Differences in MedicationAdministration MedicationStatement

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lachlan...@doseme.com.au

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Feb 4, 2019, 2:47:09 AM2/4/19
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  • Issue Summary: (include links to documentation, and describe what you've tried so far. Do NOT include request or response bodies unless this is from our public sandbox)
I have a SMART app that uses the `MedicationStatement` data structure, and am looking to move towards using the newer `MedicationAdministration` data structure. In the sandbox, patients (for example, Connie smart) have the following data for a dose of vancomycin:

```
          {
            "text": "100 mg, 10 mL/hr, IV, q12hr",
            "_text": {
              "extension": [
                {
                  "valueString": "10 Milliliter/hour Intravenous every 12 hours for 6 Days. Refills: 0."
                }
              ]
            },
            "timing": {
              "repeat": {
                "boundsQuantity": {
                  "value": 6,
                  "unit": "days",
                  "system": "http://unitsofmeasure.org",
                  "code": "d"
                },
                "duration": 10.0,
                "durationUnits": "h"
              },
              "code": {
                "text": "q12hr"
              }
            },
            "route": {
              "coding": [
                {
                  "system": "http://ncimeta.nci.nih.gov",
                  "code": "C38276",
                  "display": "INTRAVENOUS",
                  "userSelected": false
                },
                {
                  "system": "http://snomed.info/sct",
                  "code": "47625008",
                  "display": "Intravenous route (qualifier value)",
                  "userSelected": false
                }
              ],
              "text": "IV"
            },
            "quantityQuantity": {
              "value": 100.0,
              "unit": "mL",
              "system": "http://unitsofmeasure.org",
              "code": "mL"
            },
            "rateRatio": {
              "numerator": {
                "value": 100.0,
                "unit": "mL",
                "system": "http://unitsofmeasure.org",
                "code": "mL"
              },
              "denominator": {
                "value": 10.0,
                "unit": "hr",
                "system": "http://unitsofmeasure.org",
                "code": "h"
              }
            }
          }
```

Lots of information, include the duration of each dose under the `timing` key, how much / hour using the `rateRatio` and so on.

Looking at Connie's administrations, however, yields a lot less information:

```
"effectiveTimeDateTime": "2018-09-24T20:47:00.000Z",
    "medicationReference": {
      "reference": "#8981790",
      "display": "Vancomycin"
    },
    "dosage": {
      "text": "IV q12hr",
      "route": {
        "coding": [
          {
            "system": "http://ncimeta.nci.nih.gov",
            "code": "C38276",
            "display": "INTRAVENOUS",
            "userSelected": false
          },
          {
            "system": "http://snomed.info/sct",
            "code": "47625008",
            "display": "Intravenous route (qualifier value)",
            "userSelected": false
          }
        ],
        "text": "IV"
      },
      "quantity": {
        "value": 100,
        "unit": "mg",
        "system": "http://unitsofmeasure.org",
        "code": "mg"
      }

//...
```

I read this documentation: https://fhir.cerner.com/millennium/dstu2/medications/medication-administration/, as well as the fhir spec. I'd like to clarify: 

1. Since this is a `MedicationAdministration`, it is a record of administrations as they happen. Does this mean each `MedicationAdministration` represents a single dose? I came to this conclusion since the is no `effectiveTimePeriod` for `MedicationAdministration`, just a date, which could reflect that it was only a single dose. I am specifically interested in infusion drugs, like Vancomycin - not take home drugs or tablets etc.
2. It says  `"text": "IV q12hr"` in the MedicationAdminstration for the `dosage`. Does this mean that single dose was _part_ of a course that is 12 hourly? Since this appears to only represent a single dose, not a course or a number of doses. What is the significance of this field here?
3. Is this `MedicationAdminstration` reflective of what I'll be likely to get in a real world scenario? If not, extra fields can I expect (or which fields _won't_ I get)?
4. How to know the infusion length? Do I need to hit the `MedicationOrder` endpoint as well?

Thank you for your assistance. 

Kathy Pickering (Cerner)

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Feb 4, 2019, 2:05:51 PM2/4/19
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Lachlan -  See answers below
1. Since this is a `MedicationAdministration`, it is a record of administrations as they happen. Does this mean each `MedicationAdministration` represents a single dose? Yes I came to this conclusion since the is no `effectiveTimePeriod` for `MedicationAdministration`, just a date, which could reflect that it was only a single dose. I am specifically interested in infusion drugs, like Vancomycin - not take home drugs or tablets etc.
2. It says  `"text": "IV q12hr"` in the MedicationAdminstration for the `dosage`. Does this mean that single dose was _part_ of a course that is 12 hourly? Since this appears to only represent a single dose, not a course or a number of doses. What is the significance of this field here?  That is the actual order.
3. Is this `MedicationAdminstration` reflective of what I'll be likely to get in a real world scenario? If not, extra fields can I expect (or which fields _won't_ I get)?  Yes, it is reflective though there are other work flows such as Not Given and Not Done.  Rate changes and waste events are not returned. I recommend that you work with the client to create various medication administration events to test.
4. How to know the infusion length? Do I need to hit the `MedicationOrder` endpoint as well?  I need to consult the concept owner about infusion length.  The MedicationOrder endpoint reflects the order and not what was actually administered.

Kathy Pickering (Cerner)

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Feb 4, 2019, 3:43:22 PM2/4/19
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Lachlan - If the infuse volume from and through date and time is documented, it will be returned in the effectiveTimePeriod.

-  Kathy

lachlan...@doseme.com.au

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Feb 4, 2019, 7:00:46 PM2/4/19
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Thanks Kathy, that helps a lot.

lachlan...@doseme.com.au

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Feb 5, 2019, 11:42:04 PM2/5/19
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Hi Kathy, I have another question. Dave Smart's MedicationAdministration has one entry that is marked `status: 'entered-in-error'`. The `wasNotGiven` field is set to `false` - however, if a dose was entered in error, can we assume that it was not given, and in real scenario that dose will be have the `wasNotGiven` field set to `true`?

Thanks, Lachlan

Kathy Pickering (Cerner)

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Feb 7, 2019, 12:01:29 PM2/7/19
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Lachlan -  All administrations with a status of "entered-in-error" should be considered not given regardless of how wasNotGiven is set.  

-  Kathy
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