R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

11.5 Resource Medication - Content

Pharmacy Work GroupMaturity Level: 3 Trial Use Compartments: Not linked to any defined compartments

This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

11.5.1 Scope and Usage

Representing medications in the majority of healthcare settings is a matter of identifying an item from a list and then conveying a reference for the item selected either into a patient related resource or to other applications. Additional information about the medication is frequently provided for human verification, but a full representation of the details of composition and efficacy of the medicine is conveyed by referring to drug dictionaries by means of the codes they define. There are some occasions where it is necessary to identify slightly more detail, such as when dispensing a package containing a particular medicine requires identification both of the medicine and the package at once. There are also some occasions (e.g. custom formulations) where the composition of a medicine must be represented. In these cases the ingredients of the medicine have to be specified together with the amount contained, though the medication resource does not provide full details.

The Medication resource allows for medications to be characterized by the form of the drug and the ingredient (or ingredients), as well as how it is packaged. The medication will include the ingredient(s) and their strength(s) and the package can include the amount (for example, number of tablets, volume, etc.) that is contained in a particular container (for example, 100 capsules of Amoxicillin 500mg per bottle).

The medication resource can be used to describe a compounded (aka extemporaneous or magistral) product that is manufactured by the pharmacy at the time of dispensing. In this case there will be multiple ingredients which are typically base chemicals (for example, hydrocortisone powder) and there may be other ingredients that are manufactured products (for example, Glaxal Base).

If medication includes a package, further details about the composition can be provided. A package has a container (vacuum packed box, jar, etc.) and a list of the products or other packages that are in the package.

This resource is referenced by ActivityDefinition, AdverseEvent, CarePlan, EntryDefinition, Flag, Group, MedicationAdministration, MedicationDispense, MedicationRequest, MedicationStatement, MedicinalProductClinicals, Procedure, SupplyDelivery and SupplyRequest

11.5.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Medication TUDomainResourceDefinition of a Medication
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... code Σ0..1CodeableConceptCodes that identify this medication
SNOMED CT Medication Codes (Example)
... status Σ0..1codeactive | inactive | entered-in-error
MedicationStatus (Required)
... manufacturer Σ0..1Reference(Organization)Manufacturer of the item
... form 0..1CodeableConceptpowder | tablets | capsule +
SNOMED CT Form Codes (Example)
... amount ?!Σ0..1SimpleQuantityAmount of drug in package
... ingredient 0..*BackboneElementActive or inactive ingredient
.... item[x] 1..1The product contained
..... itemCodeableConceptCodeableConcept
..... itemReferenceReference(Substance | Medication)
.... isActive 0..1booleanActive ingredient indicator
.... amount 0..1RatioQuantity of ingredient present
... batch 0..1BackboneElementDetails about packaged medications
.... lotNumber 0..1stringIdentifier assigned to batch
.... expirationDate 0..1dateTimeWhen batch will expire

doco Documentation for this format

UML Diagram (Legend)

Medication (DomainResource)A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systemscode : CodeableConcept [0..1] « A coded concept that defines the type of a medication (Strength=Example)SNOMED CT Medication ?? »A code to indicate if the medication is in active usestatus : code [0..1] « A coded concept defining if the medication is in active use (Strength=Required)MedicationStatus! »Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication productmanufacturer : Reference [0..1] « Organization »Describes the form of the item. Powder; tablets; capsuleform : CodeableConcept [0..1] « A coded concept defining the form of a medication (Strength=Example)SNOMED CT Form ?? »Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc) (this element modifies the meaning of other elements)amount : Quantity(SimpleQuantity) [0..1]IngredientThe actual ingredient - either a substance (simple ingredient) or another medicationitem[x] : Type [1..1] « CodeableConcept|Reference(Substance| Medication) »Indication of whether this ingredient affects the therapeutic action of the drugisActive : boolean [0..1]Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tabletamount : Ratio [0..1]BatchThe assigned lot number of a batch of the specified productlotNumber : string [0..1]When this specific batch of product will expireexpirationDate : dateTime [0..1]Identifies a particular constituent of interest in the productingredient[0..*]Information that only applies to packages (not products)batch[0..1]

