Sorry for the question, but I don’t quite understand it.
But as much as I think about it, I can’t quite understand the difference between medicationrequest and medicationstatement. So I turn to the forum to see if by explaining my use case I end up understanding it.
First of all, the application exists and wants to be adapted to Fhir for your consultation, perhaps the existing concepts produce my doubts
My prescription app has a therapeutic plan for patients. In it, all the prescriptions that the practitioner makes to each patient, are registered. There are two different groups of medication, active and inactive (because it’s finished or because it’s closed)
Me, until now, I am using medicationstatement as entity, but reading more and more I can be wrong and the correct thing is to use medicationrequest. One of the things that confuses me the most, but this may be conditioned by how the information is currently handled, is to reflect the duration of the prescription. That is, my prescriptions can have a specific duration or be chronic, that is, they do not have an end date, but a possible renewal date, and this concept must be easily distinguishable from the others
Of course, each prescription must be associated with a clinical process and contain the corresponding dosage. Am I using the correct entity? If it should be medicationrequest, where would you place the duration of the prescription? In the dosage? In this case, how can I distinguish that the prescription is the “chronic” type?
Thanks in advance. Thank you very much and sorry for the language!
It sounds like MedicationRequest (and perhaps CarePlan) are probably best for your purpose. MedicationRequest and CarePlan are about what is planned/intended. The ‘intent’ element allows you to disambiguate between a formal “order” (i.e. a prescription) and something that is just a proposal or a plan. While orders are generally required by law to have an ‘end’ date, there’s no such requirement when talking about a ‘plan’. CarePlan also allows you to track “how things are going” with the plan (and you can link from CarePlan activities to specific MedicationRequests if you wish). If you want to be able to flag a MedicationRequest as either chronic or short term, the ‘category’ element is probably a good fit.
MedicationStatement is about stating “what is” rather than what’s planned. In R5, it’s being renamed to MedicationUsage to hopefully clarify its purpose a bit. It allows you to capture what meds a patient is currently taking (and not taking), whether prescribed or not. It does not reflect what they’re supposed to do - all of that is covered by the Request.
I have discussed the issue with my colleagues and we will use medicationRequest
I understand that in category I can mark if a prescription is chronic or not. Ok, but I still have doubts about how to move the effectivedatetime in medicationstatement to request. Could it only be in Timing within Dosage?
To be clearer, I explain the dates we handle:
Prescription Start Date: when the prescription was first started
Prescription Date: each time the medication is prescribed again, it can be 1 time or N times
End Date: when a prescription ends
Renewal Date: although it is like an end date, it really marks that the prescription is most likely to be renewed. Actually this is a concept related to the electronic dispensing of medication. That is, the practitioner prescribes something for, ie, 6 months and at 6 months it renews that prescription.
The MedicationRequest for the overall plan would have the start and end date in MedicationReqeust.dosageInstruction.timing.boundsPeriod start and end. (If there are multiple dosage instructions, you’d have to look at the earliest and latest. The start dates for individual prescriptions would be captured as separate resources - one per prescription. The ‘renewal’ date sounds like it would be the end date for the prescription.