In the Jan 21 ballot cycle I raised the issue of incomplete returns from queries, in this case, for medications. As this is a patient safety issue, my suggestion is, rather than give a false sense of confidence that using this query will give a complete return of data, provide caution for the users that the return will be partial at the present time and to use additional sources to "complete" the picture, such as patient reporting and so on. The treatment of this issue as "non-persuasive" reflects an ongoing divide in understanding between technical adequacy and clinical inadequacy. Patient safety issues raise the concern that assuming that one does what is recommended-everything will be good is not acceptable.
breaks in treatment of issues between OO and other groups, should not be allowed to let an identified problem go unresolved (e.g. its not our job to deal with the issue so we do our job and consider it resolved) rather than passing the issue to the appropriate committee to address.
Responses:
1. The commenter is correct to point out the dangerous fragmentation of FHIR Medication resources which requires a client application to merge data with many disparate resources to provide a single 'Active Medication List'.
To mitigate that risk, the designers of US Core worked closely with many vendors to achieve consensus on a single resource to serve all Active Medication of content. Please see:
https://build.fhir.org/ig/HL7/US-Core/medication-list-guidance.html
2.There is risk in either approach:
require Client Applications to understand and query across all mediation resources to create an accurate list versus
requiring FHIR servers to provide medication list in a consistent manner via MedicationRequest.