Stream: Medication
Topic: Medication link to MedicationKnowledge
Jose Costa Teixeira (Apr 14 2021 at 07:18):
We need to povide a link between a Medication and a MedKnowledge.
Some time ago I brought this up but I couldn't articulate the reason, here it is:
We need to provide more info about a Medication contained in a MedRequest. ATC code, schedule, other attributes. The other instance resources have a link to the Definition, I see no reason why Medication doesn't link to Knowledge.
Especially for contained resources in a presciption, we need to establish a link between them. We could add an extension, but this seems a core thing - to align with other resources, and because I think linking with codes won't work.
Melva Peters (Apr 14 2021 at 14:13):
Jose, if you believe this is a requirement, then enter a Jira issue with the specific use case you have.
Jose Costa Teixeira (Apr 14 2021 at 14:20):
Yes, this is a preliminary discussion to gather information /reactions worth adding to an eventual ticket
Christof Gessner (Apr 14 2021 at 18:07):
I remember a previous discussion where the argument was: The reference is typically intended via Medication.code (to medicationKnowledge.code), a change of Med.code from CodeableConcept to CodeableReference would be needed - which would add complexity but not much functionality.
Jose Costa Teixeira (Apr 14 2021 at 18:25):
the reference via code - how does that work if we have several codings in a product?
Jose Costa Teixeira (Apr 14 2021 at 18:25):
And most important, for the resources to be contained, there has to be a reference between them, I believe
Jose Costa Teixeira (Apr 14 2021 at 18:27):
(thanks @Christof Gessner I vaguely remember those discussions, I think in the IPS context.)
Jose Costa Teixeira (Apr 14 2021 at 18:27):
I don't think the Medication.code should be a codeableReference.
Jose Costa Teixeira (Apr 14 2021 at 18:28):
What I would suggest is to have a "associatedKnowledge" or "definition" or something (in Device we have .definition)
Jose Costa Teixeira (Apr 14 2021 at 18:31):
but I don't know if I'm missing something
Jean Duteau (Apr 14 2021 at 18:38):
As Melva said, please create a Jira issue so that the WG can discuss at an upcoming meeting.
Lloyd McKenzie (Apr 15 2021 at 23:14):
My leaning would be an extension for Medication.code. I think that would reflect the level of usage - and would in theory allow you to satisfy the need for the code with a reference to the definition.
Lloyd McKenzie (Apr 15 2021 at 23:15):
That said, containing the knowledge inside the Medication would be very bad practice unless it was a situation where the knowledge you were conveying was actually maintained with the Medication and not independently.
Jose Costa Teixeira (Apr 16 2021 at 06:29):
The use case is that in a prescription, you need to send out some attributes that specify the medication you want - dose form, route, pack size, substance, some excipient, manufacturer..
Jose Costa Teixeira (Apr 16 2021 at 06:30):
this would apply in the cases where there is no code (or we know that the receiver will not understand the code we send them)
Jose Costa Teixeira (Apr 16 2021 at 06:32):
so this is not a further refinement of the code (since there isn't one code) but a definition of a product
Jean Duteau (Apr 16 2021 at 14:59):
Jose Costa Teixeira said:
The use case is that in a prescription, you need to send out some attributes that specify the medication you want - dose form, route, pack size, substance, some excipient, manufacturer..
Please make a JIRA issue so that the Pharmacy group can discuss this. Note that every one of the attributes you listed can already be handled in the MedRequest or the Medication resource.
Jose Costa Teixeira (Apr 18 2021 at 12:19):
Why not an extension on Medication itself?
Jose Costa Teixeira (Apr 18 2021 at 12:19):
(instead of on Medication.code)
Jose Costa Teixeira (Apr 18 2021 at 12:23):
The attributes I gave are an example, the idea is that there will be more attributes - more codes/identifiers, more classsifications... (of the drug itself, so it would be on the Medication resource or MedicationKnowledge)
Lloyd McKenzie (Apr 18 2021 at 15:31):
Medication.code becomes somewhat redundant if there's a reference to MedicationKnowledge - and you might want to satisfy a constraint requiring that code be present through the inclusion of the reference. That was my rationale. (Plus, nesting extensions within elements makes them safer from getting wiped on updates.)
Heath Frankel (Mar 29 2022 at 08:34):
Jean Duteau said:
Please make a JIRA issue so that the Pharmacy group can discuss this. Note that every one of the attributes you listed can already be handled in the MedRequest or the Medication resource.
@Jean Duteau you say that pack size can be handled in Medication resource, are you referring to the quantity element, which has been renamed to totalValue in Release 5? This really does not reflect the concept of pack size anymore.
Jose Costa Teixeira (Mar 30 2022 at 08:20):
Pack size should be an attribute of Medication and MedKnowledge (both, because it makes sense for either, and those are still different resource types in FHIR).
Jose Costa Teixeira (Mar 30 2022 at 08:23):
@Heath Frankel I agree with your statement, but I don't see the premise (that Jean Duteau says that pack size can be handled in Medication resource) - if that is what totalVolume is about, I find that really confusing and wonder what is the requirement behind this.
Jose Costa Teixeira (Mar 30 2022 at 08:35):
And back to the point, Medication link to MedKnowledge - https://jira.hl7.org/browse/FHIR-20624
Jose Costa Teixeira (Mar 30 2022 at 08:36):
The requirement we have is that when prescribing a medication, we may need to send a more complete description of a product. And since we cannot prescribe a MedKnowledge (?) and those resources are different, the issue appears
Last updated: Apr 12 2022 at 19:14 UTC
