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 MedicationRequest

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

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 MedicationRequest resource to record, search, and fetch medication orders and requests (i.e. prescriptions) associated with a patient. It is based on the AU Base Medication Request profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the MedicationRequest 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 medication orders or prescriptions for a patient (current and historical)
  • Record or update medication orders or prescriptions for a patient

Comparison with other national and international specifications

A resource conforming to this profile is conformant to:

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

Profile specific implementation guidance

  • See the Medicine information section for guidance
  • When recording “self-prescribed” medication, MedicationRequest.requester references the Patient or RelatedPerson as the prescriber.
  • MedicationRequest resources can represent a medication using either a code with MedicationRequest.medicationCodeableConcept, or reference a Medication resource with MedicationRequest.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 Prescription Identifier or AU ETP Prescription 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.

Usage:

Formal Views of Profile Content

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

This structure is derived from AUBaseMedicationRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationRequest 0..*AUBaseMedicationRequestA request for a medication for a patient in an Australian healthcare context
... identifier S0..*Identifier, AUETPPrescriptionIdentifier, AULocalPrescriptionIdentifierExternal ids for this request
... status S1..1codeactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
... intent S1..1codeproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
... Slices for medication[x] S1..1CodeableConcept, Reference(Medication)Medication to be taken
Slice: Unordered, Closed by type:$this
.... medication[x]:medicationCodeableConcept 0..1CodeableConceptCoded Prescribed 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)Prescribed Medication
... subject S1..1Reference(AU Core Patient)Who or group medication request is for
... encounter S0..1Reference(AU Core Encounter)Encounter created as part of encounter/admission/stay
... authoredOn SC1..1dateTimeCreated date
au-core-medreq-03: Date shall be at least to day
... requester S1..1Reference(AU Core Practitioner | AU Core PractitionerRole | AU Core Organization | AU Core Patient | AU Core RelatedPerson)Who/What requested the Request
... reasonCode S0..*CodeableConceptReason or indication for ordering or not ordering the medication
... note S0..*AnnotationInformation about the prescription
... dosageInstruction S0..*AUBaseDosageDosage information in an Australian healthcare context
... dispenseRequest S0..1BackboneElementRequested dispensing
.... validityPeriod S0..1PeriodTime period supply is authorized for
.... numberOfRepeatsAllowed S0..1unsignedIntMaximum repeats authorised
.... quantity S0..1SimpleQuantityAmount of medication to supply per dispense
... substitution S0..1BackboneElementBrand substitution details
.... allowed[x] S1..1boolean, CodeableConceptBrand substitution flag

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationRequest.categoryextensiblemedicationRequest Category Codes

Constraints

IdGradePath(s)DetailsRequirements
au-core-medreq-03errorMedicationRequest.authoredOnDate shall be at least to day
: toString().length() >= 10

 

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+intent SHALL reference+token
patient+intent+status SHALL reference+token+token
_id SHOULD token
identifier SHOULD token The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
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+intent+authoredon SHOULD reference+token+date
authoredon 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.
category 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.
intent 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.
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.

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: MedicationRequest: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]/MedicationRequest?patient={Type/}[id] or optionally GET [base]/MedicationRequest?patient.identifier=[system|][code]

    Example:

    1. GET [base]/MedicationRequest?patient=5678
    2. GET [base]/MedicationRequest?patient=5678&_revinclude=Provenance:target
    3. GET [base]/MedicationRequest?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
    4. GET [base]/MedicationRequest?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952&_include=MedicationRequest:medication
    5. GET [base]/MedicationRequest?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

    Implementation Notes: Fetches a bundle of all MedicationRequest 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 intent search parameters:
    • SHOULD support these _include parameters: MedicationRequest: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]/MedicationRequest?patient={Type/}[id]&intent={system|}[code]

    Example:

    1. GET [base]/MedicationRequest?patient=5678&intent=order

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

  3. SHALL support searching using the combination of the patient and intent and status search parameters:
    • SHOULD support these _include parameters: MedicationRequest: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 code (e.g.code={system|}[code],{system|}[code],...)
    • SHALL support multipleOr search on status (e.g.status={system|}[code],{system|}[code],...)

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

    Example:

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

    Implementation Notes: Fetches a bundle of all MedicationRequest resources for the specified patient and authored on date and intent (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 fetching a MedicationRequest using the _id search parameter:
    • SHOULD support these _include parameters: MedicationRequest:medication
    • SHALL support these _revinclude parameters: Provenance:target

    GET [base]/MedicationRequest/[id] or GET [base]/MedicationRequest?_id=[id]

    Example:

    1. GET [base]/MedicationRequest/2169591
    2. GET [base]/MedicationRequest?_id=2169591
    3. GET [base]/MedicationRequest?_id=2169591&_include=MedicationRequest:medication

    Implementation Notes: Fetches a single MedicationRequest (how to search by the logical id of the resource)

  2. SHOULD support searching using the identifier search parameter:

    GET [base]/MedicationRequest?identifier={system|}[code]

    Example:

    1. GET [base]/MedicationRequest?identifier=http://gp.example.org|1032333

    Implementation Notes: Fetches a bundle containing any MedicationRequest resources matching the identifier (how to search by token)

  3. SHOULD support searching using the combination of the patient and intent and authoredon search parameters:
    • SHOULD support these _include parameters: MedicationRequest: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 authoredon comparators: gt,lt,ge,le
    • SHOULD support multipleAnd search on authoredon (e.g.authoredon=[date]&authoredon=[date]]&...)

    GET [base]/MedicationRequest?patient={Type/}[id]&intent={system|}[code]&authoredon={gt|lt|ge|le}[date]{&authoredon={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/MedicationRequest?patient=5678&intent=order&authoredon=ge2020-01-01T00:00:00Z

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