Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1 United States of America flag

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

Resource Profile: CRD Medication Request

Official URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest Version: 2.1.0
Standards status: Trial-use Maturity Level: 3 Computable Name: CRDMedicationRequest
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.42.12

This profile specifies additional constraints on the US Core MedicationRequest profile to support coverage requirements discovery.

Usage


CRD Clients SHALL use this profile to resolve references to MedicationRequest resources passed to CRD Servers (e.g. selections context references) and to populate draftOrders context objects when invoking the when invoking the following CDS Hooks:

Information provided in Must Support elements will commonly be required for CRD Servers to perform coverage requirements discovery.

NOTE: This profile is not currently based on US Core because US Core accidentally constrained out PractitionerRole. When a future version of US-Core adds support back in, this profile will be revised to extend the US Core profile

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest C 0..* USCoreMedicationRequestProfile(7.0.0) Ordering of medication for patient or group
This profile also complies with the profile US Core MedicationRequest Profile (6.1.0)
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
us-core-21: requester SHALL be present if intent is "order"
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension Content/Rules for all slices
.... medicationAdherence 0..* (Complex) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Medication Adherence Extension
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... Coverage-Information S 0..* (Complex) Coverage Info
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... status ?!SΣ 1..1 code active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


ele-1: All FHIR elements must have a @value or children
Example General: draft
... intent ?!SΣC 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.


ele-1: All FHIR elements must have a @value or children
... Slices for category S 0..* CodeableConcept Type of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.


ele-1: All FHIR elements must have a @value or children
.... category:us-core S 0..* CodeableConcept Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


ele-1: All FHIR elements must have a @value or children
... reported[x] SΣ 0..1 Reported rather than primary record
ele-1: All FHIR elements must have a @value or children
.... reportedBoolean boolean
.... reportedReference Reference(US Core Practitioner Profile(7.0.0))
... medication[x] SΣ 1..1 Medication to be taken
Binding: Medication Clinical Drug . (extensible)
ele-1: All FHIR elements must have a @value or children
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(7.0.0))
... subject SΣ 1..1 Reference(US Core Patient Profile(7.0.0)) Who or group medication request is for
ele-1: All FHIR elements must have a @value or children
... encounter S 0..1 Reference(CRD Encounter) Encounter created as part of encounter/admission/stay
ele-1: All FHIR elements must have a @value or children
... authoredOn SΣ 1..1 dateTime When request was initially authored
ele-1: All FHIR elements must have a @value or children
... requester SΣC 1..1 Reference(US Core Practitioner Profile(7.0.0)) Who/What requested the Request
ele-1: All FHIR elements must have a @value or children
... performer S 0..1 Reference(US Core Practitioner Profile(7.0.0) | HRex PractitionerRole Profile) Intended performer of administration
ele-1: All FHIR elements must have a @value or children
... reasonCode S 0..* CodeableConcept 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Reason or indication for ordering or not ordering the medication
Binding: US Core Condition Codes (extensible)
ele-1: All FHIR elements must have a @value or children
... reasonReference S 0..* Reference(Condition | Observation) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: US Core Condition or Observation that supports the prescription
ele-1: All FHIR elements must have a @value or children
... basedOn Σ 0..* Reference(CRD Medication Request | CRD Service Request) What request fulfills
ele-1: All FHIR elements must have a @value or children
... dosageInstruction S 0..* Dosage How the medication should be taken
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... text SΣ 0..1 string Free text dosage instructions e.g. SIG
ele-1: All FHIR elements must have a @value or children
.... timing SΣ 0..1 Timing When medication should be administered
ele-1: All FHIR elements must have a @value or children
.... doseAndRate SΣ 0..* Element Amount of medication administered
ele-1: All FHIR elements must have a @value or children
..... dose[x] SΣ 0..1 Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding

ele-1: All FHIR elements must have a @value or children
...... doseQuantity Quantity(SimpleQuantity)
... dispenseRequest S 0..1 BackboneElement Medication supply authorization
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... numberOfRepeatsAllowed S 0..1 unsignedInt Number of refills authorized
ele-1: All FHIR elements must have a @value or children
.... quantity S 0..1 SimpleQuantity Amount of medication to supply per dispense
ele-1: All FHIR elements must have a @value or children
... substitution S 0..1 BackboneElement Any restrictions on medication substitution
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... allowed[x] 1..1 Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.


ele-1: All FHIR elements must have a @value or children
..... allowedBoolean boolean
..... allowedCodeableConcept CodeableConcept
... priorPrescription S 0..1 Reference(CRD Medication Request) An order/prescription that is being replaced
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
MedicationRequest.statusrequiredmedicationrequest Status
http://hl7.org/fhir/ValueSet/medicationrequest-status
from the FHIR Standard
MedicationRequest.intentrequiredmedicationRequest Intent
http://hl7.org/fhir/ValueSet/medicationrequest-intent
from the FHIR Standard
MedicationRequest.categoryexamplemedicationRequest Category Codes
http://hl7.org/fhir/ValueSet/medicationrequest-category
from the FHIR Standard
MedicationRequest.category:us-corerequiredmedicationRequest Category Codes
http://hl7.org/fhir/ValueSet/medicationrequest-category
from the FHIR Standard
MedicationRequest.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationRequest.reasonCodeextensibleUSCoreConditionCodes
http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
MedicationRequest.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationRequest.substitution.allowed[x]exampleActSubstanceAdminSubstitutionCode
http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationRequestIf 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-4errorMedicationRequestIf 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-5errorMedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationRequestA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
us-core-21errorMedicationRequestrequester SHALL be present if intent is "order"
: (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Notes

While the codes for the medication are expected to be drawn from RxNorm, EHRs MAY send additional coding repetions to communicate other code systems (e.g. HCPCS J codes). This may be necessary for the payer to appropriately respond to coverage information regarding medications associated with medical and DME benefits.