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HdBe-MedicationAgreement

CBB	Description	Status
HdBe-MedicationAgreement	A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement. Purpose The goal of the medication agreement is to provide insight into the agreements reached between the prescriber and the patient on the use of medication. Instructions MedicationAgreementAdditionalInformation: When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). The patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been an intended increase.	active

CBB

Description

Status

A medication agreement is a prescriber’s proposal for a patient to use medication. An agreement to discontinue the use of medication is also a medication agreement.

Purpose

The goal of the medication agreement is to provide insight into the agreements reached between the prescriber and the patient on the use of medication.

Instructions

MedicationAgreementAdditionalInformation: When choosing a medicine, you can deviate from what is expected or from what the standard is. For example, when the hospital uses a different formulary than the community pharmacy. For reasons of efficiency, for example, one gastric acid inhibitor has been chosen in the hospital: pantoprazole. Upon admission, a patient with omeprazole is converted to pantoprazole for the duration of the stay. When discharged, the patient goes back to omeprazole. It is clear that something can go wrong here and that the patient takes both omeprazole and pantoprazole when there is no intervention. In the hospital's medication agreement for pantoprazole a remark can be made about the deviation so that it is clear that pantoprazole is the substitute for omeprazole or that it should be used in addition to omeprazole. Another example are the half strengths. The hospital sometimes stocks tablets with half the strength of the normal trade preparation (own production). The patient enters the hospital on 25 mg chlortalidone, half a tablet once a day, he receives 12.5 mg intramural chlortalidone, one tablet once a day. Then the nursing does not have to break tablets in this case. Here there is a risk that the patient will use the 25 mg again at home, but then a whole tablet at a time in stead of half a tablet. By means of an explanation in the medication agreement (Additional information) of the last chlortalidone 25 mg, it can be indicated whether this has been an intended increase.

active

MedicationAgreement			MedicationAgreement	Element id MedicationAgreement Short description MedicationAgreement Definition Root concept of the MedicationAgreement information model. This root concept contains all data elements of the MedicationAgreement information model. Data type MedicationAgreement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id MedicationAgreement.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationAgreement.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
Prescriber	I	0..1	Reference(HdBe-HealthProfessional)	Element id MedicationAgreement.Prescriber Short description Prescriber Definition The health professional that entered the medication agreement with the patient. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-HealthProfessional) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
PrescriptionReason	I	0..1	Reference(HdBe-Problem)	Element id MedicationAgreement.PrescriptionReason Short description PrescriptionReason Definition The medical reason for the prescription or for use of the medication. This can be used to enter a medical indication which was the direct cause for prescription or for use of the medication in question. It can concern every type of problem (or condition) of the patient, almost all diagnoses, complaints or symptoms. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-Problem) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
AgreedMedicine	I	1..1	Reference(HdBe-PharmaceuticalProduct)	Element id MedicationAgreement.AgreedMedicine Short description AgreedMedicine Definition The medicine agreed upon to be used. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-PharmaceuticalProduct) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
InstructionsForUse		0..1	HdBe-InstructionsForUse	Element id MedicationAgreement.InstructionsForUse Short description InstructionsForUse Definition Instructions for the use of the medication, e.g. dose and route of administration. Data type HdBe-InstructionsForUse Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
MedicationAgreementDateTime		1..1	dateTime	Element id MedicationAgreement.MedicationAgreementDateTime Short description MedicationAgreementDateTime Definition The time at which the agreement was made. Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day) Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
PeriodOfUse		0..1	HdBe-TimeInterval	Element id MedicationAgreement.PeriodOfUse Short description PeriodOfUse Definition Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). This is the time at which the instructions for use in this agreement start. In the case of an agreement to discontinue use, this is the start date of the original medication agreement. The end date indicates from when the medication is to be discontinued. Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days. End date: The time at which the period of use ends (or ended or will end). In the case of an agreement to discontinue use, this is the time at which the medication is to be discontinued. To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. With medication for an indefinite period only a start date is indicated. Data type HdBe-TimeInterval Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
MedicationAgreementStopType		0..1	CodeableConceptBinding	Element id MedicationAgreement.MedicationAgreementStopType Short description MedicationAgreementStopType Definition Stop type, the manner in which this medication is discontinued (temporary or definitive). Comments 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. Data type CodeableConcept Binding MedicationAgreementStopType codes MedicationStopType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
ReasonMedicationAgreement		0..1	CodeableConceptBinding	Element id MedicationAgreement.ReasonMedicationAgreement Short description ReasonMedicationAgreement Definition Reason for this agreement. This can be the reason to start, change or stop the medication treatment. Comments 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. Data type CodeableConcept Binding ReasonMedicationAgreement codes MedicationReason (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
MedicationAgreementAdditionalInformation		0..*	CodeableConceptBinding	Element id MedicationAgreement.MedicationAgreementAdditionalInformation Short description MedicationAgreementAdditionalInformation Definition Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way. See also the Instructions section for more information about use of the element. Comments 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. Data type CodeableConcept Binding MedicationAgreementAdditionalInformation codes MedicationAgreementAdditionalInformation (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Comment		0..1	string	Element id MedicationAgreement.Comment Short description Comment Definition Comments regarding to the medication agreement. For example: in consultation with the medical specialist. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a

