FHIR IG Statistics: StructureDefinition/profile-medication-patientChart

Resources that use this resource

Resources that this resource uses

Narrative

No narrative content found in resource

Source

{
  "resourceType": "StructureDefinition",
  "id": "profile-medication-patientChart",
  "meta": {
    "versionId": "5",
    "lastUpdated": "2022-08-26T15:27:46.467812+00:00"
  },
  "url": "http://telus.com/fhir/patientChart/StructureDefinition/medication",
  "name": "Medication",
  "status": "draft",
  "date": "2021-03-22T16:04:55.1965892+00:00",
  "description": "This is scoped for usage within the Patient Chart",
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "script10.6",
      "uri": "http://ncpdp.org/SCRIPT10_6",
      "name": "Mapping to NCPDP SCRIPT 10.6"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Medication",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Medication",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Medication",
        "path": "Medication",
        "comment": "Review complete - June 18",
        "mustSupport": true
      },
      {
        "id": "Medication.meta",
        "path": "Medication.meta",
        "mustSupport": true
      },
      {
        "id": "Medication.meta.lastUpdated",
        "path": "Medication.meta.lastUpdated",
        "mustSupport": true
      },
      {
        "id": "Medication.meta.source",
        "path": "Medication.meta.source",
        "mustSupport": true
      },
      {
        "id": "Medication.meta.profile",
        "path": "Medication.meta.profile",
        "mustSupport": true
      },
      {
        "id": "Medication.meta.security",
        "path": "Medication.meta.security",
        "mustSupport": true
      },
      {
        "id": "Medication.meta.security.system",
        "path": "Medication.meta.security.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.meta.security.code",
        "path": "Medication.meta.security.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.text",
        "path": "Medication.text",
        "comment": "??? May need to support for partner solutiion, eg mapping into a CDA document.   For eServices, there wil always be an accompanying PDF and therefore this is not required.\r\n\r\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.code",
        "path": "Medication.code",
        "comment": "Conformance Rule:  Supported Code systems that are acceptable in the message are: \r\n    CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset \r\n    DIN -  http://hl7.org/fhir/NamingSystem/ca-hc-din\r\n    NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn\r\n\r\n\r\nConformance Rule:    If a medication is recorded using a local code system, such as a HICL or GCN/FDB, this must be converted where possible to a CCDD, DIN or NPN.   If conversion is not possible (eg if a DIN no longer exists), the local code may be sent with text.    Example:  Local code systems can be used, such as  http://terminology.hl7.org/CodeSystem/FDDC - First DataBank Drug Codes along with a textual description. \r\n\r\nConformance Rule:   Compounds will be conveyed as text only.  Where possible, an ingredient list shoudl be included.  Example:   HC1% Canesten Cream\r\n\r\nConformance Rule:  either text or code must be present\r\n\r\n\r\nBackground Discussion:   DW - currently supports \"generic ingredient\", eg amoxicilin even for brand names.  MA - populates ATC and AHFS class (categorization) and sent out as part of DW extract\r\n\r\n???  there are multiple codings OR it may be more appropriate to support this via extension.    The receiving system should be able to consult a drug database to obtain further details, rather than providing this level coding to them.\r\n\r\nLocal codes (eg FDB, Viglliance) will be converted to CCDD. - existing functionality supported \r\nText is used for compounds, new/trial medications that do not have a CCDD code, non-medicinal products, eg test strips, \r\n\r\nMappings:\r\nMA: DIN or text plus local code, eg FBD?\r\nPSS:   DINs and Representative DINs. Unlikely that we send CCDD as it was done for PrescribeIT which doesn't use the API\r\nMS: N/A in UI but DIN is available in DB - does not support CCDD, Vigillance DB.     \r\nEMRAPI: code\r\nCore-CA:  supported,  https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct - same as PrescribeIT\r\nPrescribeIT:    https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct\r\nDHDR:   Have sliced this by DIN, Generic, DrugClass, DrugSubClass\r\n\r\n??? Confirm we  do NOT NEED TO SUPPORT REPRESENTATIVE DIN?  If there is a prescription (active or future), the prescription may not be DIN based but CCDD should cover it.\r\n\r\n\r\nPrescribeIT Conformance Rule: This element is used to represent the medication ordered or dispensed. A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when presribing. For compounds, a code is not used and the description will be sent as 'text'. A DIN, representative DIN or an NPN may also be used if a CCDD code is not available. This has an extensible binding meaning that the CCDD code system should be used but if a code is not available, vendors may also submit a code from the DIN or NPN code system. (Eventually CCDD will encompass all DINs and NPNs.)