FHIR Resources for MMM

FHIR resources for MMA

Functional resources – transaction content

1. Search medications for a patient: medicationRequest http://build.fhir.org/medicationrequest.html
   1. Must have a specific parameter (medicationRequest.intent or other) to select only the lists of administrations planned, not the prescriptions and encoded orders, etc.
   2. Search criteria:
      1. OPEN: Date/time of administration=<...> <-- this should be in dosageInstruction.???
      2. Patient=<...>
      3. Status = Active
      4. OPEN: Nurse=<...>
      5. medicationRequest.intent="instance-order" <-- this is agreed but needs to be in FHIR. 12446 and 12379 submitted.
         1. Do we support that the nursing app does the "encoding" from BID to "one at 9, another at 15h00"???

1. GET medicationRequests for today
   1. The response is several MedicationRequest resources:
      1. Identifier = XXX
      2. Definition (if there is a protocol, but not now)
      3. BasedOn: Pointer to prescription/plan
      4. Requisition: the multiline prescription to which each prescription belongs
      5. Status = active
      6. Stage: “instance-order”
      7. Medication: each medication
      8. Patient: patient resource
      9. Context: encounter / ????
      10. SupportingInformation (none?)
      11. dateWritten: when it was decoded
      12. Requester:
      13. reasonCode: the indication or diagnosis
      14. reasonReference: a pointer to a condition or observation
      15. note: administration notes
      16. category: outpatient or inpatient
      17. dosageinstruction.
          1. Sequence=?
          2. Text=??? (we must clarify how this differs from the Notes above)
          3. additionalInstructions=?
          4. Timing
             1. event = 13:00 or
             2. When = lunch
          5. Site
          6. Route
          7. Method
          8. Dose.doseQuantity=1
          9. Maxdoseperadministration=1

HOW TO support partial administration? Suggestion: We use administration to document every event in the administration (e.g. change of bag, change of nurse).

1. Send report of administration: medicationAdministration http://build.fhir.org/medicationadministration.html
   1. Must include non-administrations, as well as other information
   2. Do we include perfusion administration?
   3. Do we need to differentiate already-dispensed medication with to-be-dispensed medication? Suggestion: perhaps we later have to append a “dispense” resource.
   4. Later: Delivery and not administration (supplyDelivery? Dispense?)
   5. Later: consume 2 items to administer only 1.

1. 1. medicationAdministration
      1. identifier

 

 

Technical transport: How to get information from server to client

1. Option 1: REST PULL
   1. Nurse app must retrieve the medication administrations planned for the treatment.
   2. Search parameters in medicationRequest , search criteria same as above:
   3. GET, https://www.hl7.org/fhir/medicationorder.html#search

       

   Possible gap: how can we search for only this nurse?

   It is not in the search criteria. So..

   1. Client filtering from getting all records from all nurses
   2. IHE search extension
   3. Core: medicationrequest.Performer would be the best (not DispenseRequest.Performer).

      IHE can add search parameters, but we will align with HL7 first.

    

   Gap: Query on date of planned administration – should be part of the search criteria.

   IHE extension or FHIR Core. Will propose and align.

    

2. Option 2: Subscription

   Search criteria are the same above

   1. Use http://build.fhir.org/subscription.html

       

   PUSH mechanism: Messaging or email.

   For messaging, we add messageheader.

   https://www.hl7.org/fhir/messageheader.html

   1.  

Question: how to handle these transport mechanisms? Jose will ask how ITI is handling it so far.