Medication
The Medication profile is simply that from IPS (STU1):
- Profile status:
Active - Canonical URL:
http://hl7.org/fhir/uv/ips/StructureDefinition/Medication-uv-ips
Use of resource in Smart4Health
Medication resource are used to capture details about a medication, independent of a specific use case. The level of provided detail may vary significantly, from just providing the class of the active substance in the ATC classification system to providing a full list of ingredients, information about the packaging and the physical form of the medication etc.
In individual countries, medications are often assigned codes in a national medication code system, e.g. the PZN-system in Germany or RxNorm in the US. While such codes allows systematic identification of specific medications within the given country, they are much less useful outside this national context. For this reason, specific guidelines for creating Medication resources in the Smart4Health context are provided below.
Relation to other Medication profiles
The Smart4Health project simply re-uses the Medication profile from the International Patient Summary (STU1).
Guidance on filling Medication instances
These guidelines are intended to help make Medication resources as interoperable as possible across national boundaries.
- Whenever possible, avoid relying solely on national codes (e.g. PZN in Germany) for communicating details about the medication. It is preferable to also "spell out" this information using the individual fields (
ingredients,formetc.) to make it accessible to systems that do not know the national codes. - Wherever possible, include codes from international code systems (e.g. SNOMED, ATC, or EDQM) to allow interpretation outside the country of origin. This is particularly important for the
medication.codeelement. The IPS Medication profile indicates how to use of these international systems using slices and preferred bindings. - Even if an international code is available for a
CodeableConceptelement, you are encouraged to also include additional codes from other systems. Even nation-specific codes can be valuable if the data consumer is from the same country. - When filling fields of type
CodeableConcept, try to always fill theCodeableConcept.coding.displayelement for individual codes, as well as the overallCodeableConcept.textfield. - Note that the slicing of the
Medication.codeelement merely represent guidance on how one should include codes from ATC and SNOMED, respectively. They do not imply that one must use these systems. The required binding defined in these slice only apply "inside" the slices - the slices themselves are not required and can be left out. See also the discussion of this in the IPS IG.
Mandatory and must-support data elements
A valid instance according to this profile must satisfy the following constraints:
- have a code (element:
code) - IPS constraint
Note that the ingredient.strength element is restricted to follow the IPS profile for the Ratio data type, meaning that the units must be from the UCUM system.
In addition, 9 top-level elements are marked as must-support.
Examples
- Fluspiral 50 mg
- minimal-medication-example-2
- Simvastatin 40 MG
- L-THYROXIN 100 Henning Tabletten
- Diazepam-ratiopharm 10 mg Tabletten
- ASS 100 - 1a Pharma TAH Tabletten
- PROPOFOL 2% 20MG/1ML MCT
- Caelyx 50 Mg/25 ml Konz.z.Herst.e.Infusi
- Glucose 5% B.braun Ecoflac Plus
- Glucose 5% B.braun Ecoflac Plus
- PRIMPERAN ZETPIL 20MG
- PARACETAMOL TABLET 500MG
- Metoclopramide zetpil 20mg
- Metoclopramide zetpil 20mg
- TRIMETAZIDINE
Formal views of profile content
Differential view
Shows only differences relative to the base resource definition.
| MedicationIPS (Medication) | S I | Medication | Element idMedication Definition of a Medication DefinitionThis resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use. IPS Medication
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedication.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedication.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedication.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedication.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedication.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedication.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedication.identifier Business identifier for this medication DefinitionBusiness identifier for this medication. The serial number could be included as an identifier.
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| code | S Σ | 1..1 | CodeableConceptIPS | Element idMedication.code Medication that was administered or was to be administered (medication code from any code system) DefinitionMedication that was administered or was to be administered. Several kinds of medication coding could be provided as:
The value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Unordered, Open, by $this(Pattern) Discriminated by value set Binding The type of medication
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| atcClass | S Σ | 0..1 | CodeableConceptIPSBinding | Element idMedication.code:atcClass WHO ATC classification DefinitionWHO ATC classification Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept that defines the type of a medication.
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| snomed | S Σ | 0..1 | CodeableConceptIPSBinding | Element idMedication.code:snomed SNOMED CT medications DefinitionSNOMED CT medications (Pharmaceutical / biologic product) Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept that defines the type of a medication.
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| status | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedication.status active | inactive | entered-in-error DefinitionA code to indicate if the medication is in active use. This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status. A coded concept defining if the medication is in active use.
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| manufacturer | Σ | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedication.manufacturer Manufacturer of the item DefinitionDescribes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.
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| form | S | 0..1 | CodeableConceptIPSBinding | Element idMedication.form Concept - reference to a terminology or just text DefinitionDescribes 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. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept defining the form of a medication.
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| amount | Σ | 0..1 | Ratio | There are no (further) constraints on this element Element idMedication.amount Amount of drug in package DefinitionSpecific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).
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| ingredient | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idMedication.ingredient Active or inactive ingredient DefinitionIdentifies a particular constituent of interest in the product. The ingredients need not be a complete list. If an ingredient is not specified, this does not indicate whether an ingredient is present or absent. If an ingredient is specified it does not mean that all ingredients are specified. It is possible to specify both inactive and active ingredients.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| item[x] | 1..1 | There are no (further) constraints on this element Element idMedication.ingredient.item[x] The actual ingredient or content DefinitionThe actual ingredient - either a substance (simple ingredient) or another medication of a medication. The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base). Unordered, Open, by $this(Type) Constraints
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| itemCodeableConcept | S | 0..1 | CodeableConceptIPSBinding | Element idMedication.ingredient.item[x]:itemCodeableConcept Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base). 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. SNOMED CT drug substances
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S | 0..* | CodingIPS | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.coding A reference to a code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.
