{ "resourceType": "StructureDefinition", "id": "medication-ca-ps", "url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps", "version": "2.2.0", "name": "MedicationPSCA", "title": "Medication (PS-CA)", "status": "draft", "experimental": false, "date": "2024-04-09T08:00:00+00:00", "description": "This profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It allows for cross-border and cross-jurisdiction sharing of Medication Summary information.", "copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "Medication", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Medication", "derivation": "constraint", "differential": { "element": [ { "id": "Medication.extension", "path": "Medication.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "Medication.extension:strength", "path": "Medication.extension", "sliceName": "strength", "short": "Extension for representing overall medication strength.", "definition": "The overall medication strength, rather than the strength of a specific ingredient.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description" ] } ] }, { "id": "Medication.code", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHALL:populate" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHALL:no-error" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHALL:handle" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHOULD:display" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" } ] } ], "path": "Medication.code", "short": "Medication that was requested/ordered (medication code from any code system)", "definition": "Medication that was requested/ordered.", "comment": "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 using the additional bindings extension.\r\n\r\nFuture 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.\r\n\r\n In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.", "min": 1, "type": [ { "code": "CodeableConcept", "profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" ] } ], "example": [ { "label": "DIN", "valueCodeableConcept": { "coding": [ { "code": "02247611", "system": "http://hl7.org/fhir/NamingSystem/ca-hc-din", "display": "Acetaminophen 325mg (Jamieson Laboratories Ltd.)" } ], "text": "ACETAMINOPHEN 325MG" } }, { "label": "NPN", "valueCodeableConcept": { "coding": [ { "code": "80016551", "system": "http://terminology.hl7.org/CodeSystem/v3-hc-npn", "display": "Echinacea with Garlic and Ginger (Jamieson Laboratories Ltd.)" } ], "text": "Echinacea with Garlic and Ginger" } }, { "label": "CCDD", "valueCodeableConcept": { "coding": [ { "code": "02240105", "system": "http://terminology.hl7.org/CodeSystem/hc-CCDD", "display": "AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC" } ], "text": "Aveeno Anti-Itch Lotion" } } ], "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct", "extension": [ { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts" }, { "url": "documentation", "valueMarkdown": "All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" }, { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" }, { "url": "documentation", "valueMarkdown": "WHO ATC classification." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" }, { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medication-uv-ips" }, { "url": "documentation", "valueMarkdown": "SNOMED CT medications (Medicinal product)" } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" }, { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/DIN" }, { "url": "documentation", "valueMarkdown": "Health Canada Drug Identification Number set." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" }, { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" }, { "url": "documentation", "valueMarkdown": "This is the combination of the PharmaceuticalBiologicProductCode and SubstanceCode subsets." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" } ], "description": "Canadian Clinical Drug Data Set codes" } }, { "id": "Medication.form", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHALL:able-to-populate" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHALL:no-error" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/obligation", "extension": [ { "url": "code", "valueCode": "SHOULD:handle" }, { "url": "actor", "valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" } ] } ], "path": "Medication.form", "definition": "Administrable Pharmaceutical Dose Form.\r\n\r\nThis code represents the form of the medication (e.g. tablet, capsule, liquid)\r\n\r\nSince the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as reference terminology for representing Pharmaceutical Dose forms; Packages and Route of Administration\r\n\r\nIt is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT.", "comment": "See additionalBinding extension", "type": [ { "code": "CodeableConcept", "profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" ] } ], "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticaldoseformcode", "extension": [ { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiondrugform" }, { "url": "documentation", "valueMarkdown": "This binding includes HL7 V3 Codes from the PrescribeIT value set indicating the form in which the drug product is capable of being administered, dispensed, or ordered. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" }, { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-doseform" }, { "url": "documentation", "valueMarkdown": "EDQM Medicine dose forms." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" } ], "description": "SCTCA Pharmaceutical Dose Form" } }, { "id": "Medication.ingredient", "path": "Medication.ingredient", "comment": "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." }, { "id": "Medication.ingredient.item[x]", "path": "Medication.ingredient.item[x]", "slicing": { "discriminator": [ { "type": "type", "path": "$this" } ], "ordered": false, "rules": "open" } }, { "id": "Medication.ingredient.item[x]:itemCodeableConcept", "path": "Medication.ingredient.item[x]", "sliceName": "itemCodeableConcept", "comment": "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.\n\nFuture 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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/drugormedicamentsubstancecode", "description": "SNOMED CT CA drug substances." } }, { "id": "Medication.ingredient.strength", "path": "Medication.ingredient.strength", "comment": "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." } ] } }