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ccsm-cds-tools / ccsm-cds-with-tests

This repository contains clinical decision support (CDS) which provides recommendations for cervical cancer screening and management (CCSM).
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MedicationRequest: Is 'intent' missing from our L3 code? #14

Closed ssebast2 closed 2 years ago

ssebast2 commented 2 years ago

The Intent data element seems to have a 1...1 cardinality, which means it will almost always (or even always) be required/included.

The value = 'Order' seems most appropriate.

There seems to be a number of sub-categories of 'Order'. Please let us know if you feel that sub-categories should be included or if you disagree with 1) including Intent, and 2) constraining the value to 'Order'.

mickohanlon23 commented 2 years ago

There is currently no query of a MedicationRequest'sintent element in our code. However, we do put a constraint on the status of a medicationRequest, limiting it to completed.

I don't have much experience working with MedicationRequests, but U.S Core provides helpful documentation here: http://build.fhir.org/ig/HL7/US-Core/medication-list.html#get-all-medications.

I believe we would want to be following the "Get All Medications" instructions, which make it seem like limiting intent to order and plan would be appropriate. Looking at the sub-category explanations here, it seems like the four sub-categories of order would also be appropriate to include.

mickohanlon23 commented 2 years ago

@ssebast2 - Once you discuss with Rose, could you let me know:

  1. Whether I should add a constraint to MedicationRequest.intent
  2. If so, what elements you would like to constrain the data element to.
ssebast2 commented 2 years ago

@mickohanlon23 - since .intent is 1...1, it seems like it should be added to the L3. Only 'order' would be accepted. ('plan' simply means that a clinician is planning to order it, but there are lots of reasons why the order might never get placed, therefore plan should not be included.

mickohanlon23 commented 2 years ago

@ssebast2 Thanks for the explanation. Restricting intent and leaving out the plan code makes sense. It seems like the sub-categories of order should also be included, since they just specify the details of the order. Are there any reasons to exclude a MedicationRequest if they have one of the sub-category values in the intent field? Do you agree that we should restrict MedicationRequest to:

ssebast2 commented 2 years ago

@mickohanlon23 - yes, it is fin to include the child attributes under 'order'. Thanks!

mickohanlon23 commented 2 years ago

I added the intent restriction in commit: https://github.com/ccsm-cds-tools/ccsm-cds-with-tests/commit/c4b3af3b11477ba25aef14f031e1f069e68b50ec. I also added testing to make sure that a MedicationRequest with an intent of order and with an intent of one of the order sub-categories are both included, as well as a test to make sure that a MedicationRequest with an intent of proposal is not included.

I'll go ahead and resolve this issue.