Long-acting insulin (basal)

The below example is for basal insulin administrated by pump to the patient. The extension parent-device-metric will connect to the device metric which will be connected to device component pump.

{
"resourceType": "MedicationAdministration",
"id": "eb80911a-95f7-4c31-b4d9-3b2c1e1a2376",
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
"reference": "DeviceMetric/46d24edb-7afa-45c3-a12c-1b7a51d5f519"
}
}
],
"meta": {
"profile": [
"http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
]
},
"status": "completed",
"coding": [
{
"system": "http://roche.com/fhir/rdc/cs",
"code": "insulinDose",
"display": "Insulin Dose"
}
]
},
"subject": {
"reference": "Patient/SandboxPat3"
},
"start": "2021-02-05T07:02:00+00:00",
"end": "2021-02-05T08:02:00+00:00"
},
{
"actor": {
"reference": "Patient/SandboxPat3"
}
}
],
"dosage": {
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
"coding": [
{
"system": "http://roche.com/fhir/rdc/cs",
"code": "basal",
"display": "Basal"
}
]
}
}
],
"value": 1.1,
"unit": "[IU]/h",
"system": "http://unitsofmeasure.org",
"code": "[IU]/h"
}
}
}

The below example is for manual entry on the smart phone. The extension parent-device-metric will connect to the device metric which will be connected to device component of smart phone.

{
"resourceType": "MedicationAdministration",
"id": "id-medicationAdministration-pen-manual-basal",
"meta": {
"profile": [
"http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
]
},
"status": "completed",
"coding": [
{
"system": "http://snomed.info/sct",
"code": "25305005",
"display": "Long-acting insulin (substance)"
}
],
"text": "Novolin"
},
"subject": {
"reference": "Patient/SandboxPat3"
},
"effectiveDateTime": "2020-04-28T10:30:00Z",
{
"actor": {
"reference": "Patient/SandboxPat3"
}
}
],
"dosage": {
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
"coding": [
{
"system": "http://snomed.info/sct",
"code": "61968008",
"display": "Syringe, device (physical object)"
}
]
}
}
],
"dose": {
"value": 3,
"unit": "[iU]",
"system": "http://unitsofmeasure.org",
"code": "[iU]"
}
},
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
"reference": "DeviceMetric/id-deviceMetric-smartPhone-insulin"
}
}
]
}

The below example is entry from Insulin Pen. The extension parent-device-metric will connect to the device metric which will be connected device component of Insulin pen.

{
"resourceType": "MedicationAdministration",
"id": "id-medicationAdministration-pen-basal",
"meta": {
"profile": [
"http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
]
},
"status": "completed",
"coding": [
{
"system": "http://snomed.info/sct",
"code": "25305005",
"display": "Long-acting insulin (substance)"
}
],
"text": "Novolin"
},
"subject": {
"reference": "Patient/SandboxPat3"
},
"effectiveDateTime": "2020-04-28T10:30:00Z",
{
"actor": {
"reference": "Patient/SandboxPat3"
}
}
],
"dosage": {
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "CL936094",
"display": "Pen Device"
}
]
}
}
],
"dose": {
"value": 3,
"unit": "[iU]",
"system": "http://unitsofmeasure.org",
"code": "[iU]"
}
},
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
"reference": "DeviceMetric/id-deviceMetric-insulinPen-insulin"
}
}
]
}

FHIR example - Short-acting insulin (bolus)

The below example is for manual entry on the smart phone. The extension parent-device-metric will connect to the device metric which will be connected to device component of smart phone.
{
"resourceType": "MedicationAdministration",
"id": "id-medicationAdministration-pen-manual-bolus",
"meta": {
"profile": [
"http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
]
},
"status": "completed",
"coding": [
{
"system": "http://snomed.info/sct",
"code": "411531001",
"display": "Short-acting insulin (substance)"
}
],
"text": "Novolog"
},
"subject": {
"reference": "Patient/SandboxPat3"
},
"effectiveDateTime": "2020-04-28T09:20:00Z",
{
"actor": {
"reference": "Patient/SandboxPat3"
}
}
],
"dosage": {
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
"coding": [
{
"system": "http://snomed.info/sct",
"code": "61968008",
"display": "Syringe, device (physical object)"
}
]
}
}
],
"dose": {
"value": 5.1,
"unit": "[iU]",
"system": "http://unitsofmeasure.org",
"code": "[iU]"
}
},
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
"reference": "DeviceMetric/id-deviceMetric-smartPhone-insulin"
}
}
]
}
The below example is entry from Insulin Pen. The extension parent-device-metric will connect to the device metric which will be connected to device component of Insulin pen.
{
"resourceType": "MedicationAdministration",
"id": "id-medicationAdministration-pen-bolus",
"meta": {
"profile": [
"http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
]
},
"status": "completed",
"coding": [
{
"system": "http://snomed.info/sct",
"code": "411531001",
"display": "Short-acting insulin (substance)"
}
],
"text": "Novolog"
},
"subject": {
"reference": "Patient/SandboxPat3"
},
"effectiveDateTime": "2020-04-28T09:20:00Z",
{
"actor": {
"reference": "Patient/SandboxPat3"
}
}
],
"dosage": {
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
"coding": [
{
"system": "http://ncimeta.nci.nih.gov",
"code": "CL936094",
"display": "Pen Device"
}
]
}
}
],
"dose": {
"value": 5.1,
"unit": "[iU]",
"system": "http://unitsofmeasure.org",
"code": "[iU]"
}
},
{
"url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
"reference": "DeviceMetric/DeviceMetric/id-deviceMetric-insulinPen-insulin"
}
}
]
}

Medication Adminstration resource - Edited use case

The "edit" approach for medication adminstration will be as below. So this approach applies for any data point that is modelled as medication adminstration resource.

