MedicationOrder

• Overview
• Terminology Bindings
  • Contained Medication Bindings
• Extensions
  • Custom Extensions
• Search
  • Authorization Types
  • Parameters
  • Headers
  • Example
  • Errors
• Retrieve by id
  • Authorization Types
  • Headers
  • Example
  • Errors

Overview

The Medication Order resource provides orders for all medications along with administration instructions for a patient in both the inpatient and outpatient setting (orders/prescriptions filled by a pharmacy and discharge medication orders). This resource does NOT include historical or home medications documented or reported to have been taken by patient, significant other or another provider.

If the Medication Order represents a prescription (something the patient takes at home), the start, stop, and other data may not be a representation of when the medication was taken. For example, the system may not know if the patient ever filled or took the prescribed medication, or when the prescription was filled.

The following fields are returned if valued:

• Medication order id
• Date/Time order written
• Status
• Date/Time order stopped or to stop
• Patient
• Prescriber
• Patient encounter
• Medication
• Details of medication taken:
  • Dosage Instructions:
  • Patient friendly dosage display
  • Additional instructions
  • Time period and frequency
  • As needed (such as PRN for pain)
  • Route
  • Dosage
• Dispensing details:
  • Validity period
  • Number of refills
  • Amount of medication to supply/dispense

Terminology Bindings

MedicationOrder.reasonCodeableConcept

Description The reason or indication for writing the prescription. Details: SNOMED CT System: http://snomed.info/sct Details: ICD-9-CM System: http://hl7.org/fhir/sid/icd-9-cm Details: ICD-10-CM System: http://hl7.org/fhir/sid/icd-10-cm

MedicationOrder.medicationCodeableConcept

Description Identifies the medication being administered. Details: RxNorm System: http://www.nlm.nih.gov/research/umls/rxnorm

MedicationOrder.dosageInstruction.additionalInstructions

Description Supplemental instructions. Note Currently not bound to any terminology. The value would always be returned as a free-text value.

MedicationOrder.dosageInstruction.timing.code

Description Code for a known / defined timing pattern. Details: TimingAbbreviation System: http://hl7.org/fhir/timing-abbreviation Details: SNOMED CT System: http://snomed.info/sct

MedicationOrder.dosageInstruction.asNeeded[x]

Description Indicates whether the Medication is only taken when needed or the preconditions for taking the medication. Details: SNOMED CT System: http://snomed.info/sct

MedicationOrder.dosageInstruction.siteCodeableConcept

Description The anatomic site where the medication first enters the body. Details: SNOMED CT System: http://snomed.info/sct

MedicationOrder.dosageInstruction.route

Description A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subject. Details: SNOMED CT System: http://snomed.info/sct Details: NCI Metathesaurus System: http://ncimeta.nci.nih.gov

Contained Medication Bindings

Medication.code

Description A code that defines the type of medication. Details: RxNorm System: http://www.nlm.nih.gov/research/umls/rxnorm

Medication.product.form

Description Describes the form of the item. Details: NCI Metathesaurus System: http://ncimeta.nci.nih.gov

Extensions

• Patient friendly display

Custom Extensions

All URLs for custom extensions are defined as https://fhir-ehr.cerner.com/dstu2/StructureDefinition/{id}

ID	Value[x] Type	Description
patient-friendly-display	string	The display that can be used for this field when producing a view suitable for a patient.

Search

Search for MedicationOrders that meet supplied query parameters:

GET /MedicationOrder?:parameters

Implementation Notes

• MedicationOrder may have a reference to a contained Medication when the Medication cannot be represented by a CodeableConcept because it contains a unique combination of ingredients. Medications in the system always exist within the context of a MedicationOrder and cannot be be referenced independently.

Authorization Types

Parameters

Name	Required?	Type	Description
_id	Y or patient	token	The logical resource id associated with the resource.
patient	Y or _id	reference	The identity of a patient to list orders for. Example: 12345
status	N	token	The status of the medication order, may be a list separated by commas. Example: active,draft
-timing-boundsPeriod	N	date	The date-time which should fall within the period the medication should be given to the patient. Must be prefixed by ‘ge’. Example: ge2014-05-19T20:54:02.000Z
_lastUpdated	N	date	An explicit or implied date-time range within which the most recent clinically relevant update was made to the medication. Must be prefixed by ‘ge’ or ‘le’. Example: ge2014-05-19T20:54:02.000Z
_count	N	number	The maximum number of results to include in a page. Example: 50

Notes:

• The -timing-boundsPeriod and _lastUpdated parameters may not be provided at the same time.

