Stream: implementers
Topic: Planned Medication Dispensations
Martin Grundberg (Nov 22 2019 at 11:07):
We are exposing planned medication dispensations to a dispensation machine who then dispense the correct drugs and amount. What would be the best way of providing the planned dispensations to the machine? With planned dispensation I mean e.g. pills to be given to a patient which need to be prepared, based on an medication order.
Some options we have discussed:
Option 1 - List resource
Use the List resource with a code=plannedDispensations. The List would include entries of type MedicationRequest. Ideally we would also do some profiling on the MedicationRequest entries adapting them for the dispensation use case (not sure if you can bind specific profiles of the entry resources to the List.code value?).
Option 2 - Medication Request
Use the MedicationRequest resource directly without a list. We would probably have a profile specifically for adapting the MedicationRequest to the dispensation use case as well.
Maybe there are other better options?
Any recommendations of how to in the best way expose planned dispensations?
Lloyd McKenzie (Nov 22 2019 at 12:02):
I don't understand the purpose of introducing List. Note that List never "includes" other resources - it only references them. If the MedicationRequests are targeted to dispense for a single administration, the MedicationRequest.intent should be "instance-order"
Lloyd McKenzie (Nov 22 2019 at 12:02):
You might want to raise this on #Medication - that's where the drug folks typically hang out :)
Jose Costa Teixeira (Nov 22 2019 at 13:36):
IHE is calling this notion a "dispense request" which is not a prescription. This is in the Supply area. I guess MedRequest could have an extension for simple cases. My leaning would be SupplyRequest, based on what I would personally like FHIR to evolve to.
Martin Grundberg (Nov 22 2019 at 15:01):
@Lloyd McKenzie , didnt know if I could move it, so copied here: https://chat.fhir.org/#narrow/stream/179249-Medication/topic/Planned.20Medication.20Dispensations. Sounds like a better place for the question! :)
Reason for considering List is that it is used for a "Medication List", where the List has a code=medications, and then includes List.entry.item with references to MedicationStatement. I guess this could be achieved by just getting MedicationStatements for a patient directly? So, we thought one option could be to go for another type of list.
@Jose Costa Teixeira, the MedicationRequest has a section for dispenseRequest which to me seems would support this use case. But I havent looked into it in detail yet. And I have never come across the SupplyRequest resource, will absolutely have a look into that! Thx!
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I suggest we end the discussions in thread, and if needed, continue in the new one in the Medcation stream.
Cheers!
Lloyd McKenzie (Nov 22 2019 at 18:43):
@Jose Costa Teixeira The dispense is typically accompanied by administration instructions - which means MedicationRequest is the appropriate resource. It is a mini-prescription and it is created "in fulfillment of" (or in FHIR terms 'basedOn') the original authorization.
Lloyd McKenzie (Nov 22 2019 at 18:45):
Medication List is used to separate out all of the records in the EHR (which may include historic records, data that has come in as part of documents, referrals, etc.) from the "current active medication list" or the "recent medication list". It can be used as a filter, but it doesn't package anything. In your case, I'd probably just post the MedicationRequests.
Jose Costa Teixeira (Nov 22 2019 at 18:56):
@Lloyd McKenzie that is true, depends on the automated dispenser and dispense mode. There is nominal (named) dispense and non-named unit-dose dispense. If the machine is just packing individual doses, without a name or schedule, it is just a supply issue. I understand that for nominal unit-dose dispensers with posology, a medRequest can be an option.
Jose Costa Teixeira (Nov 22 2019 at 18:59):
In other words, is this the equivalent to an OMS or an RDE? There is a grey zone imo
Martin Grundberg (Nov 22 2019 at 19:45):
Medication List is used to separate out all of the records in the EHR (which may include historic records, data that has come in as part of documents, referrals, etc.) from the "current active medication list" or the "recent medication list". It can be used as a filter, but it doesn't package anything. In your case, I'd probably just post the MedicationRequests.
Didn’t really follow what you meant here? If we want to display a patient’s current/active medications, is that not a List of MedicationStatements, but instead a set of MedicationRequests?
Lloyd McKenzie (Nov 22 2019 at 19:59):
It depends - if you're talking about things you're looking at dispensing, then you're talking about "prescriptions". I.e. an authorized medication order. Those are represented using MedicationRequest. MedicationStatement is for a general summary of "what is a patient taking". A patient might have a single MedicationStatement for a drug, even though they've had 30+ prescriptions. And there might be MedicationStatements for drugs that were never prescribed. Dispenses don't happen against MedicationStatements because MedicationStatement is a recording of belief about what a patient is doing, it is not an authorization to supply or to take.
Brian Postlethwaite (Jan 10 2020 at 06:11):
In this MedicationRequest case, which field is populated with the org I'd of the pharmacy dispensing/dispensed the medication (or the specific location of the pharmacy)
Last updated: Apr 12 2022 at 19:14 UTC
