|
MedicationStatement
|
|
Definition
|
A
record
of
a
medication
that
is
being
consumed
by
a
patient.
A
MedicationStatement
may
indicate
that
the
patient
may
be
taking
the
medication
now,
or
has
taken
the
medication
in
the
past
or
will
be
taking
the
medication
in
the
future.
The
source
of
this
information
can
be
the
patient,
significant
other
(such
as
a
family
member
or
spouse),
or
a
clinician.
A
common
scenario
where
this
information
is
captured
is
during
the
history
taking
process
during
a
patient
visit
or
stay.
The
medication
information
may
come
from
e.g.
the
patient's
memory,
from
a
prescription
bottle,
or
from
a
list
of
medications
the
patient,
clinician
or
other
party
maintains
The
primary
difference
between
a
medication
statement
and
a
medication
administration
is
that
the
medication
administration
has
complete
administration
information
and
is
based
on
actual
administration
information
from
the
person
who
administered
the
medication.
A
medication
statement
is
often,
if
not
always,
less
specific.
There
is
no
required
date/time
when
the
medication
was
administered,
in
fact
we
only
know
that
a
source
has
reported
the
patient
is
taking
this
medication,
where
details
such
as
time,
quantity,
or
rate
or
even
medication
product
may
be
incomplete
or
missing
or
less
precise.
As
stated
earlier,
the
medication
statement
information
may
come
from
the
patient's
memory,
from
a
prescription
bottle
or
from
a
list
of
medications
the
patient,
clinician
or
other
party
maintains.
Medication
administration
is
more
formal
and
is
not
missing
detailed
information.
A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now, or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from e.g. the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains
The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.
|
|
Control
|
1..1
|
Summary
Comments
|
true
The WG will be updating the MedicationStatement resource to adjust each affected resource to align with the workflow pattern (see workflow.html).
|
|
Invariants
|
Defined
on
this
element
Defined on this element
mst-1
:
Reason
not
taken
is
only
permitted
if
wasNotTaken
is
true
(xpath:
not(exists(f:reasonNotTaken)
and
f:wasNotTaken/@value=false()))
: Reason not taken is only permitted if notTaken is true (
expression
: reasonNotTaken.empty() or notTaken = true, xpath: not(exists(f:reasonNotTaken) and f:notTaken/@value=false()))
mst-2
:
Reason
for
use
is
only
permitted
if
wasNotTaken
is
false
(xpath:
not(exists(*[starts-with(local-name(.),
'reasonForUse')])
and
f:wasNotTaken/@value=true()))
: Reason for use code is only permitted if notTaken is false (
expression
: reasonForUseCode.empty() or notTaken = false, xpath: not(exists(*[starts-with(local-name(.), 'reasonForUseCode')]) and f:notTaken/@value=true()))
mst-3
: Reason for use reference is only permitted if notTaken is false (
expression
: reasonForUseReference.empty() or notTaken = false, xpath: not(exists(*[starts-with(local-name(.), 'reasonForUseReference')]) and f:notTaken/@value=true()))
|
|
MedicationStatement.identifier
|
|
Definition
|
External
identifier
-
FHIR
will
generate
its
own
internal
identifiers
(probably
URLs)
which
do
not
need
to
be
explicitly
managed
by
the
resource.
The
identifier
here
is
one
that
would
be
used
by
another
non-FHIR
system
-
for
example
an
automated
medication
pump
would
provide
a
record
each
time
it
operated;
an
administration
while
the
patient
was
off
the
ward
might
be
made
with
a
different
system
and
entered
after
the
event.
Particularly
important
if
these
records
have
to
be
updated.
External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.
|
|
Note
|
This
is
a
business
identifer,
not
a
resource
identifier
(see
This is a business identifer, not a resource identifier (see
discussion
)
|
|
Control
|
0..*
|
|
Type
|
Identifier
|
|
MedicationStatement.status
|
|
Definition
|
A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed.
|
|
Control
|
1..1
|
|
Binding
|
MedicationStatementStatus:
A coded concept indicating the current status of a MedicationStatement.
