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  1. FHIR Specification Feedback
  2. FHIR-26829

Medication list patient reported medications use Intent = Plan (not order)

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    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive
    • Specification:
      US QI Core (FHIR)
    • Raised in Version:
      2.0
    • Work Group:
      Clinical Quality Information
    • Related Artifact(s):
      MedicationRequest
    • Related Section(s):
      MedicationRequest
    • Resolution Description:
      Hide

      Update QI-Core as noted for medication list to address intent = plan for self-prescribed medications and maintain intent=order for clinician-prescribed medications. This change is consistent with the US Core errata published end of August 2020.

       

      Note - as designed, for "self-prescribed" medications with intent=plan, the expectation is that the requester=Patient (or RelatedPerson). I.e., the plan is the patient's or relatedPerson's plan.  However, for the real-world implementations, the CQI WG participants believe the intent value set should include "self-prescribed" to more clearly address the use case.  Added https://jira.hl7.org/browse/FHIR-29270 for Pharmacy Committee.   

      Show
      Update QI-Core as noted for medication list to address intent = plan for self-prescribed medications and maintain intent=order for clinician-prescribed medications. This change is consistent with the US Core errata published end of August 2020.   Note - as designed, for "self-prescribed" medications with intent=plan, the expectation is that the requester=Patient (or RelatedPerson). I.e., the plan is the patient's or relatedPerson's plan.  However, for the real-world implementations, the CQI WG participants believe the intent value set should include "self-prescribed" to more clearly address the use case.  Added https://jira.hl7.org/browse/FHIR-29270  for Pharmacy Committee.   
    • Resolution Vote:
      Peter Muir/Rob Samples: 16-0-0
    • Change Category:
      Correction
    • Change Impact:
      Non-substantive

      Description

      US Core received feedback that guidance in the newest US Core medication list guidance (http://hl7.org/fhir/us/core/STU3.1/all-meds.html) specifically states:

      The MedicationRequest SHALL include all prescribed and “self-prescribed” medications reported by the Provider, Patient or Related Person.

      • SHALL use reported[x] to indicate the MedicationRequest record was captured as a secondary “reported” record rather than an original primary source-of-truth record. It may also indicate the source of the report.
      • When recording “self-prescribed” medications SHALL use intent = “order”
      • When recording “self-prescribed” orders, SHOULD use the requester to indicate the Patient or RelatedPerson as the prescriber.

      US Core received feedback from the Pharmacy WG that the 2nd bullet is inconsistent with Pharmacy specifications; it should be "When recording 'self-prescribed' medications SHALL use intent = "plan". - the 3rd bullet is correct (SHOULD use the requested to indicate the Patient or RelatedPerson as the prescriber).

      US Core plans to publish an errata to correct this issue.  QI-Core R4 guidance follows the original US Core STU 3.1 guidance. The only reference for this detail is in the QDM mapping section referenced (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html#8171-medication-active). QI-Core will need to publish an errata to address this issue for quality measures or CDS artifacts using the QI-Core MedicationRequest profile for patient-reported medications.

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            Assignee:
            Unassigned Unassigned
            Reporter:
            feisenberg Floyd Eisenberg
            Watchers:
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              Resolved:
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