QI-Core Implementation Guide: STU 4 (v4.0.0 for FHIR 4.0.0)

QI-Core Implementation Guide, Clinical Quality Improvement WG - CI build for vesion 4.0.0). This version is based on the current content of https://github.com/cqframework/qi-core/ and changes regularly. See the Directory of published versions

7.16.0 Medication

QDM defines Medication as clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm. QDM defines five contexts for Medication, each of which is listed below referencing the US-Core or FHIR resource which provides the expected context:

7.16.1 Medication, Active

This QDM context correlates with a medication on a patient’s active medication list and thus it maps to MedicationStatement. Note that MedicationStatement does not include reference to the QDM attributes route or frequency or recorder. These attributes may be important if the medication list is the only source of information about medication usage and quality measures or clinical decision support (CDS) expressions need to assess total daily dosage or cumulative dose over time. Ordered medications (MedicationRequest) or dispensed medications (MedicationDispense) or administered medications (MedicationAsminstration) represent alternative mechanisms to determine such information.

QDM Context QI-Core R4 Comments
Medication, Active MedicationStatement
MedicationStatement.status Constrain to "active"
MedicationStatement.category inpatient, outpatient, community, patient-specified
QDM Attribute
code MedicationStatement.medication[x]
id MedicationStatement.id
Dosage MedicationStatement.dosage Dosage contains all information about how medication is taken (datatype) - incorporates frequency and route but may be a string
frequency MedicationStatement.dosage.timing Refer to MedicationRequest
route MedicationStatement.dosage.site
MedicationStatement.reasonCode
relevant dateTime MedicationStatement.effective[x] dateTime
relevant period MedicationStatement.effective[x] period
MedicationStatement.dateAsserted Author dateTime not referenced in QDM
recorder

7.16.2 Medication, Administered

This QDM context correlates with a record of a patient consuming or otherwise being administered a medication. It references individual medication administration events and, therefore, may not reference frequency of administration. Note that a separate QDM and US-Core profile address Immunization, Administered.

QDM Context QI-Core R4 Comments
Medication, Administered MedicationAdministration
MedicationAdministration.status Constrain status to "In-progress" or "completed"
MedicationAdministration.category Allows specification of Inpatient, Outpatient, Community
QDM Attributes
code MedicationAdministration.medication[x] ֵExample uses SNOMED substance codes
id MedicationAdministration.id
dosage MedicationAdministration.dosage.dose Simple Quantity - Amount of medication for one administration
MedicationAdministration.dosage.rate[x] Simple Quantity
route MedicationAdministration.dosage.route
frequency MedicationAdministration.request Reference to original MedicationRequest with content about prescription
MedicationRequest.dosageInstruction.timing Timing schedule (e.g., every 8 hours)
reason MedicationAdministration.reasonCode None, given as ordered, emergency
relevant dateTime MedicationAdministration.effective[x} dateTime
relevant Period MedicationAdministration.effective[x} Period
author dateTime
Negation rationale MedicationAdministration.status Constrain status to "not-done"
MedicationAdministration.statusReason
Performer MedicationAdministration.performer.actor

7.16.3 Medication, Dispensed

This QDM context maps to the FHIR MedicationDispense resource, indicating information about medications that have been dispensed.

QDM Context QI-Core R4 Comments
Medication, Dispensed MedicationDispense
MedicationDIspense.status Constrain MedicationDispense.status to active, completed, on-hold
QDM Attributes
code MedicationDispense.medication[x] SNOMED
id MedicationDispense.id
dosage MedicationDispense.dosageInstruction ordered, calculated
supply MedicationDispense.quantity
days supplied MedicationDispense.daysSupply
frequency MedicationDispense.dosageInstruction.timing See dosageInstruction
refills MedicationDispense.authorizingPrescription Reference authorizing prescription (MedicationRequest) which contains Medication.Request.dispsenseRequest.numberOfRepeatsAllowed
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
route MedicationDispense.dosageInstruction.route See dosageInstruction
setting MedicationDispense.category Inpatient, Outpatient, Community, Discharge
reason MedicationDispense.statusReason[x[ The reason for ordering or not ordering the medication
relevant dateTime MedicationDispense.whenHandedOver When provided to patient or representative
relevant Period MedicationDispense.extension:validityPeriod
author dateTime
Negation rationale MedicationDIspense.status Constrain MedicationDispense.status codes to "cancelled, declined
MedicationDispense.statusReason The reason for ordering or not ordering the medication
Prescriber MedicationDispense.authorizingPrescription Reference authorizing prescription (MedicationRequest) which contains Medication.Request.requester
MedicationRequest.requester
Dispenser MedicationDispense.performer

7.16.4 Medication, Order

This QDM context references the US-Core MedicationRequest resource with the MedicationRequest.intent = order and MedicationRequest.setting set to the setting most appropriate for the intended meaning of the quality measure or clinical decision support (CDS) expression.

