Medication (QDM)

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The CQI Workgroup reviewed this QDM category in April 2018 consistent with QDM version 5.3. The content is updated on June 7, 2018 consistent with QDM version 5.4. The only differences between the two QDM versions are:

• Removal of the "supply" attribute from "Medication, Active", and "Medication, Administered". ["supply" is retained for "Medication, Order", "Medication, Dispensed", and "Medication, Discharge".
• Addition of a "setting" attribute to "Medication, Order" to allow differentiation of the setting in which the patient is to use the medication (consistent with the MedicationRequest.category FHIR metadata element).
  
  

QDM defines Medication as clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm. QDM defines five contexts for Medication: Medication, Active; Medication, Administered; Medication, Discharge; Medication, Dispensed; Medication, Order.

Medication, Active

QDM Attribute	QI Core Metadata Element	Comment
Medication, Active	MedicationStatement (the .status metadata allows conformance to the specific QDM datatype context)	The Medication, Active datatype requires use of the "active" status code from the FHIR value set
Dosage	MedicationStatement.dosage.dose	QDM matched to QI Core / FHIR
Frequency	MedicationStatement.dosage.timing	QDM matched to QI Core / FHIR
Route	MedicationStatement.dosage.route	QDM matched to QI Core / FHIR
Relevant Period	MedicationStatement.effective	QDM matched to QI Core / FHIR
Code	MedicationStatement.medication[x]	QDM matched to QI Core / FHIR
id	IMedicationStatement.id	QDM matched to QI Core / FHIR
Source	MedicationStatement.informationSource	Source addressed by primarySource or reportOrigin

Medication, Administered

QDM Attribute	QI Core Metadata Element	Comment
Medication, Administered	MedicationAdministration (the .status metadata allows conformance to the specific QDM datatype context)	QDM matched to QI Core / FHIR
Dosage	MedicationAdministration.dosage.dose	QDM matched to QI Core / FHIR
Frequency	MedicationStatement.dosage.timing	Medication Administration documents a single administration, thus frequency is not a concept in the Medication Administered resource.
Negation Rationale	MedicationAdministration.reasonNotGiven	QDM matched to QI Core / FHIR
Reason	MedicationAdministration.reasonCode	QDM matched to QI Core / FHIR
Route	MedicationAdministration.dosage.route	QDM matched to QI Core / FHIR
Relevant Period	MedicationAdministration.effective[x]	QDM matched to QI Core / FHIR
Author dateTime	FHIRprovenance.recorded	FHIR references authorDatetime as part of the provenance resource for all resources. Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html). The FHIR MedicationAdministration resource does not reference an author dateTime. Hence, the QDM Medication, Administered datatype author dateTime references FHIR provenance.
Code	MedicationAdministration.medication[x]	QDM matched to QI Core / FHIR
id	MedicationAdministration.id	QDM matched to QI Core / FHIR

Medication, Dispensed

QDM Attribute	QI Core Metadata Element	Comment
Medication, Dispensed	MedicationDispense (the .status metadata allows conformance to the specific QDM datatype context)	QDM matched to QI Core / FHIR
Dosage	MedicationDispense.quantity	QDM matched to QI Core / FHIR
Supply	MedicationDispense.daysSupply	QDM matched to QI Core / FHIR
Frequency	MedicationDispense.dosageInstruction.timing	QDM matched to QI Core / FHIR
Negation Rationale	MedicationDispense.notDoneReason[x]	QDM matched to QI Core / FHIR
Refills	MedicationDispense.extension (http://hl7.org/fhir/StructureDefinition/pharmacy-core-refillsRemaining)	QDM matched to QI Core / FHIR
Route	MedicationDispense.dosageInstruction.route	QDM matched to QI Core / FHIR
Relevant Period	MedicationDispense.extension (http://hl7.org/fhir/StructureDefinition/medicationdispense-validityPeriod)	QDM matched to QI Core / FHIR
Author dateTime	FHIR.provenance.dateTime	FHIR references authorDatetime as part of the provenance resource for all resources. Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html). FHIR MedicationDispense does not reference an author time. Hence, the QDM Medication, Dispensed datatype references FHIR provenance.
Code	MedicationDispense.medication[x]	QDM matched to QI Core / FHIR
id	MedicationDispense.id	QDM matched to QI Core / FHIR
Source	MedicationDispense.performer	QDM matched to QI Core / FHIR

