This wiki has undergone a migration to Confluence found Here
<meta name="googlebot" content="noindex">

Difference between revisions of "Medication (QDM)"

From HL7Wiki
Jump to navigation Jump to search
Line 62: Line 62:
 
| row2cell1 | Supply
 
| row2cell1 | Supply
 
| row2cell2 |  
 
| row2cell2 |  
| row2cell3 | Not addressed in QI Core
+
| row2cell3 | Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. The use case discussed includes a "single" dose of medication provided as an intravenous infusion. In the use case, due to the nature of the medication requiring a large amount of volume for dilution, the pharmacy provides two one-liter intravenous infusion "bags", one to follow the other to complete the ordered dose. In this use case, should the two infusion "bags" be considered a supply of 2?  The CQI Workgroup considered the issue and determined it is an implementation concern. Some guidance in QDM documentation may be helpful, but the Workgroup consensus was to consider removing supply as a requirement for Medication, Active - for discussion in the QDM User Group on April 18, 2018.
 
|-
 
|-
 
| row2cell1 | Frequency
 
| row2cell1 | Frequency
Line 96: Line 96:
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|}
 
|}
 +
 
== Medication, Dispensed ==
 
== Medication, Dispensed ==
 
{|border="1" cellpadding="2" cellspacing="0"  
 
{|border="1" cellpadding="2" cellspacing="0"  

Revision as of 20:25, 15 April 2018

Back to Harmonization of Health Quality Information Models Page

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
Supply Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. The use case discussed includes a "single" dose of medication provided as an intravenous infusion. In the use case, due to the nature of the medication requiring a large amount of volume for dilution, the pharmacy provides two one-liter intravenous infusion "bags", one to follow the other to complete the ordered dose. In this use case, should the two infusion "bags" be considered a supply of 2? The CQI Workgroup considered the issue and determined it is an implementation concern. Some guidance in QDM documentation may be helpful, but the Workgroup consensus was to consider removing supply as a requirement for Medication, Active - for discussion in the QDM User Group on April 18, 2018.
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
Supply Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. The use case discussed includes a "single" dose of medication provided as an intravenous infusion. In the use case, due to the nature of the medication requiring a large amount of volume for dilution, the pharmacy provides two one-liter intravenous infusion "bags", one to follow the other to complete the ordered dose. In this use case, should the two infusion "bags" be considered a supply of 2? The CQI Workgroup considered the issue and determined it is an implementation concern. Some guidance in QDM documentation may be helpful, but the Workgroup consensus was to consider removing supply as a requirement for Medication, Active - for discussion in the QDM User Group on April 18, 2018.
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. Is authorDatetime still appropriate for this datatype?
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 part of FHIR Provenance Resource FHIR references authorDatetime as part of the provenance resource for all resources.
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.
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. Consider removing this attribute from this QDM datatype. Also- not present 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 MedicationStatement.reasonNotTaken Not present in QI Core - refills shouldn't be an attribute for a list of medications intended at discharge - consider retiring this 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
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
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
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
Route MedicationRequest.dosageInstruction.route QDM matched to QI Core / FHIR
Author dateTime MedicationRequest.authoredOn QDM matched to QI Core / FHIR
id MedicationRequest.id QDM matched to QI Core / FHIR
Source MedicationRequest.requester QDM matched to QI Core / FHIR