Release 4 5 Preview #3
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11.5 Resource Medication - Content

Pharmacy Work Group Maturity Level : 3   Trial Use Security Category : Business Compartments : Not linked to any defined compartments

This resource is primarily used for the identification and definition of a medication medication, including ingredients, for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

Representing medications in the majority of healthcare settings is a matter of identifying an item from a list and then conveying a reference for the item selected either into a patient-related resource or to other applications. Additional information about the medication is frequently provided for human verification, but a full representation of the details of composition and efficacy of the medicine is conveyed by referring to drug dictionaries by means of the codes they define. There are some occasions where it is necessary to identify slightly more detail, such as when dispensing a package containing a particular medication requires identification both of the medicine and the package at once. There are also some occasions (e.g. custom formulations) where the composition of a medicine must be represented. In these cases, the ingredients of the medicine have to be specified together with the amount contained, though the Medication resource does not provide full details.

The Medication resource allows for medications to be characterized by the form of the drug and the ingredient (or ingredients), as well as how it is packaged. The medication will include the ingredient(s) and their strength(s) and the package can include the amount (for example, number of tablets, volume, etc.) that is contained in a particular container (for example, 100 capsules of Amoxicillin 500mg per bottle).

The Medication resource can be used to describe a compounded (aka extemporaneous or magistral) product that is manufactured by the pharmacy at the time of dispensing. In this case there will be multiple ingredients which are typically base chemicals (for example, hydrocortisone powder) and there may be other ingredients that are manufactured products (for example, Glaxal Base).

When a medication includes a package, further details about the composition can be provided. A package has a container (vacuum packed box, jar, etc.) and a list of the products or other packages that are in the package.

This resource is referenced by ActivityDefinition , AdverseEvent , CarePlan , CatalogEntry , ChargeItem , ChargeItemDefinition , ClinicalUseIssue , Flag , Group , itself, MedicationAdministration , MedicationDispense , MedicationKnowledge , MedicationRequest , MedicationStatement , MedicinalProductContraindication , MedicinalProductIndication , MedicinalProductInteraction , MedicinalProductUndesirableEffect , Procedure , SupplyDelivery and SupplyRequest SupplyDelivery .

This resource does not implement any patterns.

Structure

Name Flags Card. Type Description & Constraints doco
. . Medication TU DomainResource Definition of a Medication
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Business identifier for this medication
. . . code Σ 0..1 CodeableConcept Codes that identify this medication
SNOMED CT Medication Codes ( Example )
. . . status ?! Σ 0..1 code active | inactive | entered-in-error
Medication status codes ( Required )
. . . form doseForm 0..1 CodeableConcept powder | tablets | capsule +
SNOMED CT Form Codes ( Example )
. . . amount Σ 0..1 Ratio Amount of drug in package
. . . ingredient 0..* BackboneElement Active or inactive ingredient
. . . item[x] . item 1..1 CodeableReference ( Substance | Medication ) The actual ingredient (substance or content medication) that the ingredient.strength relates to
. . . itemCodeableConcept . isActive 0..1 CodeableConcept boolean Active ingredient indicator
. . . . strength[x] itemReference 0..1 Quantity of ingredient present
Reference Medication ingredient strength codes ( Substance | Medication Example )
. . . isActive . . strengthRatio 0..1 boolean Ratio Active ingredient indicator
. . . strength . . strengthCodeableConcept 0..1 Ratio CodeableConcept Quantity of ingredient present
. . . . . strengthQuantity Quantity
... batch 0..1 BackboneElement Details about packaged medications
. . . . lotNumber 0..1 string Identifier assigned to batch
. . . . expirationDate 0..1 dateTime When batch will expire

doco Documentation for this format

UML Diagram ( Legend )

