Withdrawn Anitbiotics with varied dosing

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Approval Status

  • Approval Status: Withdrawn
  • Example Task Force: 3/6/2014
  • SDWG: Withdarawn with preference for text - see comments

C-CDA 2.1 Example:

  • 2.16.840.1.113883.10.20.22.2.1:2014-06-09

  • 2.16.840.1.113883.10.20.22.2.1.1:2014-06-09

  • 2.16.840.1.113883.10.20.22.4.16:2014-06-09

  • 2.16.840.1.113883.10.20.22.4.23:2014-06-09

  • 2.16.840.1.113883.10.20.22.4.119

    Reference to full CDA sample:

  • Medications in empty CCD

Validation location

Comments

  • some background on the dissent for encoding this medication
  • This is an example of a medication with dosing that varies over time.
  • This is an example of a common pattern for antibiotic administration which is complex (double dose on day 1, commonly known as Z-PAK).
  • SDWG reviewed this example with the Pharmacy working group in February 2014. This dosing regimen may be characterized as a loading dose, but a similar approach could be used for a tapered dose as well. At the May 2014 Working Group the committee discussed whether this example would be better with just a free text sig which now exists as a new template in C-CDA R2.1

Custodian

  • John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)

Keywords

  • medications, Pre-coordinated medication code, dose frequency, tapered dose, loading dose

Permalink

Links

 

