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openEHR-MedicationOrder-to-FHIR-MedicationStatement-STU3-mappings.adoc

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openEHR Medication Order (as MedicationStatement) to FHIR MedicationStatement STU3 mappings

Ian McNicoll <[email protected]> v1.0.0, 06-Feb-2018

Target openEHR template

IDCR - .v1| Medication Statement list (In preparation)

This template assumes that a static list of medication orders is being maintained in the underlying CDR. A different AQL approach may be need to pull data from a live prescribing system.

FHIR resource operation Requirements

Operation : read

  1. Expose any MedicationStatement records held in the underlying openEHR CDR 'Medication Statement list' as a bundle of FHIR MedicationStatement resources, profiled to meet NHS Care-Connect Profile STU3.

  2. Deleted records, those entered in error, should not be sent.

  3. Individual MedicationStatement negations, handled in openEHR as Specific Exclusions such as 'No history of penicillin allergy' should not be exposed.

  4. Support the read, search and conformance FHIR resource operations.

  5. The following FHIR MedicationStatement data elements should be exposed where corresponding openEHR data is available.

    • id (logical resource identifier)

    • text (This will be generated narrative from concatenated structured data below)

    • status active | completed | entered-in-error | intended | stopped | on-hold

    • medicationReference.code - Mandatory

    • subject.reference - Mandatory

    • subject.identifier- Mandatory

    • subject.id- Mandatory

    • informationSource

    • assertedDate

    • effective.effectiveDate

    • taken - Mandatory y | n | unk | na

    • note - Multiple

    • reasonCode

    • dosage.text

    • dosage.additionalInstruction

    • dosage.patientInstruction

    • dosage.site

    • dosage.route

    • dosage.method

Operation: search

The following Search criteria must be supported

  • effectiveDate (including date ranges)

  • subject.id (via logicalID)

  • subject.identifier (via NHS Number)

  • status (To be Confirmed after review by Care-Connect)

Implementation will require appropriate AQL construction and or AQL resultSet filtering, for which guidance will be provided.

Operation: conformance

The AllergyIntolerance profile should emit a conformance statement on request via the /metadata resource - it is expected that the default handling provided by the HAPI-FHIR stack should be sufficient for this purpose.

Ignored FHIR Care-connect extension nodes

None

Approach

  1. Retrieve candidate openEHR Medication Order data via a an openEHR /query POST call, using AQL.

  2. openEHR data is held as DV_TEXT/DV_CODED_TEXT ELEMENT, return the whole ELEMENT value as an object.

  3. Create handlers for Excluded/Absent information items when Care-Connect guidance emerges. Assume making use of FHIR List resource for now.

AQL (includes search parameters and dv_text/dv_coded_text as objects)

select
    e/ehr_id/value as ehrId,
    e/ehr_status/subject/external_ref/id/value as subjectId,
    e/ehr_status/subject/external_ref/namespace as subjectNamespace,
    a/context/start_time/value as compositionStartTime,
    a/uid/value as compositionId,
    a/composer/name as composerName,
    b_a/uid/value as entryId,
    b_a/activities[at0001]/description[at0002]/items[at0070] as Medication_item
    b_a/activities[at0001]/description[at0002]/items[at0009]/value/value as Overall_directions_description,
    b_a/activities[at0001]/description[at0002]/items[at0173, 'Dose amount description']/value/value as Dose_amount_description,
    b_a/activities[at0001]/description[at0002]/items[at0173, 'Dose timing description']/value/value as Dose_timing_description,
    b_a/activities[at0001]/description[at0002]/items[at0044] as Additional_instruction,
    b_a/activities[at0001]/description[at0002]/items[at0105]/value/value as Patient_information_value,
    b_a/activities[at0001]/description[at0002]/items[at0107]/value/value as Monitoring_instruction_value,
    b_a/activities[at0001]/description[at0002]/items[at0018] as Clinical_indication,
    b_a/activities[at0001]/description[at0002]/items[at0091] as Route,
    b_a/activities[at0001]/description[at0002]/items[openEHR-EHR-CLUSTER.medication_substance.v0]/items[at0071] as Form,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[openEHR-EHR-CLUSTER.medication_course_summary.v0]/items[at0001]/value/defining_code/code_string as Status_code,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[openEHR-EHR-CLUSTER.medication_course_summary.v0]/items[at0028]/value/value as AssertedDate,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0012]/value/value as Order_start_date_time,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0013]/value/value as Order_stop_date_time
   from EHR e
   contains COMPOSITION a[openEHR-EHR-COMPOSITION.medication_list.v0]
   contains
      INSTRUCTION b_a[openEHR-EHR-INSTRUCTION.medication_order.v1]
   WHERE a/name/value = 'Medication statement list';
-- Optional parameters, depending on FHIR search criteria
and e/ehr_id/value = '{{fhir.patient.id_param}}'
and e/ehr_status/subject/external_ref/id/value = '{{fhir.patient.identifier.value.param}}'
and e/ehr_status/subject/external_ref/namespace =  '{{fhir.patient.identifier.system.param}}'
and b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0012]/value/value >= '{{fhir.medication_statement.effective_date_param_min}}'
and b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0012]/value/value <= '{{fhir.medication_statement.effective_date_param_max}}'
and b_a/activities[at0001]/description[at0002]/items[at0113]/items[openEHR-EHR-CLUSTER.medication_course_summary.v0]/items[at0001]/value/defining_code/code_string = '{{fhir_status_param}}',