MedicationAgreement		0..*
MedicationAgreement.Prescriber	Reference(HdBe-HealthProfessional)	0..1
MedicationAgreement.PrescriptionReason	Reference(HdBe-Problem)	0..1
MedicationAgreement.AgreedMedicine	Reference(HdBe-PharmaceuticalProduct)	1..1
MedicationAgreement.InstructionsForUse	HdBe-InstructionsForUse	0..1
MedicationAgreement.MedicationAgreementDateTime	dateTime	1..1
MedicationAgreement.PeriodOfUse	HdBe-TimeInterval	0..1
MedicationAgreement.MedicationAgreementStopType	CodeableConcept	0..1
MedicationAgreement.ReasonMedicationAgreement	CodeableConcept	0..1
MedicationAgreement.MedicationAgreementAdditionalInformation	CodeableConcept	0..*
MedicationAgreement.Comment	string	0..1

MedicationAgreement
Definition	Root concept of the MedicationAgreement information model. This root concept contains all data elements of the MedicationAgreement information model.
Cardinality	0...*
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationAgreement.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationAgreement.extension
Definition	May 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationAgreement.Prescriber
Definition	The health professional that entered the medication agreement with the patient.
Cardinality	0...1
Type	Reference(HdBe-HealthProfessional)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
MedicationAgreement.PrescriptionReason
Definition	The medical reason for the prescription or for use of the medication. This can be used to enter a medical indication which was the direct cause for prescription or for use of the medication in question. It can concern every type of problem (or condition) of the patient, almost all diagnoses, complaints or symptoms.
Cardinality	0...1
Type	Reference(HdBe-Problem)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
MedicationAgreement.AgreedMedicine
Definition	The medicine agreed upon to be used.
Cardinality	1...1
Type	Reference(HdBe-PharmaceuticalProduct)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
MedicationAgreement.InstructionsForUse
Definition	Instructions for the use of the medication, e.g. dose and route of administration.
Cardinality	0...1
Type	HdBe-InstructionsForUse
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationAgreement.MedicationAgreementDateTime
Definition	The time at which the agreement was made. Appointment date + time are required (order of the appointments must be clear in cases with multiple appointments on one day)
Cardinality	1...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationAgreement.PeriodOfUse
Definition	Start date: This is the time at which the agreement was to take effect (or took effect or will take effect). This is the time at which the instructions for use in this agreement start. In the case of an agreement to discontinue use, this is the start date of the original medication agreement. The end date indicates from when the medication is to be discontinued. Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days. End date: The time at which the period of use ends (or ended or will end). In the case of an agreement to discontinue use, this is the time at which the medication is to be discontinued. To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date. With medication for an indefinite period only a start date is indicated.
Cardinality	0...1
Type	HdBe-TimeInterval
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationAgreement.MedicationAgreementStopType
Definition	Stop type, the manner in which this medication is discontinued (temporary or definitive).
Cardinality	0...1
Type	CodeableConcept
Binding	MedicationAgreementStopType codes MedicationStopType (required)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
MedicationAgreement.ReasonMedicationAgreement
Definition	Reason for this agreement. This can be the reason to start, change or stop the medication treatment.
Cardinality	0...1
Type	CodeableConcept
Binding	ReasonMedicationAgreement codes MedicationReason (required)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
MedicationAgreement.MedicationAgreementAdditionalInformation
Definition	Additional information includes details on the structure of the agreement made that are relevant for pharmacovigilance and fulfillment by the pharmacist. This can be used e.g. to indicate that there was a conscious decision to deviate from the norm or that the agreement is to be structured in a certain way. See also the Instructions section for more information about use of the element.
Cardinality	0...*
Type	CodeableConcept
Binding	MedicationAgreementAdditionalInformation codes MedicationAgreementAdditionalInformation (required)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
MedicationAgreement.Comment
Definition	Comments regarding to the medication agreement. For example: in consultation with the medical specialist.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a

