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

D.4.1 StructureDefinition-qicore-medicationdispense

Introduction:

See the patterns page for implementation and usage patterns.

Examples:

Penicillin MedicationDispense Example

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is:

http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationdispense

Profile of MedicationDispense for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

This profile builds on MedicationDispense.

This profile was published on Wed Aug 22 00:00:00 UTC 2018 as a draft by Health Level Seven, Inc. - CQI WG.

Description of Profiles, Differentials, and Snapshots.

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense I0..*Dispensing a medication to a named patient
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
Binding: MedicationDispense Status Codes (required)
... statusReason[x] S0..1Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example)
.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(http://hl7.org/fhir/R4/detectedissue.html)
... category 0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred)
... medication[x] SΣ1..1What medication was supplied
Binding: US Core Medication Codes (RxNorm) (preferred)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(http://hl7.org/fhir/R4/medication.html)
... subject SΣ0..1Reference(QICorePatient)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Resource)Information that supports the dispensing of the medication
... performer I0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptWho performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example)
.... actor 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription 0..*Reference(QICoreMedicationRequest)Medication order that authorizes the dispense
... type 0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (example)
... quantity S0..1SimpleQuantityAmount dispensed
... daysSupply S0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver S0..1dateTimeWhen product was given out
... destination 0..1Reference(QICoreLocation)Where the medication was sent
... receiver 0..*Reference(QICorePatient | QICorePractitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text Σ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example)
.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route SΣ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate SΣI0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ1..1CodeableConceptThe kind of dose or rate specified
Binding: SNOMED CT Dosages Codes (preferred)
..... dose[x] SΣ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution I0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
.... reason 0..*CodeableConceptWhy was substitution made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
.... responsibleParty 0..*Reference(QICorePractitioner)Who is responsible for the substitution
... detectedIssue 0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory 0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense I0..*Dispensing a medication to a named patient
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
Binding: MedicationDispense Status Codes (required)
... statusReason[x] S0..1Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example)
.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(http://hl7.org/fhir/R4/detectedissue.html)
... category 0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred)
... medication[x] SΣ1..1What medication was supplied
Binding: US Core Medication Codes (RxNorm) (preferred)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(http://hl7.org/fhir/R4/medication.html)
... subject SΣ0..1Reference(QICorePatient)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Resource)Information that supports the dispensing of the medication
... performer I0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptWho performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example)
.... actor 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription 0..*Reference(QICoreMedicationRequest)Medication order that authorizes the dispense
... type 0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (example)
... quantity S0..1SimpleQuantityAmount dispensed
... daysSupply S0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver S0..1dateTimeWhen product was given out
... destination 0..1Reference(QICoreLocation)Where the medication was sent
... receiver 0..*Reference(QICorePatient | QICorePractitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text Σ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example)
.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route SΣ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate SΣI0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ1..1CodeableConceptThe kind of dose or rate specified
Binding: SNOMED CT Dosages Codes (preferred)
..... dose[x] SΣ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution I0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
.... reason 0..*CodeableConceptWhy was substitution made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
.... responsibleParty 0..*Reference(QICorePractitioner)Who is responsible for the substitution
... detectedIssue 0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory 0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
MedicationDispense.languagepreferredCommonLanguages
Max Binding: AllLanguages
MedicationDispense.statusrequiredMedicationDispense Status Codes
MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
MedicationDispense.categorypreferredMedicationDispense Category Codes
MedicationDispense.medication[x]preferredUSCoreMedicationCodes
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
MedicationDispense.typeexamplev3.ActPharmacySupplyType
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
MedicationDispense.substitution.typeexamplev3.ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexamplev3.SubstanceAdminSubstitutionReason

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2MedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-4MedicationDispenseIf 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-3MedicationDispenseIf 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-6MedicationDispenseA resource should have narrative for robust management
: text.div.exists()
dom-5MedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
mdd-1MedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
ele-1MedicationDispense.performerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.doseAndRateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.substitutionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())