2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Profile Health Services Platform Consortium (HSPC) Medication Dispense Profile - Definitions

Todo

Definitions for the hspc-medicationdispense-hspc-medicationdispense Profile.

MedicationDispense(hspc-medicationdispense)
Definition

Dispensing a medication to a named patient. This includes a description of the supply provided and the instructions for administering the medication.

Control1..1
Requirements
Comments
InvariantsDefined on this element
mdd-1: whenHandedOver cannot be before whenPrepared (xpath: not(exists(f:whenHandedOver/@value)) or not(exists(f:whenPrepared/@value)) or ( f:whenHandedOver/@value >= f:whenPrepared/@value))
MedicationDispense.id
Definition

The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.

Control0..1
Typeid
Requirements
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

MedicationDispense.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Requirements
Comments
MedicationDispense.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Requirements
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

MedicationDispense.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Typecode
Requirements
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource

Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

MedicationDispense.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Requirements
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

MedicationDispense.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Requirements
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

MedicationDispense.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationDispense.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationDispense.identifier
Definition

Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR.

Control0..1
TypeIdentifier
Is Modifiertrue
Requirements
Comments
MedicationDispense.status
Definition

A code specifying the state of the set of dispense events.

Control0..1
BindingA code specifying the state of the dispense event.
The codes SHALL be taken from MedicationDispenseStatus
Typecode
Is Modifiertrue
Requirements
Comments
MedicationDispense.patient
Definition

A link to a resource representing the person to whom the medication will be given.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Patient))
Requirements
Comments

SubstanceAdministration->subject->Patient.

MedicationDispense.dispenser
Definition

The individual responsible for dispensing the medication.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner))
Requirements
Comments
MedicationDispense.authorizingPrescription
Definition

Indicates the medication order that is being dispensed against.

Control0..*
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/MedicationPrescription))
Requirements
Comments
MedicationDispense.type
Definition

Indicates the type of dispensing event that is performed. Examples include: Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

Control0..1
BindingIndicates the type of dispensing event that is performed. Examples include: Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
For example codes, see ActPharmacySupplyType
TypeCodeableConcept
Requirements
Comments
MedicationDispense.quantity
Definition

The amount of medication that has been dispensed. Includes unit of measure.

Control0..1
TypeQuantity
Requirements
Comments
MedicationDispense.daysSupply
Definition

The amount of medication expressed as a timing amount.

Control0..1
TypeQuantity
Requirements
Comments
MedicationDispense.medication
Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Medication))
Requirements
Comments

Note: do not use Medication.name to describe the dispensed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

MedicationDispense.whenPrepared
Definition

The time when the dispensed product was packaged and reviewed.

Control0..1
TypedateTime
Requirements
Comments
MedicationDispense.whenHandedOver
Definition

The time the dispensed product was provided to the patient or their representative.

Control0..1
TypedateTime
Requirements
Comments
MedicationDispense.destination
Definition

Identification of the facility/location where the medication was shipped to, as part of the dispense event.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Location))
Requirements
Comments
MedicationDispense.receiver
Definition

Identifies the person who picked up the medication. This will usually be a patient or their carer, but some cases exist where it can be a healthcare professional.

Control0..*
TypeChoice of: Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Patient)), Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner))
Requirements
Comments
MedicationDispense.note
Definition

Extra information about the dispense that could not be conveyed in the other attributes.

Control0..1
Typestring
Requirements
Comments
MedicationDispense.dosageInstruction
Definition

Indicates how the medication is to be used by the patient.

Control0..*
Requirements
Comments

When the dose or rate is intended to change over the entire administration period, eg. Tapering dose prescriptions, multiple instances of dosage instructions will need to be supplied to convey the different doses/rates.

MedicationDispense.dosageInstruction.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
MedicationDispense.dosageInstruction.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices. The slicing rules are:
  • unordered
  • open
  • discriminators: url
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-doseType)
Definition

The type of dose. E.g., initial, maintenance, loading.

Control0..1
Typestring
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-infuseOver)
Definition

Represents the actual time the substance is infused. Note the difference between infuseOver and duration of treatment (specified in administrationFrequency). An order may call for infusing a patient TID for an hour each time over a duration of 5 days.

Control0..1
TypePeriod
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-rateIncrement)
Definition

Change in the dosing rate; usually an increase for a patient who is initiating tube feeding. E.g., 20 mL/hour.

Control0..1
TypeRatio
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-rateIncrementInterval)
Definition

Period of time after which the deliveryRateIncrement should be attempted. E.g., 4 hours.

