MedicationKnowledge FHIR Resource

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MedicationKnowledge FHIR Resource

Information Gathered

• Melva - September 29, 2017
  • From my perspective, it is very common to refer to the type of information that is expected to be in this resource as “knowledge”. It is the type of information that is provided by Drug Knowledge Base vendors like First Databank, Multum, Medispan and others. In the HL7 V3 material we have a set of queries called “Medication Knowledge-Base Query”.
• Lloyd McKenzie - September 29, 2017
  • The relationships are part of the knowledge. There's nothing catalog-specific about them. Whether a product exists in a given catalog or not is the only piece I see as being "catalog-specific". I actually expect there'll be a general resource that captures cost information that will be independent of the notion of "catalog".
  • I expect the pharmacy knowledge resource(s) will include references to PlanDefinition or ActivityDefinition to talk about things like recommended dosage instructions.
• Lorraine Constable - September 29, 2017
  • Plus, we have knowledge artifacts in the clinical reasoning space, so we don't want to collide with those definitions
• Jose - September 29, 2017
  • my request: please rename Knowledge to Definition to make sure it is a definitional resource which can be grouped in a catalog.
  • IMO Knowledge is such a broad term that can represent color (definitional) or things like "since its introduction in the market, this drug has seen 45 incident reports and has been the object of these 14 research studies".i hope we don't fall into a scope trap for something that is relatively clear and will articulate perfectly with Catalog and the IDMP stuff.
  • (unless of course if we want to start with that kind of complex knowledge. which is not in the 80% nor in the critical path for other things.)
• Jose - September 29, 2017
  • Agree, the catalog is indeed just a collection of knowledge artifacts. And their relationships. The other elements in the catalog will typically be called xxxDefinition - device, specimen, etc.
  • My point is minor for name consistency (Why is this being called 'knowledge'?) But wanted to avoid silos or unintentional overlap with the regulated drug products where much of the definitions will be starting.
  • As for catalog, it should not contain definitions (unless possibly context-dependent attributes but I'm not even sure of that). Definitions are in the xxxDefinition resources. And for the catalog, aligning attributes between devices, biological products and medication is not relevant. IMO a Definition resource should not contain "catalog" attributes like "availability"...
  • Perhaps I should prototype a small catalog example to show how this could work, and that it does not expose definitions / knowledge that is in the xxxDefinition resource
• Michael Tan - September 27, 2017
  • Just to give you an idea of what we see as a medication knowledge databank in the Netherlands, please look at our pharmaceutical therapeutic compass: https://www.farmacotherapeutischkompas.nl/.
  • It is in Dutch of course, but I think the words are clear enough to give you a general impression. On the landing page just enter a name of a drug ( for example amoxicilline) and push on the button "zoek"( search).

You will land on the information on amoxicilline with the knowledge attached on the detail page. You can see all appearances of the drug with all manufacturers, but also indications, side effects, dosage recommendations, contra-indications, medication interactions on the links on the right side.

• Lloyd - September 27, 2017
  • From my perspective, a catalog is just an organized collection of knowledge resources. I'm interested to see how much commonality we can find in the knowledge resources that will be needed for drugs, products, devices, clinical services, etc.

• Jose - September 27, 2017
  • Meanwhile I wanted to contribute so that we don't try to come up with concepts and taxonomies of our own.
  • Looking at this from different angles, I think the work with BRR will be useful.
  • My preference for MedicationDefinition iso medicationKnowledge is for clarity as an implementer - a thing called Definition has already a clear meaning in FHIR. Knowledge is fuzzy.
  • Stephen, I think I understand your point but much of what you call 'knowlegde' is actually covered by the IDMP resources in BRR and Pharmacy does not need to overlap. And a catalog is, as you taught me several years ago, a polyhierarchical structure. A graph.
  • With this, I encourage this effort and hope we articulate (not overlap) between Catalog, BRR and Pharmacy.

• Stephen - September 27, 2017
  • At a Patient Care WG meeting, the concept of MedicationKnowledge was discussed.
  • It is important to clarify what the intended purpose of this concept is.
  • Also important is to differentiate other related concepts:
    • (1) For information such as shape, size, form (e.g. tablet, liquid ...) - this belongs to product information and should not be considered "knowledge"
    • (2) For information such as pharmacokinetics (he time course of drug absorption, distribution, metabo- lism, and excretion); pharmacodynamics (the application of pharmacokinetic principles to the safe and effective therapeutic management of drugs in an individual patient); drug-drug interaction; drug-[food and other] substance interactions; drug-condition interactions .... - they belong to knowledge
    • (3) a complete list of drug items, typically one in alphabetical or other systematic order - this is drug catalogue

• Jose - September 27, 2017
  • looking back at the discussions, at some point there was an idea of splitting medication information between
    • the information to specify a product that is defined elsewhere - this is what the medication resource does
    • the information necessary to define the medication product.
  • while the latter can be covered by the discussion with BRR, i think there is a need to define non-idmp products.
  • at some point, there was some wording confusion and the notin of MedicationKnowledge appeared.
  • two remarks on this - please comment:
    • 1. like with other resources, there could/should be a thing called MedicationDefinition. i haven't seen a difference between catalog or formulary information and additional 'knowledge' - in fact, catalog is a way to share this knowledge. so i woild stick to medicationDefinition, which is something that fully details the product so that it can be stored in the server or sent in a catalog.
    • 2. in the catalog, we want to define things like 'this medication interacts with that' so that sould not be duplicated in the medication definition resource, right?
  • perhaps the confusion or the need for additional 'knowledge' is from a simplified notion of what a formulary should be. The formulary is closer to a polyhierarchical tree or a graph, rather than the simple, boring excel flat lists.
  • If we keep in mind the rich information that is in the catalogs nowadays, then we won't have to invent a graph structure and debate forever what is in a catalog or what is not

• Melva - September 14, 2017
  • Canadian Medication KnowledgeBase queries from V3