Data Element

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Medication Administration

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Support for Medication Administration (& related data elements)

Medication data are integral to informing the quality, safety, and costs of U.S. healthcare, supporting federal, state, and local public health, and guiding clinical decision-making in patient care. Across a wide range of healthcare settings, including, acute care, long-term care, and post-acute care, medication administration—as captured by electronic medication administration (eMAR) records—is considered the gold standard for accurately measuring medication exposure, including identifying the exact medications patients have received, in what formulations, doses, and for what length of time. Published data indicate that alternative data sources for medication exposure, such as pharmacy “order” (or billing) data and medication “lists” do not always reflect the medications actually received by patients. Pharmacy order/billing data are discordant with medication administration data due to variability in when billing events occur relative to actual medication administration (1,2). For example, billing can occur upon order entry or upon dispensing, neither of which reflects actual medication administration to the patient. Medication “lists”, such as those generated during medication reconciliation are based on processes that are highly variable across U.S hospitals with regard to their accuracy and comprehensiveness (3). Medication lists can also have a high level of discordance with actual administration of medications (4,5). It is crucial that medication administration be added as a requirement of US Core standards to improve the accuracy of FHIR Resources in HL7. The case for this has never been clearer as during the COVID-19 pandemic, where identification of the medications that acutely ill hospitalized patients with COVID-19 had received was integral to understanding clinical management of this new public health threat and directing public health resources, including scarce medications. There is a wide range of medication workflows in patient care, such as Medication Request, Medication Dispense, Medication Administration, and Medication Knowledge. These data elements represent distinct patient care events related to ordering, dispensing, administering, and recording of medications. Reliance on Medication Request alone provides an inaccurate picture of the wide spectrum of medication workflows in the healthcare system. The continued reliance on the Medication Request as the only USCDI medication data element is a severe limitation in achieving accurate representation of medication exposure in U.S. healthcare data. It is essential that the full range of medication events be specified in USCDI and available to support public health, regulatory, research, and pandemic response. There is a “Medication” data element that specifies the actual medication and that it should be represented with RxNorm, but it does not differentiate between medication requests (i.e., orders), medication administrations, and medication dispense activities and it does not provide information about when the medication was ordered, dispensed, or administered to the patient. A medication request represents a clinician’s order or a prescription. It is distinctly separate from administration and dispensation activities, as the medication actually administered or dispensed may have differences from the order. The US Core specification currently has a US Core MedicationRequest profile, but the request concept should be clearly called out in USCDI, which should also firmly declare that medication requests are for orders/prescriptions and are not sufficient to represent administration or dispense activities.
  1. Courter JD, Parker SK, Thurm C, Kronman MP, Weissman SJ, Shah SS, Hersh AL, Brogan TV, Patel SJ, Smith MJ, Lee BR, Newland JG, Gerber JS. Accuracy of administrative data for antimicrobial administration in hospitalized children. J Pediatric Infect Dis Soc 2018;7(3):261-63.  
  2. Schwartz DN, Evans RS, Camins BC, Khan YN, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011;32(5):472-80.   
  3. Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation.  BMJ Qual Saf 2016; 25(9):726-30.
  4. Rose AJ, Fisher SH, Passche-Orlow MK. Beyond medication reconciliation. The correct medication list. JAMA 2017;317(20):2057-8. 
  5. Gupta A, Yek C, Hendler RS. Phenytoin toxicity. JAMA 2017;317(23):2445-6. 
  6. HL7 FHIR Release 4. Medications Module Available at: https://www.hl7.org/fhir/medications-module.html.

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