HL7.FHIR.US.QICORE\QICore MedicationRequest

QI-Core Implementation Guide
5.0.0 - STU5 United States of America flag

This page is part of the Quality Improvement Core Framework (v5.0.0: STU5 (v5.0.0)) 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: QICore MedicationRequest

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest				Version: 5.0.0
Active as of 2018-08-22				Computable Name: QICoreMedicationRequest

Profile of MedicationRequest 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 MedicationRequest intentionally did not occur for a medical, patient or system reason, use the profile QICore-Medicationnotrequested.

The following example illustrates the use of the MedicationRequest profile:

define "Antithrombotic Therapy at Discharge":
  ["MedicationRequest": medication in "Antithrombotic Therapy"] Antithrombotic
    where (Antithrombotic.isCommunity() or Antithrombotic.isDischarge())
      and Antithrombotic.status in { 'active', 'completed' }
      and Antithrombotic.intent = 'order'

See the patterns page for implementation and usage patterns.

Examples

Penicillin MedicationRequest Example

Cumulative Medication Duration Example

Patient Reported MedicationRequest Example

Patient Requested MedicationRequest Example

Practitioner Ordered MedicationRequest Example

Usage:

Formal Views of Profile Content

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

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from USCoreMedicationRequestProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group dom-7: if doNotPerform is present, it SHALL be false
status	S	1..1	code	active \| on-hold \| cancelled \| completed \| entered-in-error \| stopped \| draft \| unknown
doNotPerform	S	0..1	boolean	True if medication was not requested Fixed Value: false
reported[x]	S	0..1	Reference(QICore Practitioner S \| QICore PractitionerRole S \| QICore Patient S \| QICore RelatedPerson S)	Reported rather than primary record
subject	S	1..1	Reference(QICore Patient)	Who or group medication request is for
encounter	S	0..1	Reference(QICore Encounter)	Encounter created as part of encounter/admission/stay
authoredOn	S	1..1	dateTime	When request was initially authored
requester	S	1..1	Reference(QICore Practitioner \| QICore Patient \| QICore PractitionerRole)	Who/What requested the Request
recorder		0..1	Reference(QICore Practitioner \| QICore PractitionerRole)	Person who entered the request
dosageInstruction	S	0..*	Dosage	How the medication should be taken
timing	S	0..1	Timing	When medication should be administered
repeat	S	0..1	Element	When the event is to occur
bounds[x]	S	0..1	Duration, Range, Period	Length/Range of lengths, or (Start and/or end) limits
frequency	S	0..1	positiveInt	Event occurs frequency times per period
frequencyMax	S	0..1	positiveInt	Event occurs up to frequencyMax times per period
period	S	0..1	decimal	Event occurs frequency times per period
periodMax	S	0..1	decimal	Upper limit of period (3-4 hours)
periodUnit	S	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM)
asNeeded[x]	S	0..1	boolean, CodeableConcept	Take "as needed" (for x)
site	S	0..1	CodeableConcept	Body site to administer to
route		0..1	CodeableConcept	How drug should enter body
method		0..1	CodeableConcept	Technique for administering medication
doseAndRate	S	0..*	Element	Amount of medication administered
dose[x]	S	0..1	Range, SimpleQuantity	Amount of medication per dose
dispenseRequest	S	0..1	BackboneElement	Medication supply authorization
initialFill	S	0..0
dispenseInterval	S	0..1	Duration	Minimum period of time between dispenses
validityPeriod	S	0..1	Period	Time period supply is authorized for
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized
quantity	S	0..1	SimpleQuantity	Amount of medication to supply per dispense
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-7	error	MedicationRequest	if doNotPerform is present, it SHALL be false : doNotPerform.empty() or doNotPerform=false

