StructureDefinition - Statements of Medicine Use to support exchange of digital health in Australia

[dtr-agency]

Prerequisites

• [X] I have searched open and closed issues to make sure it isn't already requested or reported
• [X] I have written a descriptive issue title

The issue / feature

Change description

Design and develop a set of materials that define a Clinical Information Object for Medicine Use for the electronic exchange of medicines information between patients, healthcare providers, and between healthcare providers and the My Health Record system infrastructure in Australia.

What are the use cases we want to support?

• We want to be able to record that a patient is or was taking a medication - which individual is this information associated with, who recorded this, when was this recorded, when were they taking the medication, which medication and dosage, the reason they are/were taking the medication etc.
• We want to be able to record changed information about medication usage including dosage change, that a patient is no longer taking a medication - which individual is this information associated with, who recorded this, when was this recorded, when were they taking the medication, which medication and dosage, the reason they are/were taking the medication etc.
• We want to be able find out the medication history for a specific individual. This will just be a list of the medicines
• We should be able to supply the standard protocol in some computable format

Forming part of wider use cases

• This profile should also serve the purpose of providing a summary statement of medicine use in general and may be a standalone statement for an individual, be an entry in a medications list (current or ceased or full history etc.), or form part of an entirely different specification.
• This profile should support broad set of authoring roles including patient-entered data and provider-entered data.
• This profile should serve the purpose of all Continuity of Care specification use cases, e.g. Shared Health Summary, Event Summary, Discharge Summary, Specialist Letter, eReferral.
• This profile should serve the purpose of some medications management use cases including shared medicines lists

The key design aspects are that:

• the key information is captured with must supports / cardinality
• it can be standalone (doesn't' require a document wrapper or section to understand its context such as who is the patient etc.)
• has enough detail to be meaningful and safe but not overly complex aka don't put must support everywhere as every item with must support on it requires a vendor to build in the capability to process
• support all known use cases
• is based on an AU Base profile that provides the common definition of concepts, extensions, terminology
• is as R5-proof as possible
• serves the following operations
  • Add (Create) a medication statement for a patient
  • Update a medication statement for a patient
  • Add (Create) medication statements for a patient
  • Update medication statement(s) for a patient
  • Delete a medication statement for a patient
  • Retrieve (Search) a patient's medication statements, potentially extended by:
    • Medicine: Clarithromycin 500mg Tablet, Paracetamol, ...
    • Medicine Category: weight management | inpatient | community | biologic | ...
    • Status of Medicine Usage: current, ceased, ...
    • Reason for taking medication: weight management, pain relief, heart disease, ...

What it actually enables people to do

The profile defines an Agency model for the concept of a summary statement of a medication. It may be a standalone statement for an individual, be an entry in a meds list, be used in a Composition section etc.

Mockups

N/A

How awesome would it be?

Fundamentally awesome - this is the basis of the Agency concept of a short concise statement of medicine item usage in R4 FHIR in clinical data exchange including terminology, etc. This contributes to the basic foundation for interoperability, re-use, and optimisation.

Workarounds

N/A

Additional context

AU Base Medication Statement

As part of the development of this profile we need to ensure:

• the R4 HL7 AU Base content used complete and correct - profile | extensions | terminology | namespaces
  • only necessary and sufficient content is present and it is all correct - is everything we need present; is there anything included that we DO NOT want in HL7 AU Base
  • issues that cannot be resolved quickly are raised in HL7 AU GitHub
  • QA for spelling and grammar,
  • ok against HL7 AU metadata conventions
  • tested invariant FHIRPath and tested the profile with examples
• design page(s) for R4 MedicationStatement profile(s) are established
• R4 MedicationStatement profile is included in the applicable existing FHIR IGs in ci-fhir-r4 (currently only Event Summary)
  • the profile(s) conform to the metadata conventions
• R4 MedicationStatement profile has at least 5 examples that conform to the profile
  • the examples conform to the contentions and principles for examples
  • the examples are linked to on the Examples tab for the applicable profiles in the FHIR IG(s)

Backlog story: https://jira.digitalhealth.gov.au/browse/CIFMM-2579

[dtr-agency]

Australian Digital Health Agency Core Medication in development.