臺灣核心實作指引(TW Core IG)
0.3.2 - Ci-Build Trial Use

臺灣核心實作指引(TW Core IG), published by 衛生福利部. This guide is not an authorized publication; it is the continuous build for version 0.3.2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cctwFHIRterm/MOHW_TWCoreIG_Build/ and changes regularly. See the Directory of published versions

Resource Profile: TW Core Medication

Official URL: https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/Medication-twcore Version: 0.3.2
Active as of 2025-02-04 Computable Name: TWCoreMedication

此臺灣核心-藥品(TW Core Medication) Profile說明本IG如何進一步定義FHIR的Medication Resource以呈現藥品的詳細資料。

Resource Medication - 內容

這個 resource 主要被用來識別和定義開處方、配藥、給藥、以及藥品使用聲明之藥品。

範圍與使用

在大部分健康照護環境中,描述藥品通常涉及從一個清單中選擇一項藥品,然後將選擇的藥品的參照資訊轉達給與病人相關的 resources 或其他應用程序。經常會提供額外的藥品資訊來進行人工確認,但是藥品的完整組成和功效的詳細資訊是透過參照藥典並使用它們定義的代碼來傳達的。有時候,當需要同時識別藥品和它的包裝,例如在配製一個有特定藥品包裝的藥品時,就需要識別更多細節。也有一些情況(例如:自製配方)需要表明藥品的組成。在這些情況下,需要具體指明藥品的成分和含量,儘管 Medication resource 並不提供完整的細節。

Medication resource 允許藥品透過其藥品劑型和成分(或多個成分)以及包裝方式進行描述。藥品將包括其成分及其強度,而包裝則包括特定容器中包含的量(例如:藥片數量、體積等),比如一瓶含100粒阿莫西林500毫克膠囊(100 capsules of Amoxicillin 500mg per bottle)。

用於描述藥局在配藥時製造的複方(即時配藥或處方藥)時,可以使用 Medication resource。這種情況下會有多種成分,通常是基本化學物質(例如:氫化可的松粉),也可能包括製成品(例如:Glaxal Base)作為其他成分。

當藥品包括包裝時,可以進一步提供有關其組成的詳細資訊。包裝通常包含一個容器(例如:真空包裝盒、罐子等)以及包裝中的產品或其他包裝的清單。

Medication resource 被以下 resources 所參照:活動定義(ActivityDefinition)、醫療不良事件(AdverseEvent)、照護計畫(CarePlan)、目錄內的條目(CatalogEntry)、費用項目( ChargeItem)、費用項目定義(ChargeItemDefinition)、標記(Flag)、群體(Group)、藥品(Medication)、給藥(MedicationAdministration)、配藥或調劑藥品(MedicationDispense)、藥品知識(MedicationKnowledge)、藥品請求(MedicationRequest)、用藥聲明(MedicationStatement)、醫藥產品禁忌(MedicinalProductContraindication)、醫藥產品適應症(MedicinalProductIndication)、醫藥產品交互作用(MedicinalProductInteraction)、醫藥產品不良反應(MedicinalProductUndesirableEffect)、處置(Procedure)、供應品遞送(SupplyDelivery)及供應品請求(SupplyRequest

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. Medication 0..* Medication 藥品的定義
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
... id Σ 0..1 id 不重複的ID用以識別儲存在特定FHIR Server中的Medication紀錄,通常又稱為邏輯性ID。
... meta Σ 0..1 Meta 此Medication Resource的metadata
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri 創建此內容所依據的一組規則
ele-1: All FHIR elements must have a @value or children
... text 0..1 Narrative Medication Resource之內容摘要以供人閱讀
ele-1: All FHIR elements must have a @value or children
... 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
... identifier Σ 0..* Identifier 此藥品的業務用識別碼
ele-1: All FHIR elements must have a @value or children
... code SΣ 0..1 CodeableConceptTW 指明這種藥品的代碼。
Binding: SNOMEDCTMedicationCodes (example): 此資料項目為可擴充綁定預設國際標準值集,但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表,待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理,以利進行跨國與跨系統之資料交換。


