Medication (PS-CA)
This version of the PS-CA Implementation Guide has been superseded by a newer version. Other releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
Additional information on this profile (including the JSON & XML structure and detailed element descriptions) can be found at Medication (PS-CA)
Profile
| Medication | I | Medication | There are no (further) constraints on this element 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.
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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 | Data Type: Codeable Concept (PS-CA) | 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. A variety of terminology is used across the Canadian Landscape to codify medications. Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. In the meantime, various code systems in use in Canada are put forward as examples and optional slices have been created to encourage the use of SNOMED CT CA terminology. Future releases of PS CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content. IPS-UV Note: 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. Data Type: Codeable Concept (PS-CA) Sliced:Unordered, Open, by $this(Pattern) BindingExample: Canadian Clinical Drug Data Set codes PrescriptionMedicinalProduct (example)Constraints
DIN {
"coding": [
{
"system": "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"
}
]
}NPN {
"coding": [
{
"system": "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"
}
]
}CCDD {
"coding": [
{
"system": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
}
]
}Mappings
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| atcClass | Σ | 0..1 | CodeableConceptBinding | Element IdMedication.code:atcClass Optional slice for representing WHO ATC classification DefinitionWHO ATC classification Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one). A coded concept that defines the type of a medication. WhoAtcUvIps (required)Constraints
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| codeSCT | Σ | 0..1 | CodeableConceptBinding | Element IdMedication.code:codeSCT Optional slice for representing SNOMED CT medications DefinitionSNOMED CT medications (Pharmaceutical / biologic product) Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one). A coded concept that defines the type of a medication. MedicationSnomedCodesUvIps (required)Constraints
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| codeCCDD | Σ | 0..1 | CodeableConceptBinding | Element IdMedication.code:codeCCDD Optional slice for representing Canadian Clinical Drug Data Set codes DefinitionValue set consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one). A coded concept that defines the type of a medication. PrescriptionMedicinalProduct (required)Constraints
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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. Medication Status Codes (required)Constraints
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| manufacturer | Σ I | 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. 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.
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| form | S | 0..1 | Data Type: Codeable Concept (PS-CA)Binding | Element IdMedication.form Concept - reference to a terminology or just text DefinitionAdministrable 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 referenceterminology for representing Pharmaceutical Dose forms; Packages 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. Work is underway to define the pan-Canadian terminology that will be preferred and/or socialized for this element. Data Type: Codeable Concept (PS-CA) BindingA coded concept defining the form of a medication. DoseFormUvIps (preferred)Constraints
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| coding | Σ | 0..* | Data Type: Coding (PS-CA) | Element IdMedication.form.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. While the IPS-UV specification considers this a MS element, some systems will not have the ability to support codings for every codeableConcept, further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance. Implementors that support codings should still send the codings for codeable concepts if they are available and receivers should not produce failures or rejections if codings are included in the patient summary in the first release (a base tenet of FHIR). Additionally vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content Unordered, Open, by $this(Pattern) Constraints
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| formSCTCA | Σ | 0..1 | Data Type: Coding (PS-CA)Binding | Element IdMedication.form.coding:formSCTCA Optional slice for representing SNOMED CT Canadian edition dose forms DefinitionSNOMED CT Canadian edition dose forms Allows for alternative encodings within a code system, and translations to other code systems. While the IPS-UV specification considers this a MS element, some systems will not have the ability to support codings for every codeableConcept, further feedback is required on whether these systems are still expected to be able to demonstrate they can construct this element when developing the patient summary instance. Implementors that support codings should still send the codings for codeable concepts if they are available and receivers should not produce failures or rejections if codings are included in the patient summary in the first release (a base tenet of FHIR). Additionally vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content PharmaceuticalDoseFormCode (required) Constraints
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| text | S Σ | 0..1 | string | There are no (further) constraints on this element Element IdMedication.form.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. Very often the text is the same as a displayName of one of the codings.
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| amount | Σ I | 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.). 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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| ingredient | 0..* | BackboneElement | Element IdMedication.ingredient Active or inactive ingredient DefinitionIdentifies a particular constituent of interest in the product. IPS-UV flags this as a MS element. It is not currently flagged as MS in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a MS requirement within the context of their own jurisdictional content.
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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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| itemReference | Reference(Substance | Medication) | There are no (further) constraints on this element Data Type | ||
| itemCodeableConcept | 0..1 | CodeableConceptBinding | Element IdMedication.ingredient.item[x]:itemCodeableConcept 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). IPS-UV flags this as a MS element. It is not currently flagged as MS in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a MS requirement within the context of their own jurisdictional content. Future releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain this element within the context of their own jurisdictional content. IPS UV Note: 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 ActiveSubstancesUvIps (preferred)Constraints
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| coding | Σ | 0..* | Coding | Element IdMedication.ingredient.item[x]:itemCodeableConcept.coding 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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Unordered, Open, by $this(Pattern) Constraints
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| ingredientSCTCA | Σ | 0..1 | CodingBinding | Element IdMedication.ingredient.item[x]:itemCodeableConcept.coding:ingredientSCTCA Optional slice for representing SNOMED CT Canadian edition drug active substances DefinitionSNOMED CT Canadian edition drug active substances 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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. DrugOrMedicamentSubstanceCode (required) Constraints
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| text | 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. Very often the text is the same as a displayName of one of the codings.
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| 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 | I | 0..1 | Data Type: Ratio (PS-CA) | 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. IPS-UV flags this as a MS element. It is not currently flagged as MS in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a MS requirement within the context of their own jurisdictional content.
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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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| 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. Note that FHIR strings SHALL NOT exceed 1MB in size
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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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Extensions
None.
Note: An earlier revision of this implementation guide included medication-strength.
Key Differences between the IPS-UV and PS-CA
Must Support Differences:
The following elements are considered "must support" in the IPS-UV specification that are relaxed in this version of the PS-CA profile:
Medication
Medication.ingredient
Note: Systems that support these elements are encouraged to send them in patient summaries
Cardinality Differences:
There are no cardinality differences between this profile and IPS-UV
Vocabulary Differences:
- Medication.code: optional slice added for Canadian Clinical Drug Data Set (CCDD) codes
- Medication.form: optional slice added for SNOMED CT Canadian edition dose forms
- Medication.ingredient.itemCodeableConcept.coding: optional slice added for SNOMED CT Canadian edition drug active substances
Other differences between the IPS and PS-CA Include:
- Medication.code:
- IPS datatype profile replaced with PS-CA datatype profile;
- Canadian vocabulary examples added
- Medication.form:
- IPS datatype profile replaced with PS-CA datatype profile
- Medication.ingredient.strength:
- IPS datatype profile replaced with PS-CA datatype profile