{
"description": "This profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It is informed by the constraints of the [Medication IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Medication-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-medication.html) to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.",
"_filename": "structuredefinition-profile-medication-ca-ps.json",
"package_name": "ca.infoway.io.psca",
"date": "2024-04-09T00:00:00-08:00",
"derivation": "constraint",
"publisher": null,
"fhirVersion": "4.0.1",
"name": "MedicationPSCA",
"abstract": false,
"copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
"type": "Medication",
"experimental": "false",
"resourceType": "StructureDefinition",
"title": "Medication (PS-CA)",
"package_version": "2.0.0-DFT-preBallot",
"status": "draft",
"id": "5f8c07d2-4009-4ab9-9487-96f46ec3d46e",
"kind": "resource",
"url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medication-ca-ps",
"version": null,
"differential": {
"element": [ {
"id": "Medication.extension:strength",
"max": "1",
"path": "Medication.extension",
"type": [ {
"code": "Extension",
"profile": [ "http://prescribeit.ca/fhir/StructureDefinition/ext-medication-strength-description" ]
} ],
"short": "Extension for representing overall medication strength.",
"sliceName": "strength",
"definition": "The overall medication strength, rather than the strength of a specific ingredient."
}, {
"path": "Medication.code",
"min": 1,
"definition": "Medication that was requested/ordered.",
"short": "Medication that was requested/ordered (medication code from any code system)",
"type": [ {
"code": "CodeableConcept",
"profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-medication-ca-ps" ]
} ],
"mustSupport": true,
"binding": {
"strength": "preferred",
"valueSet": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/hc-CCDD",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/LicensedNaturalHealthProducts"
}, {
"url": "documentation",
"valueMarkdown": "All Natural Product Number (NPN) and Homeopathic Medicine Number (DIN-HM) codes that are licensed by Health Canada and present in the Licensed Natural Health Products Database."
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"
}, {
"url": "documentation",
"valueMarkdown": "WHO ATC classification."
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medications-snomed-ct-ips-free-set"
}, {
"url": "documentation",
"valueMarkdown": "Draws on values from the SNOMED International Patient Set (IPS) subset of SNOMED CT (IPS Free Set)."
} ]
} ],
"description": "Canadian Clinical Drug Data Set codes"
},
"max": "1",
"id": "Medication.code",
"comment": "A variety of terminology is used across the Canadian Landscape to codify medications. Various code systems in use in Canada are put forward as examples and using the additional bindings extension.\r\n\r\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.\r\n\r\n In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS free-set concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.\r\n\r\nIPS-UV Note: Several kinds of medication coding could be provided as:\r\n\r\n1. The IDMP Pharmaceutical Product Identifier (PhPID), Level 1, [Substance(s)]. Example: Amoxicillin and Clavulanate Potassium; or any other equivalent coded concept;\r\n2. The IDMP Pharmaceutical Product Identifier (PhPID), Level 2 [Substance(s) + Strength + reference strength]. Example: Amoxicillin 875 mg and Clavulanate Potassium 125 mg; or any other equivalent coded concept;\r\n3. The IDMP Pharmaceutical Product Identifier (PhPID), Level 3 [Substance(s) + administrable dose form]. Example: Amoxicillin and Clavulanate Potassium, Oral Tablet; or any other equivalent coded concept;\r\n4. The IDMP Pharmaceutical Product Identifier (PhPID), Level 4 [Substance(s) + strength + reference strength + administrable dose form]. Example: Amoxicillin 875 mg and clavulanate potassium 125 mg, oral tablet; or any other equivalent coded concept 5. The IDMP Medicinal Product Identifier (MPID) or any equivalent Medicinal Product Identifier. IDMP MPID uniquely identifies a Medicinal Product, reflecting (but not replacing) any other authorization numbers allocated by a regulator. MPID implies one (set of) PhPID. The MPID shall use a common segment pattern related to a Medicinal Product, which, when each segment is valued shall define a specific MPID concept.\r\n6. The IDMP Packaged Medicinal Product Identifier (PCID) or any equivalent Packaged Medicinal Product Identifier. Uniquely identifies a Medicinal Product based on its packaging. This implies one MPID can be associated with more than one PCID, if the same Medicinal Product has more than one type of package.\r\n7. Any other kind of code that that identifies, classifies or cluster the administered product (e.g. the medicinal product or the product class)\r\n\r\nThe value sets used for the PhPID, MPID and PCID identifiers are provisional and include only few equivalent concepts used for exemplification purposes, they will be updated with real IDMP identifiers when they will become available.",
"example": [ {
"label": "DIN",
"valueCodeableConcept": {
"text": "ACETAMINOPHEN 325MG",
"coding": [ {
"code": "02247611",
"system": "http://hl7.org/fhir/NamingSystem/ca-hc-din",
"display": "Acetaminophen 325mg (Jamieson Laboratories Ltd.)"