ele-1: All FHIR elements must have a @value or children
.... Slices for coding SΣ 0..* CodingTW 由專門術語系統(terminology system)定義的代碼。此資料項目為可擴充綁定預設國際標準值集,但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表,待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理,以利進行跨國與跨系統之資料交換。
Slice: Unordered, Open by pattern:$this
ele-1: All FHIR elements must have a @value or children
..... coding:fda-medication-tw SΣ 0..1 CodingTW 此為臺灣食品藥物管理署(TFDA)維護之藥品代碼,涵蓋範圍相對完整,可免費使用,可優先選用此代碼。
Binding: 臺灣食藥署藥品及醫療器材代碼值集 (required): 應填入所綁定值集中的其中一個代碼。


ele-1: All FHIR elements must have a @value or children
..... coding:nhi-medication-tw SΣ 0..1 CodingTW 此為中央健康保險署(NHI)維護之藥品代碼,主要針對申報使用,更新頻率相對頻繁,可免費使用,可依情境選用此代碼。
Binding: 臺灣健保署用藥品項代碼值集 (required): 應填入所綁定值集中的其中一個代碼。


ele-1: All FHIR elements must have a @value or children
..... coding:nhi-medication-ch-herb-tw SΣ 0..1 CodingTW 此為中央健康保險署(NHI)維護之中藥藥品代碼,主要針對申報使用,更新頻率相對頻繁,可免費使用,可依情境選用此代碼。
Binding: 臺灣健保署中藥用藥品項值集 (required): 應填入所綁定值集中的其中一個代碼。


ele-1: All FHIR elements must have a @value or children
..... coding:rxnorm-medication-us-core SΣ 0..1 CodingTW RxNorm為美國Unified Medical Language System®中的藥品代碼,取得UMLS®授權即可免費使用,可依情境選用此代碼。
Binding: RxNorm藥品代碼值集 (required): 應填入所綁定值集中的其中一個代碼。


ele-1: All FHIR elements must have a @value or children
..... coding:atc-medication-code SΣ 0..1 CodingTW ATC代碼的版權為世界衛生組織(WHO)Collaborating Centre for Drug Statistics Methodology,可免費使用,可依情境選用此代碼。
Binding: 臺灣食藥署藥品藥理治療分類ATC碼值集 (required): 應填入所綁定值集中的其中一個代碼。


ele-1: All FHIR elements must have a @value or children
..... coding:snomedct-medication-codes SΣ 0..1 CodingTW 此為SNOMED CT代碼,若機構已有購買相關授權,亦可使用。
Binding: SNOMEDCTMedicationCodes (required): 可參考所綁定值集,但此值集只是針對這個欄位的一個可能值的範例,不預期也不鼓勵使用者一定要使用此值集的代碼。


ele-1: All FHIR elements must have a @value or children
.... text SΣ 0..1 string 概念的文字表示法
ele-1: All FHIR elements must have a @value or children
... status ?!Σ 0..1 code active | inactive | entered-in-error
Binding: Medication Status Codes (required): 應填入所綁定值集中的其中一個代碼


ele-1: All FHIR elements must have a @value or children
... manufacturer Σ 0..1 Reference(TW Core Organization) 此藥品的製造商
ele-1: All FHIR elements must have a @value or children
... form S 0..1 CodeableConceptTW powder | tablets | capsule +
Binding: SNOMEDCTFormCodes (example): 此資料項目為可擴充綁定預設國際標準值集,但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表,待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理,以利進行跨國與跨系統之資料交換。


ele-1: All FHIR elements must have a @value or children
.... Slices for coding SΣ 1..* CodingTW powder | tablets | capsule + 此資料項目為可擴充綁定預設國際標準值集,但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表,待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理,以利進行跨國與跨系統之資料交換。
Slice: Unordered, Open by pattern:$this
ele-1: All FHIR elements must have a @value or children
..... coding:v3-orderableDrugForm SΣ 1..1 CodingTW 由專門術語系統(terminology system)定義的代碼
Binding: HL7 OrderableDrugForm藥品劑型值集 (required): 應填入所綁定值集中的其中一個代碼