XML Template

<Medication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <manufacturer><!-- 0..1 Reference(Organization) Manufacturer of the item --></manufacturer>
 <form><!-- 0..1 CodeableConcept powder | tablets | capsule + --></form>
 <amount><!-- 0..1 Quantity(SimpleQuantity) Amount of drug in package --></amount>
 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <item[x]><!-- 1..1 CodeableConcept|Reference(Substance|Medication) The product contained --></item[x]>
  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <amount><!-- 0..1 Ratio Quantity of ingredient present --></amount>
 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
</Medication>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Medication;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Medication.code [ CodeableConcept ]; # 0..1 Codes that identify this medication
  fhir:Medication.status [ code ]; # 0..1 active | inactive | entered-in-error
  fhir:Medication.manufacturer [ Reference(Organization) ]; # 0..1 Manufacturer of the item
  fhir:Medication.form [ CodeableConcept ]; # 0..1 powder | tablets | capsule +
  fhir:Medication.amount [ Quantity(SimpleQuantity) ]; # 0..1 Amount of drug in package
  fhir:Medication.ingredient [ # 0..* Active or inactive ingredient
    # Medication.ingredient.item[x] : 1..1 The product contained. One of these 2
      fhir:Medication.ingredient.itemCodeableConcept [ CodeableConcept ]
      fhir:Medication.ingredient.itemReference [ Reference(Substance|Medication) ]
    fhir:Medication.ingredient.isActive [ boolean ]; # 0..1 Active ingredient indicator
    fhir:Medication.ingredient.amount [ Ratio ]; # 0..1 Quantity of ingredient present
  ], ...;
  fhir:Medication.batch [ # 0..1 Details about packaged medications
    fhir:Medication.batch.lotNumber [ string ]; # 0..1 Identifier assigned to batch
    fhir:Medication.batch.expirationDate [ dateTime ]; # 0..1 When batch will expire
  ];
]

Changes since DSTU2

Medication
Medication.status
  • Added Element
Medication.form
  • Added Element
Medication.amount
  • Added Element
Medication.ingredient
  • Added Element
Medication.ingredient.item[x]
  • Added Element
Medication.ingredient.isActive
  • Added Element
Medication.ingredient.amount
  • Added Element
Medication.batch
  • Added Element
Medication.batch.lotNumber
  • Added Element
Medication.batch.expirationDate
  • Added Element
Medication.isBrand
  • deleted
Medication.product
  • deleted
Medication.package
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 23 tests that all execute ok. 16 fail round-trip testing and 1 r3 resources are invalid (1 errors).).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Medication TUDomainResourceDefinition of a Medication
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... code Σ0..1CodeableConceptCodes that identify this medication
SNOMED CT Medication Codes (Example)
... status Σ0..1codeactive | inactive | entered-in-error
MedicationStatus (Required)
... manufacturer Σ0..1Reference(Organization)Manufacturer of the item
... form 0..1CodeableConceptpowder | tablets | capsule +
SNOMED CT Form Codes (Example)
... amount ?!Σ0..1SimpleQuantityAmount of drug in package
... ingredient 0..*BackboneElementActive or inactive ingredient
.... item[x] 1..1The product contained
..... itemCodeableConceptCodeableConcept
..... itemReferenceReference(Substance | Medication)
.... isActive 0..1booleanActive ingredient indicator
.... amount 0..1RatioQuantity of ingredient present
... batch 0..1BackboneElementDetails about packaged medications
.... lotNumber 0..1stringIdentifier assigned to batch
.... expirationDate 0..1dateTimeWhen batch will expire

doco Documentation for this format

UML Diagram (Legend)

Medication (DomainResource)A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systemscode : CodeableConcept [0..1] « A coded concept that defines the type of a medication (Strength=Example)SNOMED CT Medication ?? »A code to indicate if the medication is in active usestatus : code [0..1] « A coded concept defining if the medication is in active use (Strength=Required)MedicationStatus! »Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication productmanufacturer : Reference [0..1] « Organization »Describes the form of the item. Powder; tablets; capsuleform : CodeableConcept [0..1] « A coded concept defining the form of a medication (Strength=Example)SNOMED CT Form ?? »Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc) (this element modifies the meaning of other elements)amount : Quantity(SimpleQuantity) [0..1]IngredientThe actual ingredient - either a substance (simple ingredient) or another medicationitem[x] : Type [1..1] « CodeableConcept|Reference(Substance| Medication) »Indication of whether this ingredient affects the therapeutic action of the drugisActive : boolean [0..1]Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tabletamount : Ratio [0..1]BatchThe assigned lot number of a batch of the specified productlotNumber : string [0..1]When this specific batch of product will expireexpirationDate : dateTime [0..1]Identifies a particular constituent of interest in the productingredient[0..*]Information that only applies to packages (not products)batch[0..1]