• The _lastUpdated parameter must have a time, may be provided up to two times, and must use the ge or le prefixes. When provided twice, the lower value must have the ge prefix and the higher value must have the le prefix.

• Searching with the _lastUpdated parameter will only detect changes to fields that affect the clinical meaning of the order. An example of the types of changes that won’t be caught by this query are changes that would affect the version, but not the FHIR content.

Headers

Accept: application/json+fhir
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationOrder?patient=12724067

Response

Status: 200 OK

{
  "resourceType": "Bundle",
  "id": "b4a46440-d23a-4161-9456-1587475fc314",
  "type": "searchset",
  "total": 2,
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationOrder?patient=12724067"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationOrder/309799821",
      "resource": {
        "resourceType": "MedicationOrder",
        "id": "309799821",
        "meta": {
          "versionId": "1",
          "lastUpdated": "2020-03-20T01:00:37.000Z"
        },
        "text": {
          "status": "generated",
          "div": "<div><p><b>Medication Order</b></p><p><b>Patient Name</b>: SMART, JOE</p><p><b>Medication Name</b>: levoFLOXacin</p><p><b>Dosage Instructions</b>: 728 mg = 145.6 mL, IV Piggyback, Daily</p><p><b>Status</b>: Active</p></div>"
        },
        "dateWritten": "2020-03-05T11:26:02.000-06:00",
        "status": "active",
        "patient": {
          "reference": "Patient/12724067",
          "display": "SMART, JOE"
        },
        "prescriber": {
          "reference": "Practitioner/4122622",
          "display": "Cerner Test, Physician - Hospitalist Cerner"
        },
        "encounter": {
          "reference": "Encounter/97953480"
        },
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "82122",
              "display": "Levofloxacin",
              "userSelected": false
            }
          ],
          "text": "levoFLOXacin"
        },
        "dosageInstruction": [
          {
            "text": "728 mg = 145.6 mL, IV Piggyback, Daily",
            "_text": {
              "extension": [
                {
                  "url": "https://fhir-ehr.cerner.com/dstu2/StructureDefinition/patient-friendly-display",
                  "valueString": "IV Piggyback every day. Refills: 0."
                }
              ]
            },
            "timing": {
              "repeat": {
                "boundsPeriod": {
                  "start": "2020-03-05T11:26:00.000-06:00"
                }
              },
              "code": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/timing-abbreviation",
                    "code": "QD",
                    "display": "QD",
                    "userSelected": false
                  }
                ],
                "text": "Daily"
              }
            },
            "route": {
              "coding": [
                {
                  "system": "http://ncimeta.nci.nih.gov",
                  "code": "C38279",
                  "display": "INTRAVENOUS DRIP",
                  "userSelected": false
                },
                {
                  "system": "http://snomed.info/sct",
                  "code": "47625008",
                  "display": "Intravenous route (qualifier value)",
                  "userSelected": false
                }
              ],
              "text": "IV Piggyback"
            },
            "doseQuantity": {
              "value": 728.0,
              "unit": "mg",
              "system": "http://unitsofmeasure.org",
              "code": "mg"
            }
          }
        ],
        "dispenseRequest": {
          "validityPeriod": {
            "start": "2020-03-05T11:26:02.000-06:00"
          }
        }
      }
    },
    {
      "fullUrl": "https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationOrder/309799757",
      "resource": {
        "resourceType": "MedicationOrder",
        "id": "309799757",
        "meta": {
          "versionId": "1",
          "lastUpdated": "2020-03-20T01:00:37.000Z"
        },
        "text": {
          "status": "generated",
          "div": "<div><p><b>Medication Order</b></p><p><b>Patient Name</b>: SMART, JOE</p><p><b>Medication Name</b>: vancomycin</p><p><b>Dosage Instructions</b>: 2,275 mg, IV Piggyback, Once</p><p><b>Status</b>: Active</p></div>"
        },
        "dateWritten": "2020-03-05T11:26:02.000-06:00",
        "status": "active",
        "dateEnded": "2020-03-05T11:26:00.000-06:00",
        "patient": {
          "reference": "Patient/12724067",
          "display": "SMART, JOE"
        },
        "prescriber": {
          "reference": "Practitioner/4122622",
          "display": "Cerner Test, Physician - Hospitalist Cerner"
        },
        "encounter": {
          "reference": "Encounter/97953480"
        },
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "11124",
              "display": "Vancomycin",
              "userSelected": false
            }
          ],
          "text": "vancomycin"
        },
        "dosageInstruction": [
          {
            "text": "2,275 mg, IV Piggyback, Once",
            "_text": {
              "extension": [
                {
                  "url": "https://fhir-ehr.cerner.com/dstu2/StructureDefinition/patient-friendly-display",
                  "valueString": "IV Piggyback once. Refills: 0."
                }
              ]
            },
            "timing": {
              "repeat": {
                "boundsPeriod": {
                  "start": "2020-03-05T11:26:00.000-06:00",
                  "end": "2020-03-05T11:26:00.000-06:00"
                }
              },
              "code": {
                "text": "Once"
              }
            },
            "route": {
              "coding": [
                {
                  "system": "http://ncimeta.nci.nih.gov",
                  "code": "C38279",
                  "display": "INTRAVENOUS DRIP",
                  "userSelected": false
                },
                {
                  "system": "http://snomed.info/sct",
                  "code": "47625008",
                  "display": "Intravenous route (qualifier value)",
                  "userSelected": false
                }
              ],
              "text": "IV Piggyback"
            },
            "doseQuantity": {
              "value": 2275.0,
              "unit": "mg",
              "system": "http://unitsofmeasure.org",
              "code": "mg"
            }
          }
        ],
        "dispenseRequest": {
          "validityPeriod": {
            "start": "2020-03-05T11:26:02.000-06:00"
          }
        }
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Retrieve by id

