Medication Summary

The medication summary section contains a description of the patient's medications relevant for the scope of the patient summary. The actual content could depend on the jurisdiction, it could report:
  • the currently active medications;
  • the current and past medications considered relevant by the authoring GP;
  • the patient prescriptions or dispensations automatically extracted by a regional or a national EHR.
In all those cases however medications are documented in the Patient Summary as medication statements. This section requires either an entry indicating the subject is known not to be on any relevant medication; either an entry indicating that no information is available about medications; or entries summarizing the subject's relevant medications.

Medication Statement

Tree view

identifier..0
identifier..0
identifier..0
statusS
categoryCodeable Concept
medicationCodeableConceptCodeable Concept
medicationReferenceReference(Medication)
effective[x]S
identifier..0
identifier..0
identifier..0
reasonNotTakenCodeable Concept
reasonCodeCodeable Concept
identifier..0
textS
additionalInstructionCodeable Concept
patientInstructionS
boundsDurationDuration
boundsPeriodPeriod
boundsRangeRange
system
systemBinding
systemBinding
methodCodeable Concept
maxDosePerPeriod..0
rateQuantity..0http://hl7.org/fhir/StructureDefinition/SimpleQuantity
MedicationStatement.basedOn.identifier
Cardinality..0
MedicationStatement.partOf.identifier
Cardinality..0
MedicationStatement.context.identifier
Cardinality..0
MedicationStatement.status
Must SupportTrue
MedicationStatement.category
TypeCodeable Concept
MedicationStatement.medication[x]
Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that gives a reason for absent or unknown Medication..

TypeReference(Medication), Codeable Concept
Binding

Representation of unknown or absent medications

IPSNoMedsInfo (required)

Must SupportTrue
MedicationStatement.effective[x]
Must SupportTrue
MedicationStatement.informationSource.identifier
Cardinality..0
MedicationStatement.subject
TypeReference(http://hl7.org/fhir/StructureDefinition/Patient)
MedicationStatement.subject.identifier
Cardinality..0
MedicationStatement.derivedFrom.identifier
Cardinality..0
MedicationStatement.reasonNotTaken
TypeCodeable Concept
MedicationStatement.reasonCode
TypeCodeable Concept
MedicationStatement.reasonReference.identifier
Cardinality..0
MedicationStatement.dosage
Must SupportTrue
MedicationStatement.dosage.text
Must SupportTrue
MedicationStatement.dosage.additionalInstruction
TypeCodeable Concept
MedicationStatement.dosage.patientInstruction
Must SupportTrue
MedicationStatement.dosage.timing
Must SupportTrue
MedicationStatement.dosage.timing.repeat.bounds[x]
TypeDuration, Period, Range
MedicationStatement.dosage.timing.code
TypeCodeable Concept
MedicationStatement.dosage.timing.code.coding.system
Binding

http://hl7.org/fhir/valueset-event-timing.html (example)

MedicationStatement.dosage.site
TypeCodeable Concept
MedicationStatement.dosage.site.coding
Binding

IPSTargetSiteCode (preferred)

MedicationStatement.dosage.site.coding.system
Binding

IPSTargetSiteCode (preferred)

MedicationStatement.dosage.route
TypeCodeable Concept
Must SupportTrue
MedicationStatement.dosage.route.coding
Binding

EDQM Standards Terms

IPSRouteOfAdmin (preferred)

MedicationStatement.dosage.route.coding.system
Binding

IPSRouteOfAdmin (preferred)

MedicationStatement.dosage.method
TypeCodeable Concept
MedicationStatement.dosage.maxDosePerPeriod
Cardinality..0
MedicationStatement.dosage.maxDosePerAdministration
Cardinality..0
TypeQuantity
MedicationStatement.dosage.maxDosePerAdministration.comparator
Cardinality..0
MedicationStatement.dosage.maxDosePerLifetime
Cardinality..0
TypeQuantity
MedicationStatement.dosage.maxDosePerLifetime.comparator
Cardinality..0
MedicationStatement.dosage.rateQuantity:rateQuantity
Cardinality..0
Typehttp://hl7.org/fhir/StructureDefinition/SimpleQuantity

Medication

Tree view
system1..Fixed Value
code1..
system1..Fixed Value
code1..
system1..Fixed Value
code1..
system1..Fixed Value
code1..
system1..Fixed Value
code1..
system1..Fixed Value
code1..
system1..Fixed Value
code1..
textS
status..0
isBrand..0
isOverTheCounter..0
manufacturer..0
systemBinding
systemBinding
textS
isActive..0
amountSRatio
package..0
Medication
Comments

IPS Medication

Medication.code
ShortCodes that identify this medication, sliced to support IDMP
Cardinality..1
TypeCodeable Concept
Must SupportTrue
Medication.code.coding
Definition

A representation of the medication in a code system. The representation can be granular or may also be a class or category.