(
Required
)
|
|
Type
|
code
|
|
Is Modifier
|
true
|
|
Summary
|
true
|
|
Comments
|
MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted.
|
MedicationStatement.patient
MedicationStatement.medication[x]
|
|
Definition
|
The
person
or
animal
who
is/was
taking
the
medication.
Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
|
|
Control
|
1..1
|
|
Binding
|
SNOMED CT Medication Codes:
A coded concept identifying the substance or product being taken.
(
Example
)
|
|
Type
|
CodeableConcept
|
Reference
(
Patient
Medication
)
|
|
[x] Note
|
See
Choice of Data Types
for further information about how to use [x] |
|
Summary
|
true
|
|
Comments
|
If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. Note: do not use Medication.name to describe the medication this statement concerns. When the only available information is a text description of the medication, Medication.code.text should be used.
|
MedicationStatement.informationSource
MedicationStatement.patient
|
|
Definition
|
The
person
who
provided
the
information
about
the
taking
of
this
medication.
The person or animal who is/was taking the medication.
|
|
Control
|
0..1
1..1
|
|
Type
|
Reference
(
Patient
|
Practitioner
|
RelatedPerson
)
|
|
Summary
|
true
|
MedicationStatement.dateAsserted
MedicationStatement.effective[x]
|
|
Definition
|
The
date
when
the
medication
statement
was
asserted
by
the
information
source.
The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).
|
|
Control
|
0..1
|
|
Type
|
dateTime
|
Period
|
|
[x] Note
|
See
Choice of Data Types
for further information about how to use [x] |
|
Summary
|
true
|
|
Comments
|
If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.
|
MedicationStatement.status
MedicationStatement.informationSource
|
|
Definition
|
A
code
representing
the
patient
or
other
source's
judgment
about
the
state
of
the
medication
used
that
this
statement
is
about.
Generally
this
will
be
active
or
completed.
The person who provided the information about the taking of this medication. Note: A MedicationStatement may be derived from supportingInformation e.g claims or medicationOrder.
|
|
Control
|
1..1
0..1
|
Binding
Type
|
MedicationStatementStatus:
A
set
of
codes
indicating
the
current
status
of
a
MedicationStatement.
Reference
(
Required
Patient
|
Practitioner
|
RelatedPerson
)
|
Type
MedicationStatement.supportingInformation
|
|
Definition
|
code
Allows linking the MedicationStatement to the underlying MedicationOrder, or to other information that supports or is used to derive the MedicationStatement.
|
Is
Modifier
Control
|
true
0..*
|
Summary
Type
|
true
Reference
(
Any
)
|
|
Comments
|
Likely references would be to MedicationOrder, MedicationDispense, Claim, Observation or QuestionnaireAnswers.
|
MedicationStatement.wasNotTaken
MedicationStatement.dateAsserted
|
|
Definition
|
Set
this
to
true
if
the
record
is
saying
that
the
medication
was
NOT
taken.
The date when the medication statement was asserted by the information source.
|
|
Control
|
0..1
|
|
Type
|
boolean
Is
Modifier
dateTime
|
true
Meaning
if
Missing
If
this
is
missing,
then
the
medication
was
taken
|
Summary
|
true
|
MedicationStatement.reasonNotTaken
MedicationStatement.notTaken
|
|
Definition
|
A
code
indicating
why
the
medication
was
not
taken.
Set this to true if the record is saying that the medication was NOT taken.
|
|
Control
|
0..*
Binding
Reason
Medication
Not
Given
Codes:
A
set
of
codes
indicating
the
reason
why
the
MedicationAdministration
is
negated.
