Medication Application document (Felix Fischer, BORS Consulting GmbH)

[ig-feedback]

ch.fhir.ig.ch-emed#4.0.0-ci-build /

Emergency medical services apply medicaments directly to the patient. It would be helpful to add this information to the patient handover document EMS -> emergency department.

This requires a document for the application of medicaments.

Felix Fischer, BORS Consulting GmbH

[ziegm]

The exchange format is based on the IPAG report where the administration of the medication isn't in a seperate document, see section 3.1.2:
Eine Anwendung von Arzneimitteln wird ebenfalls im Dokument eAbgabe festgehalten. Im entsprechenden Freitextfeld „Kommentar“ kann dokumentiert werden, dass das Arzneimittel am Patienten angewendet wurde. Ein entsprechendes IHEProfil zur Dokumentation einer Arzneimittel Anwendung ist bei IHE in Vorbereitung.

FHIR does have a seperate resource to document when a patient actually consumes a medicine, or it is ohterwise administered to them: MedicationAdministration.

[ziegm]

19.10.2023 PJ/OE/MZ:
If we would adapt the Medication Dispense document (as IPAG) has described in their text, we could add the MedicationAdministration resource in the section:dispense (Reference -> MedicationDispense/MedicationAdministration).
-> Next step @ziegm : add it to DIS (check if an example is included in the IPAG report)

[ziegm]

No Use Case in the IPAG report therefore. Asked Felix Fischer if he could provide a use case.

[ziegm]

@pjolo Please review the changes:

• Add use case de/fr with examples NaCl & Fentanyl (use case supported from Felix, Medication reviewed from a emergency medical service)
• Add profiles: MedicationAdministration (DIS) & MedicationAdministration (LIST)
• Update profiles (including the new ones): Bundle (DIS) & Composition (DIS) & Bundle (LIST) & Composition (LIST)
• Update DIS Document & LIST Document pages
• Update changelog

Felix informed about the changes via e-mail (Patrick & Oliver in CC)

[pjolo]

From my side, the changes are good.

[dvribeira]

Sorry I am obviously late to the discussion, but for what is worth we had a discussion within our team concerning this and we are wondering why the administration has not been added as a separate document (even considering the IPAG quotation). We could foresee support for administration and that it does not have to be directly tied to a dispense. It is true that these changes do not prevent the addition in the future of an administration document but then if/when this is added, the reference would probably have to be done the other way round (an administration would optionally contain a reference to a dispense since the dispense had to be done before the administration).

We are going to schedule a meeting with the pharmacy expert within HUG to see what the possible impact would be on the workflow(s) and will give again feedback on this.

Once again sorry for getting late into the discussion!

[ziegm]

@dvribeira
Because it is described in the IPAG report as part of the DIS document: see above #242 (comment)

[dvribeira]

Our understanding of that quotation is that it can be added as a comment to the DIS document to just say that it was administered to the patient. If a full resource with structured data concerning the administration is added we are not sure that quotation implies that it should be done within the DIS document and the phrase about the IHE profile sounds more like in the future it would be preferable to have it as a document - but then again, using a translator might not be helping my interpretation-. In any case once I have better feedback I will provide it for what it's worth.

[ziegm]

16.11.2023 PJ/OE/MZ:
We will publish this in the next release. Please feel free to discuss this and collect feedback on it and, if desired, provide it here (as a new issue).