AU Core Implementation Guide
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AU Core Implementation Guide, published by HL7 Australia. This guide is not an authorized publication; it is the continuous build for version 1.1.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/au-fhir-core/ and changes regularly. See the Directory of published versions

Resource Profile: AU Core MedicationRequest

Official URL: http://hl7.org.au/fhir/core/StructureDefinition/au-core-medicationrequest Version: 1.1.0-ci-build
Standards status: Trial-use Maturity Level: 2 Computable Name: AUCoreMedicationRequest

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License. HL7 Australia© 2022+; Licensed Under Creative Commons No Rights Reserved.

This profile sets minimum expectations for a MedicationRequest resource to record, search, and fetch medication orders and requests (i.e. prescriptions) associated with a patient. It is based on the AU Base Medication Request profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the MedicationRequest when conforming to this profile. It provides the floor for standards development for specific uses cases in an Australian context.

See Comparison with other national and international IGs for a comparison between AU Core profiles and profiles in other implementation guides.

Usage scenarios

The following are supported usage scenarios for this profile:

  • Query medication orders or prescriptions for a patient (current and historical)
  • Record or update medication orders or prescriptions for a patient

Profile specific implementation guidance

  • See the Medicine Information page for guidance on how medicinal product identification can be structured in FHIR conformant to AU Core.
  • When recording “self-prescribed” medication, MedicationRequest.requester references the Patient or RelatedPerson as the prescriber.
  • MedicationRequest resources can represent a medication using either a code with MedicationRequest.medicationCodeableConcept, or reference a Medication resource with MedicationRequest.medicationReference.
    • Although both are marked as Must Support, responders are not required to support both a code and a reference, but they SHALL support at least one of these elements
    • A requester SHALL support both elements
    • When referencing a Medication resource, it is preferred the resource is contained but it may be an external resource
    • If an external reference to a Medication resource is used, the responder SHALL support the _include parameter for searching this element
    • The requester SHALL support all method
  • The MedicationRequest resource can represent the clinical indication as a code with MedicationRequest.reasonCode, or a reference with MedicationRequest.reasonReference to a Condition or other resource.
    • Although both are marked as Must Support, responders are not required to support both a code and a reference, but they SHALL support at least one of these elements
    • A requester SHALL support both elements

Usage:

Changes since version 1.0.0:

  • The resource metadata has changed (description)

    • Formal Views of Profile Content

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

    This structure is derived from AUBaseMedicationRequest

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationRequest 0..* AUBaseMedicationRequest A request for a medication for a patient in an Australian healthcare context
    ... status SO 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... intent SO 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... Slices for medication[x] SO 1..1 CodeableConcept, Reference(Medication) Medication to be taken
    Slice: Unordered, Closed by type:$this
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... medication[x]:medicationCodeableConcept 0..1 CodeableConcept Coded Prescribed Medication
    ..... Slices for coding 0..* Coding Code defined by a terminology system
    Slice: Unordered, Open by pattern:$this
    ...... coding:pbs SO 0..* Coding Code defined by a terminology system
    Binding: PBS Item Codes (required)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ...... coding:amt SO 0..* Coding Code defined by a terminology system
    Binding: Australian Medication . (required)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... medication[x]:medicationReference O 0..1 Reference(AU Core Medication) Prescribed Medication
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... encounter SO 0..1 Reference(AU Core Encounter) Encounter created as part of encounter/admission/stay
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... authoredOn SOC 1..1 dateTime Created date
    au-core-medreq-01: Date shall be precise to the day or, if not available, the Data Absent Reason extension shall be present
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... requester SO 1..1 Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Core RelatedPerson) Who/What requested the Request
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... reasonCode SO 0..* CodeableConcept Reason or indication for ordering or not ordering the medication
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... reasonReference SO 0..* Reference(AU Core Condition | Observation) Condition or observation that supports why the prescription is being written
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... dosageInstruction SO 0..* AUBaseDosage How the medication should be taken
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    MedicationRequest.medication[x]:medicationCodeableConcept.coding:pbsrequiredPBSItemCodes
    http://terminology.hl7.org.au/ValueSet/pbs-item
    MedicationRequest.medication[x]:medicationCodeableConcept.coding:amtrequiredAustralianMedication .
    https://healthterminologies.gov.au/fhir/ValueSet/australian-medication-1

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-medreq-01errorMedicationRequest.authoredOnDate shall be precise to the day or, if not available, the Data Absent Reason extension shall be present
    : $this.hasValue() implies (extension('http://hl7.org/fhir/StructureDefinition/data-absent-reason').value.exists().not() and $this.toString().length() >= 10)

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Below is an overview of the mandatory and optional search parameters and combined search parameters. See the AU Core CapabilityStatements for a complete list of supported RESTful interactions for this IG.

