QI-Core Implementation Guide
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This page is part of the Quality Improvement Core Framework (v6.0.0-ballot: STU6 (v6.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: QICore MedicationAdministration

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration Version: 6.0.0-ballot
Draft as of 2018-08-22 Computable Name: QICoreMedicationAdministration

Profile of MedicationAdministration for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Usage

To create an expression specifically requesting information that a MedicationAdministration intentionally did not occur for a medical, patient or system reason, use the profile QICore MedicationAdministration Not Done.

The following example illustrates the accessing MedicationAdministration data:

define "Low Dose Unfractionated Heparin Administration":
  ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
    where VTEMedication.status = 'completed'
      and VTEMedication.category ~ QICoreCommon."Inpatient"

See the patterns page for implementation and usage patterns.

Examples

Inhalant Example
Cumulative Duration Example

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MedicationAdministration

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... status S1..1codein-progress | on-hold | completed | entered-in-error | stopped | unknown
Binding: Non-Negative MedicationAdministration Status (required)
... medication[x] S1..1What was administered
Binding: Medication Clinical Drug (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICore Medication)
... subject S1..1Reference(QICore Patient)Who received medication
... effective[x] S1..1dateTime, PeriodStart and end time of administration
... request S0..1Reference(QICore MedicationRequest)Request administration performed against
... dosage 0..1BackboneElementDetails of how medication was taken
.... route S0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (preferred)
.... dose S0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationAdministration.statusrequiredNonNegativeMedicationAdministrationStatus
MedicationAdministration.medication[x]preferredMedication Clinical Drug
MedicationAdministration.dosage.routepreferredSNOMEDCTRouteCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped | unknown
Binding: Non-Negative MedicationAdministration Status (required)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICore Medication)
... subject SΣ1..1Reference(QICore Patient)Who received medication
... context S0..1Reference(QICore Encounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... effective[x] SΣ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... request S0..1Reference(QICore MedicationRequest)Request administration performed against
... dosage C0..1BackboneElementDetails of how medication was taken
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... route S0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (preferred)
.... dose S0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationAdministration.statusrequiredNonNegativeMedicationAdministrationStatus
MedicationAdministration.medication[x]preferredMedication Clinical Drug
MedicationAdministration.dosage.routepreferredSNOMEDCTRouteCodes

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationAdministrationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationAdministrationIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationAdministrationIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationAdministrationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationAdministrationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mad-1errorMedicationAdministration.dosageSHALL have at least one of dosage.dose or dosage.rate[x]
: dose.exists() or rate.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... instantiates Σ0..*uriInstantiates protocol or definition
... partOf Σ0..*Reference(MedicationAdministration | Procedure)Part of referenced event
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped | unknown
Binding: Non-Negative MedicationAdministration Status (required)
... statusReason 0..*CodeableConceptReason administration not performed
Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.


... category 0..1CodeableConceptType of medication usage
Binding: MedicationAdministration Category Codes (preferred): A coded concept describing where the medication administered is expected to occur.

... medication[x] SΣ1..1What was administered
Binding: Medication Clinical Drug (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICore Medication)
... subject SΣ1..1Reference(QICore Patient)Who received medication
... context S0..1Reference(QICore Encounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... supportingInformation 0..*Reference(Resource)Additional information to support administration
... effective[x] SΣ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... performer Σ0..*BackboneElementWho performed the medication administration and what they did
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptType of performance
Binding: MedicationAdministration Performer Function Codes (example): A code describing the role an individual played in administering the medication.

.... actor Σ1..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device)Who performed the medication administration
... reasonCode 0..*CodeableConceptReason administration performed
Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.


... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport)Condition or observation that supports why the medication was administered
... request S0..1Reference(QICore MedicationRequest)Request administration performed against
... device 0..*Reference(Device)Device used to administer
... note 0..*AnnotationInformation about the administration
... dosage C0..1BackboneElementDetails of how medication was taken
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text 0..1stringFree text dosage instructions e.g. SIG
.... site 0..1CodeableConceptBody site administered to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route S0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (preferred)
.... method 0..1CodeableConceptHow drug was administered
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... dose S0..1SimpleQuantityAmount of medication per dose
.... rate[x] 0..1Dose quantity per unit of time
..... rateRatioRatio
..... rateQuantityQuantity(SimpleQuantity)
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationAdministration.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationAdministration.statusrequiredNonNegativeMedicationAdministrationStatus
MedicationAdministration.statusReasonexampleSNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.categorypreferredMedicationAdministration Category Codes
MedicationAdministration.medication[x]preferredMedication Clinical Drug
MedicationAdministration.performer.functionexampleMedicationAdministration Performer Function Codes
MedicationAdministration.reasonCodeexampleReasonMedicationGivenCodes
MedicationAdministration.dosage.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationAdministration.dosage.routepreferredSNOMEDCTRouteCodes
MedicationAdministration.dosage.methodexampleSNOMEDCTAdministrationMethodCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from MedicationAdministration