Slicing

Unordered, Open, by system(Value)

This slicing on the coding element of Medication.code is open, with discriminator based on the value of the Coding.system element. It supports both identifiers and categories or classes for representing the medication. It carries one slice for each of the IDMP identifiers, plus one slice for the ATC classification. Other representations of the medication (such as SNOMED CT, RxNorm, jurisdictional code systems, cross-jursisdiction code systems, or any classification) use extra slices, since the slicing is open. The IDMP slices are provisional, and will be usable when the IDMP identifiers become available.

Medication.code.coding:pharmaceuticalProduct-L1
ShortPharmaceutical Product Identifier, Level 1
Definition

IDMP PhPID Level 1 (Implies ingredients) or any equivalent Pharmaceutical Product identifier.

Pharmaceutical Product Identifier (PhPID): Uniquely identifies medicinal product based on the generic composition, such as ingredients and route of administration, separate from any other details such as regulatory authorisation, organisation, packaging or naming. The PhPID can be specified at various levels of detail for a given Pharmaceutical Product.

Cardinality..1
Medication.code.coding:pharmaceuticalProduct-L1.system
Cardinality1
Fixed Value
http://hl7.org/fhir/sid/phpid-l1
Medication.code.coding:pharmaceuticalProduct-L1.code
Cardinality1
Medication.code.coding:pharmaceuticalProduct-L2
ShortPharmaceutical Product Identifier, Level 2
Definition

IDMP PhPID Level 2 (Implies ingredients and strength) or any equivalent Pharmaceutical Product identifier.

Pharmaceutical Product Identifier (PhPID): Uniquely identifies medicinal product based on the generic composition, such as ingredients and route of administration, separate from any other details such as regulatory authorisation, organisation, packaging or naming. The PhPID can be specified at various levels of detail for a given Pharmaceutical Product.

Cardinality..1
Medication.code.coding:pharmaceuticalProduct-L2.system
Cardinality1
Fixed Value
http://hl7.org/fhir/sid/phpid-l2
Medication.code.coding:pharmaceuticalProduct-L2.code
Cardinality1
Medication.code.coding:pharmaceuticalProduct-L3
ShortPharmaceutical Product Identifier, Level 3
Definition

IDMP PhPID Level 3 (Implies ingredients and dose form) or any equivalent Pharmaceutical Product identifier.

Pharmaceutical Product Identifier (PhPID): Uniquely identifies medicinal product based on the generic composition, such as ingredients and route of administration, separate from any other details such as regulatory authorisation, organisation, packaging or naming. The PhPID can be specified at various levels of detail for a given Pharmaceutical Product.

Cardinality..1
Medication.code.coding:pharmaceuticalProduct-L3.system
Cardinality1
Fixed Value
http://hl7.org/fhir/sid/phpid-l3
Medication.code.coding:pharmaceuticalProduct-L3.code
Cardinality1
Medication.code.coding:pharmaceuticalProduct-L4
ShortPharmaceutical Product Identifier, Level 4
Definition

IDMP PhPID Level 4 (Implies ingredients, strength, and dose form) or any equivalent Pharmaceutical Product identifier.

Pharmaceutical Product Identifier (PhPID): Uniquely identifies medicinal product based on the generic composition, such as ingredients and route of administration, separate from any other details such as regulatory authorisation, organisation, packaging or naming. The PhPID can be specified at various levels of detail for a given Pharmaceutical Product.

Cardinality..1
Medication.code.coding:pharmaceuticalProduct-L4.system
Cardinality1
Fixed Value
http://hl7.org/fhir/sid/phpid-l4
Medication.code.coding:pharmaceuticalProduct-L4.code
Cardinality1
Medication.code.coding:medicinalProduct
ShortMedicinal Product Identifier
Definition

IDMP Medicinal Product Identifier (MPID) or any equivalent Medicinal Product Identifier.