Example: download example view on GitHub 

<section>
    <templateId root="2.16.840.1.113883.10.20.22.2.1.1"/>
    <templateId root="2.16.840.1.113883.10.20.22.2.1.1" extension="2014-06-09"/>
    <!-- Medication Section (entries required) -->
    <code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of Medication Use"/>
    <title>MEDICATIONS</title>
    <text>
        <table border="1" width="100%">
            <thead>
                <tr>
                    <th>Medication</th>
                    <th>Instructions</th>
                    <th>Dosage</th>
                    <th>Effective Dates (start - stop)</th>
                    <th>Status</th>
                </tr>
            </thead>
            <tbody>
                <tr ID="Medication_2">
                    <td>
                        <content ID="MedicationName_2" xmlns="urn:hl7-org:v3">Azithromycin 250mg Oral Tablet</content>
                    </td>
                    <td>
                        <content>take 2 tablets on day 1, 1 tablet days 2-5</content>
                    </td>
                    <td>
                        <content>250 MG</content>
                    </td>
                    <td>Mar-10-2014 - Mar-14-2014</td>
                    <td>Active</td>
                </tr>
            </tbody>
        </table>
    </text>
    <entry typeCode="DRIV">
        <!-- This medication entry will be divided into two components -->
        <!-- This first component describes day 1 which has a different dose than days 2 through 5, shown in the second component-->
        <organizer xmlns="urn:hl7-org:v3" classCode="CLUSTER" moodCode="EVN">
            <statusCode code="active"/>
            <component>
                <substanceAdministration classCode="SBADM" moodCode="INT">
                    <!-- This medication use case is a medication to be administered. If it has been already administered use moodCode = "EVN".  -->
                    <!-- If an ordered drug then use moodCode = "RQO" Dependencies exist between moodCode, statusCode and effectiveTime  -->
                    <templateId root="2.16.840.1.113883.10.20.22.4.16"/>
                    <templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
                    <id root="bc22a9c5-bab4-4348-aa7e-a1b1897c9535"/>
                    <text>
                        <!-- This reference refers to medication information in unstructured portion of section-->
                        <reference value="#Medication_2"/>
                    </text>
                    <statusCode code="active"/>
                    <!-- This effectiveTime shows medication administration for day 1. -->
                    <!-- To include any times during the day, the high interval should either be set to end of day (as shown) or the day after last day of medication administration.-->
                    <!-- See C-CDA DSTU 383 more detail on effectiveTime/high -->
                    <effectiveTime xsi:type="IVL_TS">
                        <low value="20140310000000"/>
                        <high value="20140310235959" inclusive="true"/>
                        <!-- inclusive indicator is optional -->
                    </effectiveTime>
                    <!-- This second effectiveTime represents once per day from medication sig. -->
                    <!-- InstituionSpecified = "false" is implied in ths omission of this attribute and means that it must be administered exactly once per day-->
                    <!-- InstituionSpecified = "true"which is not default would mean that receiving institution has flexibility in dosing schedule-->
                    <!-- Operator "A" means that this timing information is in addition to previous effectiveTime information provided-->
                    <effectiveTime xsi:type="PIVL_TS" operator="A">
                        <period value="1" unit="d"/>
                    </effectiveTime>
                    <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" displayName="Oral Route of Administration"/>
                    <!-- This relates directly to the code used for medication. This medication is administered as an oral table, so no unit is needed -->
                    <!-- Azithromycin is commonly prescribed 2 tablets on day 1, which is shown below -->
                    <doseQuantity value ="2" />
                    <consumable>
                        <manufacturedProduct classCode="MANU">
                            <!-- ** Medication information ** -->
                            <templateId root="2.16.840.1.113883.10.20.22.4.23"/>
                            <templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
                            <id root="a9a55f64-3953-4f2c-b52e-c77399b854ae"/>
                            <manufacturedMaterial>
                                <!-- Medications should be specified at a level corresponding to prescription when possible, such as 250mg oral tablet (non-branded)-->
                                <code code="308460" displayName="azithromycin 250 MG Oral Tablet" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm">
                                    <originalText>
                                        <reference value="#MedicationName_2"/>
                                    </originalText>
                                </code>
                            </manufacturedMaterial>
                        </manufacturedProduct>
                    </consumable>
                </substanceAdministration>
            </component>
            <component>
                <substanceAdministration classCode="SBADM" moodCode="INT">
                    <!-- This medication use case is a medication to be administered. If it has been already administered use moodCode = "EVN". If an ordered drug then use moodCode = "RQO" -->
                    <!-- Dependencies exist between moodCode, statusCode and effectiveTime  -->
                    <templateId root="2.16.840.1.113883.10.20.22.4.16"/>
                    <templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
                    <id root="bc22a9c5-bab4-4348-aa7e-a1b1897cxxxx"/>
                    <text>
                        <!-- This reference refers to medication information in unstructured portion of section-->
                        <reference value="#Medication_2"/>
                    </text>
                    <statusCode code="active"/>
                    <!-- This effectiveTime shows medication administration starting on day 2-->
                    <!-- To include any times during the day, the high interval should either be set to end of day or the day after last day of medication administration (as shown).-->
                    <!-- See C-CDA DSTU 383 more detail on effectiveTime/high -->
                    <effectiveTime xsi:type="IVL_TS">
                        <low value="20140311000000"/>
                        <high value="20140314235959" inclusive="true"/>
                    </effectiveTime>
                    <!-- This second effectiveTime represents once per day from medication sig. -->
                    <!-- InstituionSpecified = "false" is implied in ths omission of this attribute and means that it must be administered exactly once per day-->
                    <!-- InstituionSpecified = "true"which is not default would mean that receiving institution has flexibility in dosing schedule-->
                    <!-- Operator "A" means that this timing information is in addition to previous effectiveTime information provided-->
                    <effectiveTime xsi:type="PIVL_TS" operator="A">
                        <period value="1" unit="d"/>
                    </effectiveTime>
                    <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" displayName="Oral Route of Administration"/>
                    <!-- This relates directly to the code used for medication. This medication is administered as an oral table, so no unit is needed, but it has varying dosage over its course. -->
                    <!-- Azithromycin is commonly prescribed 2 tablets on day 1 then 1 tablet daily thereafter. -->
                    <doseQuantity value ="1" />
                    <consumable>
                        <manufacturedProduct classCode="MANU">
                            <!-- ** Medication information ** -->
                            <templateId root="2.16.840.1.113883.10.20.22.4.23"/>
                            <templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
                            <id root="a9a55f64-3953-4f2c-b52e-c77399b8xxxx"/>
                            <manufacturedMaterial>
                                <!-- Medications should be specified at a level corresponding to prescription when possible, such as 250mg oral tablet (non-branded)-->
                                <code code="308460" displayName="azithromycin 250 MG Oral Tablet" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm">
                                    <originalText>
                                        <reference value="#MedicationName_2"/>
                                    </originalText>
                                </code>
                            </manufacturedMaterial>
                        </manufacturedProduct>
                    </consumable>
                </substanceAdministration>
            </component>
        </organizer>
    </entry>
</section>

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