(
Example
)
0..1
|
|
Type
|
CodeableConcept
boolean
|
Summary
Is Modifier
|
true
|
Invariants
Meaning if Missing
|
Affect
this
element
mst-1
:
Reason
not
taken
is
only
permitted
if
wasNotTaken
is
true
(xpath:
not(exists(f:reasonNotTaken)
and
f:wasNotTaken/@value=false()))
If this is missing, then the medication was taken
|
To
Do
Summary
|
Is
this
in
the
80%
for
medication
statement?
true
|
MedicationStatement.reasonForUse[x]
MedicationStatement.reasonNotTaken
|
|
Definition
|
A
reason
for
why
the
medication
is
being/was
taken.
A code indicating why the medication was not taken.
|
|
Control
|
0..1
0..*
|
|
Binding
|
Condition/Problem/Diagnosis
Codes:
Codes
identifying
why
the
medication
is
being
taken.
(
Example
)
MedicationAdministrationNegationReason
: A coded concept indicating the reason why the MedicationStatement is negated.
|
|
Type
|
CodeableConcept
|
Reference
(
Condition
)
[x]
Note
|
See
Choice
of
Data
Types
for
further
information
about
how
to
use
[x]
Invariants
|
Summary
Affect this element
mst-1
: Reason not taken is only permitted if notTaken is true (
expression
true
: reasonNotTaken.empty() or notTaken = true, xpath: not(exists(f:reasonNotTaken) and f:notTaken/@value=false()))
|
MedicationStatement.effective[x]
MedicationStatement.reasonForUseCode
|
|
Definition
|
The
interval
of
time
during
which
it
is
being
asserted
that
the
patient
was
taking
the
medication
(or
was
not
taking,
when
the
wasNotGiven
element
is
true).
A reason for why the medication is being/was taken.
|
|
Control
|
0..1
0..*
|
Type
Binding
|
dateTime
|
Period
Condition/Problem/Diagnosis Codes:
A coded concept identifying why the medication is being taken.
(
Example
)
|
[x]
Note
See
Choice
of
Data
Types
Type
for
further
information
about
how
to
use
[x]
|
Summary
CodeableConcept
|
true
|
Comments
|
If
the
medication
is
still
being
taken
at
the
time
the
statement
is
recorded,
the
"end"
date
will
be
omitted.
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
|
MedicationStatement.note
MedicationStatement.reasonForUseReference
|
|
Definition
|
Provides
extra
information
about
the
medication
statement
that
is
not
conveyed
by
the
other
attributes.
Condition that supports why the medication is being/was taken.
|
|
Control
|
0..1
0..*
|
|
Type
|
string
Reference
(
Condition
)
|
Summary
Comments
|
true
This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode.
|
MedicationStatement.supportingInformation
MedicationStatement.note
|
|
Definition
|
Allows
linking
the
MedicationStatement
to
the
underlying
MedicationOrder,
or
to
other
information
that
supports
the
MedicationStatement.
Provides extra information about the medication statement that is not conveyed by the other attributes.
|
|
Control
|
0..*
|
|
Type
|
Reference
(
Any
)
Summary
Annotation
|
true
Comments
Likely
references
would
be
to
MedicationOrder,
MedicationDispense,
Claim,
Observation
or
QuestionnaireAnswers.
MedicationStatement.medication[x]
MedicationStatement.category
|
|
Definition
|
Identifies
the
medication
being
administered.
This
is
either
a
link
to
a
resource
representing
the
details
of
the
medication
or
a
simple
attribute
carrying
a
code
that
identifies
the
medication
from
a
known
list
of
medications.
Indicates where type of medication statement and where the medication is expected to be consumed or administered.
|
|
Control
|
1..1
0..1
|
Type
Binding
|
CodeableConcept
|
Reference
(
Medication
MedicationStatementCategory:
A coded concept identifying where the medication included in the is expected to be consumed or administered
(
Example
)
|
[x]
Note
See
Choice
of
Data
Types
Type
for
further
information
about
how
to
use
[x]
|
Summary
code
|
true
|
MedicationStatement.dosage
|
Comments
Definition
|
If
only
a
code
is
specified,
then
it
needs
to
be
a
code
for
a
specific
product.
