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-medicationrequest

Introduction:

See the patterns page for implementation and usage patterns.

Examples:

Penicillin MedicationRequest 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-medicationrequest

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

This profile builds on USCoreMedicationRequestProfile.

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
.. MedicationRequest I0..*Ordering of medication for patient or group
... 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 ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required)
... statusReason 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example)
... intent ?!Σ1..1codeproposal | plan | order | original-order | instance-order | option
Binding: medicationRequest Intent (required)
... category S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (preferred)
... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required)
... doNotPerform ?!SΣ0..1booleanTrue if request is prohibiting action
... reported[x] Σ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(http://hl7.org/fhir/R4/patient.html | http://hl7.org/fhir/R4/practitioner.html | http://hl7.org/fhir/R4/practitionerrole.html | http://hl7.org/fhir/R4/relatedperson.html | http://hl7.org/fhir/R4/organization.html)
... medication[x] SΣ1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (preferred)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(StructureDefinition-qicore-medication.html)
... subject SΣ1..1Reference(QICorePatient)Who or group medication request is for
... encounter S0..1Reference(QICoreEncounter)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ1..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(QICorePractitioner | QICorePractitionerRole | QICorePatient | QICoreRelatedPerson | QICoreOrganization | QICoreDevice)Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)Intended performer of administration
... performerType Σ0..1CodeableConceptDesired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example)
... recorder 0..1Reference(QICorePractitioner | QICorePractitionerRole)Person who entered the request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Problem (preferred)
... reasonReference 0..*Reference(Condition | Observation)Condition or observation that supports why the prescription is being written
... instantiatesCanonical Σ0..*canonical()Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)What request fulfills
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... courseOfTherapyType 0..1CodeableConceptOverall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes (example)
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note 0..*AnnotationInformation about the prescription
... dosageInstruction S0..*DosageHow the medication should be taken
.... 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 SΣ0..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 Σ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site SΣ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate ΣI0..*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 Σ0..1CodeableConceptThe kind of dose or rate specified
Binding: DoseAndRateType (example)
..... dose[x] Σ0..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
... dispenseRequest SI0..1BackboneElementMedication supply authorization
.... 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
.... initialFill I0..1BackboneElementFirst fill details
..... 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
..... quantity 0..1SimpleQuantityFirst fill quantity
..... duration 0..1DurationFirst fill duration
.... dispenseInterval 0..1DurationMinimum period of time between dispenses
.... validityPeriod 0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed 0..1unsignedIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution I0..1BackboneElementAny restrictions on medication substitution
.... 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
.... allowed[x] 1..1Whether substitution is allowed or not
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
..... allowedBooleanboolean
..... allowedCodeableConceptCodeableConcept
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
... priorPrescription 0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue 0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest I0..*Ordering of medication for patient or group
... 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 ids for this request
... status ?!SΣ1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required)
... statusReason 0..1CodeableConceptReason for current status
Binding: medicationRequest Status Reason Codes (example)
... intent ?!Σ1..1codeproposal | plan | order | original-order | instance-order | option
Binding: medicationRequest Intent (required)
... category S0..*CodeableConceptType of medication usage
Binding: medicationRequest Category Codes (preferred)
... priority Σ0..1coderoutine | urgent | asap | stat
Binding: RequestPriority (required)
... doNotPerform ?!SΣ0..1booleanTrue if request is prohibiting action
... reported[x] Σ0..1Reported rather than primary record
.... reportedBooleanboolean
.... reportedReferenceReference(http://hl7.org/fhir/R4/patient.html | http://hl7.org/fhir/R4/practitioner.html | http://hl7.org/fhir/R4/practitionerrole.html | http://hl7.org/fhir/R4/relatedperson.html | http://hl7.org/fhir/R4/organization.html)
... medication[x] SΣ1..1Medication to be taken
Binding: US Core Medication Codes (RxNorm) (preferred)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(StructureDefinition-qicore-medication.html)
... subject SΣ1..1Reference(QICorePatient)Who or group medication request is for
... encounter S0..1Reference(QICoreEncounter)Encounter created as part of encounter/admission/stay
... supportingInformation 0..*Reference(Resource)Information to support ordering of the medication
... authoredOn SΣ1..1dateTimeWhen request was initially authored
... requester SΣ1..1Reference(QICorePractitioner | QICorePractitionerRole | QICorePatient | QICoreRelatedPerson | QICoreOrganization | QICoreDevice)Who/What requested the Request
... performer 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)Intended performer of administration
... performerType Σ0..1CodeableConceptDesired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example)
... recorder 0..1Reference(QICorePractitioner | QICorePractitionerRole)Person who entered the request
... reasonCode 0..*CodeableConceptReason or indication for ordering or not ordering the medication
Binding: US Core Problem (preferred)
... reasonReference 0..*Reference(Condition | Observation)Condition or observation that supports why the prescription is being written
... instantiatesCanonical Σ0..*canonical()Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)What request fulfills
... groupIdentifier Σ0..1IdentifierComposite request this is part of
... courseOfTherapyType 0..1CodeableConceptOverall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes (example)
... insurance 0..*Reference(Coverage | ClaimResponse)Associated insurance coverage
... note 0..*AnnotationInformation about the prescription
... dosageInstruction S0..*DosageHow the medication should be taken
.... 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 SΣ0..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 Σ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site SΣ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate ΣI0..*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 Σ0..1CodeableConceptThe kind of dose or rate specified
Binding: DoseAndRateType (example)
..... dose[x] Σ0..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
... dispenseRequest SI0..1BackboneElementMedication supply authorization
.... 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
.... initialFill I0..1BackboneElementFirst fill details
..... 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
..... quantity 0..1SimpleQuantityFirst fill quantity
..... duration 0..1DurationFirst fill duration
.... dispenseInterval 0..1DurationMinimum period of time between dispenses
.... validityPeriod 0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed 0..1unsignedIntNumber of refills authorized
.... quantity 0..1SimpleQuantityAmount of medication to supply per dispense
.... expectedSupplyDuration 0..1DurationNumber of days supply per dispense
.... performer 0..1Reference(Organization)Intended dispenser
... substitution I0..1BackboneElementAny restrictions on medication substitution
.... 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
.... allowed[x] 1..1Whether substitution is allowed or not
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
..... allowedBooleanboolean
..... allowedCodeableConceptCodeableConcept
.... reason 0..1CodeableConceptWhy should (not) substitution be made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
... priorPrescription 0..1Reference(MedicationRequest)An order/prescription that is being replaced
... detectedIssue 0..*Reference(DetectedIssue)Clinical Issue with action
... eventHistory 0..*Reference(Provenance)A list of events of interest in the lifecycle