Node mappings

FHIR node:: medicationStatement.id

openEHR AQL node

if entryId is not null compositionId + | + entryId else compositionId

Valueset mappings

None

ℹ️
 The FHIR id is constructed by a concatenation of the openEHR compositionId and entryId as above. If entryID is null, simply send the compositionID.
=== FHIR node

medicationStatement.status

openEHR AQL node

  • Status_code ⇒ medicationStatement.status

Datatype Mapping style

DV_CODED_TEXT ⇒ Code

Valueset Mappings
FHIR Valueset

active | completed | entered-in-error | intended | stopped | on-hold

local::at0021::Active ⇒ active (default) local::at0024::Completed ⇒ completed local::at0022::Never active ⇒ stopped local::at0023::Stopped ⇒ stopped local::at0025::Obsolete ⇒ stopped local::at0026::Suspended ⇒ on-hold local::at0027::Draft ⇒ intended

FHIR node:: medicationStatement.medicationReference.code

openEHR AQL node

  • MedicationName ⇒ medicationStatement.medicationReference.code

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.subject

openEHR AQL node

ehrId ⇒ medicationStatement.subject.reference subjectId ⇒ medicationStatement.subject.identifier.value subjectNamespace ⇒ medicationStatement.subject.identifier.system

Valueset mappings

  1. For subjectNamespace ⇒ medicationStatement.subject.identifier.system

    1. uk.nhs.nhs_number ⇒ https://fhir.nhs.uk/Id/nhs-number

ℹ️
 We are using the patient’s openEHR ehrId as the id of the FHIR subject resource, and using the patient’s NHS Number, carried in the openEHR 'ehr' object as subjectId as the patient identifier. If the subjectNamespace is not uk.nhs.nhs_number, it should not be mapped to https://fhir.nhs.uk/Id/nhs-number but simply passed through unchanged.

FHIR node: medicationStatement.asserter

openEHR AQL nodes

composerIdentifier ⇒ medicationStatement.asserter.identifier.value composerNamespace ⇒ medicationStatement.asserter.identifier.system composerName ⇒ medicationStatement.asserter.name

Datatype mapping

DV_TEXT ⇒ Identifier

FHIR node: medicationStatement.assertedDate

openEHR AQL node

Last_updated ⇒ medicationStatement.assertedDate

Datatype mapping

DV_DATE_TIME ⇒ dateTime

FHIR node: medicationStatement.effective.effectiveDate

openEHR AQL node

Order_start_date ⇒ medicationStatement.effective.effectiveDate

Datatype mapping

DV_DATE_TIME ⇒ dateTime

=== FHIR node

medicationStatus.taken

openEHR AQL node

None - hardwire value to unk as this a mandatory field.

FHIR node: medicationStatement.note

openEHR AQL node

Comment ⇒ medicationStatement.note.text

Datatype mapping

DV_TEXT ⇒ Annotation.

  • dosage.site

  • dosage.route

  • dosage.method

FHIR node: medicationStatement.reasonCode

openEHR AQL node

  • Reason ⇒ medicationStatement.reasonCode

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.dosage.text

openEHR AQL node

  • Reason ⇒ medicationStatement.dosage.text

Datatype mapping

DV_TEXT ⇒ CodeableConcept

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.dosage.additionalInstruction

openEHR AQL node

  • Reason ⇒ medicationStatement.dosage.additionalInstruction

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.dosage.patientInstruction

openEHR AQL node

  • Reason ⇒ medicationStatement.dosage.patientInstruction

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.dosage.method

openEHR AQL node

  • Reason ⇒ medicationStatement.dosage.method

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.dosage.site

openEHR AQL node

  • Reason ⇒ medicationStatement.dosage.site

Datatype mapping

DV_TEXT ⇒ CodeableConcept

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.dosage.route

openEHR AQL node

  • Reason ⇒ medicationStatement.dosage.route

Datatype mapping

DV_TEXT ⇒ CodeableConcept
see Datatype mapping guidance

FHIR node: medicationStatement.text

FHIR Narrative block

This is optional in Care-Connect but is good practice.

