Details
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Change Request
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Resolution: Persuasive
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Medium
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FHIR Core (FHIR)
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R4
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Pharmacy
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MedicationDispense
MedicationRequest
MedicationStatement -
Dosage
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11.10.0.1
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Daniel Zhang / Margaret Weiker: 10-0-0
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Enhancement
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Compatible, substantive
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R5
Description
Providers can specify multiple PRN reasons/indications on medication orders in our system (e.g. take as needed for nausea and vomiting). Currently, there's not a great way to represent multiple PRN reasons in the Dosage datatype/in MedicationRequest.dosageInstruction (and equivalents). While the dosage.asNeededBoolean can convey some detail, the reasons themselves are hard to transmit clearly.
We've looked at multiple options:
1) Multiple dosageInstruction repetitions, each with an asNeededCodeableConcept representing one of the reasons - this may cause confusion as it's unclear what dose + timing specified in each Dosage element is for/needs agreement on what dose + timing specified in each Dosage element is for (i.e. is it every 6 hours as needed for nausea and also every 6 hours as needed for vomiting (two doses allowed every 6 hours), or every 6 hours as needed for nausea or vomiting (one dose allowed every 6 hours)).
2) Multiple MedicationRequest resources, each representing a PRN reason - similar confusion about what the dose + timing is for.
3) New 0..* codeableConcept element representing PRN reasons (either in place of or in addition to asNeededBoolean) - this seems like the most straightforward option (and easiest for backporting to previous versions as extensions).