    FHIR search operations are described here and the syntax used to describe AU Core interactions is defined here.

    Any search parameter defined in FHIR may be ‘allowed’ by the system unless explicitly marked as “SHALL NOT”. A few items are marked as MAY in this implementation guide to highlight their potential relevance.

    Parameter(s) Conformance Type(s) Requirements (when used alone or in combination)
    patient SHALL reference The requester SHALL provide at least an id value and MAY provide both the Type and id values. The responder SHALL support both.

    The requester SHOULD support chained search patient.identifier using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile. The responder SHOULD support chained search patient.identifier using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile.
    patient+status SHALL reference+token
    patient+intent SHOULD reference+token
    patient+intent+status SHOULD reference+token+token
    _id SHOULD token
    patient+intent+authoredon SHOULD reference+token+date
    authoredon MAY date A requester SHALL provide a value precise to the second + time offset. A responder SHALL support a value precise to the second + time offset.

    The requester SHALL support these search comparators gt, lt, ge, le. The responder SHALL support these search comparators gt, lt, ge, le.

    The requester SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le. The responder SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le.
    intent MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.
    status MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHALL support multipleOr. The responder SHALL support multipleOr.

    Mandatory Search Parameters

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching using the patient search parameter:
      • SHOULD support these _include parameters: MedicationRequest:medication
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/MedicationRequest?patient={Type/}[id] or optionally GET [base]/MedicationRequest?patient.identifier=[system|][code]

      Example:

      1. GET [base]/MedicationRequest?patient=5678
      2. GET [base]/MedicationRequest?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
      3. GET [base]/MedicationRequest?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952&_include=MedicationRequest:medication
      4. GET [base]/MedicationRequest?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient (how to search by reference and how to search by token)

    2. SHALL support searching using the combination of the patient and status search parameters:
      • SHOULD support these _include parameters: MedicationRequest:medication
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support multipleOr search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/MedicationRequest?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/MedicationRequest?patient=5678&status=active
      2. GET [base]/MedicationRequest?patient=5678&status=active&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and status (how to search by reference and how to search by token)

    Optional Search Parameters

    The following search parameters and search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the _id search parameter:
      • SHOULD support these _include parameters: MedicationRequest:medication

      GET [base]/MedicationRequest?_id=[id]

      Example:

      1. GET [base]/MedicationRequest?_id=2169591
      2. GET [base]/MedicationRequest?_id=2169591&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle with the requested MedicationRequest, instead of just the resource itself, and allows for the inclusion of additional search parameters such as _include, _revinclude, or _lastUpdated (how to search by id of the resource)

    2. SHOULD support searching using the combination of the patient and intent and authoredon search parameters:
      • SHOULD support these _include parameters: MedicationRequest:medication
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support these authoredon comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on authoredon (e.g.authoredon=[date]&authoredon=[date]]&...), and if multipleAnd is supported, SHALL support the search comparators gt,lt,ge,le

      GET [base]/MedicationRequest?patient={Type/}[id]&intent={system|}[code]&authoredon={gt|lt|ge|le}[date]{&authoredon={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/MedicationRequest?patient=5678&intent=order&authoredon=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent and date (how to search by reference and how to search by token and how to search by date)

    3. SHOULD support searching using the combination of the patient and intent search parameters:
      • SHOULD support these _include parameters: MedicationRequest:medication
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/MedicationRequest?patient={Type/}[id]&intent={system|}[code]

      Example:

      1. GET [base]/MedicationRequest?patient=5678&intent=order

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent (how to search by reference and how to search by token)

    4. SHOULD support searching using the combination of the patient and intent and status search parameters:
      • SHOULD support these _include parameters: MedicationRequest:medication
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support multipleOr search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/MedicationRequest?patient={Type/}[id]&intent={system|}[code]&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/MedicationRequest?patient=5678&intent=order&status=active
      2. GET [base]/MedicationRequest?patient=5678&intent=order&status=active&_include=MedicationRequest:medication

      Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and intent and status (how to search by reference and how to search by token)