Stream: Medication
Topic: MedicationRequest.Medication
Ernesto Quevedo Caballero (Feb 13 2020 at 16:17):
Are you considering to add MedicationKnowledge as a possible type of reference in the MedicationRequest.Medication for the next versions?
Jean Duteau (Feb 13 2020 at 16:49):
No. MedicationKnowledge's scope is completely different from Medication and the MedRequest/Dispense/Statement/Administration resources just need a means to identify the medication (which is Medication's scope). There is no need to link to MedKnowledge.
Morten Ernebjerg (Dec 08 2021 at 11:34):
I was looking at how to represent (in R4) the statement that a patient is not taking a specific medication. For both MedicationStatment (R4) and MedicationUsage (R5), the spec includes an example with the title "Patient reports they are not taking Tylenol PM" (R4 example, lates build R5 example) which would match that. However, in both these examples it seems very hard to tell that it is about medications not being taken (at least for machines that cannot read the text in note).
For the R4 example, the status is set to "active" and statusReason gives the SNOMED code for "Liver enzymes abnormal"; note contains "Patient cannot take acetaminophen as per Dr instructions". But the status "active" is defined as meaning "The medication is still being taken" which contradicts the title & note. So I would have expected status = "not-taken" (not a perfect match since it sounds like it suggests that patients should/could have taken the medication, but seems the closest).
For the R5 example, the status is "recorded", the reason the same as the statusReason in the R4 version, and the note identical. The status seems appropriate, but reason is defined as "[a] concept, Condition or observation that supports why the medication is being/was taken", which, as it stands, seems to rule out that it can be a reason for smt. not being taken. Even if reasons for not-taking are allowed, a given reason does not necessarily imply "taking" or "not taking" - e.g. elevated blood pressure is a reason to take a blood-pressure lowering drug, but may be a reason not to take other drugs that e.g. could push it even higher.
Based on that, I'm unsure how to proceed in R4. I'd like some representation that makes it easy for a system to automatically recognize that a medication is not being taken, but the examples make me wonder whether that easily doable.
Lloyd McKenzie (Dec 08 2021 at 14:24):
@Melva Peters @Jean Duteau
Jean Duteau (Dec 08 2021 at 17:03):
hmm, you are quite correct that the example is wrong in both R4 and R5. Can you create a JIRA issue for us to fix them?
In R4: the status should be 'not-taken'
In R5: we introduced the 'adherence' backbone element that would allow you to put 'not-taking' in the adherence.code (it's an example code so if you had better codes you could use those) and then put the reason why the patient is not taking (if needed) in adherence.reason.
Morten Ernebjerg (Dec 09 2021 at 06:47):
@Jean Duteau Thanks for the guidance, that should work for me - will open a JIRA ticket.
Out of curiosity: For conditions, the spec guidance is not to use Condition to capture the fact that a patient does not have condition Y (unless it was previously believed to be the case) and instead use Questionnaire or Observation. Have similar approaches been considered or used for "not taking X"?
Morten Ernebjerg (Dec 09 2021 at 06:58):
JIRA #FHIR-34437
gauri raut (Dec 20 2021 at 05:34):
Hi,
I am working on HL7 v2 to FHIR mapping for RDE^O11. As per multiple discussions on Zulip, we have mapped RXC segment to ingredients of Medication received in RXO/RXE segment. I am unsure about how data will be received in v2. Can someone please confirm if it is clinically possible to have different components of the same Medication? Or there would be unique Medication Code in RXO/RXE for every combination of RXCs. For example,
Message 1:
RXO|123^TestMed^SNOMED|TAB|5|mg|125|ml|
RXC|A|abc^Comp1^SNOMED|||
RXC|B|xyz^Comp2^SNOMED|||
Message 2:
RXO|123^TestMed^SNOMED|TAB|5|mg|125|ml|
RXC|A|pqr^Comp1^SNOMED|||
RXC|B|xyz^Comp2^SNOMED|||
Lloyd McKenzie (Dec 20 2021 at 15:23):
@Hans Buitendijk
Last updated: Apr 12 2022 at 19:14 UTC
