AU Core Implementation Guide
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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

General Guidance

Page standards status: Informative

Contained Resources

In some circumstances, the content referred to in the resource reference does not have an independent existence apart from the resource that contains it - it cannot be identified independently, and nor can it have its own independent transaction scope. For example, use of a Medication resource to represent medicinal product identification within the context of a MedicationRequest. In these circumstances the resource should be contained.

If referencing a contained resource, both the contained resource and the referencing resource SHALL conform to an AU Core profile. Further guidance about the general use case for contained resources can be found in the base FHIR specification.

In AU Core profiles:

  • Systems constructing a resource that represent medication or body structure information are encouraged to make use of contained resources.
    • Operations on Medication resources are expected to be within the context of a referencing resource query such as an MedicationAdministration, MedicationDispense, MedicationRequest or MedicationStatement.
    • Operations on BodyStructure resources are expected to be within the context of a referencing resource query such as a DiagnosticReport, Observation, or ServiceRequest.
  • Otherwise, when responding to a query, servers should not use inline contained resources to represent the returned data.

Extensibility – “additional” elements

A server may send “additional” elements beyond those flagged with Must Support in an AU Core profile. Additional elements allow local requirements to be reflected including technical and workflow context for the resource, and extending the health information supported in exchanges. For this reason extensibility is generally allowed in AU Core profiles, only in some use case profiles are the rules tightened to limit the nature of additional information that can be sent.

Depending on local requirements, a client application may ignore these “additional” elements, may treat the data as for rendering only, or be capable of recognising and using the element.

Medicine information

The FHIR standard defines the following resources for exchanging medicine information:

AU Core Medication is profiled to support medicinal product identification in an Australian healthcare context. AU Core profiles of MedicationStatement (with AU Core Medication) are used to support summary statements of medicine use. AU Core profiles of MedicationAdministration (with AU Core Medication) are used to support medication chart and other administration use cases. AU Core profiles of MedicationDispense (with AU Core Medication) are used to support dispense records and ePrescribing use cases. AU Core profiles of MedicationRequest (with AU Core Medication) are used to support prescription, ordering, and ePrescribing use cases.

Medicinal Product Identification

For extemporaneous medications, the medication code is the mandatory primary mechanism to identify a medicine but contain only a text list of ingredients or it may be a code from a medicines terminology.

For non-extemporaneous medications, the medication code (or set of codes) is the mandatory primary mechanism to identify a medicine and its defining attributes (by terminology lookup) including form and strength.

Australian Medicines Terminology (AMT) is the national terminology for identification and naming of medicines in clinical systems for Australia. The AMT is published monthly to include new items on the Australian Register of Therapeutic Goods from the TGA, as well as items listed on the Pharmaceutical Benefits Scheme. The AMT is published as part of SNOMED CT-AU (Australian edition of SNOMED CT) and can be downloaded in a variety of formats from the National Clinical Terminology Service (NCTS).

TBD: Insert PBS.

In addition to the medication code, the majority of use cases support exchange of structured medicine information as separate data elements covering brand name, generic name, item form and strength, and manufacturer.

These data elements may be supported as coded, or text, and systems are likely to use a combination of coded and text elements when constructing a Medication resource. The guidance for how to support coded or text is summarised below:

  1. For coded support for brand name, generic name, manufacturer, item form and strength:

    Example: Medication with coded brand name, generic name, manufacturer, item form and strength.

