This is the current version of the PS-CA Implementation Guide. Other releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
Medication (PS-CA)
Additional information on this profile (including the JSON & XML structure and detailed element descriptions) can be found at package/structuredefinition-profile-medication-ca-ps.json
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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| 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. Unordered, Open, by url(Value) Constraints
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| strength | I | 0..1 | Extension(string) | Element IdMedication.extension:strength Extension for representing overall medication strength. Alternate namesextensions, user content DefinitionThe overall medication strength, rather than the strength of a specific ingredient. 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. http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description Constraints
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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 | package/StructureDefinition-CodeableConcept-ca-ps.jsonBinding | 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. 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. package/StructureDefinition-CodeableConcept-ca-ps.json BindingCanadian Clinical Drug Data Set codes package/valueset-canadianclinicaldrugdataset.json (preferred)Constraints
DIN {
"coding": [
{
"system": "http://hl7.org/fhir/NamingSystem/ca-hc-din",
"code": "02247611",
"display": "Acetaminophen 325mg (Jamieson Laboratories Ltd.)"
}
],
"text": "ACETAMINOPHEN 325MG"
}NPN {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-hc-npn",
"code": "80016551",
"display": "Echinacea with Garlic and Ginger (Jamieson Laboratories Ltd.)"
}
],
"text": "Echinacea with Garlic and Ginger"
}CCDD {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/hc-CCDD",
"code": "02240105",
"display": "AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC"
}
],
"text": "Aveeno Anti-Itch Lotion"
}Mappings
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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 | package/StructureDefinition-CodeableConcept-ca-ps.jsonBinding | 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. For all CodeableConcepts, at least one of coding or text must be present. If coding contains only a display value (no code) then CodeableConcept must include text. package/StructureDefinition-CodeableConcept-ca-ps.json BindingSCTCA Pharmaceutical Dose Form package/ValueSet-pharmaceuticaldoseformcode.json (preferred)Constraints
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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 Must Support element. It is not currently flagged as Must Support 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 Must Support 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 Must Support element. It is not currently flagged as Must Support 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 Must Support 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 CA drug substances. package/ValueSet-drugormedicamentsubstancecode.json (preferred)Constraints
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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 | package/StructureDefinition-Ratio-ca-ps.json | 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 Must Support element. It is not currently flagged as Must Support 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 Must Support requirement within the context of their own jurisdictional content. package/StructureDefinition-Ratio-ca-ps.json Constraints
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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
This profile uses the following extensions:
Medication: Medication Strength Description
Key Differences between the IPS-UV and PS-CA
Must Support Differences:
The following elements are considered Must Support in the Medication (IPS) profile that are relaxed in this version of the PS-CA profile:
Medication.ingredientand sub-elementsNote: 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- package/valueset-canadianclinicaldrugdataset.json indicated as preferred
- additionalBindings added for:
- package/valueset-LicensedNaturalHealthProducts.json (NPN & DIN-HM) codes,
- WHO ATC Classification (already additionalBinding in IPS),
- IPS FreeSet (already additionalBinding in IPS)
Medication.form- package/ValueSet-pharmaceuticaldoseformcode.json indicated as preferred
- additionalBindings added for:
- Prescribe IT package/ValueSet-prescriptiondrugform.json (derived from HL7 v3)
- EDQM Medicine Dose Form (already additionalBinding in IPS)
Medication.ingredient.itemCodeableConcept.coding- package/ValueSet-drugormedicamentsubstancecode.json indicated as preferred
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