Control0..1
TypeQuantity
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-rateGoal)
Definition

The target rate to reach for this infusion. Note that deliveryRateGoal is typically less than the maximum delivery rate which is the rate not to exceed. For enteral feeding orders, a target tube feeding rate of 75ml/hour may be specified.

Control0..1
TypeRatio
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-minDosePerPeriod)
Definition

The minimum total quantity of a therapeutic substance that may be administered to a subject over the period of time. E.g., 10 mg in 24 hours.

Control0..1
TypeRatio
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-maxDeliveryRate)
Definition

The maximum rate of substance administration. This value may be used as a stopping condition when a deliveryRateIncrement is specified without a count.

Control0..1
TypeRatio
Requirements
Comments
MedicationDispense.dosageInstruction.extension (http://hl7.org/fhir/ExtensionDefinition/medicationprescription-maxDeliveryVolume)
Definition

The maximum volume of fluid to administer to a patient.

Control0..1
TypeQuantity
Requirements
Comments
MedicationDispense.dosageInstruction.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationDispense.dosageInstruction.additionalInstructions
Definition

Additional instructions such as "Swallow with plenty of water" which may or may not be coded.

Control0..1
TypeCodeableConcept
Requirements
Comments
MedicationDispense.dosageInstruction.schedule[x]
Definition

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions, for example. "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013".

Control0..1
TypeChoice of: dateTime, Period, Timing
Requirements
Comments
MedicationDispense.dosageInstruction.asNeeded[x]
Definition

If set to true or if specified as a CodeableConcept, indicates that the medication is only taken when needed within the specified schedule rather than at every scheduled dose. If a CodeableConcept is present, it indicates the pre-condition for taking the Medication.

Control0..1
BindingA coded concept identifying the pre-condition that should hold prior to consuming a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up", etc.
TypeChoice of: boolean, CodeableConcept
Requirements
Comments
MedicationDispense.dosageInstruction.site
Definition

A coded specification of the anatomic site where the medication first enters the body.

Control0..1
BindingA coded concept describing the site location the medicine enters into or onto the body
For example codes, see SNOMED CT Anatomical Structure for Administration Site Codes
TypeCodeableConcept
Requirements
Comments
MedicationDispense.dosageInstruction.route
Definition

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subject.

Control0..1
BindingA coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
For example codes, see SNOMED CT Route Codes
TypeCodeableConcept
Requirements
Comments
MedicationDispense.dosageInstruction.method
Definition

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. Examples: Slow Push; Deep IV.

Terminologies used often pre-coordinate this term with the route and or form of administration.

Control0..1
BindingA coded concept describing the technique by which the medicine is administered
For example codes, see SNOMED CT Introduction (procedure) for Administration Method Codes
TypeCodeableConcept
Requirements
Comments
MedicationDispense.dosageInstruction.dose[x]
Definition

The amount of therapeutic or other substance given at one administration event.

Control0..1
TypeChoice of: Range, Quantity
Requirements
Comments

Note that this specifies the quantity of the specified medication, not the quantity of active ingredient(s). The prescribed strength can be calculated by multiplying the doseQuantity by the strength of each active ingredient in the prescribed Medication. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule.

MedicationDispense.dosageInstruction.rate
Definition

Identifies the speed with which the substance is introduced into the subject. Typically the rate for an infusion. 200ml in 2 hours.

Control0..1
TypeRatio
Requirements
Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, each change should be captured as a distinct "dosage" repetition, except for titration orders.

MedicationDispense.dosageInstruction.maxDosePerPeriod
Definition

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time, e.g. 1000mg in 24 hours.

Control0..1
TypeRatio
Requirements
Comments
MedicationDispense.substitution
Definition

Indicates whether or not substitution was made as part of the dispense. In some cases substitution will be expected but doesn't happen, in other cases substitution is not expected but does happen. This block explains what substitition did or did not happen and why.

Control0..1
Requirements
Comments
MedicationDispense.substitution.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
MedicationDispense.substitution.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationDispense.substitution.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

MedicationDispense.substitution.type
Definition

A code signifying whether a different drug was dispensed from what was prescribed.

Control1..1
BindingA coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription
For example codes, see ActSubstanceAdminSubstitutionCode
TypeCodeableConcept
Requirements
Comments
MedicationDispense.substitution.reason
Definition

Indicates the reason for the substitution of (or lack of substitution) from what was prescribed.

Control0..*
BindingA coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
For example codes, see SubstanceAdminSubstitutionReason
TypeCodeableConcept
Requirements
Comments
MedicationDispense.substitution.responsibleParty
Definition

The person or organization that has primary responsibility for the substitution.

Control0..*
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner))
Requirements
Comments

rename.