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	USCoreMedicationRequestProfile	Ordering of medication for patient or group dom-7: if doNotPerform is present, it SHALL be false
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active \| on-hold \| cancelled \| completed \| entered-in-error \| stopped \| draft \| unknown Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
intent	?!SΣ	1..1	code	proposal \| plan \| order \| original-order \| reflex-order \| filler-order \| instance-order \| option Binding: medicationRequest Intent (required): The kind of medication order.
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
doNotPerform	?!SΣ	0..1	boolean	True if medication was not requested Fixed Value: false
reported[x]	SΣ	0..1	Reference(QICore Practitioner \| QICore PractitionerRole \| QICore Patient \| QICore RelatedPerson)	Reported rather than primary record
medication[x]	SΣ	1..1		Medication to be taken Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(QICore Patient)	Who or group medication request is for
encounter	S	0..1	Reference(QICore Encounter)	Encounter created as part of encounter/admission/stay
authoredOn	SΣ	1..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(QICore Practitioner \| QICore Patient \| QICore PractitionerRole)	Who/What requested the Request
recorder		0..1	Reference(QICore Practitioner \| QICore PractitionerRole)	Person who entered the request
dosageInstruction	S	0..*	Dosage	How the medication should be taken
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
timing	SΣ	0..1	Timing	When medication should be administered
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
repeat	SΣC	0..1	Element	When the event is to occur
bounds[x]	SΣ	0..1		Length/Range of lengths, or (Start and/or end) limits
boundsDuration			Duration
boundsRange			Range
boundsPeriod			Period
frequency	SΣ	0..1	positiveInt	Event occurs frequency times per period
frequencyMax	SΣ	0..1	positiveInt	Event occurs up to frequencyMax times per period
period	SΣ	0..1	decimal	Event occurs frequency times per period
periodMax	SΣ	0..1	decimal	Upper limit of period (3-4 hours)
periodUnit	SΣ	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: UnitsOfTime (required): A unit of time (units from UCUM).
asNeeded[x]	SΣ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	SΣ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How drug should enter 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	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	SΣ	0..*	Element	Amount of medication administered
dose[x]	SΣ	0..1		Amount of medication per dose
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dispenseRequest	S	0..1	BackboneElement	Medication supply authorization
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
dispenseInterval	S	0..1	Duration	Minimum period of time between dispenses
validityPeriod	S	0..1	Period	Time period supply is authorized for
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized
quantity	S	0..1	SimpleQuantity	Amount of medication to supply per dispense
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationRequest.status	required	medicationrequest Status
MedicationRequest.intent	required	medicationRequest Intent
MedicationRequest.category	example	medicationRequest Category Codes
MedicationRequest.category:us-core	required	medicationRequest Category Codes
MedicationRequest.medication[x]	extensible	Medication Clinical Drug
MedicationRequest.dosageInstruction.timing.repeat.periodUnit	required	UnitsOfTime
MedicationRequest.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes
MedicationRequest.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes
MedicationRequest.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	If 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-4	error	MedicationRequest	If 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-5	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
dom-7	error	MedicationRequest	if doNotPerform is present, it SHALL be false : doNotPerform.empty() or doNotPerform=false
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
tim-1	error	MedicationRequest.dosageInstruction.timing.repeat	if there's a duration, there needs to be duration units : duration.empty() or durationUnit.exists()
tim-2	error	MedicationRequest.dosageInstruction.timing.repeat	if there's a period, there needs to be period units : period.empty() or periodUnit.exists()
tim-4	error	MedicationRequest.dosageInstruction.timing.repeat	duration SHALL be a non-negative value : duration.exists() implies duration >= 0
tim-5	error	MedicationRequest.dosageInstruction.timing.repeat	period SHALL be a non-negative value : period.exists() implies period >= 0
tim-6	error	MedicationRequest.dosageInstruction.timing.repeat	If there's a periodMax, there must be a period : periodMax.empty() or period.exists()
tim-7	error	MedicationRequest.dosageInstruction.timing.repeat	If there's a durationMax, there must be a duration : durationMax.empty() or duration.exists()
tim-8	error	MedicationRequest.dosageInstruction.timing.repeat	If there's a countMax, there must be a count : countMax.empty() or count.exists()
tim-9	error	MedicationRequest.dosageInstruction.timing.repeat	If there's an offset, there must be a when (and not C, CM, CD, CV) : offset.empty() or (when.exists() and ((when in ('C' \| 'CM' \| 'CD' \| 'CV')).not()))
tim-10	error	MedicationRequest.dosageInstruction.timing.repeat	If there's a timeOfDay, there cannot be a when, or vice versa : timeOfDay.empty() or when.empty()