NOTE

TBD

FLAT AQL (avoids use of dv_text/dv_coded_text as objects)

select
    e/ehr_id/value as ehrId,
    e/ehr_status/subject/external_ref/id/value as subjectId,
    e/ehr_status/subject/external_ref/namespace as subjectNamespace,
    a/context/start_time/value as compositionStartTime,
    a/uid/value as compositionId,
    a/composer/name as composerName,
    b_a/uid/value as entryId,
    b_a/activities[at0001]/description[at0002]/items[at0070]/value/value as Medication_item_value,
    b_a/activities[at0001]/description[at0002]/items[at0070]/value/defining_code/code_string as Medication_item_code,
    b_a/activities[at0001]/description[at0002]/items[at0070]/value/defining_code/terminology_id/value as Medication_item_terminology,
    b_a/activities[at0001]/description[at0002]/items[at0009]/value/value as Overall_directions_description,
    b_a/activities[at0001]/description[at0002]/items[at0173, 'Dose amount description']/value/value as Dose_amount_description,
    b_a/activities[at0001]/description[at0002]/items[at0173, 'Dose timing description']/value/value as Dose_timing_description,
    b_a/activities[at0001]/description[at0002]/items[at0044]/value/value as Additional_instruction_value,
    b_a/activities[at0001]/description[at0002]/items[at0044]/value/defining_code/code_string as Additional_instruction_code,
    b_a/activities[at0001]/description[at0002]/items[at0044]/value/defining_code/terminology_id/value as Additional_instruction_terminology,
    b_a/activities[at0001]/description[at0002]/items[at0105]/value/value as Patient_information_value,
    b_a/activities[at0001]/description[at0002]/items[at0107]/value/value as Monitoring_instruction_value,
    b_a/activities[at0001]/description[at0002]/items[at0018]/value/value as Clinical_indication_value,
    b_a/activities[at0001]/description[at0002]/items[at0018]/value/defining_code/code_string as Clinical_indication_code,
    b_a/activities[at0001]/description[at0002]/items[at0018]/value/terminology_id/value as Clinical_indication_terminology,
    b_a/activities[at0001]/description[at0002]/items[at0091]/value/value as Route_value,
    b_a/activities[at0001]/description[at0002]/items[at0091]/value/defining_code/code_string as Route_code,
    b_a/activities[at0001]/description[at0002]/items[at0091]/value/defining_code/terminology_id/value as Route_terminology,
    b_a/activities[at0001]/description[at0002]/items[openEHR-EHR-CLUSTER.medication_substance.v0]/items[at0071]/value/value as Form_value,
    b_a/activities[at0001]/description[at0002]/items[openEHR-EHR-CLUSTER.medication_substance.v0]/items[at0071]/value/defining_code/code_string as Form_code,
    b_a/activities[at0001]/description[at0002]/items[openEHR-EHR-CLUSTER.medication_substance.v0]/items[at0071]/value/defining_code/terminology_id/value as Form_terminology,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[openEHR-EHR-CLUSTER.medication_course_summary.v0]/items[at0001]/value/defining_code/code_string as Status_code,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[openEHR-EHR-CLUSTER.medication_course_summary.v0]/items[at0028]/value/value as AssertedDate,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0012]/value/value as Order_start_date_time,
    b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0013]/value/value as Order_stop_date_time
   from EHR e
   contains COMPOSITION a[openEHR-EHR-COMPOSITION.medication_list.v0]
   contains
      INSTRUCTION b_a[openEHR-EHR-INSTRUCTION.medication_order.v1]
   WHERE a/name/value = 'Medication statement list';
-- Optional parameters, depending on FHIR search criteria
and e/ehr_id/value = '{{fhir.patient.id_param}}'
and e/ehr_status/subject/external_ref/id/value = '{{fhir.patient.identifier.value.param}}'
and e/ehr_status/subject/external_ref/namespace =  '{{fhir.patient.identifier.system.param}}'
and b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0012]/value/value >= '{{fhir.medication_statement.effective_date_param_min}}'
and b_a/activities[at0001]/description[at0002]/items[at0113]/items[at0012]/value/value <= '{{fhir.medication_statement.effective_date_param_max}}'
and b_a/activities[at0001]/description[at0002]/items[at0113]/items[openEHR-EHR-CLUSTER.medication_course_summary.v0]/items[at0001]/value/defining_code/code_string = '{{fhir_status_param}}',