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The Medication domain includes a number of related resources
MedicationRequest | An order for both supply of the medication and t= he instructions for administration of the medicine to a patient. |
MedicationDispense= td> | Provision of a supply of a medication with the i= ntention that it is subsequently consumed by a patient (usually in response= to a prescription). |
MedicationAdminist= ration | When a patient actually consumes a medicine, or = it is otherwise administered to them |
MedicationStatement | This is a record of a medication being taken by = a patient or that a medication has been given to a patient, where the recor= d is the result of a report from the patient or another clinician, or deriv= ed from supporting information (for example, Claim, Observation or Medicati= onRequest). A medication statement is not a part of the prescribe->dispe= nse->administer sequence, but is a report that such a sequence (or at le= ast a part of it) did take place, resulting in a belief that the patient ha= s received a particular medication. |
Element | Current | Discussion |
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Code |
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Vaccines may not be covered (see immunization= resource, in which case immunization substances could be removed from the = medication codes valueset). Should we draw the distinction between pr= oducts and the more abstract substances and say that only products can be a= dministered? Jim Case noted that vaccine substances are going to be r= etired (they also exist as products). Possible use case for using sub= stances for TPN (total parenteral nutrition). Also for post coordinated exp= ression used in "code", however this could still be a type of product if us= ed as an ingredient. Can we simplify this then and cover all use case= s with a binding of: < 763158003 |Medicinal product (product)| = |
Form |
|
421967003 |Drug dose form (qualifier value)| = is no longer a sensible binding. It only has 15 descendants. < 736= 542009 |Pharmaceutical dose form (dose form)| is a preferable binding. <= p>Options for dealing with conflict (from another resource)=See S= NOMED on FHIR Meeting (20171017).pptx : 1.Restrict bodyS=
ite to [0..0] and require finding site in code |
Ingredient.item.itemCodeableConcept | < 105590001 |Substance (substance)| = JR noted that this field could also allow recursive composition with furthe= r Medication resources eg for a combination pack. Is this link still valid?= |
|
amount | It is not clear what this element refers to - th= e pack, the amount |
Other supporting elements
Element | Current | Discussion |
---|---|---|
Dosage.AdministrationSite | Anatomical Structure | This precludes acquired structures, so a more ge= neral binding of << 442083009 |Anatomical or acquired body structure = (body structure)| might be more helpful. |
Note: Interesting situation with anesthesia where = the quantity might be - for example - a rate of flow of medication and the = denominator would be time.
Refusal reason is a wrong binding. Those codes in SNOMED rel= ate to the actual medication that was refused. Perhaps better o= ption to use << 182895007 |Drug declined by patient (situation)|=
Note that 242990004 |Drug not available for administration (event)|= is another item in that valueset, but it is concerning that we're picking = from different sub-hierarchies here.