If
more
information
is
required,
then
the
use
of
the
medication
resource
is
recommended.
Note:
do
not
use
Medication.name
to
describe
the
medication
this
statement
concerns.
When
the
only
available
information
is
a
text
description
of
the
medication,
Medication.code.text
should
be
used.
Indicates how the medication is/was used by the patient.
|
|
Control
|
0..*
|
MedicationStatement.dosage
MedicationStatement.dosage.text
|
|
Definition
|
Indicates
how
the
medication
is/was
used
by
the
patient.
Free text dosage information as reported about a patient's medication use. When coded dosage information is present, the free text may still be present for display to humans.
|
|
Control
|
0..*
0..1
|
Summary
Type
|
true
string
|
MedicationStatement.dosage.text
MedicationStatement.dosage.additionalInstructions
|
|
Definition
|
Free
text
dosage
information
as
reported
about
a
patient's
medication
use.
When
coded
dosage
information
is
present,
the
free
text
may
still
be
present
for
display
to
humans.
Additional instructions such as "Swallow with plenty of water" which may or may not be coded.
|
|
Control
|
0..1
0..*
|
Type
Binding
|
string
SNOMED CT Additional Dosage Instructions:
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
(
Example
)
|
Summary
Type
|
true
CodeableConcept
|
|
MedicationStatement.dosage.timing
|
|
Definition
|
The
timing
schedule
for
giving
the
medication
to
the
patient.
The
Schedule
data
type
allows
many
different
expressions,
for
example.
"Every
8
hours";
"Three
times
a
day";
"1/2
an
hour
before
breakfast
for
10
days
from
23-Dec
2011:";
"15
Oct
2013,
17
Oct
2013
and
1
Nov
2013".
The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions, for example. "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
|
|
Control
|
0..1
|
|
Type
|
Timing
|
Summary
true
|
MedicationStatement.dosage.asNeeded[x]
|
|
Definition
|
Indicates
whether
the
Medication
is
only
taken
when
needed
within
a
specific
dosing
schedule
(Boolean
option),
or
it
indicates
the
precondition
for
taking
the
Medication
(CodeableConcept).
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).
Specifically
if
'boolean'
datatype
is
selected,
then
the
following
logic
applies:
If
set
to
True,
this
indicates
that
the
medication
is
only
taken
when
needed,
within
the
specified
schedule.
Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified schedule.
|
|
Control
|
0..1
|
|
Binding
|
MedicationAsNeededReason
:
A
coded
concept
identifying
the
precondition
that
should
be
met
or
evaluated
prior
to
consuming
or
administering
a
medication
dose.
For
example
"pain",
"30
minutes
prior
to
sexual
intercourse",
"on
flare-up"
etc.
SNOMED CT Medication As Needed Reason Codes:
A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
(
Example
)
|
|
Type
|
boolean
|
CodeableConcept
|
[x]
Note
See
Choice
of
Data
Types
for
further
information
about
how
to
use
[x]
Summary
[x] Note
|
true
See
Choice of Data Types
for further information about how to use [x]
|
|
MedicationStatement.dosage.site[x]
|
|
Definition
|
A
coded
specification
of
or
a
reference
to
the
anatomic
site
where
the
medication
first
enters
the
body.
A coded specification of or a reference to the anatomic site where the medication first enters the body.
|
|
Control
|
0..1
|
|
Binding
|
SNOMED
CT
Anatomical
Structure
for
Administration
Site
Codes:
A
coded
concept
describing
the
site
location
the
medicine
enters
into
or
onto
the
body.
(
SNOMED CT Anatomical Structure for Administration Site Codes:
A coded concept describing the site location the medicine enters into or onto the body.
