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MedicationRequest Profile

Canonical../StructureDefinition/nexus-emr-core-medicationrequest
Statusdraft · 1.26.0
BaseMedicationRequest (constraint)
SourceFSH · JSON

Defines the Nexus EMR FHIR profile for MedicationRequest resources, based on CA-Core constraints, for aggregating prescription data from multiple EMRs.

Overview

Overview

The Nexus EMR Core MedicationRequest profile represents prescriptions and medication orders within primary care EMR systems. This profile captures comprehensive prescription details including medication, dosage, route, frequency, and dispensing instructions across the Nexus EMR ecosystem.

Key Features

  • Inline Medication: Medication represented via medicationCodeableConcept (text required; product-level DIN and ingredient-level CCDD/ATC codings all optional)
  • Strength Extension: Medication strength captured on the medicationStrength extension (text plus optional structured quantity)
  • Flexible Dosage Instructions: Supports both free-text sig and structured dosing
  • Route Flexibility: Standard terminology with fallback to source EMR codes
  • Dispense Management: Includes quantity, refills, and pharmacy instructions
  • Prescriber Tracking: Links to practitioner who authored the prescription

Medication Representation Approach

Medication is represented inline with medicationCodeableConcept. The earlier contained-Medication pattern (a medicationReference pointing at a contained Medication resource, via the now-removed NexusEmrContainedMedicationCore profile) has been removed.

The profile requires:

  • medicationCodeableConcept.text (required): human-readable medication name.
  • DIN coding (optional): medicationCodeableConcept.coding sliced for the Canadian Drug Identification Number, under http://hl7.org/fhir/NamingSystem/ca-hc-din. That URI changed in 1.20.0 -- an earlier revision fixed http://hl7.org/fhir/sid/ca-hc-din, which no publisher declares, and stored data may still carry it. Write the new form and accept either when reading; the slice definition carries the full note. The representative-DIN strategy the slice follows originates in the PrescribeIT specification.
  • Raw codes (optional): additional source-EMR codings for lossless round-tripping.
  • Strength (optional): carried on the medicationStrength extension as human-readable text plus an optional structured numerator/denominator quantity.

Prescription Components

Essential elements include:

  • Medication Details: Drug name via CodeableConcept, strength via extension
  • Sig Instructions: Complete dosage instructions as free text (required)
  • Timing: Structured frequency and duration when available
  • Route: How medication should be administered
  • Quantity: Amount to dispense and number of refills

Clinical Workflow Support

The profile supports various prescription scenarios:

  • New prescriptions from encounters
  • Refill authorizations
  • Medication changes and discontinuations
  • Prescription renewals
  • Standing orders and protocols

Status Management

Tracks prescription lifecycle:

  • Active: Current prescriptions being filled
  • Completed: Fully dispensed prescriptions
  • Stopped: Discontinued medications
  • On-hold: Temporarily suspended prescriptions
  • Cancelled: Prescriptions that should not be filled

Terminology bindings

Path Strength Value set
MedicationRequest.status required medicationrequest-status
MedicationRequest.intent required medicationrequest-intent
MedicationRequest.dosageInstruction.route preferred route-codes
MedicationRequest.dosageInstruction.doseAndRate.dose[x].code required ucum-units