Medication, Discharge

QDM Attribute	QI Core Metadata Element	Comment
Medication, Discharge	MedicationRequest.intent	New profile created to address Medication-request-category = dischargeMedication (LOINC code 8654-6 Hospital Discharge medications) bound to RxNorm. The MedicationRequest.Intent is constrained to "plan" to address recommendations to the patient. The MedicationRequest.category content does not yet include discharge medications.
Dosage	MedicationRequest.dosageInstruction.dose[x]	Note - modeled using MedicationRequest - could also be modeled as MedicationStatement with a status of "intended". May be modeled better as a component of a discharge instruction set but I can't find that in QI Core or FHIR
Supply		Supply shouldn't be required for Medication, Discharge since it is a set of medication instructions for a patient after departing from the hospital. However, in some cases, EHRs incorporate data from medication orders (prescriptions) written for post-discharge use into the discharge medication list provided to patients. In such cases, the supply may be present for newly prescribed medications. Such information is not covered in MedicationStatement in QI Core.
Frequency	MedicationRequest.dosageInstruction.timing	Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.
Negation Rationale	MedicationStatement.reasonNotTaken	Medication Request in QI Core does not reference negation rationale
Refills	MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	The mapping is somewhat problematic. The Medication, Discharge maps to MedicationRequest using the .intent metadata element constrained the "plan" - i.e., recommendation to the patient about which medications to take after discharge. While MedicationRequest has a .dispenseRequest.numberOfRepeatsAllowed, that metadata element is relevant for a prescription and not a medication list provided as a patient recommendation. Consider retiring this "refills" attribute for Medication, Discharge in QDM
Route	MedicationRequest.dosageInstruction.route	QDM matched to QI Core / FHIR
Author dateTime	MedicationRequest.authoredOn	Start of relevant period - no specific author time in QI Core. In the case of Medication, Discharge, the "request" is either to the patient (for medications present in the home or those obtained over-the-counter) or a reference to the prescription sent to the pharmacy that is included in the discharge medication instructions. Note MedicationRequest.dispenseRequest.validityPeriod (Consider prescription validity as a QDM attribute) MedicationRequest.dosageInstruction.timing (Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.)
Code	MedicationRequest.reasonCode	QDM matched to QI Core / FHIR
id	MedicationRequest.id	QDM matched to QI Core / FHIR

Medication, Order

QDM Attribute	QI Core Metadata Element	Comment
Medication, Order	MedicationRequest.intent	Medication Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. Constrain to "order" from the intent value set for QDM datatypes with the order context.
Dosage	MedicationRequest.dosageInstruction.dose[x]	QDM matched to QI Core / FHIR
Supply	MedicationRequest.dispenseRequest.quantity	QDM matched to QI Core / FHIR
Frequency	MedicationRequest.dosageInstruction.timing	QDM matched to QI Core / FHIR
Setting	MedicationRequest.category	QDM matched to QI Core / FHIR
Code	MedicationRequest.medication	QDM matched to QI Core / FHIR
Method	MedicationRequest.dosageInstruction.method	QDM matched to QI Core / FHIR
Negation Rationale	MedicationStatement.reasonNotTaken	Medication Request in QI Core does not reference negation rationale. See FHIR Tracker Item 15941 addressing notDoneReason requirement.
Reason	MedicationRequest.reasonCode	QDM matched to QI Core / FHIR
Refills	MedicationRequest.dispenseRequest.numberOfRepeatsAllowed	QDM matched to QI Core / FHIR
Relevant Period	MedicationRequest.dispenseRequest.expectedSupplyDuration	QDM matched to QI Core / FHIR, except that expectedSupplyDuration is an interval, to map to relevantPeriod, it needs to be anchored to a starting date. Use start of dispenseRequest.validityPeriod as the starting date for the expectedSupplyDuration.
Route	MedicationRequest.dosageInstruction.route	QDM matched to QI Core / FHIR
Author dateTime	MedicationRequest.authoredOn	QDM matched to QI Core / FHIR Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html).
id	MedicationRequest.id	QDM matched to QI Core / FHIR
Source	MedicationRequest.requester	QDM matched to QI Core / FHIR