Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.

Data Element
Medication Instructions
Description (*Please confirm or update this field for the new USCDI version*)

Directions for administering or taking a medication.

Examples include but are not limited to prescription directions for taking a medication, and package instructions for over-the-counter medications.

Usage notes: May include route, quantity, timing/frequency, and special instructions (PRN, sliding scale, taper).

Submitted By: Shelly Spiro / Pharmacy HIT Collaborative
Data Element Information
Data Element Description Represents an instruction for the administration of medication to a patient - both in the inpatient (hospital) and community setting. It can also include instructions for the dispensing, the reasons why the administration should occur and other data. https://www.hl7.org/fhir/medicationrequest.html
Rationale for Separate Consideration FHIR resources are part of a suite of resources and should all be under USCDI Medication as they are needed for eCare Plans, including but not limited to the Pharmacist eCare Plan.
Use Case Description(s)
Use Case Description These foundational FHIR resources are part of a suite of resources and should all be under USCDI Medication as they are needed for eCare Plans, including but not limited to the Pharmacist eCare Plan.
Estimate the breadth of applicability of the use case(s) for this data element At least 21 pharmacy system vendors are FHIR enabled and are created millions of Pharmacist eCare Plans throughout the US.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) RxNorm and SNOMED CT
Additional Specifications https://www.hl7.org/fhir/medications-module.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts https://www.ecareplaninitiative.com/
https://216b2f95-65cb-4e7e-bd94-a9b066b0a193.filesusr.com/ugd/b303f5_a66df3115abd40a58659bae8f51b4aad.pdf
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) MedicationKnowledge resource is draft
Restrictions on Use (e.g. licensing, user fees) None known.
Privacy and Security Concerns None known.
Estimate of Overall Burden Burden is on the EHR and pharmacy system vendors to implement.
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by CDC_DSMH_WG on

CDC comment on data element-Medication Instructions

CDC recommends that ONC should expand Medication Instructions to include Medication Request Status Reason, Priority, and Do Not Perform. Status Reason identifies why the request is in its current status, Priority indicates urgency (e.g., routine, urgent, ASAP, stat), and Do Not Perform indicates that the provider is requesting the medication not be administered. Rationale: These elements provide important context for interpreting medication requests, including why a request was changed or suspended, its urgency, and whether the medication should not be given. Including them would improve alignment with FHIR/QI-Core and support clinical care and quality measurement.

FHIR path(s):
MedicationRequest.statusReason
MedicationRequest.priority
MedicationRequest.doNotPerform
 

Submitted by rdillaire on

CMS CCSQ supports CDC’s…

CMS CCSQ supports CDC’s recommendation to expand Medication Instructions definition to include Medication Request Status Reason, Priority, and Do Not Perform. 

Submitted by BLampkins_CSTE on

Medication Instructions - CSTE Comment

Medication data are critical for exchange with public health and is included in eCR standards. They are particularly important for STI programs, HIV and TB surveillance, as well as for public health response and surveillance for antimicrobial resistant pathogen infections. The ability to exchange data on prescribing of opioid medications in particular is of great importance to public health programs which aim to reduce opioid overdoses and deaths.

Submitted by BLampkins_CSTE on

CSTE Comment - v5

Medication data is critical for exchange with public health and is included in eCR standards. It is especially important for STI programs, HIV and TB surveillance as well as for public health response and surveillance for antimicrobial resistant pathogen infections.   CSTE also strongly agrees that the ability to exchange data on prescribing of opioid medications in particular is of great importance to public health programs which aim to reduce opioid overdoses and deaths.

Submitted by CDC_DSMH_WG on

CDC's Comment for draft USCDI v5

CDC supports the inclusion of this data element in USCDI v5 as it is an element that may be necessary for calculation of our digital quality metrics from FHIR data.

Submitted by kelly.clarke@j… on

Comment

Highly support and agree with the addition of this new data element. This will ensure patient safety during medication administration and when exchanging information, the receiver will have full image of medication.

Submitted by CDC_DSMH_WG on

CDC's Consolidated Comment for USCDI v5

 

  • “Directions for administering or taking a medication. Examples include but are not limited to prescription directions for taking a medication, and package instructions for over-the-counter medications. Usage notes: May include route, quantity, timing/frequency, and special instructions (PRN, sliding scale, taper).”
  • As a new addition in USCDI v4 Standards, the data element “Medication Instructions” includes information on prescription medication route, quantity dispensed, timing/frequency and instructions on use, e.g. PRN, in a single field. This information is essential for a more complete understanding of the medication usage; information on the dose, alone, does not fully quantify the amount or duration of use of the medication. However, unstandardized text in a combined field will have limited utility as the content and format may vary by data source and each piece of information will be difficult and resource-intensive to extract. CDC suggests standardized, separate variables for route of administration, quantity (or, alternatively, days’ supply), frequency, and unit of frequency, in addition to a text field with special instructions.

NACCHO Comment: Support - Separate elements will ensure that LHDs receive coded values, rather than combined text. This will reduce the burden of data preparation on LHDs.

Submitted by pwilson@ncpdp.org on

NCPDP Comment

NCPDP recommends updating the data element definition to “Directions for administering or taking a medication including route of administration (e.g., oral), dose quantity (e.g., take 1 pill), timing or hours of administration (e.g., once a day or every 12 hours), special instructions (e.g., as needed, for pain, for cough)

  • Include several specific components:
    • Route of administration
    • Dose quantity
    • Timing or hours
    • Special instructions
    • Duration”

Submitted by hswmin on

THIA Comment on Medications: Medication Instructions

The Texas Health Informatics Alliance (THIA) Policy and Standards Working Group supports the proposal for medication instructions. It is important to know if medications have been changed at discharge. It is frustrating for end-users to have to reconcile medications from outside entities. Patients can bring their discharge paperwork, but discharge paperwork is often lost during the follow-up process. The proposal for medication instructions may make it easier for physicians when receiving an accurate medication list from other institutions.

Submitted by gsgordon on

If it's good enough for US Core...

Considering MedicationRequest and most of its elements are Must Support in US Core, and the central aspect of prescription records in healthcare, I'm surprised that this isn't bread and butter part of USCDI

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