Example instances

MedicationAgreement
Prescriber	Reference to HealthProfessional (E. Penninx)
PrescriptionReason	Reference to Problem (Listeriosis)
AgreedMedicine	Reference to PharmaceuticalProduct (Acetaminophen 500 mg)
InstructionsForUse	Reference to InstructionsForUse (Vanaf 6 maart 2016 1x per week op maandag in de middag 500 mg)
MedicationAgreementDateTime	2016-03-04 15:52:30
PeriodOfUse	Reference to TimeInterval (start: 2016-03-06 )
MedicationAgreementStopType
ReasonMedicationAgreement	266709005 - Medication commenced (code by SNOMED CT)
MedicationAgreementAdditionalInformation
Comment

zib MedicationAgreement-v1.2 difference

Concept	Category	Description
`PrescriberReason`	textual	Removed context regarding the Dutch G-standard.
`MedicationAgreementStopType`	terminology	Renamed ValueSet from MedicationAgreementStopType to MedicationStopType, to be able to reuse it at MedicationUse and AdministrationAgreement. Also replaced Dutch SNOMED-CT codes with international codes in ValueSet MedicationStopType.
`ReasonMedicationAgreement`	terminology	Renamed ValueSet from MedicationAgreementReason to MedicationReason, to be able to reuse it at MedicationUse2. Replaced several values in ValueSet. 1. Added SNOMED-CT code for Unknown and Other. 2. Added CodeSystem MedicationReason which replaces all Dutch SNOMED-CT codes. 3. Removed all Dutch SNOMED-CT codes from valueset.
`MedicationAgreementAdditionalInformation`	terminology	Replaced several values in MedicationAgreementAdditionalInformation valueSet. 1. Replaced OTH with SNOMED-CT code for Other. 2. Added SNOMED-CT code for Unknown. 3. Added CodeSystem MedicationAgreementAdditionalInformation which replaces all Dutch SNOMED-CT codes. 4. Removed all Dutch SNOMED-CT codes from valueset.
description.Instructions	textual	Replaced 'a intended increase' with 'an intended increase'.

Terminology Bindings

Path	Name	Strength	URL
MedicationAgreementStopType	MedicationStopType	required	https://fhir.healthdata.be/ValueSet/MedicationStopType
ReasonMedicationAgreement	MedicationReason	required	https://fhir.healthdata.be/ValueSet/MedicationReason
MedicationAgreementAdditionalInformation	MedicationAgreementAdditionalInformation	required	https://fhir.healthdata.be/ValueSet/MedicationAgreementAdditionalInformation