Medication ( DomainResource ) Business identifier for this medication identifier : Identifier [0..*] A 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 code : CodeableConcept [0..1] « A coded concept that defines the type of a medication. (Strength=Example) SNOMEDCTMedicationCodes ?? » A code to indicate if the medication is in active use (this element modifies the meaning of other elements) status : code [0..1] « A coded concept defining if the medication is in active use. (Strength=Required) Medication Status ! » Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product manufacturer : Reference [0..1] « Organization » Describes the form of the item. Powder; tablets; capsule form doseForm : CodeableConcept [0..1] « A coded concept defining the form of a medication. (Strength=Example) SNOMEDCTFormCodes ?? » Specific 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.) amount : Ratio [0..1] Ingredient The actual ingredient - either (substance or medication) that the ingredient.strength relates to. This is represented as a substance (simple ingredient) concept from a code system or described in another medication of a medication resource (Substance or Medication) item[x] item : Type DataType [1..1] « CodeableConcept | Reference ( Substance | Medication ) » Indication of whether this ingredient affects the therapeutic action of the drug isActive : boolean [0..1] Specifies 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 but can also be expressed a quantity when the denominator is assumed to be 1 tablet strength strength[x] : Ratio DataType [0..1] « Ratio | CodeableConcept | Quantity ; A coded concpet defining the strength of an ingredient. (Strength=Example) Medication Ingredient Strengt... ?? » Batch The assigned lot number of a batch of the specified product lotNumber : string [0..1] When this specific batch of product will expire expirationDate : dateTime [0..1] Identifies a particular constituent of interest in the product ingredient [0..*] Information that only applies to packages (not products) batch [0..1]

XML Template

<Medication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier for this medication --></identifier>
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <manufacturer><!-- 0..1 Reference(Organization) Manufacturer of the item --></manufacturer>
 <</form>

 <doseForm><!-- 0..1 CodeableConcept powder | tablets | capsule + --></doseForm>

 <amount><!-- 0..1 Ratio Amount of drug in package --></amount>
 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <</item[x]>

  <item><!-- 1..1 CodeableReference(Medication|Substance) The ingredient (substance or medication) that the ingredient.strength relates to --></item>

  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <</strength>

  <strength[x]><!-- 0..1 Ratio|CodeableConcept|Quantity Quantity of ingredient present --></strength[x]>

 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
</Medication>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:;

[ a fhir:Medication;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Medication.identifier [ Identifier ], ... ; # 0..* Business identifier for this medication
  fhir:Medication.code [ CodeableConcept ]; # 0..1 Codes that identify this medication
  fhir:Medication.status [ code ]; # 0..1 active | inactive | entered-in-error
  fhir:Medication.manufacturer [ Reference(Organization) ]; # 0..1 Manufacturer of the item
  fhir:

  fhir:Medication.doseForm [ CodeableConcept ]; # 0..1 powder | tablets | capsule +

  fhir:Medication.amount [ Ratio ]; # 0..1 Amount of drug in package
  fhir:Medication.ingredient [ # 0..* Active or inactive ingredient
    # . One of these 2
      fhir: ]
      fhir:) ]

    fhir:Medication.ingredient.item [ CodeableReference(Medication|Substance) ]; # 1..1 The ingredient (substance or medication) that the ingredient.strength relates to

    fhir:Medication.ingredient.isActive [ boolean ]; # 0..1 Active ingredient indicator
    fhir:

    # Medication.ingredient.strength[x] : 0..1 Quantity of ingredient present. One of these 3
      fhir:Medication.ingredient.strengthRatio [ Ratio ]
      fhir:Medication.ingredient.strengthCodeableConcept [ CodeableConcept ]
      fhir:Medication.ingredient.strengthQuantity [ Quantity ]

  ], ...;
  fhir:Medication.batch [ # 0..1 Details about packaged medications
    fhir:Medication.batch.lotNumber [ string ]; # 0..1 Identifier assigned to batch
    fhir:Medication.batch.expirationDate [ dateTime ]; # 0..1 When batch will expire
  ];
]

Changes since R3

Medication.identifier Added Element
Medication
Medication.status
  • Change value set from http://hl7.org/fhir/ValueSet/medication-status http://hl7.org/fhir/ValueSet/medication-status|4.0.0 to http://hl7.org/fhir/ValueSet/medication-status|4.0.1 Now marked as Modifier Medication.amount Added Element Medication.ingredient.strength Added Element http://hl7.org/fhir/ValueSet/medication-status|4.5.0
Medication.batch Medication.doseForm
  • Added Element
Medication.batch.lotNumber Medication.ingredient.item
  • Added Mandatory Element
Medication.batch.expirationDate Medication.ingredient.strength[x]
  • Added Element
Medication.isBrand deleted Medication.isOverTheCounter deleted Medication.ingredient.amount Medication.form
  • deleted
Medication.package Medication.ingredient.item[x]
  • deleted
Medication.image Medication.ingredient.strength
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 23 tests that all execute ok. 22 fail round-trip testing and 22 r3 resources are invalid (0 errors). )

Structure

Name Flags Card. Type Description & Constraints doco
. . Medication TU DomainResource Definition of a Medication
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Business identifier for this medication
. . . code Σ 0..1 CodeableConcept Codes that identify this medication
SNOMED CT Medication Codes ( Example )
. . . status ?! Σ 0..1 code active | inactive | entered-in-error
Medication status codes ( Required )
. . . form doseForm 0..1 CodeableConcept powder | tablets | capsule +
SNOMED CT Form Codes ( Example )
. . . amount Σ 0..1 Ratio Amount of drug in package
. . . ingredient 0..* BackboneElement Active or inactive ingredient
. . . item[x] . item 1..1 CodeableReference ( Substance | Medication ) The actual ingredient (substance or content medication) that the ingredient.strength relates to
. . . itemCodeableConcept . isActive 0..1 CodeableConcept boolean Active ingredient indicator
. . . . strength[x] itemReference 0..1 Quantity of ingredient present
Reference Medication ingredient strength codes ( Substance | Medication Example )
. . . isActive . . strengthRatio 0..1 boolean Ratio Active ingredient indicator
. . . strength . . strengthCodeableConcept 0..1 Ratio CodeableConcept Quantity of ingredient present
. . . . . strengthQuantity Quantity
... batch 0..1 BackboneElement Details about packaged medications
. . . . lotNumber 0..1 string Identifier assigned to batch
. . . . expirationDate 0..1 dateTime When batch will expire

doco Documentation for this format

UML Diagram ( Legend )

Medication ( DomainResource ) Business identifier for this medication identifier : Identifier [0..*] A 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 code : CodeableConcept [0..1] « A coded concept that defines the type of a medication. (Strength=Example) SNOMEDCTMedicationCodes ?? » A code to indicate if the medication is in active use (this element modifies the meaning of other elements) status : code [0..1] « A coded concept defining if the medication is in active use. (Strength=Required) Medication Status ! » Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product manufacturer : Reference [0..1] « Organization » Describes the form of the item. Powder; tablets; capsule form doseForm : CodeableConcept [0..1] « A coded concept defining the form of a medication. (Strength=Example) SNOMEDCTFormCodes ?? » Specific 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.) amount : Ratio [0..1] Ingredient The actual ingredient - either (substance or medication) that the ingredient.strength relates to. This is represented as a substance (simple ingredient) concept from a code system or described in another medication of a medication resource (Substance or Medication) item[x] item : Type DataType [1..1] « CodeableConcept | Reference ( Substance | Medication ) » Indication of whether this ingredient affects the therapeutic action of the drug isActive : boolean [0..1] Specifies 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 but can also be expressed a quantity when the denominator is assumed to be 1 tablet strength strength[x] : Ratio DataType [0..1] « Ratio | CodeableConcept | Quantity ; A coded concpet defining the strength of an ingredient. (Strength=Example) Medication Ingredient Strengt... ?? » Batch The assigned lot number of a batch of the specified product lotNumber : string [0..1] When this specific batch of product will expire expirationDate : dateTime [0..1] Identifies a particular constituent of interest in the product ingredient [0..*] Information that only applies to packages (not products) batch [0..1]

XML Template

<Medication xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier for this medication --></identifier>
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <manufacturer><!-- 0..1 Reference(Organization) Manufacturer of the item --></manufacturer>
 <</form>

 <doseForm><!-- 0..1 CodeableConcept powder | tablets | capsule + --></doseForm>

 <amount><!-- 0..1 Ratio Amount of drug in package --></amount>
 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <</item[x]>

  <item><!-- 1..1 CodeableReference(Medication|Substance) The ingredient (substance or medication) that the ingredient.strength relates to --></item>

  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <</strength>

  <strength[x]><!-- 0..1 Ratio|CodeableConcept|Quantity Quantity of ingredient present --></strength[x]>

 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
</Medication>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:;

