QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreMedication

Defining URL: | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
Version: | 4.1.0
Name: | QICoreMedication
Status: | Draft as of 8/22/18
Definition: | Profile of Medication for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
Publisher: | http://www.hl7.org/Special/committees/cqi/index.cfm
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication

Usage

See the patterns page for implementation and usage patterns.

    define function "GetMedicationCode"(request MedicationRequest):
      if request.medication is CodeableConcept then
        request.medication as CodeableConcept
      else
        (singleton from ([Medication] M where M.id = GetId((request.medication as Reference).reference))).code

### Examples

Example of an IV medication - Alemtuzumab

### Formal Views of Profile Content

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

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from USCoreMedicationProfile

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

- QICoreOrganization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICoreSubstance (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-substance)
- QICoreMedication (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication)

This structure is derived from USCoreMedicationProfile

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile | Definition of a Medication
code | S | 1..1 | CodeableConcept | Codes that identify this medication Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
manufacturer |  | 0..1 | Reference(QICoreOrganization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): This value set includes all dose form codes from SNOMED CT - provided as an exemplar.
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(QICoreSubstance | QICoreMedication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile | Definition of a Medication
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for this medication
code | S Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(QICoreOrganization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): This value set includes all dose form codes from SNOMED CT - provided as an exemplar.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(QICoreSubstance | QICoreMedication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile | Definition of a Medication
code | Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
Documentation for this format

This structure is derived from USCoreMedicationProfile

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

- QICoreOrganization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICoreSubstance (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-substance)
- QICoreMedication (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication)

Differential View

This structure is derived from USCoreMedicationProfile

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile | Definition of a Medication
code | S | 1..1 | CodeableConcept | Codes that identify this medication Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
manufacturer |  | 0..1 | Reference(QICoreOrganization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): This value set includes all dose form codes from SNOMED CT - provided as an exemplar.
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(QICoreSubstance | QICoreMedication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile | Definition of a Medication
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier for this medication
code | S Σ | 1..1 | CodeableConcept | Codes that identify this medication Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(QICoreOrganization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): This value set includes all dose form codes from SNOMED CT - provided as an exemplar.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(QICoreSubstance | QICoreMedication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet
Medication.language | preferred | CommonLanguages Max Binding: AllLanguages
Medication.code | preferred | USCoreMedicationCodes
Medication.status | required | Medication Status Codes
Medication.form | example | SNOMEDCTFormCodes

#### Constraints

Id | Grade | Path | Details | Requirements
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | Best Practice | Medication | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | Medication.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Medication.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Medication.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Medication.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Medication.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.manufacturer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.form | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.amount | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.ingredient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.ingredient.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Medication.ingredient.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Medication.ingredient.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Medication.ingredient.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Medication.ingredient.item[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.ingredient.isActive | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.ingredient.strength | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.batch | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.batch.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Medication.batch.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Medication.batch.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | Medication.batch.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | Medication.batch.lotNumber | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | Medication.batch.expirationDate | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |