Submitted by EmoryHealthcare on
Medications Data Class - L2 Data Elements as of 9.20.2023
- Emory Healthcare (EHC) submits its support for the inclusion of all Data Elements currently listed as Level 2 under the Medications data class in draft USCDI v5.
- EHC submits its particular interest in the inclusion of Date Medication Prescribed and Date Medication Administered in Draft USCDI v5. EHC providers and quality officers use the time from prescription to delivery as a factor that can be reviewed to support responsive patient care. Longer periods of time can be indicators of more systemic problems – from workflow to SDOH-related patient experiences. If a framework for collecting these data elements were consistently available across the healthcare ecosystem, EHC and others would be better able to identify opportunities to improve care quality, provide patient support and/or implement new best practices, especially if available in concert with Negation Rationale and statuses. The applicable Fast Health Care Interoperability Resources (FHIR®) data type referenced in the data element submission supports a level of specificity, referencing both date and time, that would assist with care quality improvement activities.
- However, EHC encourages ONC to evaluate the benefit of having data elements that support the distinction of medication administration (i.e., given in an inpatient setting) and dispensation (i.e., given in an outpatient setting). Emory Healthcare offers for consideration “Date Medication Administered” and “Date Medication Dispensed,” which would mirror the Date Medication Administered Level 2 data element, but support a better understanding of the care context.
Submitted by rbaker@cdisc.org on
Medication Administration FHIR Resource and US Core
CDISC supports the use of the MedicationAdministration Resource as part of US Core IG Medication Profile.
We recommend the ONC and USCDI promote the use of FHIR MedicationAdministration Resource elements to support the HL7 US Core to use case. This will aid in the full picture of the medication perspective. The current US Core has Medication, MedicationDispense,and MedicationRequest. Currently, the US Core which is informed by USCDI does not include the MedicationAdministration Resource.
This will help researchers understand all aspects of the medication: the request (order), the dispense (pharmacy filling), the statement (patient/participant stating meds taken) and finally, the most important in healthcare - the medication administration (the health providers giving the drugs to the patients).
The record of medication administration is a central healthcare use case. It represents the record where a healthcare provider has administered the drug. This data not only helps with clinical research but will provide insight into drugs ordered (MedicationRequest), drugs dispensed (MedicationDispense) by having the ability to see in the hospital/healthcare setting which drugs were actually administered against those ordered and provided which makes a difference in the analysis of how sick a patient is. For example, the Levophed was ordered and given is very different than the Levophed was on standby for hypotension. Consider as well, the use of MedicationStatement which means the patient said they were taking these medications. This likely is the most accurate reflection of what the person is actually taking. This can be validated against the MedicationRequest and MedicationDispense which provides insight on if indeed the person is taking the medications and if they are taking them as often as prescribed.
The key aspect of capturing med records distinctly include collecting all core bits of information regarding the records of medications and their administration should be a part of the US Core.
In the current US Core FHIR build, R6.
MedicationAdministration is Maturity Level 2; MedicationDispense is Maturity Level 2; MedicationRequest is Maturity Level 4; MedicationStatement is Maturity Level 4; Medication is Maturity Level 4
The Medication Administration resource is used in the following IGs:
This fulfills the following criteria for promotion:
• The record of an actual administration of a medication to a patient is one of the most central healthcare use cases. Currently a suite of Medication administration-related concepts are in the Level 2 section of USCDI. All of these are central healthcare components so the longer the data for these concepts remain wildly unstandardized in US EHRs, the longer there will be no realistic expectation of interoperability. There are many strong justifications for need of standardized structured data of this concept the clinical research:
• These elements are not niche needs for a few research requirements. They are the center of patient-provider data exchange and the continued lack of standardized representation of these concepts should be the single driving reason for their inclusion in USCDI version 5.
• Healthcare use case: The lack of any standardized representation of administration of medications inherently prevents interoperability of this information and restricts critical sharing of this information across health systems (such us in those qHINs participating in TEFCA). Lack of easy sharing of administered drugs can result in serious, sometimes lethal, misjudgments on patient medication usage.
• A Clinical research context: Retrospective analyses of healthcare data are becoming a more common tool in clinical research for safety or efficacy for new indications of existing medications. In such analyses there may be one or more “exposure” drugs (ie, the drug of interest) and one or many “concomitant” medications. Researchers (and regulatory reviewers) will need to know enough information of the status of a drug administration where applicable. This information will supply critical differential information with which a researcher or regulatory reviewer can assess the relative probability of the listed drug record actually resulting in consumption by the patient. They can then determine the utility of the information in the context of the specific research and evidence generation needs of any given clinical study.