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| text | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. The text should be at the displayName level and not on this level.
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| (All Slices) | There are no (further) constraints on this element | |||
| itemReference | Reference(Substance | Medication) | There are no (further) constraints on this element Data type | ||
| isActive | 0..1 | boolean | There are no (further) constraints on this element Element idMedication.ingredient.isActive Active ingredient indicator DefinitionIndication of whether this ingredient affects the therapeutic action of the drug. True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). False indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive).
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| strength | S I | 0..1 | RatioIPS | Element idMedication.ingredient.strength A ratio of two Quantity values - a numerator and a denominator DefinitionA relationship of two Quantity values - expressed as a numerator and a denominator. The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.
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| batch | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedication.batch Details about packaged medications DefinitionInformation that only applies to packages (not products).
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.batch.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.batch.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.batch.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| lotNumber | 0..1 | string | There are no (further) constraints on this element Element idMedication.batch.lotNumber Identifier assigned to batch DefinitionThe assigned lot number of a batch of the specified product.
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| expirationDate | 0..1 | dateTime | There are no (further) constraints on this element Element idMedication.batch.expirationDate When batch will expire DefinitionWhen this specific batch of product will expire.
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Snapshot view
Shows all constraints, including those from underlying profiles and the base resource definition.
| MedicationIPS (Medication) | S I | Medication | Element idMedication Definition of a Medication DefinitionThis resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use. IPS Medication
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedication.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedication.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedication.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedication.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedication.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedication.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedication.identifier Business identifier for this medication DefinitionBusiness identifier for this medication. The serial number could be included as an identifier.
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| code | S Σ | 1..1 | CodeableConceptIPS | Element idMedication.code Medication that was administered or was to be administered (medication code from any code system) DefinitionMedication that was administered or was to be administered. Several kinds of medication coding could be provided as:
The value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Unordered, Open, by $this(Pattern) Discriminated by value set Binding The type of medication
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| atcClass | S Σ | 0..1 | CodeableConceptIPSBinding | Element idMedication.code:atcClass WHO ATC classification DefinitionWHO ATC classification Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept that defines the type of a medication.
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| snomed | S Σ | 0..1 | CodeableConceptIPSBinding | Element idMedication.code:snomed SNOMED CT medications DefinitionSNOMED CT medications (Pharmaceutical / biologic product) Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept that defines the type of a medication.
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| status | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedication.status active | inactive | entered-in-error DefinitionA code to indicate if the medication is in active use. This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status. A coded concept defining if the medication is in active use.
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| manufacturer | Σ | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedication.manufacturer Manufacturer of the item DefinitionDescribes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.
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| form | S | 0..1 | CodeableConceptIPSBinding | Element idMedication.form Concept - reference to a terminology or just text DefinitionDescribes 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. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept defining the form of a medication.
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| amount | Σ | 0..1 | Ratio | There are no (further) constraints on this element Element idMedication.amount Amount of drug in package DefinitionSpecific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).
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| ingredient | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idMedication.ingredient Active or inactive ingredient DefinitionIdentifies a particular constituent of interest in the product. The ingredients need not be a complete list. If an ingredient is not specified, this does not indicate whether an ingredient is present or absent. If an ingredient is specified it does not mean that all ingredients are specified. It is possible to specify both inactive and active ingredients.
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| item[x] | 1..1 | There are no (further) constraints on this element Element idMedication.ingredient.item[x] The actual ingredient or content DefinitionThe actual ingredient - either a substance (simple ingredient) or another medication of a medication. The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base). Unordered, Open, by $this(Type) Constraints
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| itemCodeableConcept | S | 0..1 | CodeableConceptIPSBinding | Element idMedication.ingredient.item[x]:itemCodeableConcept Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base). 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. SNOMED CT drug substances
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| coding | S | 0..* | CodingIPS | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.coding A reference to a code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.
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| text | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.item[x]:itemCodeableConcept.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. The text should be at the displayName level and not on this level.
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| itemReference | Reference(Substance | Medication) | There are no (further) constraints on this element Data type | ||
| isActive | 0..1 | boolean | There are no (further) constraints on this element Element idMedication.ingredient.isActive Active ingredient indicator DefinitionIndication of whether this ingredient affects the therapeutic action of the drug. True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). False indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive).
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| strength | S I | 0..1 | RatioIPS | Element idMedication.ingredient.strength A ratio of two Quantity values - a numerator and a denominator DefinitionA relationship of two Quantity values - expressed as a numerator and a denominator. The Ratio datatype should only be used to express a relationship of two numbers if the relationship cannot be suitably expressed using a Quantity and a common unit. Where the denominator value is known to be fixed to "1", Quantity should be used instead of Ratio.
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| batch | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedication.batch Details about packaged medications DefinitionInformation that only applies to packages (not products).
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.batch.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.batch.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idMedication.batch.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| lotNumber | 0..1 | string | There are no (further) constraints on this element Element idMedication.batch.lotNumber Identifier assigned to batch DefinitionThe assigned lot number of a batch of the specified product.
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| expirationDate | 0..1 | dateTime | There are no (further) constraints on this element Element idMedication.batch.expirationDate When batch will expire DefinitionWhen this specific batch of product will expire.
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