I’d love some advice that I can pass on to other modellers…
Many times it is clear where an INSTRUCTION or ACTION should be modelled in a template ie an order vs something that has been done.
In the clinical scenario where we want to extract and share a list of medications that a patient is currently taking I’m faced with two options…
- Include the list of INSTRUCTIONs that make up the current Medication list, package it up and send to the receiving EHR, with the added benefit that they can include the INSTRUCTIONs and immediately have the potential to use it to populate their new Medication List; OR
- Include the medication list as ACTIONs, such that it accurately represents the actual things the patient is taking or has been administered.
So, my assumptions are:
- If extracting from an openEHR system natively to another openEHR system, the first option makes most sense.
- If a patient is adding meds into their phone app, I’d like model it as an ACTION, representing what they say they are taking but not adding in the extra semantics and apparent authority that this is correct enough to prescribe from, which is somewhat implied in an INSTRUCTION.
Now, my question: If sending from an openEHR system via FHIR, in this context we are likely mapping to a FHIR Medication Statement resource and it is not clear to me whether INSTRUCTION or ACTION class might be better to model in the source template that will be the basis for the extract.
The FHIR Medication Statement is here: https://www.hl7.org/fhir/medicationstatement.html
It is described as: “A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future.” So, to me it is a munge of ACTION (past and current) plus INSTRUCTION (future) - but not intended to be as detailed as any of these. It is clearly a technical construct that does potentially facilitate FHIR exchange in the technical sense, but doesn’t make much sense to me as a clinician, especially if it ends up duplicating the record of meds taken, being taken or ordered. We can record the info captured from consumers and carers etc in our existing models using RM for provenance and don’t need a separate model for the purpose.
I also note that we have an EVALUATION for a Medication summary that is intended to provide an overview of drugs that need a helicopter view such as steroid administration over time, cumulative toxic drug intake etc. Quite a different notion, and primarily a clinical purpose.
I’m reluctant to advocate for an equivalent archetype to the FHIR Medication Statement, mainly because of the duplication issues and overheads.