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... status S1..1codein-progress | on-hold | completed | entered-in-error | stopped | unknown
Binding: Non-Negative MedicationAdministration Status (required)
... medication[x] S1..1What was administered
Binding: Medication Clinical Drug (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICore Medication)
... subject S1..1Reference(QICore Patient)Who received medication
... effective[x] S1..1dateTime, PeriodStart and end time of administration
... request S0..1Reference(QICore MedicationRequest)Request administration performed against
... dosage 0..1BackboneElementDetails of how medication was taken
.... route S0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (preferred)
.... dose S0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationAdministration.statusrequiredNonNegativeMedicationAdministrationStatus
MedicationAdministration.medication[x]preferredMedication Clinical Drug
MedicationAdministration.dosage.routepreferredSNOMEDCTRouteCodes

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped | unknown
Binding: Non-Negative MedicationAdministration Status (required)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICore Medication)
... subject SΣ1..1Reference(QICore Patient)Who received medication
... context S0..1Reference(QICore Encounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... effective[x] SΣ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... request S0..1Reference(QICore MedicationRequest)Request administration performed against
... dosage C0..1BackboneElementDetails of how medication was taken
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... route S0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (preferred)
.... dose S0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationAdministration.statusrequiredNonNegativeMedicationAdministrationStatus
MedicationAdministration.medication[x]preferredMedication Clinical Drug
MedicationAdministration.dosage.routepreferredSNOMEDCTRouteCodes

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationAdministrationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationAdministrationIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationAdministrationIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationAdministrationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationAdministrationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mad-1errorMedicationAdministration.dosageSHALL have at least one of dosage.dose or dosage.rate[x]
: dose.exists() or rate.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... instantiates Σ0..*uriInstantiates protocol or definition
... partOf Σ0..*Reference(MedicationAdministration | Procedure)Part of referenced event
... status ?!SΣ1..1codein-progress | on-hold | completed | entered-in-error | stopped | unknown
Binding: Non-Negative MedicationAdministration Status (required)
... statusReason 0..*CodeableConceptReason administration not performed
Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.


... category 0..1CodeableConceptType of medication usage
Binding: MedicationAdministration Category Codes (preferred): A coded concept describing where the medication administered is expected to occur.

... medication[x] SΣ1..1What was administered
Binding: Medication Clinical Drug (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICore Medication)
... subject SΣ1..1Reference(QICore Patient)Who received medication
... context S0..1Reference(QICore Encounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... supportingInformation 0..*Reference(Resource)Additional information to support administration
... effective[x] SΣ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... performer Σ0..*BackboneElementWho performed the medication administration and what they did
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptType of performance
Binding: MedicationAdministration Performer Function Codes (example): A code describing the role an individual played in administering the medication.

.... actor Σ1..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device)Who performed the medication administration
... reasonCode 0..*CodeableConceptReason administration performed
Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.


... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport)Condition or observation that supports why the medication was administered
... request S0..1Reference(QICore MedicationRequest)Request administration performed against
... device 0..*Reference(Device)Device used to administer
... note 0..*AnnotationInformation about the administration
... dosage C0..1BackboneElementDetails of how medication was taken
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text 0..1stringFree text dosage instructions e.g. SIG
.... site 0..1CodeableConceptBody site administered to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route S0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (preferred)
.... method 0..1CodeableConceptHow drug was administered
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... dose S0..1SimpleQuantityAmount of medication per dose
.... rate[x] 0..1Dose quantity per unit of time
..... rateRatioRatio
..... rateQuantityQuantity(SimpleQuantity)
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationAdministration.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationAdministration.statusrequiredNonNegativeMedicationAdministrationStatus
MedicationAdministration.statusReasonexampleSNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.categorypreferredMedicationAdministration Category Codes
MedicationAdministration.medication[x]preferredMedication Clinical Drug
MedicationAdministration.performer.functionexampleMedicationAdministration Performer Function Codes
MedicationAdministration.reasonCodeexampleReasonMedicationGivenCodes
MedicationAdministration.dosage.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationAdministration.dosage.routepreferredSNOMEDCTRouteCodes
MedicationAdministration.dosage.methodexampleSNOMEDCTAdministrationMethodCodes

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron