工作组: Pharmacy & Public Health and Emergency Response 标准状态: Informative

This module is concerned with resources and functionality in 3 main domains:

  • The ordering, dispensing, administration of medications and recording statements of medication use.
  • Recording of Immunizations given (or not given), evaluation of given immunizations and recommendations for an individual patient at a point in time.
  • The creation or querying for medications as part of drug information or drug knowledge.
资源名称描述
药品医嘱/处方
MedicationRequest

用于表示对患者的用药说明,包括配药说明、用药原因和其他相关数据。此资源的通用别名是“处方”或“药品医嘱”。

它的英文名称之所以直译为“用药请求”,是为了与FHIR工作流模式中的其他请求类资源保持一致。 此资源本身只能表示下达医嘱的内容,而不可用于表示医嘱的执行。医嘱的执行是通过“医嘱执行工作流”(通用FHIR工作流的一部分)实现的,此资源在“医嘱执行工作流”中仅用于表示医嘱的内容。

发药配药
MedicationDispense
为患者所需的备药供给,通常是对处方的响应。
用药记录
MedicationAdministration
患者的实际用药记录,无论是服用还是其它方式的用药。
MedicationStatement This is a record indicating that a patient may be taking a medication now, has taken the medication in the past, or will be taking the medication in the future. The source for this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. A medication statement is not a part of the prescribe->dispense->administer sequence, but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication. It may be used to construct a patients 'Current Medications' list.
药物
Medication
此资源用于表示可用于患者的实际药物。其它与药物相关的资源都引用了它。由于药物都被收纳入药物术语体系(如中国的“药典”),这意味这药物都能用可编码概念的形式来表示,所以在大多数情况下,没必要使用此资源。然而,在某此情况下,除了基本的药物信息之外,可能还需要更多的细节信息,比如药物的包装、是否为通用药品、是否含有活性成分等等。这时就需要用于此资源了。
MedicationKnowledge The MedicationKnowledge resource is draft and is included for comment purposes. This resource represents information about a medication, for example, details about the medication including interactions, contraindications, cost, regulatory status, administration guidelines, etc.

Immunizations

NameDescription
Immunization The Immunization resource is intended to cover the recording of current and historical administration of vaccines to patients across all healthcare disciplines in all care settings and all regions. This includes immunization of both humans and animals, but does not include the administration of non-vaccine agents, even those that may have or claim to have immunological effects.
ImmunizationRecommendation A patient's point-in-time immunization and recommendation (i.e. forecasting a patient's immunization eligibility according to a published schedule) with optional supporting justification
ImmunizationEvaluation The ImmunizationEvaluation resource is intended to cover communicating the results of an evaluation of a vaccine administration event (documented using the Immunization resource) against a set of published recommendations (protocols).
NameDescription Immunization The Immunization resource is intended to cover the recording of current and historical administration of vaccines to patients across all healthcare disciplines in all care settings and all regions. This includes immunization of both humans and animals, but does not include the administration of non-vaccine agents, even those that may have or claim to have immunological effects. ImmunizationRecommendation A patient's point-in-time immunization and recommendation (i.e. forecasting a patient's immunization eligibility according to a published schedule) with optional supporting justification ImmunizationEvaluation The ImmunizationEvaluation resource is intended to cover communicating the results of an evaluation of a vaccine administration event (documented using the Immunization resource) against a set of published recommendations (protocols).
  • Placing a Medication Request (aka Prescription or Order). The MedicationRequest resource represents the details of what medication the prescriber intends the patient to receive and other details such as the dose, timing and route. However, while it represents that order, the actual workflow around the supply (dispensing) and administration of that medication is managed by the common workflow functionality, resulting in the creation of the other medication resources (MedicationDispense, MedicationAdministration) as it executes.
  • Listing a patient's current medications. This is represented using the List resource, which allows an author to construct a 'curated' list. This has features beyond a simple collection of resources - such as the ability to state that the patient is not currently taking any medications at the time that the list is constructed, or changes that are made at a point in time (sometimes called medication reconciliation). FHIR defines a number of specific functional lists for this purpose, and a specific operation to retrieve it. Note that FHIR does not describe how the list should be maintained by the individual system, as that will vary widely between implementations.
  • Retrieving a list of Immunizations. This can be achieved using a simple query against the Immunization resource type. Note that an Immunization resource can specifically state that it was not given, as well as any reactions that occurred. Note that if the reaction is considered to be an indication of an allergy or intolerance, then a separate AllergyIntolerance resource should be created.
  • Retrieving recommendations for a specific patient at a point in time. The recommendation for immunizations to give would be represented by an ImmunizationRecommendation resource, but the determination of that recommendation is a part of Decision Support, with the actual immunization schedule being represented by a generic Plan Definition, individual Care Plan or some other record.
  • Dispensing a medication based on a Medication Request (aka Prescription or Order). The MedicationDispense resource represents the details of the dispensing event including the actual product provided to the patient and the dosage to be administered or consumed.
  • Retrieving the planned medication therapy for specific patient at a point in time. The intended medication therapy may be represented by an individual Care Plan.
  • Retrieving information about a medication either as a stand alone request or as while reviewing a patients' medication list
There are other resources that are of particular interest in the medication domain.

As with all clinical data, Medications (in particular) can be sensitive information as specific medications can indicate the presence of private information such as mental health disorders or HIV. However, withholding information about what medications a person is taking can lead to catastrophic results, and so needs to be considered very carefully. At the least, a clinician should be made aware that there is information available that they have not been given when making clinical decisions.

For more general considerations, see the Security and Privacy module.

The Pharmacy workgroup has plans to improve all existing resources e.g. adding in features that support detailing our conditional orders in a structured way; evaluating requirements for supporting drug formularies and medication knowledge. This work is expected to include the development and approval of a new resource and may involve updates to the Medication Resource.