MedicationStatement

Introduction

Scope and Usage

Common usage includes:

• the recording of non-prescription and/or recreational drugs
• the recording of an intake medication list upon admission to hospital
• the summarization of a patient's "active medications" in a patient profile

A MedicationStatement SHALL NOT be used to record substance abuse or the use of other agents such as tobacco or alcohol UNLESS those agents have been prescribed, e.g. nicotine patches or gum, long term care alcohol, etc. These should recorded as Social History Observations.

This resource does not produce a medication list, but it does produce individual medication statements that may be used in the List resource to construct various types of medication lists. Note that other medication lists can also be constructed from the other Pharmacy resources (e.g., MedicationRequest, MedicationAdministration).

A medication statement is not a part of the prescribe -> dispense -> administer sequence, but is a report by a patient, significant other or a clinician that one or more of the prescribe, dispense or administer actions has occurred, resulting is a belief that the patient is, has, or will be using a particular medication.

MedicationStatement includes an adherence element. Note that this adherence is specific to that instance of MedicationStatement. If MedicationStatement.adherence is being tracked over time, then instances of MedicationStatement would report adherence for the interval noted in effectivePeriod.

MedicationStatement is an event resource from a FHIR workflow perspective - see Workflow Event

Boundaries and Relationships

The MedicationStatement resource is used to record a medications or substances that the patient reports as being taken, not taking, have taken in the past or may take in the future. It can also be used to record medication use that is derived from other records such as a MedicationRequest. The statement is not used to request or order a medication, supply or device. When requesting medication, supplies or devices when there is a patient focus or instructions regarding their use, a MedicationRequest, SupplyRequest or DeviceRequest should be used instead.

The Medication domain includes a number of related resources

This resource is distinct from MedicationRequest, MedicationDispense and MedicationAdministration. Each of those resources refers to specific events - an individual order, an individual provisioning of medication or an individual dosing. MedicationStatement is a broader assertion covering a wider timespan and is independent of specific events. The existence of resource instances of any of the preceding three types may be used to infer a medication statement. However, medication statements can also be captured on the basis of other information, including an assertion by the patient or a care-giver, the results of a lab test, etc.

To indicate the link between a MedicationStatement instance and the Medication Request, Dispense, or Administration that was used to derive the MedicationStatement, the reference should be placed in the MedicationStatement.derivedFrom element.

StructureDefinition

Elements (Simplified)

• MedicationStatement [0..*]: - Record of medication being taken by a patient
• MedicationStatement.identifier [0..*]: Identifier External identifier
• MedicationStatement.partOf [0..*]: [Reference(Procedure](/Reference(Procedure), MedicationStatement)) Part of referenced event
• MedicationStatement.status [1..1]: code required:medication-statement-status recorded | entered-in-error | draft
• MedicationStatement.category [0..*]: CodeableConcept example:medicationrequest-category Type of medication statement
• MedicationStatement.medication [1..1]: CodeableReference example:medication-statement-medication-codes The medication that is/was taken (or not taken)
• MedicationStatement.subject [1..1]: [Reference(Patient](/Reference(Patient), Group)) Who is/was taking the medication
• MedicationStatement.encounter [0..1]: Reference(Encounter) Encounter associated with MedicationStatement
• MedicationStatement.effective[x] [0..1]: dateTime, Period, Timing The date/time or interval when the medication is/was/will be taken
• MedicationStatement.dateAsserted [0..1]: dateTime When the usage was asserted?
• MedicationStatement.author [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization, Patient, RelatedPerson, Device)) Who/What authored the statement
• MedicationStatement.informationSource [0..*]: [Reference(Device](/Reference(Device), Patient, Practitioner, PractitionerRole, RelatedPerson, Organization, Group)) Person or organization that provided the information about the taking of this medication
• MedicationStatement.derivedFrom [0..*]: Reference(Resource) Link to information used to derive the MedicationStatement
• MedicationStatement.reason [0..*]: CodeableReference example:condition-code Reason for why the medication is being/was taken
• MedicationStatement.note [0..*]: Annotation Further information about the usage
• MedicationStatement.relatedClinicalInformation [0..*]: [Reference(Observation](/Reference(Observation), Condition)) Link to information relevant to the usage of a medication
• MedicationStatement.dosage [0..1]: DosageDetails Details of how medication is/was taken or should be taken
• MedicationStatement.adherence [0..1]: BackboneElement Indicates whether the medication is or is not being consumed or administered
• MedicationStatement.adherence.code [1..1]: CodeableConcept example:medication-statement-adherence Type of adherence
• MedicationStatement.adherence.reason [0..1]: CodeableConcept example:reason-medication-status-codes Details of the reason for the current use of the medication

