AU Core Implementation Guide
0.2.2-preview - Preview Australia flag

This page is part of the Australian Core IG (v0.2.2-preview: AU Core) based on FHIR R4. For a full list of available versions, see the Directory of published versions

Resource Profile: AU Core MedicationDispense

Official URL: http://hl7.org.au/fhir/core/StructureDefinition/au-core-medicationdispense Version: 0.2.2-preview
Standards status: Draft Maturity Level: 0 Computable Name: AUCoreMedicationDispense

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License. HL7 Australia© 2022+; Licensed Under Creative Commons No Rights Reserved.

This profile sets minimum expectations for a MedicationDispense resource to record, search, and fetch medication dispense history associated with a patient. It is based on the AU Base Medication Dispense profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the MedicationDispense when conforming to this profile. It provides the floor for standards development for specific uses cases in an Australian context.

Usage scenarios

The following are supported usage scenarios for this profile:

  • Query medications dispensed for a patient
  • Record or update a record of dispense for a patient

Comparison with other national and international specifications

A resource conforming to this profile is conformant to:

No equivalent International Patient Access or International Patient Summary profile.

Conformance in reverse is not guaranteed, i.e. a resource conforming to US Core MAY NOT conform to AU Core.

Profile specific implementation guidance

  • See the Medicine information section for guidance
  • MedicationDispense resources can represent the reason a dispense was not performed using either a code with MedicationDispense.statusReasonCodeableConcept, or reference a DetectedIssue resource with MedicationDispense.statusReasonReference.
    • Although both are marked as must support, servers are not required to support both a code and a reference, but they SHALL support at least one of these elements
    • A client application SHALL support both elements
  • MedicationDispense resources can represent a medication using either a code with MedicationDispense.medicationCodeableConcept, or reference a Medication resource with MedicationDispense.medicationReference.
    • Although both are marked as must support, servers are not required to support both a code and a reference, but they SHALL support at least one of these elements
    • A client application SHALL support both elements
    • When referencing a Medication resource, it is preferred the resource is contained but it may be an external resource
  • Source system identifiers SHOULD be included as AU Local Dispense Identifier to support electronic medication management (EMM) workflow and deduplication across medication resources.
    • See guidance on the construction of an identifier on the relevant Identifier profile page and the section on Business Identifiers in AU Base.

    Specific feedback is sought on supporting the reason a dispense was not performed. Is support for text or a code sufficient? What is the case for supporting a referenced DetectedIssue resource?

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from AUBaseMedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*AUBaseMedicationDispenseA dispense record for a medication for a patient in an Australian healthcare context
au-core-mdd-01: The location shall at least have a valid identifier or address or type
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... dispenseNumber S0..1integerNumber of this dispense
URL: http://hl7.org.au/fhir/StructureDefinition/dispense-number
... identifier S0..*Identifier, AULocalDispenseIdentifierExternal identifier
... statusReason[x] S0..1CodeableConcept, Reference(DetectedIssue)Why a dispense was not performed
... category S0..1CodeableConceptType of medication dispense
... Slices for medication[x] S1..1CodeableConcept, Reference(Medication)What medication was supplied
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationCodeableConcept 0..1CodeableConceptCoded Dispensed Medication
..... Slices for coding 0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
...... coding:pbs S0..*CodingPBS Item Code
...... coding:amt S0..*CodingAMT Medicines
.... medication[x]:medicationReference 0..1Reference(AU Core Medication)Dispensed Medication
... subject S1..1Reference(AU Core Patient)Who the dispense is for
... context S0..1Reference(AU Core Encounter)Encounter / Episode associated with event
... performer SC0..*BackboneElementWho performed event
.... function S0..1CodeableConceptWho performed the dispense and what they did
.... actor S1..1Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Core RelatedPerson)Individual who was performing
... location SC0..1Reference(AU Core Location)Where the dispense occurred
... authorizingPrescription S0..*Reference(AU Core MedicationRequest)Medication order that authorizes the dispense
... quantity S0..1SimpleQuantityAmount dispensed
... daysSupply S0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenHandedOver S1..1dateTimeWhen product was given out
... note S0..*AnnotationInformation about the dispense
... dosageInstruction S0..*AUBaseDosageDosage information in an Australian healthcare context
... substitution S0..1BackboneElementWhether a substitution was performed on the dispense
.... wasSubstituted S1..1booleanWhether a substitution was or was not performed on the dispense

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
au-core-mdd-01errorMedicationDispenseThe location shall at least have a valid identifier or address or type
: performer.exists() or location.exists()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Below is an overview of the mandatory and optional search parameters and combined search parameters. FHIR search operations and the syntax used to describe the interactions is described here.

Any search parameter defined in FHIR may be ‘allowed’ by the system unless explicitly marked as “SHALL NOT”. A few items are marked as MAY in this implementation guide to highlight their potential relevance.

Parameter(s) Conformance Type(s) Requirements (when used alone or in combination)
patient SHALL reference The client SHALL provide at least an id value and MAY provide both the Type and id values. The server SHALL support both.
patient+status SHALL reference+token
patient.identifier SHOULD reference.token The client SHALL provide both the system and code values. The server SHALL support both.

The client SHOULD support search using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile. The server SHOULD support search using the using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile.
patient+whenhandedover SHOULD reference+date
status MAY token The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
whenhandedover MAY date A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.

Mandatory Search Parameters

The following search parameters and search parameter combinations SHALL be supported:

  1. SHALL support searching using the patient search parameter:
    • SHOULD support these _include parameters: MedicationDispense:medication
    • SHALL support these _revinclude parameters: Provenance:target
    • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

    GET [base]/MedicationDispense?patient={Type/}[id] or optionallyGET [base]/MedicationDispense?patient.identifier=[system|][code]

    Example:

    1. GET [base]/MedicationDispense?patient=5678
    2. GET [base]/MedicationDispense?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
    3. GET [base]/MedicationDispense?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

    Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient (how to search by reference and how to search by token)

  2. SHALL support searching using the combination of the patient and status search parameters:
    • SHOULD support these _include parameters: MedicationDispense:medication
    • SHALL support these _revinclude parameters: Provenance:target
    • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
    • SHALL support multipleOr search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/MedicationDispense?patient=5678&status=active
    2. GET [base]/MedicationDispense?patient=5678&status=active&_include=MedicationDispense:medication

    Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient and status (how to search by reference and how to search by token)

Optional Search Parameters

The following search parameters and search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and whenhandedover search parameters:
    • SHOULD support these _include parameters: MedicationDispense:medication
    • SHALL support these _revinclude parameters: Provenance:target
    • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
    • SHALL support these whenhandedover comparators: gt,lt,ge,le
    • SHOULD support multipleAnd search on whenhandedover (e.g.whenhandedover=[date]&whenhandedover=[date]]&...)

    GET [base]/MedicationDispense?patient={Type/}[id]&whenhandedover={gt|lt|ge|le}[date]{&whenhandedover={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/MedicationDispense?patient=5678&whenhandedover=ge2020-01-01T00:00:00Z
    2. GET [base]/MedicationDispense?patient.identifier=http://example.org/fhir/mrn|12345&whenhandedover=ge2020-01-01T00:00:00Z
    3. GET [base]/MedicationDispense?patient.identifier=http://example.org/fhir/mrn|12345&whenhandedover=ge2020-01-01T00:00:00Z&_include=MedicationDispense:medication

    Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient and date (how to search by reference and how to search by date)