QI-Core Implementation Guide
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QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

Resource Profile: QICore MedicationAdministration Not Done

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministrationnotdone Version: 7.0.0
Active as of 2018-08-22 Computable Name: QICoreMedicationAdministrationNotDone

Negation profile of MedicationAdministration for decision support/quality metrics. Indicates that a medication was not administered for a reason.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
QI Elements:
  • extension(recorded): (QI) Recorded
  • extension(recorded): (QI) Recorded
  • status: (QI) not-done
  • status: (QI) not-done
  • statusReason: (QI) Reason administration not performed
  • medication[x]: (QI) What was administered
  • medication[x].extension(codeOptions): (QI) Url of a value set of candidate medications
  • subject: (QI) Who received medication
  • context: (QI) Encounter or Episode of Care administered as part of
  • effective[x]: (QI) Start and end time of administration
  • request: (QI) Request administration performed against
  • dosage: (QI) Details of how medication was taken
  • dosage.route: (QI) Path of substance into body
  • dosage.dose: (QI) Amount of medication per dose
Primary code path: medication
(PCPath) This element is the primary code path for this resource CQL Retrieve


NOTE TO BALLOT REVIEWERS:
  • US Core 7.0, and thus QI-Core 7.0, has a new approach to USCDI requirements.
    • As noted in the US Core 7.0 Must Support section, US Core 7.0 no longer highlights mandatory (cardinality 1..* or 1..1) and Must Support elements with a (USCDI) indicator as such items must be supported for interoperability.
    • Those USCDI elements that are not mandatory or Must Support now include an indicator (ADDITIONAL USCDI) in US Core. QI-Core 7.0 does not reference USCDI elements; rather, users should access US Core 7.0 to understand its implementation of USCDI version 4.
  • We invite comments about the approach and suggestions for other options that would also avoid unnecessary noise or reading load to the QI-Core profile representation.
  • Further, QI-Core 7.0 does not discuss USCDI+Quality because at the time of ballot preparation, no published version of USCDI+Quality is available. We seek reviewer advice regarding how QI-Core might address future USCDI+Quality.

Usage

The MedicationAdministration profile defines the conformance expectations for a MedicationAdministration event, regardless of whether it is a positive or negative statement. The MedicationAdministrationDone and MedicationAdministrationNotDone profiles represent the positive and negative statements for a MedicationAdministration event.

To create an expression indicating existence of a MedicationAdministration, use the profile QICoreMedicationAdministrationDone; to specifically request information that a MedicationAdministration intentionally did not occur for a medical, patient or system reason, use the profile QICoreMedicationAdministrationNotDone.

The following example illustrates an expression to retrieve instances that meet measure intent for exclusion:

define "Low Dose Unfractionated Heparin for VTE Prophylaxis Not Administered":
  ["MedicationAdministrationNotDone": "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
    where VTEMedication.category ~ QICoreCommon."Inpatient"
      and (VTEMedication.reasonCode in "Medical Reason" or VTEMedication.reasonCode in "Patient Refusal")

For a more complete discussion of representation of negation within QI-Core and quality improvement artifacts, see the Negation in QI-Core topic.

See the patterns page for implementation and usage patterns.

Examples

Negation example using a valuesetMedication not administered using a value set to indicate what was not administered; indicates that none of the medications in the given value set were administered
Negation example using a codeMedication not administered using a code to indicate that a particular medication was not administered; indicates that a specific medication, by code, was not administered

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationAdministration C 0..* QICoreMedicationAdministration Administration of medication to a patient
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
qma-1: To indicate what medication, either a reference to a Medication or at least one coding in the medication or a codeOptions extension shall be provided
... 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 1..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... recorded 1..1 dateTime (QI) Recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationAdministration.recorded
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
... statusReason 1..1 CodeableConcept (QI) Reason administration not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed


ele-1: All FHIR elements must have a @value or children
... medication[x] ΣC 1..1 (QI) What was administered
Binding: Medication Clinical Drug . (preferred): The set of RxNorm codes to represent medications


ele-1: All FHIR elements must have a @value or children
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions C 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... subject Σ 1..1 Reference(QICore Patient) (QI) Who received medication
ele-1: All FHIR elements must have a @value or children
... effective[x] Σ 1..1 (QI) Start and end time of administration
ele-1: All FHIR elements must have a @value or children
.... effectiveDateTime dateTime
.... effectivePeriod Period

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MedicationAdministration.statusrequiredFixed Value: not-done
http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.1
from the FHIR Standard
MedicationAdministration.statusReasonextensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationAdministration.medication[x]preferredMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationAdministrationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationAdministrationIf 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-4errorMedicationAdministrationIf 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-5errorMedicationAdministrationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationAdministrationA 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()
qma-1errorMedicationAdministrationTo indicate what medication, either a reference to a Medication or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()

 

Other representations of profile: CSV, Excel, Schematron