The FHIR profiles used for the Medication Statement Event Message Bundle

FHIR Profiles

The following FHIR profiles are used to form the Medication Statement Event Message Bundle:

Bundle Structure

Specifies referencing within the Event Message Bundle.


Medication Statement (open in new TAB)

Medication Statement data item mapping to FHIR profiles

The Medication Statement follows the same pattern as Medication Statement in Transfer of Care. As such there are 2 distinct lists - one for the active medications, and one for the discontinued medications. Following the Transfer of Care pattern, each list uses a FHIR List resource.

The Mapping tables shown below defines the FHIR elements that SHALL be used to encode the Healthy Child Event Specification data items for each DCH Event Message payload. Some common data item mappings, such as patient, publisher or Date/Time of event information, are defined within the Header mapping table and SHALL be considered in parallel with the payload mapping.

Medication Statement for Active Medications

Active medications uses a List resource to bound all the active medications. Active medications include those that the patient is known to be actively taking. Active medications include medications that have been changed within this episode of care. Changed medication details appear in the MedicationChangeSummary extension of the MedicationStatement resource.

The Child Health Event data items are fulfilled by elements within the FHIR resources listed below:

Medication Statement List (Active Medications)

Note that CareConnect-List-1.entry.flag & CareConnect-List-1.entry.emptyReason must not be used.

DCH Data Item FHIR Resource element Mandatory/
Required/
Optional
Notes
List.code CareConnect-List-1.code Mandatory Fixed value code=”1102411000000102” display=”Active medications” system=”http://snomed.info/sct”
List.status CareConnect-List-1.status Mandatory Fixed value=”current”
List.mode CareConnect-List-1.mode Mandatory Fixed value=”snapshot”
List.title CareConnect-List-1.title Mandatory Fixed value=”Medication Active List”
List.subject CareConnect-List-1.subject Mandatory  
List.encounter CareConnect-List-1.encounter Mandatory  
List.date CareConnect-List-1.date Mandatory The date the List was created
List.source CareConnect-List-1.source Mandatory The practitioner who created the List
List.entry.item CareConnect-List-1.entry.item Mandatory Link to the active MedicationStatement

Medication Statement (Active Medications)

DCH Data Item FHIR Resource element Mandatory/
Required/
Optional
Notes
Date/Time CareConnect-MedicationStatement-1.effectivePeriod.start Mandatory  
Medication Name CareConnect-Medication-1.code Required Where medication code is not known, the name of the medication should be sent as text in Medication.code.text
Form CareConnect-Medication-1.form Optional  
Route CareConnect-MedicationStatement-1.dosage.route Optional  
Site CareConnect-MedicationStatement-1.dosage.site Optional  
Method CareConnect-MedicationStatement-1.dosage.method Optional  
Dose directions description CareConnect-MedicationStatement-1.dosage.text Optional  
Dose amount description CareConnect-MedicationStatement-1.dosage.text Optional Dose amount should be concatenated with the dose description text
Dose timing description CareConnect-MedicationStatement-1.dosage.text Optional Dose timing should be concatenated with the dose description text
Structured dose direction cluster CareConnect-MedicationStatement-1.dosage.additionalInstruction Optional MedicationStatement.additionalInstruction to be used as a string element for “Continue Indefinitely”; “Do not discontinue” and “Stop when course complete”.
Dose direction duration CareConnect-MedicationStatement-1.dosage.additionalInstruction Optional Structured duration instructions may use the FHIR element MedicationStatement.effective[x].effectivePeriod otherwise FHIR element MedicationStatement.note as a degrade to text.
Additional instruction CareConnect-MedicationStatement-1.note Optional  

Medication Statement for Changed Medications

If a medication is changed, the changeSummary extension for the [new] medication should be completed as follows:

