Can you keep track of repeat prescriptions? (and other medication questions)

Hi there,

We my company is modelling prescriptions using the “medication request” and related resources (medicationRequestDosageInstruction and MedicationDispenseRequest) .

In the linked MedicationDispenseRequest resource I can record the number of repeats allowed (and related information).

However, I am unclear if I am able to record if a medicationrequest IS a repeat?
If so, how would one record that a prescription is one of the repeats? And infer/ keep track the number remaining?

we are likely going to use “on-hold” status to define repeat prescriptions awaiting sign off

Any help about above would be appreciated

The other q’s I wanted to confirm is where can one keep track of whether the medication is ready for collection/ collected?

If we had data from the pharmacy, we could update the MedicationDispense resource
Presumably we could link this to the related prescription with “authorising prescription” element?

However, we may not receive data from the pharmacy and rely on a patient report of collecting medication [keeping in mind that if a patient does NOT report collecting their meds, they CANNOT have the medication dispensed again] - could we use the medicationdispense resource in this way in theory?

The other option we considered is using an extension on the Medicationrequest status and adding “fulfilled” ?

There are standard extensions on MedicaitonDispense to be able to capture fills remaining and/or quantity remaining. MedicationDispense.type allows you to indicate whether something is an initial fill or refill (if the system keeps track).

Note that ‘repeat’ refers to refills authorized on the original prescription. If you’re talking about a renewal prescription, that’ll be a separate MedicationRequest (with a link to the order it’s a renewal of).

MedicationDispense.status of ‘in-progress’ means it’s ready for pick-up while ‘complete’ means it’s been picked up.

MedicationRequest doesn’t generally keep track of what’s happened in terms of fulfillment. If you wanted to track this linkage, it would be done via Task, where a pharmacy could indicate whether a particular fulfillment request had been executed or not. (Different pharmacies might be responsible for different fills.) The MedicationRequest can be changed to ‘completed’ when the ordering clinician/system has reason to believe that the patient has consumed all of the authorized medication. If or how this is determined can vary.

Thanks for answering all my questions @lloyd

2 things -

  1. Is this correct:?We have understood the Backbone Element in MedicationRequest “DispenseRequest” to include initial fill/ refill/ quantities requested and the related MedicationDispense resource (MedicationDispense - FHIR v4.0.1) == the resource generated by the system when there is data received from the pharmacy
  2. There are no standard extensions that we can find relating to MedicationDispense resource (MedicationDispense - FHIR v4.0.1) (can see MedicationDispense.type but cannot find initial fill/refill data like as as per Backbone element of the medicationrequest resource- is that because the MedicationDispense will be linked back to the authorising script where that data can be inferred?
  1. The backbone element in MedicationRequest reflects the original authorization - both what should happen per fill as well as the total number of fills/quantity. In general, there’s no expectation that the MedicationRequest would be updated as dispenses occur. However, because some systems do update the MedicationRequest to track “quantity remaining” or “fills remaining”, there are standard extensions for this.
  2. The extensions I was looking at are Extension: quantityRemaining - FHIR v4.6.0 and Extension: refillsRemaining - FHIR v4.6.0. However, it looks like these weren’t defined in R4. You can choose to pre-adopt them, but depending on the tooling you use for validation, you might see validation messages.