(
Example
)
|
|
Type
|
CodeableConcept
|
Reference
(
BodySite
)
|
[x]
Note
See
Choice
of
Data
Types
for
further
information
about
how
to
use
[x]
Summary
[x] Note
|
true
See
Choice of Data Types
for further information about how to use [x]
|
|
MedicationStatement.dosage.route
|
|
Definition
|
A
code
specifying
the
route
or
physiological
path
of
administration
of
a
therapeutic
agent
into
or
onto
a
subject.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subject.
|
|
Control
|
0..1
|
|
Binding
|
SNOMED
CT
Route
Codes:
A
coded
concept
describing
the
route
or
physiological
path
of
administration
of
a
therapeutic
agent
into
or
onto
the
body
of
a
subject.
(
SNOMED CT Route Codes:
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
(
Example
)
|
|
Type
|
CodeableConcept
|
Summary
true
|
MedicationStatement.dosage.method
|
|
Definition
|
A
coded
value
indicating
the
method
by
which
the
medication
is
intended
to
be
or
was
introduced
into
or
on
the
body.
This
attribute
will
most
often
NOT
be
populated.
It
is
most
commonly
used
for
injections.
For
example,
Slow
Push,
Deep
IV.
A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.
|
|
Control
|
0..1
|
|
Binding
|
MedicationAdministrationMethod
:
A
coded
concept
describing
the
technique
by
which
the
medicine
is
administered.
SNOMED CT Administration Method Codes:
A coded concept describing the technique by which the medicine is administered.
(
Example
)
|
|
Type
|
CodeableConcept
|
Summary
true
|
Comments
|
One
of
the
reasons
this
attribute
is
not
used
often,
is
that
the
method
is
often
pre-coordinated
with
the
route
and/or
form
of
administration.
This
means
the
codes
used
in
route
or
form
may
pre-coordinate
the
method
in
the
route
code
or
the
form
code.
The
implementation
decision
about
what
coding
system
to
use
for
route
or
form
code
will
determine
how
frequently
the
method
code
will
be
populated
e.g.
if
route
or
form
code
pre-coordinate
method
code,
then
this
attribute
will
not
be
populated
often;
if
there
is
no
pre-coordination
then
method
code
may
be
used
frequently.
One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.
|
MedicationStatement.dosage.quantity[x]
MedicationStatement.dosage.dose[x]
|
|
Definition
|
The
amount
of
therapeutic
or
other
substance
given
at
one
administration
event.
The amount of therapeutic or other substance given at one administration event.
|
|
Control
|
0..1
|
|
Type
|
SimpleQuantity
|
Range
|
[x]
Note
See
Choice
of
Data
Types
for
further
information
about
how
to
use
[x]
Summary
[x] Note
|
true
See
Choice of Data Types
for further information about how to use [x]
|
|
MedicationStatement.dosage.rate[x]
|
|
Definition
|
Identifies
the
speed
with
which
the
medication
was
or
will
be
introduced
into
the
patient.
Typically
the
rate
for
an
infusion
e.g.
100
ml
per
1
hour
or
100
ml/hr.
May
also
be
expressed
as
a
rate
per
unit
of
time
e.g.
500
ml
per
2
hours.
Currently
we
do
not
specify
a
default
of
'1'
in
the
denominator,
but
this
is
being
discussed.
Other
examples:
200
mcg/min
or
200
mcg/1
minute;
1
liter/8
hours.
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
|
|
Control
|
0..1
|
|
Type
|
Ratio
|
Range
[x]
Note
See
Choice
of
Data
Types
|
SimpleQuantity
for
further
information
about
how
to
use
[x]
|
Summary
[x] Note
|
true
See
Choice of Data Types
for further information about how to use [x]
|
|
MedicationStatement.dosage.maxDosePerPeriod
|
|
Definition
|
The
maximum
total
quantity
of
a
therapeutic
substance
that
may
be
administered
to
a
subject
over
the
period
of
time.
For
example,
1000mg
in
24
hours.
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
|
|
Control
|
0..1
|
|
Type
|
Ratio
|
Summary
true
To
Do
Is
this
in
the
80%
for
medication
statement?
©
HL7.org
2011+.
FHIR
DSTU2
(v1.0.2-7202)
generated
on
Sat,
Oct
24,
2015
07:43+1100.
Links:
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