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Friday, March 11, 2011

Medication Status in CCD

One of the things that people often want to know about medications is whether they are still actively be used by the patient, or whether they are historical.  Some look to find this in the status element of the substanceAdministation or supply act, but that is used for a different purpose.  It is used to record the state of the act according to the state model defined in the HL7 RIM.  For example, when dealing with a request or order for medications, the state is completed when the order is filled.  When dealing with an event, such as the administration of a medication, the state is completed when the med has been given to the patient.  That means that what that statusCode element implies about the medication depends upon the type of act (specifically its mood).

In the IHE PCC Technical Framework, the medication entry often has effectiveTime elements that tell you the intended or actual time of use (see yesterday's post for how to use those).  But even then, you may not know the dates, but still want to indicate that this is a historical medication.
So a different mechanism is needed to indicate that a medication is currently active, on hold (e.g., blood thinners before surgery), or no longer active.  The CCD specification contains a Medication Status entry that can appear within a substanceAdministration or supply act to support this.

The medication status entry looks like this and should appear at the end1 of the substanceAdministration or supply act (with all other entryRelationship elements:

The codes and display names that you can use for this entry are:

CodeDisplay Name
421139008On Hold
392521001Prior History
73425007No Longer Active

I don't know what the difference between Prior History and No Longer Active are.  They are nearly enough equivalent that you should be able to assume that if either of those codes are present, the medication is no longer being used.

   -- Keith

1 It need not appear exactly at the end, so long as it is with all the other entryRelationship elements.  But if you don't know where to put it, that's the best place for me to tell you, because it will be correct according to the CDA schema.


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  2. Hallo,
    I am working at a local implementation guide for a Patient Summary document, based on CCD and IHE PCC works.
    I found some problems in the interpretation of the statusCode of the substanceAdministration of a Medication.
    IHE PCC constraints that “The status of all elements must be "completed". The act has either occurred, or the request or order has been placed.”

    But another interpretation of this status element says: An Act in mood INT with a status of "completed" means all intended acts are fully complete. The status has nothing to do with the creation of the order. (The status of the creation of the order would be the status of the ControlAct representing the creation of the order)

    So, for an ongoing medication (still active) the statusCode shouldn’t be “completed” until all the drugs are subministered; and then the first effectiveTime can have defined a high date/time (in the past).

    Even HL7 experts haven’t an unique interpretation of statusCode / moodCode use, and this does not bode well.

    What do you think about it?