List an individual MedicationOrder by its id:

GET /MedicationOrder/:id

Authorization Types

Headers

Accept: application/json+fhir
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/dstu2/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationOrder/309799821

Response

Status: 200 OK

{
  "resourceType": "MedicationOrder",
  "id": "309799821",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2020-03-20T01:00:37.000Z"
  },
  "text": {
    "status": "generated",
    "div": "<div><p><b>Medication Order</b></p><p><b>Patient Name</b>: SMART, JOE</p><p><b>Medication Name</b>: levoFLOXacin</p><p><b>Dosage Instructions</b>: 728 mg = 145.6 mL, IV Piggyback, Daily</p><p><b>Status</b>: Active</p></div>"
  },
  "dateWritten": "2020-03-05T11:26:02.000-06:00",
  "status": "active",
  "patient": {
    "reference": "Patient/12724067",
    "display": "SMART, JOE"
  },
  "prescriber": {
    "reference": "Practitioner/4122622",
    "display": "Cerner Test, Physician - Hospitalist Cerner"
  },
  "encounter": {
    "reference": "Encounter/97953480"
  },
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "82122",
        "display": "Levofloxacin",
        "userSelected": false
      }
    ],
    "text": "levoFLOXacin"
  },
  "dosageInstruction": [
    {
      "text": "728 mg = 145.6 mL, IV Piggyback, Daily",
      "_text": {
        "extension": [
          {
            "url": "https://fhir-ehr.cerner.com/dstu2/StructureDefinition/patient-friendly-display",
            "valueString": "IV Piggyback every day. Refills: 0."
          }
        ]
      },
      "timing": {
        "repeat": {
          "boundsPeriod": {
            "start": "2020-03-05T11:26:00.000-06:00"
          }
        },
        "code": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/timing-abbreviation",
              "code": "QD",
              "display": "QD",
              "userSelected": false
            }
          ],
          "text": "Daily"
        }
      },
      "route": {
        "coding": [
          {
            "system": "http://ncimeta.nci.nih.gov",
            "code": "C38279",
            "display": "INTRAVENOUS DRIP",
            "userSelected": false
          },
          {
            "system": "http://snomed.info/sct",
            "code": "47625008",
            "display": "Intravenous route (qualifier value)",
            "userSelected": false
          }
        ],
        "text": "IV Piggyback"
      },
      "doseQuantity": {
        "value": 728.0,
        "unit": "mg",
        "system": "http://unitsofmeasure.org",
        "code": "mg"
      }
    }
  ],
  "dispenseRequest": {
    "validityPeriod": {
      "start": "2020-03-05T11:26:02.000-06:00"
    }
  }
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.