MedicationRequest being basedOn MedicationStatement

Hi,

Why MedicationRequest can’t be based on an Medication Statement?

I’m trying to design a medication reconciliation process on hospital admission and the practicioner may want to say that he wants to “Continue” an active Medication Statement and be able to create a medication request based on that statement but how to represent that link/connection?

Thanks in advance,
Sérgio

Hi Sergio

A MedicationStatement, depending on the source of information used to construct it, may not necessarily have all the information required to create a valid/complete MedicationRequest.

That being said, suppose you do have all the necessary information, it seems MedicationRequest.basedOn references only any of the following: CarePlan, MedicationRequest, ServiceRequest, and ImmunizationRecommendation. I believe it would be wise to develop your solution in line with these guidelines.

You do however have the option to use MedicationRequest.supportingInformation, type Reference(Any), which can " include additional information (for example, patient height and weight) that supports the ordering of the medication.", in your case a reference to the MedicationStatement that you used as a basis.

Does that help answer your question?

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I have added a FHIR JIRA issues to discuss this: https://jira.hl7.org/browse/FHIR-25946

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Hi blessed_tabvirwa1

Thanks for the answer.

But if a MedicationStatement is elegible as patient active medication, i should be able to reconcile that active medication and be able to link it to a new medication request if practicioner says he wants to continue the medication statement.

Thanks

MedicationStatement doesn’t reflect what a provider wants/recommends. It only reflects what is believed to be happening. There’s no authorization/recommendation/approval implicit in the existence of a MedicationStatement. If you want to reflect that a medication is planned, proposed, recommended, authorized, intended, etc., the appropriate resource is always MedicationRequest. If you just want to say that a patient is still taking a medication (whether desired or not), then you can either update the existing MedicationStatement to have a longer period or create a new one. However, the new one wouldn’t be “based on” the prior MedicationStatement, it would just be a net new assertion of “The patient is believed to be on medication X for this period of time”.