Profile: Medication
Additional guidance based on the UKCore Medication resource.
| UKCoreMedication (Medication) | C | Medication | There are no (further) constraints on this element Element idMedicationShort description 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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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedication.idShort description 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.metaShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedication.implicitRulesShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedication.languageShort description 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.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedication.textShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedication.containedShort description 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 | C | 0..* | Extension | There are no (further) constraints on this element Element idMedication.extensionShort description 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) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| MedicationTradeFamily | C | 0..1 | Extension(CodeableConcept) | Element idMedication.extension:MedicationTradeFamilyShort description Used to identify a Trade Family or brand associated with a Medication, specifically when the medication is defined using a dm+d Virtual Therapeutic Moiety (VTM) concept Alternate namesextensions, user content DefinitionA Trade Family or brand associated with a Medication, in particular a Virtual Therapeutic Moiety (VTM). 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. https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationTradeFamily ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedication.modifierExtensionShort description 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idMedication.identifierShort description Business identifier for this medication DefinitionBusiness identifier for this medication. The serial number could be included as an identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| code | S Σ | 1..1 | CodeableConceptBinding | Element idMedication.codeShort description Codes that identify this medication DefinitionA code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems. 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. UKCoreMedicationCode (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedication.statusShort description 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) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| manufacturer | Σ C | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idMedication.manufacturerShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| form | 0..1 | CodeableConceptBinding | Element idMedication.formShort description powder | tablets | capsule + DefinitionDescribes the form of the item. Powder; tablets; capsule. When Medication is referenced from MedicationRequest, this is the ordered form. When Medication is referenced within MedicationDispense, this is the dispensed form. When Medication is referenced within MedicationAdministration, this is administered form. A coded concept defining the form of a medication. UKCoreMedicationForm (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| amount | Σ C | 0..1 | Ratio | There are no (further) constraints on this element Element idMedication.amountShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| ingredient | 0..* | BackboneElement | There are no (further) constraints on this element Element idMedication.ingredientShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.ingredient.idShort description 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 | C | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.extensionShort description 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 ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedication.ingredient.modifierExtensionShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| item[x] | 1..1 | There are no (further) constraints on this element Element idMedication.ingredient.item[x]Short description 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). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| itemCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| itemReference | Reference(Medication | Substance) | 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.isActiveShort description 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). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| strength | C | 0..1 | Ratio | There are no (further) constraints on this element Element idMedication.ingredient.strengthShort description Quantity of ingredient present DefinitionSpecifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| batch | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedication.batchShort description Details about packaged medications DefinitionInformation that only applies to packages (not products). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedication.batch.idShort description 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 | C | 0..* | Extension | There are no (further) constraints on this element Element idMedication.batch.extensionShort description 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 ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedication.batch.modifierExtensionShort description 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| lotNumber | 0..1 | string | There are no (further) constraints on this element Element idMedication.batch.lotNumberShort description 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 The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| expirationDate | 0..1 | dateTime | There are no (further) constraints on this element Element idMedication.batch.expirationDateShort description When batch will expire DefinitionWhen this specific batch of product will expire. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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Additional Guidance
form (for medication characteristics)
Recent implementations have highlighted the need to identify intended release characteristics such as modified release timing when medicines are prescribed at the moiety (VTM) level. Currently this information is only conveyed as unstructured dosage.text with no clear way to represent it in FHIR/Dose Syntax.
To address this gap, an interim approach has been agreed whereby in addition to the use as defined within the FHIR standard and UKCore implementation, the form element may be used to describe characteristics of the medication where these are not already defined within the dm+d concept. While it is recognised that these characteristics are not technically medication forms, this pragmatic solution enables safe and consistent encoding until a more robust mechanism is available.
A longer-term solution is planned as an extension to the UKCore-Medication profile to support structured medication characteristics, using a preferred binding to a defined list of SNOMED terms.
An example use case is when using a VTM concept and wish to specify modified release characteristics of either 12 or 24 hour.
The following list of SNOMED terms is applicable for medication characteristics using both the interim and longer-term solution(s), providing clearer alignment and reducing the risk of misinterpretation across systems.
| SNOMED Code | SNOMED Term |
|---|---|
| 9906401000001106 | 12-hour modified-release dosage form (qualifier value) |
| 9906901000001102 | 24-hour modified-release dosage form (qualifier value) |
| 9906701000001104 | Gastro-resistant dosage form (qualifier value) |
| 737051004 | Modified-release (release characteristic) |
| 736849007 | Conventional release (release characteristic) |
| 764775005 | Conventional release and prolonged-release (release characteristic) |
| 736848004 | Delayed-release (release characteristic) |
| 737596001 | Dual delayed-release (release characteristic) |
| 737594003 | Delayed-release and prolonged-release (release characteristic) |
| 736847009 | Prolonged-release (release characteristic) |
| 422059006 | Metered-dose inhaler |
| 422197009 | Breath-actuated inhaler |
| 9906001000001101 | Dry powder inhaler |
| 9906801000001108 | Nebuliser |
Example
{
"resourceType": "Medication",
"id": "UKCore-Medication-Characteristics-Example",
"code": {
"coding": [
{
"system": "https://dmd.nhs.uk",
"code": "773372004",
"display": "Morphine"
}
]
},
"form": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "9906401000001106",
"display": "12-hour modified-release dosage form (qualifier value)"
}
]
}
}