SNOMED on FHIR

Space shortcuts

Page tree

Versions Compared

Old Version 4

changes.mady.by.user Peter G. Williams

Saved on

compared with

New Version Current

changes.mady.by.user Peter G. Williams

Saved on

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

The Medication domain includes a number of related resources

MedicationRequestAn order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispenseProvision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministrationWhen a patient actually consumes a medicine, or it is otherwise administered to them
MedicationStatementThis is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician, or derived from supporting information (for example, Claim, Observation or MedicationRequest). A medication statement is not a part of the prescribe->dispense->administer sequence, but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication.

Taken from http://build.fhir.org/medicationstatement.html

Child Pages

Children Display



ElementCurrentDiscussion
Code

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 products and the more abstract substances and say that only products can be administered?

Jim Case noted that vaccine substances are going to be retired (they also exist as products).

Possible use case for using substances for TPN (total parenteral nutrition). Also for post coordinated expression used in "code", however this could still be a type of product if used as an ingredient.

Can we simplify this then and cover all use cases 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.

< 736542009 |Pharmaceutical dose form (dose form)| is a preferable binding.

Options for dealing with conflict (from another resource)

See SNOMED on FHIR Meeting (20171017).pptx :

1.Restrict bodySite to [0..0] and require finding site in code
2.BodySite can only be populated if code has no finding site
3.BodySite (if exists) must be a specialization of finding site
4.BodySite must always be a specialization or self of finding site
5.Only allow conditions with no finding sites and include bodySite
6.Any condition and any bodySite

Ingredient.item.itemCodeableConcept

<< < 105590001 |Substance (substance)|

JR noted that this field could also allow recursive composition with further Medication resources eg for a combination pack. Is this link still valid?

amount
It is not clear what this element refers to - the pack, the amount


Other supporting elements

ElementCurrentDiscussion
Dosage.AdministrationSiteAnatomical StructureThis precludes acquired structures, so a more general 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.

MedicationAdministration

Refusal reason is a wrong binding.   Those codes in SNOMED relate to the actual medication that was refused.   Perhaps better option 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.