[ a fhir:Medication;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Medication.identifier [ Identifier ], ... ; # 0..* Business identifier for this medication
  fhir:Medication.code [ CodeableConcept ]; # 0..1 Codes that identify this medication
  fhir:Medication.status [ code ]; # 0..1 active | inactive | entered-in-error
  fhir:Medication.manufacturer [ Reference(Organization) ]; # 0..1 Manufacturer of the item
  fhir:

  fhir:Medication.doseForm [ CodeableConcept ]; # 0..1 powder | tablets | capsule +

  fhir:Medication.amount [ Ratio ]; # 0..1 Amount of drug in package
  fhir:Medication.ingredient [ # 0..* Active or inactive ingredient
    # . One of these 2
      fhir: ]
      fhir:) ]

    fhir:Medication.ingredient.item [ CodeableReference(Medication|Substance) ]; # 1..1 The ingredient (substance or medication) that the ingredient.strength relates to

    fhir:Medication.ingredient.isActive [ boolean ]; # 0..1 Active ingredient indicator
    fhir:

    # Medication.ingredient.strength[x] : 0..1 Quantity of ingredient present. One of these 3
      fhir:Medication.ingredient.strengthRatio [ Ratio ]
      fhir:Medication.ingredient.strengthCodeableConcept [ CodeableConcept ]
      fhir:Medication.ingredient.strengthQuantity [ Quantity ]

  ], ...;
  fhir:Medication.batch [ # 0..1 Details about packaged medications
    fhir:Medication.batch.lotNumber [ string ]; # 0..1 Identifier assigned to batch
    fhir:Medication.batch.expirationDate [ dateTime ]; # 0..1 When batch will expire
  ];
]

Changes since Release 3

Medication.identifier Added Element
Medication
Medication.status
  • Change value set from http://hl7.org/fhir/ValueSet/medication-status http://hl7.org/fhir/ValueSet/medication-status|4.0.0 to http://hl7.org/fhir/ValueSet/medication-status|4.0.1 Now marked as Modifier Medication.amount Added Element Medication.ingredient.strength Added Element http://hl7.org/fhir/ValueSet/medication-status|4.5.0
Medication.batch Medication.doseForm
  • Added Element
Medication.batch.lotNumber Medication.ingredient.item
  • Added Mandatory Element
Medication.batch.expirationDate Medication.ingredient.strength[x]
  • Added Element
Medication.isBrand deleted Medication.isOverTheCounter deleted Medication.ingredient.amount Medication.form
  • deleted
Medication.package Medication.ingredient.item[x]
  • deleted
Medication.image Medication.ingredient.strength
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 23 tests that all execute ok. 22 fail round-trip testing and 22 r3 resources are invalid (0 errors). )

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis a

11.5.3 Best practices for using 'Medication'
Path Definition Type Reference
Medication.code A coded concept that defines the type of a medication. Example SNOMEDCTMedicationCodes
Medication.status A coded concept defining if the medication is in active use. Required Medication Status Codes
Medication.form Medication.doseForm A coded concept defining the form of a medication. Example SNOMEDCTFormCodes
Medication.ingredient.strength[x] A coded concpet defining the strength of an ingredient. Example Medication Ingredient Strength Codes

Medication does not have a status. If Medication was used to support a formulary use case, then an extension can be used to convey formulary statuses, such as active (e.g. the medication can be ordered) or inactive (e.g. the medication can be documented, but not ordered). Pharmacy is evaluating formulary use cases. Feedback is encouraged to the Pharmacy working group.

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
code token Returns medications for a specific code Medication.code 13 Resources
expiration-date N date Returns medications in a batch with this expiration date Medication.batch.expirationDate
form token Returns medications for a specific dose form Medication.form
identifier token Returns medications with this external identifier Medication.identifier
ingredient D reference Returns medications for this ingredient reference (Medication.ingredient.item as Reference) ( Medication , Substance ) Medication.ingredient.item.reference
ingredient-code D token Returns medications for this ingredient code (Medication.ingredient.item as CodeableConcept) Medication.ingredient.item.concept
lot-number N token Returns medications in a batch with this lot number Medication.batch.lotNumber
manufacturer reference Returns medications made or sold for this manufacturer Medication.manufacturer
( Organization )
status N token Returns medications for this status Medication.status