IDMP MPID uniquely identifies a Medicinal Product, reflecting (but not replacing) any other authorisation numbers allocated by a regulator.

MPID implies one (set of) PhPID. The MPID shall use a common segment pattern related to a Medicinal Product, which when each segment is valued shall define a specific MPID concept. The pattern is: • a) Country code segment (ISO 3166-1 alpha-2 code elements); • b) Marketing Authorization Holder (Organization Identifier) code segment; • c) Medicinal Product code segment (Unique Medicinal Product Identifier). • Any change of the values related to these three code segments shall result in the assignment of a new MPID.

Cardinality..1
Medication.code.coding:medicinalProduct.system
Cardinality1
Fixed Value
http://hl7.org/fhir/sid/mpid
Medication.code.coding:medicinalProduct.code
Cardinality1
Medication.code.coding:packagedProduct
ShortPackaged Medicinal Product Identifier
Definition

IDMP Packaged Medicinal Product Identifier or any equivalent Packaged Medicinal Product Identifier.

Uniquely identifies a Medicinal Product based on its packaging. This implies one MPID can be associated with more than one PCID, if the same Medicinal Product has more than one type of package;

The PCID shall use a common segment pattern related to a package of a Medicinal Product, which when each segment is valued, shall define a specific PCID concept. The pattern is: • a) MPID for the Medicinal Product • b) package description code segment, which refers to a unique identifier for each package.

Cardinality..1
Medication.code.coding:packagedProduct.system
Cardinality1
Fixed Value
http://hl7.org/fhir/sid/pcid
Medication.code.coding:packagedProduct.code
Cardinality1
Medication.code.coding:atcClass
ShortProduct classification or cluster
Definition

ATC classification for medication product

Cardinality..1
Binding

ATC class for the medication

WHOATC (extensible)

Medication.code.coding:atcClass.system
Cardinality1
Fixed Value
http://www.whocc.no/atc
Medication.code.coding:atcClass.code
Cardinality1
Medication.code.text
Definition

This element is supposed to be valorized with the complete Medicinal Product Name as approved by the Medicines Regulatory Agency in a jurisdiction. The name may be applicable in one or more country/language combinations.

Must SupportTrue
Medication.status
Cardinality..0
Medication.isBrand
Cardinality..0
Medication.isOverTheCounter
Cardinality..0
Medication.manufacturer
Cardinality..0
Medication.form
Definition

Describes the form of the item. Powder; tablets; capsule.

Administrable Pharmaceutical Dose Form. This code represents the form of the medication (e.g. tablet, capsule, liquid)

Since the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as referecne terminology for representing Pharmaceutical Dose forms;Pakages and Route of Administration.

It is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT.

TypeCodeable Concept
Binding

IPSDoseForm (example)

Must SupportTrue
Medication.form.coding.system
Binding

EDQM Standard Terms

IPSDoseForm (required)

Medication.ingredient
Must SupportTrue
Medication.ingredient.itemCodeableConcept:itemCodeableConcept
TypeCodeable Concept
Binding

SNOMED CT drug substances

IPSActiveSubstances (preferred)

Comments

The IDMP ISO 11238 standard addresses the identification and exchange of regulated information on substances. The Global Ingredient Archival System (GInAS) will provide a common global identifier for all of the substances used in medicinal products, providing a definition of substances globally consistent with this standard. Those identifiers however are yet available for concrete usage, therefore in this version of the template, SNOMED CT has been chosen as reference terminology also for the active substances. This choice will be revised based on the availability and the maturity of GInAS.

Medication.ingredient.itemCodeableConcept:itemCodeableConcept.coding
Must SupportTrue
Medication.ingredient.itemCodeableConcept:itemCodeableConcept.coding.system
Binding

IPSActiveSubstances (preferred)

Medication.ingredient.itemCodeableConcept:itemCodeableConcept.text
Must SupportTrue
Medication.ingredient.isActive
Cardinality..0
Medication.ingredient.amount
TypeRatio
Must SupportTrue
Medication.package
Definition

Removed as pre-adoption of R4.

Cardinality..0