XML Template

<Medication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <manufacturer><!-- 0..1 Reference(Organization) Manufacturer of the item --></manufacturer>
 <form><!-- 0..1 CodeableConcept powder | tablets | capsule + --></form>
 <amount><!-- 0..1 Quantity(SimpleQuantity) Amount of drug in package --></amount>
 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <item[x]><!-- 1..1 CodeableConcept|Reference(Substance|Medication) The product contained --></item[x]>
  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <amount><!-- 0..1 Ratio Quantity of ingredient present --></amount>
 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
</Medication>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Medication;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Medication.code [ CodeableConcept ]; # 0..1 Codes that identify this medication
  fhir:Medication.status [ code ]; # 0..1 active | inactive | entered-in-error
  fhir:Medication.manufacturer [ Reference(Organization) ]; # 0..1 Manufacturer of the item
  fhir:Medication.form [ CodeableConcept ]; # 0..1 powder | tablets | capsule +
  fhir:Medication.amount [ Quantity(SimpleQuantity) ]; # 0..1 Amount of drug in package
  fhir:Medication.ingredient [ # 0..* Active or inactive ingredient
    # Medication.ingredient.item[x] : 1..1 The product contained. One of these 2
      fhir:Medication.ingredient.itemCodeableConcept [ CodeableConcept ]
      fhir:Medication.ingredient.itemReference [ Reference(Substance|Medication) ]
    fhir:Medication.ingredient.isActive [ boolean ]; # 0..1 Active ingredient indicator
    fhir:Medication.ingredient.amount [ Ratio ]; # 0..1 Quantity of ingredient present
  ], ...;
  fhir:Medication.batch [ # 0..1 Details about packaged medications
    fhir:Medication.batch.lotNumber [ string ]; # 0..1 Identifier assigned to batch
    fhir:Medication.batch.expirationDate [ dateTime ]; # 0..1 When batch will expire
  ];
]

Changes since DSTU2

Medication
Medication.status
  • Added Element
Medication.form
  • Added Element
Medication.amount
  • Added Element
Medication.ingredient
  • Added Element
Medication.ingredient.item[x]
  • Added Element
Medication.ingredient.isActive
  • Added Element
Medication.ingredient.amount
  • Added Element
Medication.batch
  • Added Element
Medication.batch.lotNumber
  • Added Element
Medication.batch.expirationDate
  • Added Element
Medication.isBrand
  • deleted
Medication.product
  • deleted
Medication.package
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 23 tests that all execute ok. 16 fail round-trip testing and 1 r3 resources are invalid (1 errors).).

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

11.5.2.1 Terminology Bindings

PathDefinitionTypeReference
Medication.code A coded concept that defines the type of a medicationExampleSNOMED CT Medication Codes
Medication.status A coded concept defining if the medication is in active useRequiredMedicationStatus
Medication.form A coded concept defining the form of a medicationExampleSNOMED CT Form Codes

11.5.3 Best practices for using 'Medication'

Medication does not have a status. If Medication was used to support a formulary use case, then an extension can be used to convey formulary statuses, such as active (e.g. the medication can be ordered) or inactive (e.g. the medication can be documented, but not ordered). Pharmacy is evaluating formulary use cases. Feedback is encouraged to the Pharmacy working group.

11.5.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
codetokenCodes that identify this medicationMedication.code4 Resources
formtokenpowder | tablets | capsule +Medication.form
ingredientreferenceThe product containedMedication.ingredient.item.as(Reference)
(Medication, Substance)
ingredient-codetokenThe product containedMedication.ingredient.item.as(CodeableConcept)
manufacturerreferenceManufacturer of the itemMedication.manufacturer
(Organization)
statustokenactive | inactive | entered-in-errorMedication.status