Mappings

• MedicationStatement Mappings — 40 mapping entries

Resource Packs

list-MedicationStatement-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../publish/List.xsd">
  <id value="MedicationStatement-packs"/>
  <status value="current"/>
  <mode value="working"/>
</List>

Search Parameters

• adherence — token — Returns statements based on adherence or compliance — MedicationStatement.adherence.code
• category — token — Returns statements of this category of MedicationStatement — MedicationStatement.category
• code — token — Return statements of this medication code — MedicationStatement.medication.concept
• effective — date — Date when patient was taking (or not taking) the medication — MedicationStatement.effective.ofType(dateTime) | MedicationStatement.effective.ofType(Period)
• encounter — reference — Returns statements for a specific encounter — MedicationStatement.encounter
• identifier — token — Return statements with this external identifier — MedicationStatement.identifier
• medication — reference — Return statements of this medication reference — MedicationStatement.medication.reference
• patient — reference — Returns statements for a specific patient. — MedicationStatement.subject.where(resolve() is Patient)
• source — reference — Who or where the information in the statement came from — MedicationStatement.informationSource
• status — token — Return statements that match the given status — MedicationStatement.status
• subject — reference — The identity of a patient, animal or group to list statements for — MedicationStatement.subject

Full Search Parameters

Examples

• example001 — medicationstatementexample1 — Patient reports they are taking Tylenol PM and has the bottle
• example002 — medicationstatementexample2 — Patient reports they are not taking Tylenol PM
• example003 — medicationstatementexample3 — Patient reports that they are taking the "little pink pill"
• example004 — medicationstatementexample4 — Patient reports they were taking Amoxicillin in the past but are not taking it now
• example005 — medicationstatementexample5 — Patient reports they previous said they took Amoxicillin but really didn't
• example006 — medicationstatementexample6 — Care Giver reports that the Patient took Amoxicillin
• example007 — medicationstatementexample7 — Patient reports they intend to use Mometasone in the future
• example008 — medicationstatementexample8 — Patient reports they used the given patches over the last 30 days.
• example009 — medicationstatementexample9 — Patient reports they used the medication patch on this day.
• example010 — medicationstatementexample10 — Patient is currently not taking any medications.
• medicationstatement-example — medicationstatement-example
• medicationstatement-examples-header — medicationstatement-examples-header

Full Examples

Mapping Exceptions

medicationstatement-event-mapping-exceptions.xml

Divergent Elements

• Event.identifier → MedicationStatement.identifier
  • shortUnmatched | reason=Unknown | pattern=Business identifier for medication statement | resource=External identifier
  • definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this medication statement by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=Identifiers associated with this Medication Statement that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
  • commentsUnmatched | reason=Unknown | pattern=Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. | resource=This is a business identifier, not a resource identifier.
  • requirementsUnmatched | reason=Unknown | pattern=Allows identification of the medication statement as it is known by various participating systems and in a way that remains consistent across servers.
• Event.status → MedicationStatement.status
  • shortUnmatched | reason=Unknown | pattern=preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown | resource=recorded | entered-in-error | draft
  • definitionUnmatched | reason=Unknown | pattern=The current state of the medication statement. | resource=A code representing the status of recording the medication statement.
  • commentsUnmatched | reason=Unknown | pattern=A nominal state-transition diagram can be found in the (Event pattern documentation

