HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1 - Local Development build (v0.9.1). See the Directory of published versions

MedicationStatement

 

The official URL for this profile is:

http://hl7.org/fhir/us/mcode/StructureDefinition/obf-MedicationStatement

A record of the use of a medication (individual administration or entire course). The use may be reported by the patient or clinician and adminstration does not have to be directly observed.

Implementation note: Although FHIR supports the asserter (information source) and date asserted, it does not have a place for the author (who created and is responsible for the statement) and recorder (who entered the statement). Extensions are provided.

Conformance note: The treatment of 'not taken' has changed from DSTU2 and STU3 to R4. In R4, status and statusReason are used to indicate medications not taken. For upward compatibility, the 'not taken' attributes are profiled out. ReasonCode is a choice of CodeableConcept or ref(Condition) in DSTU2, and limited to one reason (pick a type). In STU3 and R4, there can be multiple reason codes, and multiple reason references, simultaneously.

Implementation note: Preference is given to using the National Library of Medicine (NLM) RxNorm terminology for medications. RxNorm is a coding standard established by the Office of the National Coordinator (ONC). However, RxNorm is restricted to FDA-approved drugs and does not include clinical trial drugs. MedicationStatement allows for the inclusion of other coding systems like the NCI Thesaurus (NCIT) to represent clinical trial oncology drugs.

This profile builds on USCoreMedicationStatementProfile.

This profile was published on Thu Aug 01 00:00:00 EDT 2019 as a active by HL7 International Clinical Interoperability Council.

Summary

Mandatory: 0 element (1 nested mandatory element)
Must-Support: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Mapping Source

This structure represents the following mapping definition:

obf.MedicationStatement maps to http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationstatement:
  Language maps to language
  ImplicitRules maps to implicitRules
  Metadata.VersionId maps to meta.versionId
  Metadata.SourceSystem maps to meta.source
  Metadata.Profile maps to meta.profile
  Metadata.LastUpdated maps to meta.lastUpdated
  Metadata.SecurityLabel maps to meta.security
  Metadata.Tag maps to meta.tag
  Narrative maps to text
  Identifier maps to identifier
  MedicationBasedOn maps to basedOn
  MedicationStatementPartOf maps to partOf
  Status maps to status
  StatusReason maps to statusReason
  Category maps to category
  MedicationCodeOrReference maps to medication[x]
  SubjectOfRecord maps to subject
  CareContext maps to context
  OccurrenceTimeOrPeriod maps to effective[x]
  StatementDateTime maps to dateAsserted
  MedicationInformationSource maps to informationSource
  SupportingInformation maps to derivedFrom  //erroneous attribute name in FHIR STU3, R4
  ReasonCode maps to reasonCode
  MedicationReasonReference maps to reasonReference
  Annotation maps to note
  Dosage maps to dosage

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement I0..*obf-MedicationStatement
... 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)
Max Binding: AllLanguages
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... obf-TreatmentIntent-extension S0..1CodeableConceptTreatmentIntent
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TreatmentIntent-extension
Binding: TreatmentIntentVS (required)
... obf-TerminationReason-extension S0..*CodeableConceptTerminationReason
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension"
.... valueCodeableConcept 1..1CodeableConceptValue of extension
Binding: TreatmentTerminationReasonVS (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal identifier
... basedOn Σ0..*Reference(ServiceRequest | US Core MedicationRequest Profile)Fulfils plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | obf-MedicationStatement | obf-Procedure | obf-Observation)Part of referenced event
... status ?!SΣ1..1codeactive | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
Binding: Medication Status Codes (required)
... statusReason 0..*CodeableConceptReason for current status
Binding: SNOMEDCTDrugTherapyStatusCodes (example)
... category Σ0..1CodeableConceptType of medication usage
Binding: Medication Status Codes (preferred)
... medication[x] SΣ1..1CodeableConcept, Reference(US Core Medication Profile)What medication was taken
Binding: US Core Medication Codes (RxNorm) (extensible)
... subject SΣ1..1Reference(obf-Patient)Who is/was taking the medication
... context Σ0..1Reference(US Core Encounter Profile | EpisodeOfCare)Encounter / Episode associated with MedicationStatement
... effective[x] SΣ1..1dateTime, PeriodThe date/time or interval when the medication is/was/will be taken
... dateAsserted SΣ1..1dateTimeWhen the statement was asserted?
... informationSource 0..1Reference(obf-Patient | US Core Practitioner Profile | RelatedPerson | US Core Organization Profile)Person or organization that provided the information about the taking of this medication
... derivedFrom S0..*Reference(Resource)Additional supporting information
... reasonCode 0..1CodeableConceptReason for why the medication is being/was taken
Binding: Condition/Problem/DiagnosisCodes (example)
... reasonReference 0..1Reference(obf-Condition | obf-Observation | obf-DiagnosticReport)Condition or observation that supports why the medication is being/was taken
... note 0..*AnnotationFurther information about the statement
... dosage 0..1DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Summary

