How to schedule individual MedicationRequest Administrations?

Question

I am looking to find the best/recommended way to implement the MedicationRequest/MedicationAdministration workflow. Possiblities that I have explored are:

1. Using the MedicationRequest by itself, and at runtime, determine when the dosages should occur and if they fall withing the boundaries of the current shift, or
2. Using Tasks to create a limited amount of upcoming dosage Tasks, or
3. Using MedicationRequests resources based on the original MedicationRequest to indicate each separate dosage

Pros of option 1:

• Smallest storage footprint

Cons of option 1:

• Requires most run-time work (have to evaluate timing to determine if dosage is required this shift, more work determining missed dosages)

Pros of option 2:

• Common use of Tasks could be used against other Orders (ProcedureRequests, etc.) for a common workflow (e.g. show all Tasks this shift)

Cons of option 2:

• Default Fhir SearchPararmeters defined do not allow for search on Task.restriction.period (which I believe is how you define the period in which the Task is to be performed).
• Only place to link MedicationAdministration to Task is supportingInformation, but the field definition (Additional information (for example, patient height and weight)) doesn't seem like it is appropriate to put the Task there. Possibly use Provenenace, and use that to link Task to MedicationAdministration in eventHistory, but this seems like a stretch.

Pros of option 3:

• MedicationRequest.intent has order and instance-order as values. The documentation seems to indicate that this would be a good fit (overall request has intent=order, individual specific dosages would have instance-order)
• MedicationRequest has a Fhir-defined search parameter on timing.event that could be used to find events for a specific period.

Cons of option 3:

• http://hl7.org/fhir/us/meds/guidance.html#fetching-active-medications-orders states "A MedicationRequest resource query SHALL be all that is required to access the “all active medication orders”." The query example given is GET /MedicationRequest?patient=[id]&status=active{&_include=MedicationRequest:medication}. This kind of hints to me that they expect searches to be more done on status than time period. Not really a strong "con" against this approach, but definitely not a "pro" for using this method.

Any advice about the methods used by other implementations would be greatly appreciated.

Answer 1

The general design expectation is that you would creaste "instance" orders for each administration.