Stream: argonaut
Topic: No known meds
Josh Mandel (Feb 26 2020 at 21:53):
I see http://hl7.org/fhir/us/core/StructureDefinition-us-core-allergyintolerance.html#mandatory-and-must-support-data-elements includes an explanation of how to say "no known allergies".
But I don't see similar guidance about "no known meds". Am I just looking in the wrong spots or are we silent on this?
Brett Marquard (Feb 27 2020 at 17:00):
Good question, I don't remember developing, or getting request, to explicitly assert 'no known medications'
David Hay (Feb 27 2020 at 22:52):
Sounds like something useful to have. FWIW the IPS do have guidance (https://build.fhir.org/ig/HL7/fhir-ips/design.html#representing-known-absent-and-not-known) - in fact that is how the question came about!
David Hay (Feb 27 2020 at 22:53):
As I read/understand it, it means that there is a resource with a code of 'no known...' - specifically not the section.emptyReason...
Josh Mandel (Feb 27 2020 at 22:54):
I think I agree with your reading, but it's kind of implicit. An example would help.
Richard Townley-O'Neill (Feb 27 2020 at 23:41):
FWIW
In Australian Base IG no known meds is managed by the observation AU Assertion of No Relevant Finding Profile with Observation.value of "No known current medicines". See example http://build.fhir.org/ig/hl7au/au-fhir-base/Observation-norelevantfinding-example3.html.
The ValueSet is defined using the SNOMED CT-AU refset Assertion of Absence
Rob Hausam (Feb 28 2020 at 04:37):
In IPS we decided to go with an explicit statement of absence as being likely the least ambiguous and potentially most widely interoperable representation. It would be nice to be able to back that up with a solid base of evidence (rather than primarily anecdotes and opinions), but I'm not aware of sufficient data for that being available. So far in IPS we seem to have gotten a reasonable degree of acceptance of this approach.
Josh Mandel (Mar 02 2020 at 20:12):
So to say "no meds", Australia uses an Observation; IPS uses a MedicationRequest; US Core doesn't.
Eric Haas (Mar 02 2020 at 20:19):
I'm not sure what the "No known meds" context is .. to allergies or med lists? And to reiterate Brett's point we did not get an implementer request to address it - why exactly has it been raised here?
Jenni Syed (Mar 02 2020 at 20:21):
We actually do have specific guidance for NKA - http://hl7.org/fhir/us/core/StructureDefinition-us-core-allergyintolerance.html
Jenni Syed (Mar 02 2020 at 20:22):
In our system, we do explicitly record knowledge of no known allergies/no known med allergies/etc as part of regulatory certification
Jenni Syed (Mar 02 2020 at 20:23):
I'm not aware of similar requirements for meds, but I can dig a bit. It's possible it's more on the "compliance and meds rec" workflow, which wasn't something that was exposed via API/compliance wasn't something that was really tracked in med statement (it's getting closer as of R5 with some new fields). And meds rec itself is likely something that would require List resources as they're "snapshot in time" things
Eric Haas (Mar 02 2020 at 20:24):
so the context is allergies... We address NKA specifically and are silent on NKM. specifically
Josh Mandel (Mar 02 2020 at 20:27):
Right, this conversation started with "US Core provides an approach to no known allergies, but not an approach to no known meds".
Jenni Syed (Mar 02 2020 at 20:28):
@Josh Mandel I'm guessing that's due to the regulatory context of "the API" and what came over from Argonaut/recognition of how some systems handled "no known"
Jenni Syed (Mar 02 2020 at 20:29):
there was also a very large "negation" discussion for all the PC resources :) That may also have had some influence. Not sure if we had similar discussion for pharmacy
Jenni Syed (Mar 03 2020 at 18:48):
I confirmed internally that, unlike NKA and NKMA, the no known meds is more an encounter-specific thing that is often part of the compliance and history workflows
Jenni Syed (Mar 03 2020 at 18:50):
at least for us :)
Rob Hausam (Mar 03 2020 at 19:00):
The two situations of allergies and meds really are somewhat different. It's pretty easy to imagine that someone has an allergy that they aren't aware of or that they maybe don't remember to disclose, but it's quite a bit harder to imagine that someone doesn't know or can't recall whether they are regularly taking one or more medications (versus none). The exception to that, of course, is with significant cognitive impairment, but in that case normally someone else will be managing the medications and will be providing the information.
Josh Mandel (Mar 03 2020 at 19:12):
That's fair, but in both cases there's an important distinction between "I didn't ask" and "I asked and got an answer of none."
Jenni Syed (Mar 03 2020 at 19:40):
meds tend to change much more fluidly than allergies as well
Jenni Syed (Mar 03 2020 at 19:41):
we even know when some will "end" that were previously reported
Jenni Syed (Mar 03 2020 at 19:42):
@Josh Mandel agree that those are distinct, but the workflow is a bit different and how long that answer is "good" for seems more tenuous ?
Rob Hausam (Mar 03 2020 at 19:44):
@Josh Mandel Yes, I agree that distinction is important. And IPS does use MedicationStatement (not MedicationRequest) for explicit statements of "No information about medications" and "No known medications" (in Absent or Unknown Medication value set).
Jenni Syed (Mar 03 2020 at 19:44):
still important to do that (in the US) for meds rec/review workflows
Rob Hausam (Mar 03 2020 at 19:45):
and I agree with @Jenni Syed's points
Keith Boone (Mar 05 2020 at 17:38):
@Rob Hausam For meds prescribed on an "As needed basis", it's quite possible that a patient might say "Not taking any meds (right now)". Recently my wife was asked about a medication on her list, and she indicated she's not taking it. And she's not. But in a few weeks when allergy season starts, she might very well start taking it again. Some meds prescribed for use under particular circumstances are only needed at particular times, and so, since the patient isn't taking them "right now", can be readily be missed.
Rob Hausam (Mar 05 2020 at 19:38):
@Keith Boone "Not taking" or "have not taken" is different from "no known", but I agree it is common and needed.
Keith Boone (Mar 05 2020 at 22:57):
Consider how this would be implemented on a portal? Portal: Are you taking any meds? Patient: No. Portal: Records as "No Known".
That's the difference between a standard and an implementation, which we have to consider in the standard. I agree, the semantics are distinct, but implementation nuances will take away the opportunity to make some of those fine-grained distinctions that we can pontificate upon as standards developers.
Last updated: Apr 12 2022 at 19:14 UTC
