{ "resourceType": "StructureDefinition", "id": "medicationstatement-ca-ps", "url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationstatement-ca-ps", "version": "2.2.0", "name": "MedicationStatementPSCA", "title": "Medication Statement (PS-CA)", "status": "draft", "experimental": false, "date": "2024-04-09T08:00:00+00:00", "description": "This profile represents the constraints applied to the MedicationStatement resource by the PS-CA project to represent a record of a medication statement 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": "MedicationStatement", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationStatement", "derivation": "constraint", "differential": { "element": [ { "id": "MedicationStatement", "path": "MedicationStatement", "comment": "Jurisdictions mapping prescription data into FHIR profiles for the patient summary should use 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." }, { "id": "MedicationStatement.extension", "path": "MedicationStatement.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "MedicationStatement.extension:RenderedDosageInstruction", "path": "MedicationStatement.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": "MedicationStatement.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": "MedicationStatement.status", "comment": "IPS Note: The entered-in-error concept is not permitted. Implementers should be aware that the shift to R5 MedicationUsage will also involve a new value set for status that is expected to be constrained to: recorded, entered-in-error, and draft.", "mustSupport": true }, { "id": "MedicationStatement.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": "MedicationStatement.medication[x]", "definition": "Identifies the medication being administered or the assertion of no known medications. 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": "MedicationStatement.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": "MedicationStatement.subject", "type": [ { "code": "Reference", "targetProfile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" ] } ], "mustSupport": true }, { "id": "MedicationStatement.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": "MedicationStatement.subject.reference", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.effective[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": "MedicationStatement.effective[x]", "min": 1, "mustSupport": true }, { "id": "MedicationStatement.reasonCode", "path": "MedicationStatement.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/healthconditioncode" }, { "url": "documentation", "valueMarkdown": "A value set for health-related conditions which can be diagnoses, the results of a clinical observation or assessment of judgment" } ] }, { "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": "MedicationStatement.dosage", "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": "MedicationStatement.dosage", "mustSupport": true }, { "id": "MedicationStatement.dosage.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": "MedicationStatement.dosage.text", "mustSupport": true }, { "id": "MedicationStatement.dosage.timing", "path": "MedicationStatement.dosage.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": "MedicationStatement.dosage.route", "path": "MedicationStatement.dosage.route", "comment": "See additionalBinding extension.", "type": [ { "code": "CodeableConcept", "profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" ] } ], "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" } } ] } }