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
MedicationRequest.languagepreferredCommonLanguages
Max Binding: AllLanguages
MedicationRequest.statusrequiredmedicationrequest Status
MedicationRequest.statusReasonexamplemedicationRequest Status Reason Codes
MedicationRequest.intentrequiredmedicationRequest Intent
MedicationRequest.categorypreferredmedicationRequest Category Codes
MedicationRequest.priorityrequiredRequestPriority
MedicationRequest.medication[x]preferredUSCoreMedicationCodes
MedicationRequest.performerTypeexampleProcedurePerformerRoleCodes
MedicationRequest.reasonCodepreferredUSCoreProblem
MedicationRequest.courseOfTherapyTypeexamplemedicationRequest Course of Therapy Codes
MedicationRequest.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationRequest.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationRequest.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationRequest.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationRequest.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationRequest.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
MedicationRequest.substitution.allowed[x]examplev3.ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reasonexamplev3.SubstanceAdminSubstitutionReason

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2MedicationRequestIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-4MedicationRequestIf 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-3MedicationRequestIf 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-6MedicationRequestA resource should have narrative for robust management
: text.div.exists()
dom-5MedicationRequestIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
ele-1MedicationRequest.dosageInstruction.doseAndRateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationRequest.dispenseRequestAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationRequest.dispenseRequest.initialFillAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationRequest.substitutionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())