7.16.5 Medication, Discharge

This QDM context specifically references the discharge medication list provided to a patient at the time of discharge from an inpatient setting. The list may include reference to new prescriptions sent to a pharmacy for dispensing and self-administration after discharge. It may also include over-the-counter medications and those medications already present in the patient’s home for which new prescriptions are not necessary.  The QDM Medication, Discharge concept is mapped to MedicationRequest as a request to the patient to take the medication with MedicationRequest.intent = plan and MedicationRequest.setting = discharge.

QDM Context QI-Core R4 Comments
Medication, Order MedicationRequest
MedicationRequest.status Constrain to active, completed, on-hold
MedicationRequest.statusReason
Request context (order Vs recommended) MedicationRequest.intent Constrain to "order" for Medication, Order - note that QDM does not include Medication, Recommended - should that concept be desired, use MedicationRequest.intent constrained to "plan"
QDM Attributes
code MedicationRequest.medication[x] RsNorm
id MedicationRequest.id
dosage MedicationRequest.dosageinstruction.doseAndRate.dose[x] Range, quantity
supply MedicationRequest.dispenseRequest.quantity Amount to be dispensed in one fill
days supplied MedicationRequest.dispenseRequest.expectedSupplyDuration Duration
frequency MedicationRequest.dosageInstruction.timing Timing schedule (e.g., every 8 hours)
refills MedicationRequest.dispenseRequest.numberOfRepeatsAllowed Integer
route MedicationRequest.dosageInstruction.site
setting MedicationRequset.category Constrain category to: Inpatient, Outpatient, Community (see Medication Discharge row for QDM Medication, Discharge)
reason MedicationRequest.reasonCode The reason for ordering or not ordering the medication
relevant dateTime
relevant Period MedicationRequest.dispenseRequest.validityPeriod
author dateTime MedicationRequest.authoredOn
Negation rationale MedicationRequest.doNotPerform
MedicationRequest.reasonCode The reason for ordering or not ordering the medication
Prescriber MedicationRequest.requester Note - MedicationRequest.performer indicates the performer expected to administer the medication
Medication, Discharge
setting MedicationRequset.category Constrain category to "Discharge" for QDM Medication, Discharge

7.16.6 Immunization, Order

This QDM context references the US-Core MedicationRequest resource as there is no other FHIR resource to reference an order for an immunization. The mapping uses the US-Core MedicationRequest resource with the MedicationRequest.intent = order and MedicationRequest.setting set to the setting most appropriate for the intended meaning of the quality measure or clinical decision support (CDS) expression.

QDM Context QI-Core R4 Comments
Immunization, Order MedicationRequest
MedicationRequest.status Constrain to active, completed, on-hold
MedicationRequest.statusReason The reason for ordering or not ordering the medication
MedicationRequest.intent Constrain to "order" for Medication, Order - note that QDM does not include Medication, Recommended - should that concept be desired, use MedicationRequest.intent constrained to "plan"
QDM Attributes
code MedicationRequest.medication[x] RxNorm
id MedicationRequest.id
active dateTime MedicationRequest.dispenseRequest.validityPeriod
author dateTime MedicationRequest.authoredOn
dosage MedicationRequest.dosageinstruction.doseAndRate.dose[x] Range, quantity
route MedicationRequest.dosageInstruction.site
reason MedicationRequest.reasonCode The reason for ordering or not ordering the medication
supply MedicationRequest.dispenseRequest.quantity Amount to be dispensed in one fill
Negation rationale MedicationRequest.doNotPerform Boolean
MedicationRequest.reasonCode The reason for ordering or not ordering the medication
Requester MedicationRequest.requester Note - MedicationRequest.performer indicates the performer expected to administer the medication