Current Medications vs Medication List

In the BC E2E document specification (HL7 CDA), there are two related sections:

1. Current Medications
2. History of Medication Use

hQuery's internal record only has a single medication list per individual record. Which E2E section maps to this structure?

Recommendation Summary and Rationale

As the queries can be asked at any time, the "current medication" list can be derived from the history of medication use. The history of medication use contains more information, allowing for a greater range of questions. It is also closer in concept to medication list.

Thus, if only one concept is supported, the history of medication use is the more robust section.

Notes

This question was posed to the scoophealth list on 2 Oct 2012 and received the following responses. They are preserved here on the wiki because the issue is fundamental to answer the initial research questions for scoop.

###From Glen

SHORT ANSWER. I recommend that the E2E exports that we generate from OSCAR should not contain a "Current Medications" section, just a "Medications & Prescriptions section" which corresponds to the complete Medication List History as captured in OSCAR.

LONG ANSWER:

Two quotes from the E2E spec:

1. "The Current Medications Section is a summary view of the patient’s active medications and will include only the current medications that the patient is on as at a set date. Only medications with a Record Status set to Active should be included in this section and consequently, it is only relevant to the Episodic Documents use case when historical medications are not of interest and not appropriate to be used in the EMR Conversion or Patient Transfer use cases. This section may be referred to as the “Useful Medication List” and includes the date that the list was generated as accurate. This section may be used to communicate the current medications when it is not appropriate or desired to send the entire medication list history."
2. "The Medications & Prescriptions section provides the detailed medication history for the patient. This section will include both active and historical medications and prescriptions along with any dispensing and administering information available."

Also, the C32 document does not contain a "Current Medications" section.

In addition, the four E2E templates put slightly stronger wording on including the Medication List section. More from the spec:

EMR CONVERSION

• SHALL NOT include a Current Medications section
• SHALL include one Medications & Prescriptions - Medication List section

GENERIC EPISODIC DOCUMENT

• MAY include one Current Medications section
• MAY include one Medications & Prescriptions - Medication List section

PATIENT TRANSFER

• MAY include one Current Medications section
• SHOULD include one Medications & Prescriptions - Medication List section

UNSTRUCTURED DOCUMENT

• nothing

Interestingly enough, the example PITO E2E document does not include a template ID that it conforms to - which I guess means that it isn't any one of these four types.

My conclusion: based on (1) above I'm comfortable excluding Current Medications in our E2E exports provided that the Medication List History is included. We really should pick an E2E template - EMR conversion contains the strongest imperatives for information inclusion.

From Morgan

I would agree with Glen's statements and probably add a few comments for context

Yes - current medications are exactly that --> what is being taken currently.

In my clinical head, they are not prescriptions, but concepts of meds you are taking. That is: In one sense, I don't care if your prescription is a week long or 6 months long, I just want to know what you are taking right now. So it is time dependent in the context of the current time. A referral document or a review in the Emerg, current meds is important. Current meds could include things that are not prescribed as well.

When prescribing, the prescription history becomes more important:

• do you need more meds soon
• are you using them too quickly?
• are you not using them quickly enough (e.g. missing doses)
• etc

In OSCAR, we looked through this and there is not really a concept of a current medication list. It is somewhat derived in two ways:

• by prescription start / end
• by the boolean flag "ongoing medication" (which is similar, useful, but not the same)

An ongoing medication is something that I would expect that the patient would continue until we decided to change it (i.e. longer than a single prescription). Other medications I would assume would stop at the end of the prescription. I may, based on clinical indications change my mind (represcribe a short term med or stop an ongoing med, of course).

The Medications and Prescriptions section aligns more closely with OSCAR's prescribing-centric data model.

We can derive which prescriptions we think should be "current medications" from the end dates of prescriptions, although this will be fuzzy in several ways:

• if med utilization rates are not equal to prescribed we can be off
• if meds are stopped due to side effects or loss
• if a med is taken that is not prescribed
• if a med is prescribed / changed by someone outside of OSCAR

Now, you've answered the question, but the above context will be important in our future.