CSCR-089-Med-Add Orderable & Administerable Medication CMETs

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Submitted by: John Hatem	Revision date: 01/14/2009
Submitted date: 01/14/2009	Change request ID: CSCR-089

Issue

Documentation of what medication information was associated with a medication order or medication event needs to be allowed in the clinical statement model. This may be an ingredient, a medication or a packaged medicine.

Recommendation

Add the R_OrderableMedication universal CMET to the model, associating it with the SubstanceAdministration class in the model. The orderable medication would be associated with the SubstanceAdministration class via a consumable (CSM) participation.

Add the R_AdministerableMedication universal CMET to the model, associating it with the Supply class in the model. The administerable medication would be associated with the Supply class via a product (PRD) participation.

• Remove AgentChoice from the consumable (CSM) participation on the SubstanceAdministration class
  • Also removes MaterialKind, MaterialPart and MaterialPart2. Pharmacy WG believes all of these constructs are present in current CMET
• Add a consumable (CSM) participation from SubstanceAdministration to the R_OrderableMedication universal CMET
  • Remove contextControlCode from consumable (CSM) participation
• Remove ManufacturedProduct from the product (PRD) participation on the Supply class
  • Also removes Organization and DrugOrOtherMaterial. Pharmacy WG believes all of these constructs are present in current CMET
• Add a product (PRD) participation from Supply to the R_AdministrableMedication universal CMET
  • Remove contextControlCode from product (PRD) participation
  • Change cardinality on product to CMET from 1..* to 0..1

Resolution

15-Jan-09 - Motion to accept: John, Patrick

Only make following changes

• Relax product.contextControlCode participation to 0..1 optional
• Only replace R_Medication with R_OrderableMedication[universal], keep rest the same.
• Instead of replacing Manufactured Product, add choice of R_AdministerableMedication[universal] while keeping device participation to ManufacturedProduct

Against: 0; Abstain: 1; In Favor: 20

• Need to follow-up on the topic related to cardinality (temporarily removed from the motion):
  • Add a product (PRD) participation from Supply to the R_AdministrableMedication universal CMET

Remove contextControlCode from product (PRD) participation Change cardinality on product to CMET from 1..* to 0..1. Follow-up indicated that Rx prefers 0..*. To be discussed in follow-up.

20-Jan-09 - We need to get Rx to clarify the use case where the Supply does not have a product associated with it.

12-Feb-09 - Only use case is where one transcribes from a conversation where the product was not known, e.g., "it was a little pink pill". Should this be done by relating to a supply that is not known rather then no relationship. Material name would be unknown and description would be "little pink pill", rather then relationship being zero. Cardinality would then be 1..*. John to check with Pharmacy.

20-Feb-09 - Changes approved on 15-Jan-09 added to CSP v 1.2.02 (CVB)

3-Mar-09 - John confirmed that Pharmacy agrees with the approach - requiring a product participation - even when all we could state was "little pink pill".

5-Mar-09 - Product Participation cardinality 1..*. If one can only be "vague", like "little pink pill", we still have a participation with "little pink pill" in the entity.desc in the CMET. Patrick, Austin.

Against: 0; Abstain: 0; In Favor: 6

No further changes required to model - complete