\r\n\r\nCode systems that are acceptable in the message are: CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn\r\n\r\nEMRs and PMSs must support sending and receiving all levels of drug terminology defined in the Canadian Clinical Drug Data (CCDD) Set including: Therapeutic Moiety (TM), Non-proprietary Therapeutic Product (NTP), Manufactured Product (MP) as well as Device NTP for devices. In cases where an appropriate Canadian Clinical Drug Data Set value is not yet available within the point-of-service system, the system can send a DIN or Natural Product Number (NPN) or a DIN with the (isRepresentative) value set to 'true'.\r\n\r\nIf no drug code (TM, NTP, MP, or DIN) is available in the point of service system, only then should the system send the drug name as text without a code. The pharmacy system must always display the textual name of the medication or non-medication provided in the message to the user when displaying the prescription. This represents the name of the medication or non-medication (e.g. device) as seen by the prescriber at the time of prescribing.\r\n\r\nDHDR - 4 slices - DIN/PIN (1..1), generic(0..1), class (0..1) and sub-class (0..1) - all support system, code, display\r\n\r\n\r\nDepending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true.  As described in the coding datatype: \"A coding may be marked as a \"userSelected\" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one).",
        "min": 1,
        "mustSupport": true,
        "binding": {
          "strength": "preferred",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
        }
      },
      {
        "id": "Medication.code.coding",
        "path": "Medication.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            }
          ],
          "rules": "open"
        },
        "comment": "Core-CA:  supported 0..1\r\n\r\nConformance Rule:  must be included in the message when known\r\n\r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding.system",
        "path": "Medication.code.coding.system",
        "comment": "Core-CA:  supported\r\n\r\nThe URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding.code",
        "path": "Medication.code.coding.code",
        "comment": "Core-CA:  supported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding.display",
        "path": "Medication.code.coding.display",
        "comment": "Usage Rule:   If text and display are identical, the display does not need to be sent.\r\nUsage Note:   This must be present for local code systems such as HICL.   \r\nUsage Rule:  This may be used to convey the name associated with the code and is important in the case where the display name is english, and the text (that which the physican saw) is french.\r\n\r\nMappings:\r\nCore-CA:  not supported\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size",
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:CCDD",
        "path": "Medication.code.coding",
        "sliceName": "CCDD",
        "max": "1"
      },
      {
        "id": "Medication.code.coding:CCDD.system",
        "path": "Medication.code.coding.system",
        "min": 1,
        "fixedUri": "https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset",
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:CCDD.code",
        "path": "Medication.code.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:CCDD.display",
        "path": "Medication.code.coding.display",
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:NPN",
        "path": "Medication.code.coding",
        "sliceName": "NPN",
        "max": "1"
      },
      {
        "id": "Medication.code.coding:NPN.system",
        "path": "Medication.code.coding.system",
        "min": 1,
        "fixedUri": "http://hl7.org/fhir/NamingSystem/ca-hc-npn",
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:NPN.code",
        "path": "Medication.code.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:DIN",
        "path": "Medication.code.coding",
        "sliceName": "DIN",
        "max": "1"
      },
      {
        "id": "Medication.code.coding:DIN.system",
        "path": "Medication.code.coding.system",
        "min": 1,
        "fixedUri": "http://hl7.org/fhir/NamingSystem/ca-hc-din",
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:DIN.code",
        "path": "Medication.code.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.code.coding:VaccineCodeGeneric",
        "path": "Medication.code.coding",
        "sliceName": "VaccineCodeGeneric",
        "comment": "Usage Note:   When conveying the medication list, prescribed vaccines may be specified here in the context of a prescription.   \r\n\r\nCodes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true."
