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lachlan...@doseme.com.au
Feb 4, 2019, 2:47:09 AM2/4/19
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If this is a question about an error or issue you are seeing, please fill out the following fields:
- 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)
Feb 4, 2019, 2:05:51 PM2/4/19
to Cerner FHIR Developers
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)
Feb 4, 2019, 3:43:22 PM2/4/19
to Cerner FHIR Developers
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
Feb 4, 2019, 7:00:46 PM2/4/19
to Cerner FHIR Developers
Thanks Kathy, that helps a lot.
lachlan...@doseme.com.au
Feb 5, 2019, 11:42:04 PM2/5/19
to Cerner FHIR Developers
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)
Feb 7, 2019, 12:01:29 PM2/7/19
to Cerner FHIR Developers
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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