     {
   "resourceType": "Medication",
     ...
     "code": {
       "coding": [
         {
           "extension": [
             {
               "url": "http://hl7.org.au/fhir/StructureDefinition/medication-type",
               "valueCoding": {
                 "system": "http://terminology.hl7.org.au/CodeSystem/medication-type",
                 "code": "UPD",
                 "display": "Unbranded product with no strengths or form"
               }
             }
           ],
           "system": "http://pbs.gov.au/code/item",
           "code": "02647H",
           "display": "BENZYLPENICILLIN"
         },
         {
           "extension": [
             {
               "url": "http://hl7.org.au/fhir/StructureDefinition/medication-type",
               "valueCoding": {
                 "system": "http://terminology.hl7.org.au/CodeSystem/medication-type",
                 "code": "BPD",
                 "display": "Branded product with no strengths or form"
               }
             }
           ],
           "system": "http://snomed.info/sct",
           "code": "3539011000036105",
           "display": "Benpen"
         },
         {
           "extension": [
             {
               "url": "http://hl7.org.au/fhir/StructureDefinition/medication-type",
               "valueCoding": {
                 "system": "http://terminology.hl7.org.au/CodeSystem/medication-type",
                 "code": "UPDSF",
                 "display": "Unbranded product with strengths and form"
               }
             }
           ],
           "system": "http://snomed.info/sct",
           "code": "32753011000036104",
           "display": "benzylpenicillin 3 g injection, 1 vial"
         },
         {
           "extension": [
             {
               "url": "http://hl7.org.au/fhir/StructureDefinition/medication-type",
               "valueCoding": {
                 "system": "http://terminology.hl7.org.au/CodeSystem/medication-type",
                 "code": "BPDSF",
                 "display": "Branded product with strengths and form"
               }
             }
           ],
           "system": "http://snomed.info/sct",
           "code": "32328011000036106",
           "display": "Benpen 3 g powder for injection, 1 vial"
         }
       ]
     },
     "manufacturer": {
       "identifier": {
         "system": "http://pbs.gov.au/code/manufacturer",
         "value": "CS"
       }
     },
     "form": {
       "coding": [
         {
           "system": "http://snomed.info/sct",
           "code": "129011000036109",
           "display": "injection"
         }
       ],
       "text": "Injection"
     },
     "ingredient": [
       {
         "itemCodeableConcept": {
           "coding": [
             {
               "system": "http://snomed.info/sct",
               "code": "1849011000036104",
               "display": "benzylpenicillin"
             }
           ]
         },
         "strength": {
           "numerator": {
             "value": 3,
             "unit": "g"
           },
           "denominator": {
             "value": 1,
             "unit": "unit"
           }
         }
       }
     ]
 }
  2. For non-coded support for brand name, generic name, manufacturer, item form and strength:

    Example: Medication with text only brand name, generic name, item form and strength.

    {
  "resourceType": "Medication",
   ...
   "extension": [
     {
       "url": "http://hl7.org.au/fhir/StructureDefinition/medication-generic-name",
       "valueString": "Benzylpenicillin"
     },
     {
       "url": "http://hl7.org.au/fhir/StructureDefinition/medication-brand-name",
       "valueString": "Benpen"
     }
   ],
   "code": {
     "text": "Benpen 3 g powder for injection, 1 vial"
   },
   "manufacturer": {
     "display": "Seqirus"
   }
}

Lists

TBD: Insert guidance.

Representing communication preferences

Patient

The table below provides guidance on representing communication preferences for a patient. Blank cells in the table indicate that the given element is absent from the resource.

Scenario communication.language communication.preferred extension:interpreterRequired Notes
Preferred language is English No element sent, as per the guidance in the Comments of Patient.communication
Preferred language is other than English language.coding 'true'
Interpreter required, language is known language.coding 'true' 'true'
Interpreter required, language is not known 'true'
Interpreter is not required 'false'
Communicates with multiple languages language.coding Each language instantiated in separate communication nodes; communication.preferred and extension:interpreterRequired may be sent as needed.

Example: Patient resource with interpreter required and language is known

{
  "resourceType" : "Patient",
    ...
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired",
          "valueBoolean" : true
        }          
       ]
    },
    ...
    "communication" : [
    {
      "language" : {
        "coding" : [
          {
            "system" : "urn:ietf:bcp:47",
            "code" : "yue"
          }
        ],
        "text" : "Cantonese"
      },
      "preferred" : true
    }
  ]
}

RelatedPerson

The table below provides guidance on representing communication preferences for a related person. Blank cells in the indicate that the given element is absent from the resource.

Scenario communication.language communication.preferred Notes
Preferred language is English No element sent, as per the guidance in the Comments of RelatedPerson.communication
Preferred language is other than English language.coding 'true'
Communicates with multiple languages language.coding Each language instantiated in separate communication nodes; communication.preferred may be sent as needed.

Blank cells in the above table indicate that the given element is absent from the resource.