Dosage Quantity

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Nikson k john

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May 4, 2018, 8:21:39 AM5/4/18
to Cerner FHIR Developers
Hi Team,

Need some help in interpreting the Medication Administration "contained" node.

I can see 2 medicines Acetaminophen and Glucose and Amount numerator is specified for both, coding node is also available for both.
But I could see only one dosage node/information. I am not able to interpret this representation. Dosage is for which medicine.

Could you please explain how can i interpret this data. My requirement is to read and store all the medication administration details for the patient.



{
  "resource": {
    "resourceType": "MedicationAdministration",
    "id": "7277333",
    "meta": {
      "versionId": "7277334",
      "lastUpdated": "2017-11-21T21:57:15.000Z"
    },
    "contained": [
      {
        "resourceType": "Medication",
        "id": "7277333",
        "product": {
          "ingredient": [
            {
              "item": {
                "reference": "#7277335-1",
                "display": "Acetaminophen"
              },
              "amount": {
                "numerator": {
                  "value": 120,
                  "unit": "mg",
                  "system": "http://unitsofmeasure.org",
                  "code": "mg"
                }
              }
            },
            {
              "item": {
                "reference": "#7277337-2",
                "display": "Glucose 100 MG/ML Injectable Solution"
              },
              "amount": {
                "numerator": {
                  "value": 50,
                  "unit": "mL",
                  "system": "http://unitsofmeasure.org",
                  "code": "mL"
                }
              }
            }
          ]
        }
      },
      {
        "resourceType": "Medication",
        "id": "7277335-1",
        "code": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "161",
              "display": "Acetaminophen",
              "userSelected": false
            }
          ],
          "text": "acetaminophen"
        }
      },
      {
        "resourceType": "Medication",
        "id": "7277337-2",
        "code": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "237648",
              "display": "Glucose 100 MG/ML Injectable Solution",
              "userSelected": false
            }
          ],
          "text": "Dextrose 10% in Water"
        }
      }
    ],
    "status": "completed",
    "patient": {
      "reference": "Patient/4642007",
      "display": "Smart, Connie"
    },
    "practitioner": {
      "reference": "Practitioner/1776007",
      "display": "Julius, Scott"
    },
    "encounter": {
      "reference": "Encounter/4251906"
    },
    "prescription": {
      "reference": "MedicationOrder/22954085"
    },
    "wasNotGiven": false,
    "effectiveTimeDateTime": "2017-11-21T21:56:00.000Z",
    "medicationReference": {
      "reference": "#7277333",
      "display": "Acetaminophen"
    },
    "note": "2017-11-21T21:57:13.000Z - 1776007 - Result comment for acetaminophen - added diluent in charting window",
    "dosage": {
      "text": "120 mg Oral q4hr",
      "route": {
        "coding": [
          {
            "system": "http://ncimeta.nci.nih.gov",
            "code": "C38288",
            "display": "ORAL",
            "userSelected": false
          },
          {
            "system": "http://snomed.info/sct",
            "code": "26643006",
            "display": "Oral route (qualifier value)",
            "userSelected": false
          }
        ],
        "text": "Oral"
      },
      "quantity": {
        "value": 120,
        "unit": "mg",
        "system": "http://unitsofmeasure.org",
        "code": "mg"
      }
    }
  }
}

Michele Mottini

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May 4, 2018, 9:17:31 AM5/4/18
to Cerner FHIR Developers
Look at the medicationReference:

   "medicationReference": {
      "reference": "#7277333",
      "display": "Acetaminophen"
    },
  

...the medication is the one with id 7277333, so the first one

  - Michele
  CareEvolution Inc


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Nikson k john

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May 7, 2018, 10:20:35 AM5/7/18
to Cerner FHIR Developers
Hi Cerner team,

Could you please explain me more?


Regards,
Nikson



Kathy Pickering (Cerner)

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May 7, 2018, 2:00:51 PM5/7/18
to Cerner FHIR Developers
Nikson -  The dosage is for Acetaminophen.  During administration, the dextrose diluent was added.

-Kathy
Message has been deleted

Nikson k john

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May 8, 2018, 8:31:06 AM5/8/18
to Cerner FHIR Developers
By looking at the data we can say it is for acetaminophen. But am trying to map the medication details with the dosage programatically

i want to map the dosage given in the response with the medication Acetaminophen programatically. So how to find the link?

"resourceType": "Medication",
        "id": "7277335-1",
        "code": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "161",
              "display": "Acetaminophen",
              "userSelected": false
            }
          ],
          "text": "acetaminophen"
        }


Nikson k john

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May 11, 2018, 8:01:01 AM5/11/18
to Cerner FHIR Developers
Could you please look into this?

Thank you
Nikson,

Jenni Syed (Cerner)

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May 11, 2018, 11:21:57 AM5/11/18
to Cerner FHIR Developers
Nikson,

This is a multi-ingredient administration. The dosage right now is on each of the ingredients in the contained medication (Acetaminophen 120 mg diluted in 50 mL of dextrose in water). You follow the link from the parent medicationReference (#7277333) That Medication has 2 ingredients the first (references #7277335-1) has a dose of 120 mg, the second (#7277337-2) was 50 mL.

We're looking at the dosage text to confirm that's what would be displayed when the nurse makes a decision to dilute the med during administration/get some clinical input so we can add more details. However, from a programatic approach, you would need to go to each ingredient to get the dose on multi-ingredients.

~ Jenni
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