Drug Mixture

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 2022-06-23
  • SDWG: Pending

C-CDA 2.1 Example:

  • Medications Section: 2.16.840.1.113883.10.20.22.2.1.1:2014-06-09
  • Medication Activity: 2.16.840.1.113883.10.20.22.4.16:2014-06-09
  • Medication Information: 2.16.840.1.113883.10.20.22.4.23:2014-06-09

Reference to full CDA sample:

  • Medications in empty CCD

Validation location

Comments

  • This is an example of a mixture of three or more different drug ingredients, each with a different relative concentration.
  • Note the use of the urn:ihe:pharm:medication namespace, which is required by the UV Medication Information (detail) template. The CDA schema doesn't recognize content from this namespace and so flags it as invalid by default, although extension content from other namespaces is allowed in CDA even when not recognized by the schema (see 1.4 CDA Extensibility).

Custodian

  • Matt Szczepankiewicz, mszczepa@epic.com (GitHub: mjszczep)

Keywords

  • drug mixture

Permalink

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Example: download example view on GitHub

<!-- Note the use of the urn:ihe:pharm:medication namespace, which is required by the UV Medication Information (detail) template.
     The CDA schema doesn't recognize content from this namespace and so flags it as invalid by default, although extension content from other namespaces
     is allowed in CDA even when not recognized by the schema (see 1.4 CDA Extensibility).
 -->
<section xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:pharm="urn:ihe:pharm:medication">
    <templateId root="2.16.840.1.113883.10.20.22.2.1" /> 
    <templateId root="2.16.840.1.113883.10.20.22.2.1" extension="2014-06-09" /> 
    <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" /> 
    <id root="4A2D0868-7307-11EC-BD4E-460231621F93" /> 
    <code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of Medication use Narrative" /> 
    <title>Medications</title> 
    <text>
       <!-- ... -->
    </text>
    <!-- Example mixture:
            diphenhydrAMINE hydrochloride 5 mg, lidocaine 50 mg in aluminum & magnesium hydroxide-simethicone 80-80-8 mg/mL -->
    <entry typeCode="DRIV">
        <substanceAdministration classCode="SBADM" moodCode="INT">
            <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 extension="1012722087" root="1.2.840.114350.1.13.861.1.7.2.798268" /> 
            <text>
                <reference value="#Med1"/>diphenhydrAMINE hydrochloride 5 mg, lidocaine 50 mg in aluminum &amp; magnesium hydroxide-simethicone 80-80-8 mg/mL SUSP 1.6667 mL
            </text>
            <statusCode code="active" /> 
            <effectiveTime xsi:type="IVL_TS">
                <low value="20220111" /> 
                <high value="20220119055900+0000" /> 
            </effectiveTime>
            <effectiveTime xsi:type="PIVL_TS" institutionSpecified="true" operator="A">
                <period unit="d" value=".5" /> 
            </effectiveTime>
            <routeCode code="C38289" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" displayName="Mouth/Throat">
                <originalText>Mouth/Throat</originalText> 
            </routeCode>
            <!-- The patient should take 5 mL of this mixture at a time. -->
            <doseQuantity unit="mL" value="5" /> 
            <consumable typeCode="CSM">
                <manufacturedProduct classCode="MANU">
                    <!-- This manufacturedProduct conforms to both the C-CDA Medication Information (V2)
                         template AND the UV Medication Information (detail) template:
                         https://art-decor.org/art-decor/decor-templates--pharmcda-?section=templates&id=2.16.840.1.113883.10.21.4.11 -->
                    <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" /> 
                    <templateId root="2.16.840.1.113883.10.21.4.11" />
                    <manufacturedMaterial>
                        <!-- There's no code for this mixture... -->
                        <code codeSystem="2.16.840.1.113883.6.88" nullFlavor="OTH" />
                        <!-- The element SHOULD contain the name of the medication. -->
                        <name>diphenhydrAMINE hydrochloride 5 mg, lidocaine 50 mg, aluminum &amp; magnesium hydroxide-simethicone 80-80-8 mg/mL SUSP 1.6667 mL</name>
                        <!-- This code represents the pharmaceutical dose form (e.g., tablet, capsule, liquid) and SHOULD be present, if not implied by the product.
                            It MAY be present if implied by the product.
                            The value of this code may affect the units used in the substance administration quantity element. -->
                        <pharm:formCode code="385023001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Oral solution" />
                        <!-- The following other elements MAY be included, in order:
                                 lotNumberText
                                 pharm:expirationTime
                                 pharm:asContent
                                 pharm:asSpecializedKind -->
                        <!-- diphenhydrAMINE hydrochloride 5 mg -->
                        <!-- The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.10430 RoleClassIngredientEntity (DYNAMIC).
                             Here, the classCode of "ACTI" indicates that this is an active ingredient. -->
                        <pharm:ingredient classCode="ACTI">
                            <!-- The pharm:quantity below demonstrates the case where the pharm:code doesn't encapsulate the ingredient's
                                 concentration, although this is likely to be more rare than the case where it does. For an example of the more common case,
                                 see the following two ingredients in this example. -->
                            <pharm:quantity>
                                <!-- For ingredients with an unspecified concentration, the pharm:quantity
                                represents the amount of the INGREDIENT in the mixture:
                                1 mg of diphenhydrAMINE hydrochloride per 1 mL of the mixture. -->
                                <pharm:numerator xsi:type="PQ" value="1" unit="mg" />
                                <pharm:denominator xsi:type="PQ" value="1" unit="mL" />
                            </pharm:quantity>
                            <pharm:ingredientSubstance classCode="MMAT" determinerCode="KIND">
                                <!-- This pharm:code DOES NOT encapsulate the ingredient's concentration! -->
                                <pharm:code code="1362" displayName="diphenhydrAMINE hydrochloride"
                                    codeSystem="2.16.840.1.113883.6.88"
                                    codeSystemName="RxNorm"/>
                            </pharm:ingredientSubstance>
                        </pharm:ingredient>
                        <!-- lidocaine 50 mg -->
                        <pharm:ingredient classCode="ACTI">
                            <!-- The pharm:quantity below demonstrates the case where the pharm:code encapsulates the ingredient's
                                 concentration. -->
                            <pharm:quantity>
                                <!-- For ingredients with a specified concentration, the pharm:quantity
                                     represents the amount of the PRODUCT in the mixture:
                                     0.2 mL of a 50 mg/mL lidocaine solution per 1 mL of the mixture.