DCH Data Item FHIR Resource element Mandatory/
Required/
Optional
Notes
status CareConnect-MedicationStatement-1.Extension-CareConnect-MedicationChangeSummary-1.status Optional  
Indication CareConnect-MedicationStatement-1.Extension-CareConnect-MedicationChangeSummary-1.indication Optional  
Date of Change CareConnect-MedicationStatement-1.Extension-CareConnect-MedicationChangeSummary-1.dateChanged Optional  
Description of Amendment CareConnect-MedicationStatement-1.Extension-CareConnect-MedicationChangeSummary-1.detailsOfAmendment Optional  

Medication Statement for Medical Devices (not coded in dm+d)

Some medical devices, trial drugs, non-UK sourced drugs etc. are not coded in dm+d. In these cases, the same pattern as for Medication Statement (Active Medications) should be following, using Medication.code.text, rather than Medication.code.

DCH Data Item FHIR Resource element Mandatory/
Required/
Optional
Notes
Medication Device Entry (not in dm+d) CareConnect-Medication-1.code.text Optional Medication and medical devices not in dm+d should use Medication.code.text, and follow the same pattern as Medication Statement (Active Medications)

Resource Population Requirements and Guidance

The following requirements and resource population guidance should be followed in addition to the requirements and guidance outlined in the data item mapping above and in the Event Header requirements page.

Bundle

Resource Cardinality 1..1
Element Cardinality Additional Guidance
type 1..1 Fixed value: message

Event-MessageHeader-1

The Event-MessageHeader-1 resource included as part of the event message SHALL conform to the Event-MessageHeader-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality 1..1
Element Cardinality Additional Guidance
extension(messageEventType) 1..1  
event 1..1 Fixed Value: “​medication-statement-1 | ​Medication Statement”
responsible 1..1 This will reference the responsible Organization resource
focus 1..1 This will reference the CareConnect-Encounter-1 resource which contains information relating to the event message.

CareConnect-Organization-1

The CareConnect-Organization-1 resource included as part of the event message SHALL conform to the CareConnect-Organization-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality 1..*
Element Cardinality Additional Guidance
identifier.system 1..1 Fixed value: https://fhir.nhs.uk/Id/ods-organization-code
identifier.value 1..1 Organisation’s ODS Organization Code
name 1..1 Organisation’s Name

CareConnect-HealthcareService-1

The CareConnect-HealthcareService-1 resource included as part of the event message SHALL conform to the CareConnect-HealthcareService-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality 1..1
Element Cardinality Additional Guidance
providedBy 1..1 This will reference the ‘sender’ organization of the event message.
type 1..1 This will represent the type of service responsible for the event message. This will have a fixed value from the ValueSet CareConnect-CareSettingType-1
specialty 1..1 HealthcareService.specialty SHALL use a value from https://fhir.nhs.uk/STU3/ValueSet/DCH-Specialty-1

CareConnect-Patient-1

The CareConnect-Patient-1 resource included as part of the event message SHALL conform to the CareConnect-Patient-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality 1..1
Element Cardinality Additional Guidance
identifier 1..1 Patient NHS Number SHALL be included within the nhsNumber identifier slice
name (official) 1..1 Patients name as registered on PDS, included within the resource as the official name element slice
birthDate 1..1 The patient birth date shall be included in the patient resource

CareConnect-Encounter-1

The CareConnect-Encounter-1 resource included as part of the event message SHALL conform to the CareConnect-Encounter-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality 1..1
Element Cardinality Additional Guidance
Encounter.type.coding(childHealthEncounterType) 1..1 Encounter.type.coding(childHealthEncounterType) SHALL use a value from https://fhir.nhs.uk/STU3/ValueSet/DCH-ChildHealthEncounterType-1
Encounter.reason.coding(snomedCT) 1..1 Encounter.reason.coding(snomedCT) SHALL use a value from https://fhir.nhs.uk/STU3/ValueSet/DCH-AdmissionReason-1
serviceProvider 1..1 This will reference the Organisation resource hosting the Encounter
location 1..1 This will reference the Encounter’s Location
subject 1..1 This will reference the patient resource representing the subject of this event