Mandatory: 0 element (1 nested mandatory element)
Must-Support: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Mapping Source

This structure represents the following mapping definition:

obf.MedicationStatement maps to http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationstatement:
  Language maps to language
  ImplicitRules maps to implicitRules
  Metadata.VersionId maps to meta.versionId
  Metadata.SourceSystem maps to meta.source
  Metadata.Profile maps to meta.profile
  Metadata.LastUpdated maps to meta.lastUpdated
  Metadata.SecurityLabel maps to meta.security
  Metadata.Tag maps to meta.tag
  Narrative maps to text
  Identifier maps to identifier
  MedicationBasedOn maps to basedOn
  MedicationStatementPartOf maps to partOf
  Status maps to status
  StatusReason maps to statusReason
  Category maps to category
  MedicationCodeOrReference maps to medication[x]
  SubjectOfRecord maps to subject
  CareContext maps to context
  OccurrenceTimeOrPeriod maps to effective[x]
  StatementDateTime maps to dateAsserted
  MedicationInformationSource maps to informationSource
  SupportingInformation maps to derivedFrom  //erroneous attribute name in FHIR STU3, R4
  ReasonCode maps to reasonCode
  MedicationReasonReference maps to reasonReference
  Annotation maps to note
  Dosage maps to dosage

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement I0..*obf-MedicationStatement
... 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)
Max Binding: AllLanguages
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... obf-TreatmentIntent-extension S0..1CodeableConceptTreatmentIntent
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TreatmentIntent-extension
Binding: TreatmentIntentVS (required)
... obf-TerminationReason-extension S0..*CodeableConceptTerminationReason
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension"
.... valueCodeableConcept 1..1CodeableConceptValue of extension
Binding: TreatmentTerminationReasonVS (required)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal identifier
... basedOn Σ0..*Reference(ServiceRequest | US Core MedicationRequest Profile)Fulfils plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | obf-MedicationStatement | obf-Procedure | obf-Observation)Part of referenced event
... status ?!SΣ1..1codeactive | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
Binding: Medication Status Codes (required)
... statusReason 0..*CodeableConceptReason for current status
Binding: SNOMEDCTDrugTherapyStatusCodes (example)
... category Σ0..1CodeableConceptType of medication usage
Binding: Medication Status Codes (preferred)
... medication[x] SΣ1..1CodeableConcept, Reference(US Core Medication Profile)What medication was taken
Binding: US Core Medication Codes (RxNorm) (extensible)
... subject SΣ1..1Reference(obf-Patient)Who is/was taking the medication
... context Σ0..1Reference(US Core Encounter Profile | EpisodeOfCare)Encounter / Episode associated with MedicationStatement
... effective[x] SΣ1..1dateTime, PeriodThe date/time or interval when the medication is/was/will be taken
... dateAsserted SΣ1..1dateTimeWhen the statement was asserted?
... informationSource 0..1Reference(obf-Patient | US Core Practitioner Profile | RelatedPerson | US Core Organization Profile)Person or organization that provided the information about the taking of this medication
... derivedFrom S0..*Reference(Resource)Additional supporting information
... reasonCode 0..1CodeableConceptReason for why the medication is being/was taken
Binding: Condition/Problem/DiagnosisCodes (example)
... reasonReference 0..1Reference(obf-Condition | obf-Observation | obf-DiagnosticReport)Condition or observation that supports why the medication is being/was taken
... note 0..*AnnotationFurther information about the statement
... dosage 0..1DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON, TTL), Schema: XML Schematron

 

Terminology Bindings

PathConformanceValueSet
MedicationStatement.languagepreferredCommonLanguages
Max Binding: AllLanguages
MedicationStatement.extension:terminationreason.valueCodeableConceptrequiredTreatmentTerminationReasonVS
MedicationStatement.statusrequiredMedication Status Codes
MedicationStatement.statusReasonexampleSNOMEDCTDrugTherapyStatusCodes
MedicationStatement.categorypreferredMedication Status Codes
MedicationStatement.medication[x]extensibleUSCoreMedicationCodes
MedicationStatement.reasonCodeexampleCondition/Problem/DiagnosisCodes

 

Constraints

IdPathDetailsRequirements
dom-2MedicationStatementIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-4MedicationStatementIf 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-3MedicationStatementIf 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-6MedicationStatementA resource should have narrative for robust management
: text.div.exists()
dom-5MedicationStatementIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()