      },
      {
        "id": "Medication.code.coding:VaccineCodeTradename",
        "path": "Medication.code.coding",
        "sliceName": "VaccineCodeTradename"
      },
      {
        "id": "Medication.code.text",
        "path": "Medication.code.text",
        "comment": "Usage Rule:   Text is mandatory as it may be different than the display,  Example:  in some cases the text may include the strength and the display may not.  \r\nUsage Note:   This is used for compounds or custom administrations such as allergy shots, IUDs  \r\n\r\nMappings:\r\nCore-CA:  supported 0..1 \r\n\r\nPatient Chart Conformance Rule:  Mandatory.  Official name recorded in the source system. This MUST be the name of the medication or non-medication.  This may be the generic ingredient(s) or CCDD/DIN name or compound description or product name.\r\n\r\nVery often the text is the same as a displayName of one of the codings.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.manufacturer",
        "path": "Medication.manufacturer",
        "mustSupport": true
      },
      {
        "id": "Medication.manufacturer.display",
        "path": "Medication.manufacturer.display",
        "mustSupport": true
      },
      {
        "id": "Medication.form",
        "path": "Medication.form",
        "comment": "Conformance Rule:   This is only used if this is not already included in the code and then only if this is known.   This could occur if the CCDD code was in the 8xxxxxx series which indicates only an ingredient and where the physician specified the form but not the strength\r\n\r\nMappings:\r\nDHDR:  is supported, - [code-system-local-base]/ca-on-drug-subclass-ahfs; this is a read only system and EMRs can display\r\nPrescribeIT: https://fhir.infoway-inforoute.ca/ValueSet/dispensabledrugform\r\nCA-Core:   Not supported, Same as PrescribeIT (preferred)\r\n\r\nEMRAPI: Form\r\n*EMRs who support PrescribeIT can support the same value set\r\nMA: Patient chart --> Meds --> Add new --> Drug name --> field beside Dose\r\nPSS: ending CCDD to PrescribeIT but it doesn't use the API.\r\nMS: Quantity per dose DDL -> codified form; mapping exercise\r\n\r\nPrescribeIT Usage Notes: The prescription drug form is optional to send to PrescribeIT™ but is required in some provinces in order to meet the prescribing standards set out by the College of Physicians and Surgeons. As a result the EMR must support allowing the prescriber to send a prescription drug form when the drug form is not specified by the drug identifier (e.g. for compounds, drugs prescribed using a Therapeutic Moiety or Representative DIN).\r\n\r\nConformance Rule: A Code must be supplied if one is available from the PrescriptionDrugForm subset. If the user picks a prescription drug form that does not have a code in the PrescriptionDrugForm subset, only then can text be supplied without a code.\r\n\r\nWhen Medication is referenced from MedicationRequest, this is the ordered form.  When Medication is referenced within MedicationDispense, this is the dispensed form.  When Medication is referenced within MedicationAdministration, this is administered form.",
        "mustSupport": true,
        "binding": {
          "strength": "preferred",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/dispensabledrugform"
        }
      },
      {
        "id": "Medication.form.coding",
        "path": "Medication.form.coding",
        "mustSupport": true
      },
      {
        "id": "Medication.form.coding.system",
        "path": "Medication.form.coding.system",
        "comment": "Conformance Rule:   If the system is known it must be populated. \r\n\r\nThe URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.",
        "mustSupport": true
      },
      {
        "id": "Medication.form.coding.code",
        "path": "Medication.form.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.form.text",
        "path": "Medication.form.text",
        "comment": "Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner\r\n\r\nery often the text is the same as a displayName of one of the codings.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.amount",
        "path": "Medication.amount",
        "comment": "Discussion Note:   Canadian issue where the DIN is the same regardless of the amount, so you need to be able to specify the amount, et 3ml versus 10ml.   This may occur with injectibles.   This is more relevant to the dispense.   \r\n\r\nPatient Chart - not supported, this is unclear and may be complicated\r\nDW - not supported\r\nCHR & EMRs - not supported\r\n\r\nMappings:\r\nCA-Core - not supported\r\nPrescribeIT: not supported; was not in May2016\r\nEMRs - this is not in the spreadsheet - is this concept supported?\r\n\r\n\r\nThe Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit.  Where the denominator value is known to be fixed to \"1\", Quantity should be used instead of Ratio."