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. | resource=This status concerns just the recording of the medication statement. MedicationStatement.adherence should be used for indicating a patient's adherence to the information in this resource. Note, the statuses are different than in previous releases for MedicationStatement or MedicationStatement.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

• Event.code → MedicationStatement.medication
  • missingTypes | reason=Unknown | pattern=CodeableConcept
  • extraTypes | reason=Unknown
  • shortUnmatched | reason=Unknown | pattern=What service was done | resource=The medication that is/was taken (or not taken)
  • definitionUnmatched | reason=Unknown | pattern=A code that identifies the specific service or action that was or is being performed. | resource=Identifies the medication taken (or not taken). This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
• Event.subject → MedicationStatement.subject
  • shortUnmatched | reason=Unknown | pattern=Individual service was done for/to | resource=Who is/was taking the medication
  • definitionUnmatched | reason=Unknown | pattern=The individual or set of individuals the action is being or was performed on. | resource=The person, animal or group who is/was taking the medication.
  • requirementsUnmatched | reason=Unknown | pattern=Links the medication statement to the Patient context. May also affect access control.
• Event.encounter → MedicationStatement.encounter
  • shortUnmatched | reason=Unknown | pattern=Encounter the medication statement is part of | resource=Encounter associated with MedicationStatement
  • definitionUnmatched | reason=Unknown | pattern=The Encounter during which this medication statement was created or to which the creation of this record is tightly associated. | resource=The encounter that establishes the context for this MedicationStatement.
  • commentsUnmatched | reason=Unknown | pattern=This will typically be the encounter the medication statement was created during, but some medication statements may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).
  • requirementsUnmatched | reason=Unknown | pattern=Links the medication statement to the Encounter context. May also affect access control.
• Event.occurrence[x] → MedicationStatement.effective[x]
  • shortUnmatched | reason=Unknown | pattern=When medication statement occurred/is occurring | resource=The date/time or interval when the medication is/was/will be taken
  • definitionUnmatched | reason=Unknown | pattern=The date, period or timing when the medication statement did occur or is occurring. | resource=The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.adherence element is Not Taking).
  • commentsUnmatched | reason=Unknown | pattern=This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. . | resource=This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken and is expected to continue indefinitely at the time the usage is recorded, the "end" date will be omitted. If the end date is known, then it is included as the "end date". The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.
• Event.reason → MedicationStatement.reason
  • summary | reason=Unknown | pattern=true
  • shortUnmatched | reason=Unknown | pattern=Why was medication statement performed? | resource=Reason for why the medication is being/was taken
  • definitionUnmatched | reason=Unknown | pattern=Describes why the medication statement occurred in coded or textual form or Indicates another resource whose existence justifies this medication statement. | resource=A concept, Condition or observation that supports why the medication is being/was taken.
  • commentsUnmatched | reason=Unknown | pattern=Textual reasons can be captured using reasonCode.text. | resource=This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
• Event.note → MedicationStatement.note
  • shortUnmatched | reason=Unknown | pattern=Comments made about the event | resource=Further information about the usage
  • definitionUnmatched | reason=Unknown | pattern=Comments made about the medication statement by the performer, subject or other participants. | resource=Provides extra information about the Medication Statement that is not conveyed by the other attributes.

Unmapped Elements

• Event.partOf — Unknown
• Event.reported — Unknown
• Event.relevantHistory — Unknown
• Event.location — Unknown
• Event.statusReason — Unknown
• Event.performer.actor — Unknown
• Event.performer.function — Unknown
• Event.category — Unknown
• Event.recorded — Unknown
• Event.product — Unknown
• Event.performer — Unknown

medicationstatement-fivews-mapping-exceptions.xml

Unmapped Elements

• FiveWs.actor — Unknown
• FiveWs.cause — Unknown
• FiveWs.version — Unknown
• FiveWs.witness — Unknown
• FiveWs.where — Unknown
• FiveWs.context — Unknown
• FiveWs.init — Unknown
• FiveWs.who — Unknown
• FiveWs.grade — Unknown
• FiveWs.planned — Unknown