{ "resourceType": "StructureDefinition", "id": "medicationrequest-ca-ps", "url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationrequest-ca-ps", "version": "2.2.0", "name": "MedicationRequestPSCA", "title": "Medication Request (PS-CA)", "status": "draft", "experimental": false, "date": "2024-04-09T08:00:00+00:00", "description": "This profile represents the constraints applied to the MedicationRequest resource by the PS-CA project and allows for cross-border and cross-jurisdiction sharing of information record of a medication request information in the patient summary.", "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": "MedicationRequest", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationRequest", "path": "MedicationRequest", "comment": "Jurisdictions mapping prescription data into FHIR profiles for the patient summary should support the MedicationRequest resource. Use of the MedicationStatement profile should be reserved for communicating a statement about the patient's usage of the medication that is ultimately provided by a patient, significant other, or a clinician.\n\nThe MedicationRequest resource is not included in the [current](https://hl7.org/fhir/uv/ips/history.html) (as of November 2021) published release of IPS ([release 1.0.0, STU1](https://hl7.org/fhir/uv/ips/STU1/)), but is in the [development](http://build.fhir.org/ig/HL7/fhir-ips) preview of the next release." }, { "id": "MedicationRequest.extension", "path": "MedicationRequest.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "MedicationRequest.extension:RenderedDosageInstruction", "path": "MedicationRequest.extension", "sliceName": "RenderedDosageInstruction", "short": "Extension for representing rendered dosage instruction.", "definition": "A free form textual specification generated from the input specifications as created by the provider. This is made up of either an 'Ad-hoc instruction' or 'Textual rendition of the structured dosage lines', plus route, dosage unit, and other pertinent administration information specified by the provider.", "comment": "Use of structured fields for dosage instructions is heavily encouraged by this specification to promote interoperability of patient summaries. However, this extension is provided to make implementers aware that legacy medication data may come from some systems in this format. This extension is used by PrescribeIT implementations when the system has difficulty sending very complex dosage instructions in the form of structured data. Implementers are encouraged to read the PrescribeIT Specification (https://specs.prescribeit.ca/R5.0/erx/extension-ext-medication-rendered-dosage.html) to understand the context around its use.", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://prescribeit.ca/fhir/StructureDefinition/ext-rendered-dosage-instruction" ] } ] }, { "id": "MedicationRequest.status", "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": "MedicationRequest.status", "comment": "In the scope of the IPS the entered-in-error concept is not allowed.", "mustSupport": true }, { "id": "MedicationRequest.intent", "path": "MedicationRequest.intent", "comment": "This element is considered mandatory in the Base FHIR R4 Specification. \r\n\r\nBase R4 Note: It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable." }, { "id": "MedicationRequest.doNotPerform", "path": "MedicationRequest.doNotPerform", "comment": "In the scope of the PSCA MedicationRequest, the doNotPerform concept is not allowed to be set to true. Other sections may be used to convey medications that a patient should or will not take.", "patternBoolean": false }, { "id": "MedicationRequest.medication[x]", "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": "MedicationRequest.medication[x]", "definition": "Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code. To improve global interoperability is strongly encouraged that the reference to a medication resource is used, limiting the usage of the medicationCodeableConcept only to the cases in which no other information than a simple code is available.", "type": [ { "code": "CodeableConcept", "profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" ] }, { "code": "Reference", "targetProfile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps" ] } ], "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": "per PCHDCF: The alternate value set can be used for the international use case where the medication is not available in Canada and therefore does not appear in the recommended pan-Canadian value sets" } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" } ] } }, { "id": "MedicationRequest.subject", "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": "MedicationRequest.subject", "type": [ { "code": "Reference", "targetProfile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" ] } ], "mustSupport": true }, { "id": "MedicationRequest.subject.reference", "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": "MedicationRequest.subject.reference", "min": 1, "mustSupport": true }, { "id": "MedicationRequest.authoredOn", "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": "MedicationRequest.authoredOn", "mustSupport": true }, { "id": "MedicationRequest.reasonCode", "path": "MedicationRequest.reasonCode", "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/medicationreasoncode", "extension": [ { "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding", "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionindicationforuse" }, { "url": "documentation", "valueMarkdown": "Commonly used reason for which a medication is being ordered reference set (foundation metadata concept)" } ] } ] } }, { "id": "MedicationRequest.dosageInstruction.text", "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": "MedicationRequest.dosageInstruction.text", "mustSupport": true }, { "id": "MedicationRequest.dosageInstruction.timing", "path": "MedicationRequest.dosageInstruction.timing", "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": "MedicationRequest.dosageInstruction.route", "path": "MedicationRequest.dosageInstruction.route", "comment": "See additionalBinding extension.\r\n\r\n IPS-UV no longer 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..", "binding": { "strength": "preferred", "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/routeofadministration", "extension": [ { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration" }, { "url": "documentation", "valueMarkdown": "EDQM Standards Terms for route." } ], "url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding" }, { "extension": [ { "url": "purpose", "valueCode": "candidate" }, { "url": "valueSet", "valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionrouteofadministration" }, { "url": "documentation", "valueMarkdown": "Route of administration for the prescription from the PrescribeIT value set. 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" } ], "description": "SCTCA Route of Administration" } } ] } }