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 Clinical Quality Framework (CQF) Medication Prescription Profile - Definitions

Todo

Definitions for the cqf-medicationprescription-cqf-medicationprescription Profile.

MedicationPrescription(cqf-medicationprescription)
Definition

Profile of medication prescription, indicating which elements must be supported in rule and measure interpreters. Includes active and completed prescriptions, not those that were stopped, on-hold, superceded, or entered in error.

Control1..1
Requirements
Comments
MedicationPrescription.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.

MedicationPrescription.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
MedicationPrescription.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.

MedicationPrescription.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).

MedicationPrescription.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.

MedicationPrescription.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.

MedicationPrescription.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.

MedicationPrescription.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.

MedicationPrescription.identifier
Definition

External identifier - one that would be used by another non-FHIR system - for example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an erntire workflow process where records have to be tracked through an entire system.

Control0..*
TypeIdentifier
Is Modifiertrue
Requirements
Comments
MedicationPrescription.dateWritten
Definition

The date (and perhaps time) when the prescription was written.

Control0..1
TypedateTime
Must Supporttrue
Requirements
Comments
MedicationPrescription.status
Definition

active | on-hold | completed | stopped.

Control0..1
BindingA code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
The codes SHALL be taken from CQFMedicationPrescriptionStatus
Typecode
Is Modifiertrue
Must Supporttrue
Requirements
Comments
MedicationPrescription.patient
Definition

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

Control1..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Patient))
Must Supporttrue
Requirements
Comments

SubstanceAdministration->subject->Patient.

MedicationPrescription.prescriber
Definition

The healthcare professional responsible for authorizing the prescription.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner))
Must Supporttrue
Requirements
Comments
MedicationPrescription.encounter
Definition

A link to a resource that identifies the particular occurrence of contact between patient and health care provider.

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

SubstanceAdministration->component->EncounterEvent.

MedicationPrescription.reasonCodeableConcept
Definition

Can be the reason or the indication for writing the prescription.

Control0..1
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
MedicationPrescription.note
Definition

Extra information about the prescription that could not be conveyed by the other attributes.

Control0..1
Typestring
Requirements
Comments
MedicationPrescription.medication
Definition

Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an 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))
Must Supporttrue
Requirements
Comments

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

MedicationPrescription.dosageInstruction
Definition

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

Control0..*
Must Supporttrue
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.

MedicationPrescription.dosageInstruction.id
Definition

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

Control0..1
Typeid
Requirements
Comments
MedicationPrescription.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.

MedicationPrescription.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.

MedicationPrescription.dosageInstruction.text
Definition

Free text dosage instructions can be used for cases where the instructions are too complex to code. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication.

Control0..1
Typestring
Requirements
Comments
MedicationPrescription.dosageInstruction.additionalInstructions
Definition

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

Control0..1
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
MedicationPrescription.dosageInstruction.scheduled[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
Must Supporttrue
Requirements
Comments
MedicationPrescription.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
Must Supporttrue
Requirements
Comments
MedicationPrescription.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
Must Supporttrue
Requirements
Comments
MedicationPrescription.dosageInstruction.route
Definition

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

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
Must Supporttrue
Requirements
Comments
MedicationPrescription.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
Must Supporttrue
Requirements
Comments
MedicationPrescription.dosageInstruction.doseQuantity
Definition

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

Control0..1
TypeQuantity
Must Supporttrue
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.

MedicationPrescription.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
Must Supporttrue
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.

MedicationPrescription.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
Must Supporttrue
Requirements
Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets ever 4 hours to a maximum of 8/day".

MedicationPrescription.dispense
Definition

Deals with details of the dispense part of the order.

Control0..1
Must Supporttrue
Requirements
Comments
MedicationPrescription.dispense.id
Definition

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

Control0..1
Typeid
Requirements
Comments
MedicationPrescription.dispense.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.

MedicationPrescription.dispense.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.

MedicationPrescription.dispense.medication
Definition

Identifies the medication being administered. This is a link to a resource that represents the medication which may be the details of the medication or simply an 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))
Must Supporttrue
Requirements
Comments
MedicationPrescription.dispense.validityPeriod
Definition

Design Comments: This indicates the validity period of a prescription (stale dating the Prescription) It reflects the prescriber perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations. Rationale: Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Control0..1
TypePeriod
Must Supporttrue
Requirements
Comments
MedicationPrescription.dispense.numberOfRepeatsAllowed
Definition

An integer indicating the number of repeats of the Dispense. UsageNotes: For example, the number of times the prescribed quantity is to be supplied including the initial standard fill.

Control0..1
Typeinteger
Must Supporttrue
Requirements
Comments

If displaying "number of authorized refills", subtract 1 from this number.

MedicationPrescription.dispense.quantity
Definition

The amount that is to be dispensed for one fill.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
MedicationPrescription.dispense.expectedSupplyDuration
Definition

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

Control0..1
TypeDuration
Must Supporttrue
Requirements
Comments
MedicationPrescription.substitution
Definition

Indicates whether or not substitution can or should be part of the dispense. In some cases substitution must happen, in other cases substitution must not happen, and in others it does not matter. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Control0..1
Must Supporttrue
Requirements
Comments
MedicationPrescription.substitution.id
Definition

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

Control0..1
Typeid
Requirements
Comments
MedicationPrescription.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.

MedicationPrescription.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.

MedicationPrescription.substitution.type
Definition

A code signifying whether a different drug should be 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
Must Supporttrue
Requirements
Comments
MedicationPrescription.substitution.reason
Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Control0..1
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
Must Supporttrue
Requirements
Comments