QI-Core Implementation Guide
4.1.0 - release

This page is part of the Quality Improvement Core Framework (v4.1.0: STU 4) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Resource Profile: QICoreMedicationAdministration

Defining URL:http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
Version:4.1.0
Name:QICoreMedicationAdministration
Status:Draft as of 8/22/18
Definition:

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

Publisher:http://www.hl7.org/Special/committees/cqi/index.cfm
Source Resource:XML / JSON / Turtle

The official URL for this profile is: 

http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
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-mednotadministered.

The MedicationAdministration and MedicationNotAdministered profiles represent the positive and negative statements for a medication administration. To ensure instances retrieved meet positive intent, applications should check the status element as illustrated in this example:

// QICoreMedicationAdministration
// @profile: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
define MedicationAdministration:
  [MedicationAdministration] M
    where M.status in { 'in-progress', 'on-hold', 'completed' }

The following example illustrates the accessing MedicationAdministration data:

// connectathon/fhir4/cql/EXM108_FHIR4-8.2.000.cql
define "Low Dose Unfractionated Heparin Administration":
  ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
    where VTEMedication.status = 'completed'
      and VTEMedication.category ~ "Inpatient"

See the patterns page for implementation and usage patterns.

Examples

Inhalant Example

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 | not-done | on-hold | completed | entered-in-error | stopped | unknown
... statusReason S0..*CodeableConceptReason administration not performed
... medication[x] S1..1What was administered
Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICoreMedication)
... context S0..1Reference(QICoreEncounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... effective[x] S1..1dateTime, PeriodStart and end time of administration
... performer 0..*BackboneElementWho performed the medication administration and what they did
.... actor 1..1Reference(QICorePractitioner | QICorePatient | QICoreRelatedPerson | QICoreDevice)Who performed the medication administration
... reasonCode S0..*CodeableConceptReason administration performed
... request 0..1Reference(QICoreMedicationRequest)Request administration performed against
... device 0..*Reference(QICoreDevice)Device used to administer
... dosage 0..1BackboneElementDetails of how medication was taken
.... route S0..1CodeableConceptPath of substance into body
.... dose S0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... id Σ0..1stringLogical 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)
Max Binding: AllLanguages: A human language.

... 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 | not-done | on-hold | completed | entered-in-error | stopped | unknown
Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.

... statusReason S0..*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: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICoreMedication)
... subject SΣ1..1Reference(QICorePatient)Who received medication
... context S0..1Reference(QICoreEncounter | 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(QICorePractitioner | QICorePatient | QICoreRelatedPerson | QICoreDevice)Who performed the medication administration
... reasonCode S0..*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 0..1Reference(QICoreMedicationRequest)Request administration performed against
... device 0..*Reference(QICoreDevice)Device used to administer
... note 0..*AnnotationInformation about the administration
... dosage I0..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 (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... 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
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... status ?!Σ1..1codein-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.

... statusReason 0..*CodeableConceptReason administration not performed
Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.


... medication[x] Σ1..1What was administered
Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICoreMedication)
... context 0..1Reference(QICoreEncounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... effective[x] Σ1..1Start and end time of administration
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
... reasonCode 0..*CodeableConceptReason administration performed
Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.


... dosage I0..1BackboneElementDetails of how medication was taken
.... route 0..1CodeableConceptPath of substance into body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... dose 0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format

Differential View

This structure is derived from MedicationAdministration

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... status S1..1codein-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
... statusReason S0..*CodeableConceptReason administration not performed
... medication[x] S1..1What was administered
Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICoreMedication)
... context S0..1Reference(QICoreEncounter | EpisodeOfCare)Encounter or Episode of Care administered as part of
... effective[x] S1..1dateTime, PeriodStart and end time of administration
... performer 0..*BackboneElementWho performed the medication administration and what they did
.... actor 1..1Reference(QICorePractitioner | QICorePatient | QICoreRelatedPerson | QICoreDevice)Who performed the medication administration
... reasonCode S0..*CodeableConceptReason administration performed
... request 0..1Reference(QICoreMedicationRequest)Request administration performed against
... device 0..*Reference(QICoreDevice)Device used to administer
... dosage 0..1BackboneElementDetails of how medication was taken
.... route S0..1CodeableConceptPath of substance into body
.... dose S0..1SimpleQuantityAmount of medication per dose

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration 0..*MedicationAdministrationAdministration of medication to a patient
... id Σ0..1stringLogical 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)
Max Binding: AllLanguages: A human language.

... 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 | not-done | on-hold | completed | entered-in-error | stopped | unknown
Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.

... statusReason S0..*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: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(QICoreMedication)
... subject SΣ1..1Reference(QICorePatient)Who received medication
... context S0..1Reference(QICoreEncounter | 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(QICorePractitioner | QICorePatient | QICoreRelatedPerson | QICoreDevice)Who performed the medication administration
... reasonCode S0..*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 0..1Reference(QICoreMedicationRequest)Request administration performed against
... device 0..*Reference(QICoreDevice)Device used to administer
... note 0..*AnnotationInformation about the administration
... dosage I0..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 (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... 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

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
MedicationAdministration.languagepreferredCommonLanguages
Max Binding: AllLanguages
MedicationAdministration.statusrequiredMedicationAdministration Status Codes
MedicationAdministration.statusReasonexampleSNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.categorypreferredMedicationAdministration Category Codes
MedicationAdministration.medication[x]preferredUSCoreMedicationCodes
MedicationAdministration.performer.functionexampleMedicationAdministration Performer Function Codes
MedicationAdministration.reasonCodeexampleReasonMedicationGivenCodes
MedicationAdministration.dosage.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationAdministration.dosage.routeexampleSNOMEDCTRouteCodes
MedicationAdministration.dosage.methodexampleSNOMEDCTAdministrationMethodCodes

Constraints

IdGradePathDetailsRequirements
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-1errorMedicationAdministration.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorMedicationAdministration.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorMedicationAdministration.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorMedicationAdministration.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorMedicationAdministration.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.instantiatesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.partOfAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.statusReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.medication[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.subjectAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.contextAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.supportingInformationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.effective[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.performerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.performer.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorMedicationAdministration.performer.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorMedicationAdministration.performer.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorMedicationAdministration.performer.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorMedicationAdministration.performer.functionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.performer.actorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.reasonCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.reasonReferenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.requestAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.deviceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.noteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.dosageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
mad-1errorMedicationAdministration.dosageSHALL have at least one of dosage.dose or dosage.rate[x]
: dose.exists() or rate.exists()
ele-1errorMedicationAdministration.dosage.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorMedicationAdministration.dosage.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorMedicationAdministration.dosage.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorMedicationAdministration.dosage.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorMedicationAdministration.dosage.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.dosage.siteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.dosage.routeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.dosage.methodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.dosage.doseAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.dosage.rate[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorMedicationAdministration.eventHistoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())