} ]
}
}, {
"label": "NPN",
"valueCodeableConcept": {
"text": "Echinacea with Garlic and Ginger",
"coding": [ {
"code": "80016551",
"system": "http://terminology.hl7.org/CodeSystem/v3-hc-npn",
"display": "Echinacea with Garlic and Ginger (Jamieson Laboratories Ltd.)"
} ]
}
}, {
"label": "CCDD",
"valueCodeableConcept": {
"text": "Aveeno Anti-Itch Lotion",
"coding": [ {
"code": "02240105",
"system": "http://terminology.hl7.org/CodeSystem/hc-CCDD",
"display": "AVEENO ANTI-ITCH LOTION (calamine 3 % and pramoxine hydrochloride 1 % lotion) JOHNSON & JOHNSON INC"
} ]
}
} ]
}, {
"id": "Medication.form",
"path": "Medication.form",
"type": [ {
"code": "CodeableConcept",
"profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" ]
} ],
"binding": {
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticaldoseformcode",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptiondrugform"
}, {
"url": "documentation",
"valueMarkdown": "This binding includes HL7 V3 Codes from the PrescribeIT value set indicating the form in which the drug product is capable of being administered, dispensed, or ordered. Implementers should anticipate that data collected and or exchanged in the context of ePrescribing may contain concepts from this valueSet. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding",
"extension": [ {
"url": "purpose",
"valueCode": "candidate"
}, {
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-doseform"
}, {
"url": "documentation",
"valueMarkdown": "EDQM Medicine dose forms."
} ]
} ],
"description": "SCTCA Pharmaceutical Dose Form"
},
"comment": "See additionalBinding extension",
"definition": "Administrable Pharmaceutical Dose Form.\r\n\r\nThis code represents the form of the medication (e.g. tablet, capsule, liquid)\r\n\r\nSince the EDQM Standards Terms, together with UCUM, is one of the IDMP terminologies actually available for usage, this code system has been selected as reference terminology for representing Pharmaceutical Dose forms; Packages and Route of Administration\r\n\r\nIt is known that also alternative jurisdictional and international terminologies are known to be used for this concept domain, as NCI or SNOMED CT.",
"mustSupport": true
}, {
"id": "Medication.ingredient",
"path": "Medication.ingredient",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content."
}, {
"id": "Medication.ingredient.itemCodeableConcept",
"path": "Medication.ingredient.itemCodeableConcept",
"binding": {
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/drugormedicamentsubstancecode",
"description": "SNOMED CT CA drug substances."
},
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain this element within the context of their own jurisdictional content.\n\nIPS UV Note: The IDMP ISO 11238 standard addresses the identification and exchange of regulated information on substances.\n\nThe Global Ingredient Archival System (GInAS) will provide a common global identifier for all of the substances used in medicinal products, providing a definition of substances globally consistent with this standard.\n\nThose identifiers however are yet available for concrete usage, therefore in this version of the template, SNOMED CT has been chosen as reference terminology also for the active substances.\n\nThis choice will be revised based on the availability and the maturity of GInAS."
}, {
"id": "Medication.ingredient.strength",
"path": "Medication.ingredient.strength",
"type": [ {
"code": "Ratio",
"profile": [ "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/Ratio-ca-ps" ]
} ],
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. Vendors should expect that some jurisdictions may add a Must Support requirement within the context of their own jurisdictional content."
} ]
},
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Medication"
}