov 11 2017 at 11:57):
If the content, once mixed in is inseparable from a practical perspective, it's an ingredient
Jose Costa Teixeira (Nov 11 2017 at 11:58):
i would think ingredients as more the regulated, authorized ingredient in a manufactured product
Jose Costa Teixeira (Nov 11 2017 at 12:11):
the description of the attribute is broad enough, so we can live with it. Perhaps too much IDMP in my head.
Lloyd McKenzie (Nov 11 2017 at 12:31):
From HL7's perspective, an ingredient injected into a IV bag or mixed as part of a custom compound is no less an ingredient than if introduced by the manufacturer
Jose Costa Teixeira (Nov 11 2017 at 12:35):
that seems to also hold for ingredients to be added (prescribing a cocktail). i just checked and with the new structure, it would also support traceability (lot and numbers)
Brett Esler (Nov 14 2017 at 00:49):
Catching up - with the current CI build I can see Medication.package (STU3) has gone; with batch, amount elements moved assume we should use ingredient element to reference combination pack content - like Nexium HP7? For the content that was in container element (STU3) is that represented at all somewhere in current build at all?
Jose Costa Teixeira (Nov 14 2017 at 06:05):
@Brett Esler the idea is that a medication can contain other medications. whether we are talking a big box containing small boxes, a package containing different drugs, an infusion containing some substances or a tablet containing 2 substances.
Jose Costa Teixeira (Nov 14 2017 at 06:05):
i think this restructuring is a good step forward (i had my questions about calling all those "ingredients" but that is minor).
Jose Costa Teixeira (Nov 14 2017 at 06:07):
Still not perfect IMO but much closer.
Jose Costa Teixeira (Nov 14 2017 at 06:07):
can you see a case where it is not working?
Brett Esler (Nov 14 2017 at 06:20):
Thanks @Jose Costa Teixeira was just coming to some understanding where the package element had gone; I think it makes sense - like you think ingredient and the description seems to suggest Substance more than contained Medications units/packs - a thesaurus anyone? part, constituent, component ?
Jose Costa Teixeira (Nov 14 2017 at 06:43):
Oh, i long for Thesaurus / Glossary discussions :)
Jose Costa Teixeira (Nov 14 2017 at 06:44):
But as long as the concepts are workable, I am ok
Jose Costa Teixeira (Nov 14 2017 at 06:46):
as we go into details, and look at IDMP and other standards and medication concepts, we see that some words are kind of reserved, and some concepts may be unclear, but it's not possible to bring all that into the discussion atm. I hope BRR and Pharmacy will bring it home when they get to details, catalogs, IDMP...
Jose Costa Teixeira (Nov 14 2017 at 14:19):
but @Brett Esler if you want a glossary and if you have LOTS of patience you can look at IDMP (if you have access to it). There have been a good amount of clever people and things like these terms are defined there.
Jose Costa Teixeira (Nov 14 2017 at 14:20):
and you can always look at skmtglossary.org
Last updated: Apr 12 2022 at 19:14 UTC
