medication dosing instruction text fields

[Richard Hensel]

Hi, I have a couple questions surrounding the medication order results:

1. I have a need to see exactly what is stored in the EMR (not a standardized code) for medication orders. In the dosingInstruction.timing.code hash, there is a 'coding' property (standardized) and a 'text' property. Does the text property reflect what is stored in the EMR database field exactly? Or is it some value mapped to the coding value?

"code": {

"coding": [{

"system": "http://hl7.org/fhir/timing-abbreviation",

"code": "QD",

"display": "QD",

"userSelected": false

}

],

"text": "Daily"

}

2. Same question for route & asNeededCodeableConcept

3. With regard to 'doseQuantity', I know in the database there are 2 stored values: a dose ordered and a dose converted (for example: dose ordered = '50 mg' and dose converted = '2 tablets' OR dose ordered = '25 mg' and dose converted = '5 mL'). Often times for liquids the dose converted is based on the weight of the patient (especially for kids) so calculating it in an app is problematic. Is there any way to get both values?

4. route codes: DSTU2 says that route codes should be from snomed (http://hl7.org/fhir/DSTU2/valueset-route-codes.html) but I'm seeing NIH codes. Is there an explanation for that?

Thanks for any help provided.

[Jenni Syed (Cerner)]

Hi Richard,

1. I have a need to see exactly what is stored in the EMR (not a standardized code) for medication orders. In the dosingInstruction.timing.code hash, there is a 'coding' property (standardized) and a 'text' property. Does the text property reflect what is stored in the EMR database field exactly? Or is it some value mapped to the coding value?

"code": {

"coding": [{

"system": "http://hl7.org/fhir/timing-abbreviation",

"code": "QD",

"display": "QD",

"userSelected": false

}

],

"text": "Daily"

}

2. Same question for route & asNeededCodeableConcept

Anytime there's a type of codeableConcept, the codeableConcept.text is set from the local display in our system, assuming it's applicable/exists. This is true for the three fields you reference above.

3. With regard to 'doseQuantity', I know in the database there are 2 stored values: a dose ordered and a dose converted (for example: dose ordered = '50 mg' and dose converted = '2 tablets' OR dose ordered = '25 mg' and dose converted = '5 mL'). Often times for liquids the dose converted is based on the weight of the patient (especially for kids) so calculating it in an app is problematic. Is there any way to get both values?

For FHIR, unfortunately, we can only return one (there is only one simple quantity field for dose). It does not currently allow us to provide both these values. There are rules which we follow to determine which to prefer, but it varies based on a few factors.

 

4. route codes: DSTU2 says that route codes should be from snomed (http://hl7.org/fhir/DSTU2/valueset-route-codes.html) but I'm seeing NIH codes. Is there an explanation for that?

That binding is listed as an example valueset in the FHIR specification, which means it's just there as an example of what can be returned - you can choose any valueset when implementing the spec. In our bindings documentation, we document that we can return SNOMED or the NCI terms. We've been evaluating preferring SNOMED instead of preferring NCI. For some history, we moved to NCI based on a older profile for argonaut that didn't make it to the final version.

~ Jenni

[Jenni Syed (Cerner)]

Note: we just pushed some updates. Route should be returning both NCI and SNOMED now. Let me know if you see issues!

~ Jenni