In context of https://jira.hl7.org/browse/FHIR-28375 we propose that MedicationRequest.medication[x] does not require both the .medicationCodeableConcept and .medicationReference.

We note that the current construct where within .medicationReference only the .code is required thus effectively being the same as medicationCodeableConcept, while also systems only need to convey the code without the other details. A system that only maintains the medication code (RxNorm) would be required, under current requirements, to “support” both options for sending the exact same information. Therefore, .medication as a reference should be optional and available for use in systems that store and need to convey the additional, optional information (as per US Core) that comes into play with compounded medications.

As the FHIR US Core profile is used for accessing and exchanging data based on what the source system has, this should not require the data source system to add functionality to capture a patient as part of the provenance.

Links to pages:

http://hl7.org/fhir/us/core/StructureDefinition-us-core-medicationrequest.html

https://build.fhir.org/ig/HL7/US-Core-R4/StructureDefinition-us-core-medicationrequest.html