  • effectiveDateTime - will have the timestamp of the medication administration. This will remain the same unless the user updates also the administration timestamp
  • identifier - will have the same unique identifier with which it has been ingested already
  • status - will always be "completed" for the updated resource

   

Below is a sample for updating a pen_basal_injection_unit with internal confidence ID "BBBBB-BBBBB-BBBBB":

   

Step Description Insulin Units Injected TimeStamp Type Identifier
1 A pen_basal_injection_unit is entered 4 2020-04-28T10:30:00Z manual entry BBBBB-BBBBB-BBBBB
2 The entry is updated 3 2020-04-28T10:30:00Z manual entry BBBBB-BBBBB-BBBBB

The following bundle is generated on Step 2.

{
    "resourceType": "MedicationAdministration",
    "id": "id-medicationAdministration-pen-manual-basal",
    "meta": {
        "profile":  [
            "http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
        ]
    },
    "identifier":  [
                    {
                        "system": "http://roche.com/fhir/rdc/sid/medication-administration/mysugr",
                        "value": "BBBBB-BBBBB-BBBBB"
                    }
                ],
    "status": "completed",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "25305005",
                "display": "Long-acting insulin (substance)"
            }
        ],
        "text": "Novolin"
    },
    "subject": {
        "reference": "Patient/SandboxPat3"
    },
    "effectiveDateTime": "2020-04-28T10:30:00Z",
    "performer":  [
        {
            "actor": {
                "reference": "Patient/SandboxPat3"
            }
        }
    ],
    "dosage": {
        "extension":  [
            {
                "url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
                "valueCodeableConcept": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "61968008",
                            "display": "Syringe, device (physical object)"
                        }
                    ]
                }
            }
        ],
        "dose": {
            "value": 3,
            "unit": "[iU]",
            "system": "http://unitsofmeasure.org",
            "code": "[iU]"
        }
    },
    "extension":  [
        {
            "url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
            "valueReference": {
                "reference": "DeviceMetric/id-deviceMetric-smartPhone-insulin"
            }
        }
    ]
}

Medication Adminstration Delete use case

The "Delete" approach for medication adminstration resource will be as below. So this approach applies for any data point that is modelled as medication adminstration.

  • effectiveDateTime - will have the timestamp of the medication adminstration.
  • identifier - will have the same unique identifier with which it has been ingested already
  • status - will always be "entered-in-error" for the deleted resource

   

Below is a sample for deleting pen_basal_injection_unit with internal confidence ID AAAA-AAAA-A

   

Step Description Insulin Units Injected TimeStamp Type Identifier
1 A pen_basal_injection_unit is entered 4 2020-04-28T10:30:00Z manual entry BBBBB-BBBBB-BBBBB
2 The entry is updated 3 2020-04-28T10:30:00Z manual entry BBBBB-BBBBB-BBBBB
3 The entry is deleted; In FHIR it is logically deleted by replacing it with "entered-in-error" status 2020-04-28T10:30:00Z

The following bundle is generated on Step 3.


{
    "resourceType": "MedicationAdministration",
    "id": "id-medicationAdministration-pen-manual-basal",
    "meta": {
        "profile":  [
            "http://roche.com/fhir/rdc/StructureDefinition/medication-administration"
        ]
    },
    "identifier":  [
                    {
                        "system": "http://roche.com/fhir/rdc/sid/medication-administration/mysugr",
                        "value": "BBBBB-BBBBB-BBBBB"
                    }
                ],
    "status": "entered-in-error",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "25305005",
                "display": "Long-acting insulin (substance)"
            }
        ],
        "text": "Novolin"
    },
    "subject": {
        "reference": "Patient/SandboxPat3"
    },
    "effectiveDateTime": "2020-04-28T10:30:00Z",
    "performer":  [
        {
            "actor": {
                "reference": "Patient/SandboxPat3"
            }
        }
    ],
    "dosage": {
        "extension":  [
            {
                "url": "http://roche.com/fhir/rdc/StructureDefinition/medication-administration-dosage/admin-type",
                "valueCodeableConcept": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "61968008",
                            "display": "Syringe, device (physical object)"
                        }
                    ]
                }
            }
        ],
        "dose": {
            "value": 3,
            "unit": "[iU]",
            "system": "http://unitsofmeasure.org",
            "code": "[iU]"
        }
    },
    "extension":  [
        {
            "url": "http://roche.com/fhir/rdc/StructureDefinition/parent-device-metric",
            "valueReference": {
                "reference": "DeviceMetric/id-deviceMetric-smartPhone-insulin"
            }
        }
    ]
}