Medication models: Where does "route" belong?

[siljelb (Silje Ljosland Bakke)]

@heather.leslie

Different routes often require different doses - oral vs IM analgesics/antiemetics will require 2 orders.

I’m assuming we’re talking hospital settings here? When you’re into PRN injectable analgesics/antiemetics they would normally be titrated, not given according to a set dosage.

@heather.leslie

Just as we record the actual term a clinician chooses from a value set, even if a preferred term is stored and used for persistence, I’m still curious about the investigating the medicolegal issues re ensuring that the complete order for how a drug should be administered needs to be explicitly recorded.

Sure. Do we have any legal frameworks to lean on in this level of detail?

@heather.leslie

Also understanding the provenance of our model - where else is this design pattern used in parallel standards or are we isolated here?

Good question. The “Route” element was added to the INSTRUCTION.medication_order archetype by @ian.mcnicoll on 29 Oct 2015, with this set of references:

openEHR Foundation Medication archetypes http://www.openehr.org/knowledge

NEHTA's Therapeutic Good Use Data Group from the NEHTA Website http://www.nehta.gov.au

Intermountain Healthcare Medication order model, Personal Communication to Sam Heard by Dr Stan Huff.

Royal Australian College of General Practitioners. Fact Sheet: Medicines List. 2010.

At that time, FHIR was at DSTU2, and had Route as part of the “DosageInstruction” group within the MedicationOrder resource: MedicationOrder - FHIR v1.0.2. I.e. similar to today’s pattern only they’ve divided it up into separate resources. I don’t know how to find the references for FHIR resources.