ele-1: All FHIR elements must have a @value or children
..... coding:snomed-sct-form-codes SΣ 0..1 CodingTW 由專門術語系統(terminology system)定義的代碼
Binding: SNOMEDCTFormCodes (required): 應填入所綁定值集中的其中一個代碼


ele-1: All FHIR elements must have a @value or children
.... text SΣ 0..1 string 概念的文字表示法
ele-1: All FHIR elements must have a @value or children
... amount Σ 0..1 Ratio 每包裝的藥品數量或容量
ele-1: All FHIR elements must have a @value or children
... ingredient 0..* BackboneElement 有使用或沒有使用的藥品成份
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
.... item[x] 1..1 實際的成份或內容物
ele-1: All FHIR elements must have a @value or children
..... itemCodeableConcept CodeableConcept(CodeableConceptTW)
..... itemReference Reference(TW Core Medication | Substance)
.... isActive 0..1 boolean 有效成份指標
ele-1: All FHIR elements must have a @value or children
.... strength 0..1 Ratio 所含成份的劑量
ele-1: All FHIR elements must have a @value or children
... batch 0..1 BackboneElement 關於包裝藥品的細節
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
.... lotNumber 0..1 string 藥品的批號
ele-1: All FHIR elements must have a @value or children
.... expirationDate 0..1 dateTime 有效期限
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Medication.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Medication.codeexampleSNOMEDCTMedicationCodes
http://hl7.org/fhir/ValueSet/medication-codes
from the FHIR Standard
Medication.code.coding:fda-medication-twrequiredTWMedicationFDA
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-fda-tw
from this IG
Medication.code.coding:nhi-medication-twrequiredTWMedicationNHI (a valid code from 臺灣健保署用藥品項)
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-nhi-tw
from this IG
Medication.code.coding:nhi-medication-ch-herb-twrequiredTWCHHerbMedicationNHI (a valid code from 臺灣健保署中藥用藥品項)
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/nhi-medication-ch-herb-tw
from this IG
Medication.code.coding:rxnorm-medication-us-corerequiredTWMedicationRXNORM
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-rxnorm-tw
from this IG
Medication.code.coding:atc-medication-coderequiredTWMedcationATC
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medcation-atc-tw
from this IG
Medication.code.coding:snomedct-medication-codesrequiredSNOMEDCTMedicationCodes
http://hl7.org/fhir/ValueSet/medication-codes
from the FHIR Standard
Medication.statusrequiredMedication Status Codes
http://hl7.org/fhir/ValueSet/medication-status|4.0.1
from the FHIR Standard
Medication.formexampleSNOMEDCTFormCodes
http://hl7.org/fhir/ValueSet/medication-form-codes
from the FHIR Standard
Medication.form.coding:v3-orderableDrugFormrequiredOrderableDrugForm
https://twcore.mohw.gov.tw/ig/twcore/ValueSet/v3-orderableDrugForm
from this IG
Medication.form.coding:snomed-sct-form-codesrequiredSNOMEDCTFormCodes
http://hl7.org/fhir/ValueSet/medication-form-codes
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationIf 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-4errorMedicationIf 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-5errorMedicationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationA 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()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

以下概述了此Profile所需的RESTful FHIR互動功能。有關TW Core IG支援的RESTful互動功能的完整清單,請參閱TW Core Server能力聲明

建議應該支援以下查詢參數:

  1. 建議應該(SHOULD) 支援透過查詢參數 _id 查詢所有Medication:
    (如何透過token查詢)
    GET [base]/Medication?_id=[id]
    GET [base]/Medication/[id]

    例子:
    (1) GET [base]/Medication?_id=med-example
    (2) GET [base]/Medication/med-example

  2. 建議應該(SHOULD) 支援透過查詢參數 code 查詢所有Medication:
    (如何透過token查詢)
    GET [base]/Medication?code={system|}[code]

    例子:
    (1) GET [base]/Medication?code=https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/medication-fda-tw|衛署藥輸字第025485號