                                     Receivers may multiply these together to obtain the concentration of the INGREDIENT:
                                     (0.2 mL / 1 mL) * (50 mg/mL) = 10 mg of lidocaine / 1 mL of the mixture.

                                     Note that sending "10 mg" as the quantity/numerator for "lidocaine hydrochloride 50 mg/mL"
                                     would be incorrect and create an inconsistency with compound ingredients (see ALTERNATE
                                     EXAMPLE below). -->
                                <pharm:numerator xsi:type="PQ" value="0.2" unit="mL" />
                                <pharm:denominator xsi:type="PQ" value="1" unit="mL" />
                            </pharm:quantity>
                            <pharm:ingredientSubstance classCode="MMAT" determinerCode="KIND">
                                <!-- This pharm:code encapsulates the ingredient's concentration! -->
                                <pharm:code code="1011092" displayName="lidocaine hydrochloride 50 MG/ML"
                                    codeSystem="2.16.840.1.113883.6.88"
                                    codeSystemName="RxNorm"/>
                            </pharm:ingredientSubstance>
                        </pharm:ingredient>
                        
                        <!-- ALTERNATE EXAMPLE: This ingredient isn't part of this mixture, but demonstrates how an active ingredient with multiple different
                                                components may be represented in one.
                        <pharm:ingredient classCode="ACTI">
                            Once again, this pharm:quantity represents the amount of the compound PRODUCT in the mixture:
                            0.4 mg of "allantoin 0.02 mg/mg / benzethonium chloride 0.002 mg/mg / lidocaine hydrochloride 0.04 mg/mg Oral Gel"
                            per 1 mL of the mixture.

                            Receivers may multiply these together to obtain the concentration of each INGREDIENT:
                            (0.4 mg / 1 mL) * (allantoin 0.02 mg/mg) = 0.008 mg of allantoin / 1 mL of the mixture
                            (0.4 mg / 1 mL) * (benzethonium chloride 0.002 mg/mg) = 0.0008 mg of benzethonium chloride / 1 mL of the mixture
                            (0.4 mg / 1 mL) * (lidocaine hydrochloride 0.04 mg/mg) = 0.016 mg of lidocaine hydrochloride / 1 mL of the mixture

                            <pharm:quantity>
                                <pharm:numerator xsi:type="PQ" value="0.4" unit="mg" />
                                <pharm:denominator xsi:type="PQ" value="1" unit="mL" />
                            </pharm:quantity>
                            <pharm:ingredientSubstance classCode="MMAT" determinerCode="KIND">
                                <pharm:code code="2566834" displayName="allantoin 0.02 MG/MG / benzethonium chloride 0.002 MG/MG / lidocaine hydrochloride 0.04 MG/MG Oral Gel"
                                    codeSystem="2.16.840.1.113883.6.88"
                                    codeSystemName="RxNorm"/>
                            </pharm:ingredientSubstance>
                        </pharm:ingredient>
                        -->
                        
                        <!-- aluminum & magnesium hydroxide-simethicone -->
                        <pharm:ingredient classCode="BASE">
                            <!-- The quantity of a mixture's base should generally just use the nullFlavor "QS".
                                 Note that "QS" isn't part of the set of allowed nullFlavors in CDA R2.0--it's only
                                 normative in CDA R2.1--but since this element comes from outside the CDA namespace,
                                 neither the CDA R2.0 nor the CDA R2.1 validation rules apply to it. -->
                            <pharm:quantity nullFlavor="QS" />
                            <pharm:ingredientSubstance classCode="MMAT" determinerCode="KIND">
                                <!-- For BASE ingredients, pharm:code may include the ingredient's concentration.
                                     This is to ensure that the correct base product is used when there are multiple strengths available (D5W vs D10W).
                                     Since pharm:quantity is not specified for base ingredients, there is no simple calculation for a final
                                     concentration of the base. Typically, bases are not therapeutic and the final concentration isn’t a concern. -->
                                <pharm:code code="237870"
                                    displayName="aluminum hydroxide 80 MG/ML / magnesium hydroxide 80 MG/ML / simethicone 8 MG/ML Oral Suspension"
                                    codeSystem="2.16.840.1.113883.6.88"
                                    codeSystemName="RxNorm"/>
                            </pharm:ingredientSubstance>
                        </pharm:ingredient>
                    </manufacturedMaterial>
                </manufacturedProduct>
            </consumable>
        </substanceAdministration>
    </entry>
</section>
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