      },
      {
        "id": "Medication.ingredient",
        "path": "Medication.ingredient",
        "comment": "Conformance Rule:   This is used to specify the ingredients in compounds when this has been recorded in the sending system.   This may be a code (eg DIN or CCDD) or text to describe each ingredient.  \r\n\r\n***Anne - add MedicaitonStrengthDescription extension here as strength is too hard to support as a ratio\r\n\r\nExample - HC1% in Canesten cream (Medication.code.text) - 1% would be in the extension, Medication Strength\r\n\r\n**** follow PrescribeIT rules\r\n\r\nMappings:\r\nCA-Core: not supported\r\nPrescribeIT:  supported as future, item, isActive, amount\r\nDHDR:  not supported\r\nEMRAPI:  not supported\r\nEMRs:  PSS does not support, MA can specify discrete ingredients\r\n\r\nThe ingredients need not be a complete list.  If an ingredient is not specified, this does not indicate whether an ingredient is present or absent.  If an ingredient is specified it does not mean that all ingredients are specified.  It is possible to specify both inactive and active ingredients.",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.item[x]",
        "path": "Medication.ingredient.item[x]",
        "comment": "Conformance Rule:   If there is no codified value, text should be sent\r\n\r\nNot all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
        }
      },
      {
        "id": "Medication.ingredient.item[x].coding",
        "path": "Medication.ingredient.item[x].coding",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.item[x].coding.system",
        "path": "Medication.ingredient.item[x].coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.item[x].coding.code",
        "path": "Medication.ingredient.item[x].coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.item[x].text",
        "path": "Medication.ingredient.item[x].text",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.isActive",
        "path": "Medication.ingredient.isActive",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength",
        "path": "Medication.ingredient.strength",
        "comment": "Usage Note:   This is not supported as many sending systems only support a string representation of strength.  As such, an extension for Medication Strength description will be added and used in place of this data element.\r\n\r\nThe Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit.  Where the denominator value is known to be fixed to \"1\", Quantity should be used instead of Ratio.",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.numerator",
        "path": "Medication.ingredient.strength.numerator",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.numerator.value",
        "path": "Medication.ingredient.strength.numerator.value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.numerator.unit",
        "path": "Medication.ingredient.strength.numerator.unit",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.numerator.system",
        "path": "Medication.ingredient.strength.numerator.system",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.numerator.code",
        "path": "Medication.ingredient.strength.numerator.code",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.denominator",
        "path": "Medication.ingredient.strength.denominator",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.denominator.value",
        "path": "Medication.ingredient.strength.denominator.value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.denominator.unit",
        "path": "Medication.ingredient.strength.denominator.unit",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.denominator.system",
        "path": "Medication.ingredient.strength.denominator.system",
        "mustSupport": true
      },
      {
        "id": "Medication.ingredient.strength.denominator.code",
        "path": "Medication.ingredient.strength.denominator.code",
        "mustSupport": true
      },
      {
        "id": "Medication.batch",
        "path": "Medication.batch",
        "comment": "Usage Notes:   The lotNumber and expirationDate should be sent if known.   This is typically used for medication admin, such as immunizations, allergy shots, etc.\r\n\r\nMappings:\r\nCA-Core: not supported\r\nPrescribeIT:  not supported\r\nDHDR:  not supported\r\nEMRAPI:  not supported\r\nEMRs:  not supported",
        "mustSupport": true
      },
      {
        "id": "Medication.batch.lotNumber",
        "path": "Medication.batch.lotNumber",
        "mustSupport": true
      },
      {
        "id": "Medication.batch.expirationDate",
        "path": "Medication.batch.expirationDate",
        "mustSupport": true
      }
    ]
  }
}