CareConnect-Location-1

The CareConnect-Location-1 resource included as part of the event message SHALL conform to the CareConnect-Location-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality 0..1

CareConnect-Practitioner-1

The CareConnect-Practitioner-1 resource included as part of the event message SHALL conform to the CareConnect-Practitioner-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality TBC

CareConnect-PractitionerRole-1

The CareConnect-PractitionerRole-1 resource included as part of the event message SHALL conform to the CareConnect-PractitionerRole-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality TBC
Element Cardinality Additional Guidance
organization 1..1 This will reference the Organization resource responsible for the event
practitioner 1..1 This will reference the Practitioner resource responsible for the event
PractitionerRole.code(careProfessionalType) 1..1 PractitionerRole.code(careProfessionalType) SHALL use a value from https://fhir.nhs.uk/STU3/ValueSet/DCH-ProfessionalType-1
PractitionerRole.code(keyWorkerStatus) 0..1 If Practitioner is a key worker, PractitionerRole.codekeyWorkerStatus SHALL use a value from https://fhir.nhs.uk/STU3/ValueSet/DCH-KeyWorkerStatus-1
PractitionerRole.specialty 1..1 PractitionerRole.specialty SHALL use a value from https://fhir.nhs.uk/STU3/ValueSet/DCH-Specialty-1

CareConnect-Medication-1

The CareConnect-Medication-1 resource included as part of the event message SHALL conform to the CareConnect-Medication-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality TBC
Element Cardinality Additional Guidance
Medication.code 1..1 Medication.code SHOULD use a value from https://fhir.hl7.org.uk/STU3/ValueSet/CareConnect-MedicationCode-1

CareConnect-MedicationStatement-1

The CareConnect-MedicationStatement-1 resource included as part of the event message SHALL conform to the CareConnect-MedicationStatement-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality TBC
Element Cardinality Additional Guidance  
subject 1..1 This will reference the patient resource representing the subject of this event  
context 1..1 This will reference the encounter resource representing the context of this event  
medicationReference 1..1 This will reference the medication resource representing what medication was taken  
taken 1..1 MedicatioStatement.taken SHALL use a value from http://hl7.org/fhir/stu3/valueset-medication-statement-taken.html  

CareConnect-List-1

The CareConnect-List-1 resource included as part of the event message SHALL conform to the CareConnect-List-1 constrained FHIR profile and the additional population guidance as per the table below:

Resource Cardinality TBC
Element Cardinality Additional Guidance
mode 1..1 Fixed Value: snapshot
code 1.1 code SHALL take a value from https://fhir.hl7.org.uk/STU3/ValueSet/CareConnect-ListCode-1
subject 1..1 This will reference the patient resource representing the subject of this event
encounter 0..1 This MAY reference the encounter resource representing the context of this event
source 0..1 This MAY reference the practitioner resource representing who defined the list
entry.item 1..* This SHALL reference individual medication statement resources

Medication Statement Example

Profile Change Mappings for Medication Statement

Profiles used in Demographics Update Event Messages 1.2.1-Release Candidate are replaced with:

Demographic-Event-Messages Demographic-Event-Messages-CareConnect
DCH-Bundle-1 Bundle
DCH-MessageHeader-1 Event-MessageHeader-1
CareConnect-Organization-1 CareConnect-Organization-1
DCH-HealthcareService-1 CareConnect-HealthcareService-1
CareConnect-DCH-Patient-1 CareConnect-Patient-1
CareConnect-DCH-Encounter-1 CareConnect-Encounter-1
CareConnect-Location-1 CareConnect-Location-1
CareConnect-DCH-Practitioner-1 CareConnect-Practitioner-1
CareConnect-DCH-PractitionerRole-1 CareConnect-PractitionerRole-1
CareConnect-DCH-Medication-1 CareConnect-Medication-1
CareConnect-DCH-MedicationStatement-1 CareConnect-MedicationStatement-1
CareConnect-ITK-Medication-List-1 CareConnect-List-1
Tags: fhir