FHIR Resources for MMM
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FHIR resources for MMA
Functional resources – transaction content
- Search medications for a patient: medicationRequest http://build.fhir.org/medicationrequest.html
- Must have a specific parameter (medicationRequest.intent or other) to select only the lists of administrations planned, not the prescriptions and encoded orders, etc.
- Search criteria:
- OPEN: Date/time of administration=<...> <-- this should be in dosageInstruction.???
- Patient=<...>
- Status = Active
- OPEN: Nurse=<...>
- medicationRequest.intent="instance-order" <-- this is agreed but needs to be in FHIR. 12446 and 12379 submitted.
- Do we support that the nursing app does the "encoding" from BID to "one at 9, another at 15h00"???
- GET medicationRequests for today
- The response is several MedicationRequest resources:
- Identifier = XXX
- Definition (if there is a protocol, but not now)
- BasedOn: Pointer to prescription/plan
- Requisition: the multiline prescription to which each prescription belongs
- Status = active
- Stage: “instance-order”
- Medication: each medication
- Patient: patient resource
- Context: encounter / ????
- SupportingInformation (none?)
- dateWritten: when it was decoded
- Requester:
- reasonCode: the indication or diagnosis
- reasonReference: a pointer to a condition or observation
- note: administration notes
- category: outpatient or inpatient
- dosageinstruction.
- Sequence=?
- Text=??? (we must clarify how this differs from the Notes above)
- additionalInstructions=?
- Timing
- event = 13:00 or
- When = lunch
- Site
- Route
- Method
- Dose.doseQuantity=1
- Maxdoseperadministration=1
- The response is several MedicationRequest resources:
HOW TO support partial administration? Suggestion: We use administration to document every event in the administration (e.g. change of bag, change of nurse).
- Send report of administration: medicationAdministration http://build.fhir.org/medicationadministration.html
- Must include non-administrations, as well as other information
- Do we include perfusion administration?
- Do we need to differentiate already-dispensed medication with to-be-dispensed medication? Suggestion: perhaps we later have to append a “dispense” resource.
- Later: Delivery and not administration (supplyDelivery? Dispense?)
- Later: consume 2 items to administer only 1.
- medicationAdministration
- identifier
- medicationAdministration
Technical transport: How to get information from server to client
- Option 1: REST PULL
- Nurse app must retrieve the medication administrations planned for the treatment.
- Search parameters in medicationRequest , search criteria same as above:
- 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..
- Client filtering from getting all records from all nurses
- IHE search extension
- 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.
- Option 2: Subscription
- Search criteria are the same above
- PUSH mechanism: Messaging or email.
- For messaging, we add messageheader.
- https://www.hl7.org/fhir/messageheader.html
Question: how to handle these transport mechanisms? Jose will ask how ITI is handling it so far.