Product and Consumable Participations in Supply and SubstanceAdministration
The HL7 product Participation associates a specified material (via an appropriate Role) with the instance of the Supply class instance that delivers this material to a subject. Similarly the "consumable" associates a specified material (via an appropriate Role) with the instance of the SubstanceAdministration class instance that delivers this material to a subject. In both these cases, the relevant Act class instance itself only needs to specify the action involved and does not need to indicate the nature of the material supplied or administered.
In SNOMED CT concepts that are subtypes of [ 432102000 | administration of therapeutic substance] can also specify the nature of the substance administered. Refinement of any particular type of administration is possible by applying values to the "direct substance" attribute to represent administration of any pharmaceutical product. Therefore, there is a potential overlap between two approaches to representation of the nature of the substance administered.
- When using SNOMED CT to communicate about the supply or administration of a substance the nature of the substance SHOULD be specified in the Entity.code of the Entity associated with the Role that is the target of the relevant product or consumable Participation. When using this form of representation:
- the Act.code of the SubstanceAdministration class instance SHOULD be coded using a SNOMED CT concept that is a subtype of [ <<432102000 | administration of therapeutic substance ], but which does not specify a [ 363701004 | direct substance ].
- the nature of the substance administered SHOULD be expressed using an appropriate SNOMED CT concept in the Entity.code attribute of Entity playing the Role that is the target of the relevant participation.
Example: SubstanceAdministration.code= [ 36673005 | intradermal injection ] with associated Entity (via a consumable Participation and an appropriate Role), in which Entity.code=[ <<82573000 | lidocaine ] OR
- When using SNOMED CT to summarize information about a particular type of medication (e.g. use of a local anesthetic during a procedure), a SNOMED CT expression that includes information about the nature of the substance administered MAY be used. However, this form SHOULD NOT be used for communicating about the prescription, supply or personal administration of medication.
Example: SubstanceAdministration.code=[ 36673005 | intradermal injection | 363701004 | direct substance | << 82573000 | lidocaine ]
The first approach follows the form recommended by the Pharmacy TC and endorsed by the Clinical Statement pattern and other domain committees. The alternative approach may be relevant for summary notes related to certain types of treatment but is not appropriate for prescribing or medication management as it does not provide a reference to a specific quantifiable amount of the substances administered nor does it allow reference to batch numbers and detailed product information.