|Submitted By: Robert C Dieterle / Submitted on behalf of the Da Vinci Project|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||Medication dispense information is the primary information required by payers (in particular PBMs) to authorize payment for medications. It is the only accurate record of the actual medication (e.g. generic) that was dispensed to the patient along with specific administration information. This information is valuable to both patients (as a record of what was submitted for payment) and to providers (to verify that the first essential step in a medication therapy has been followed – acquire the prescribed medication).
Medication dispense information is necessary to confirm appropriate and high quality of care is received for patients across different populations. It is clinically relevant from a care perspective particularly at hospital discharge and during follow-up clinical visits to ensure that the patient is complying with prescribed treatment. Failure to start medication treatment post discharge is the primary cause for hospital readmission.
|Estimated number of stakeholders capturing, accessing using or exchanging||Level 2 – annually 4.38 billion retail prescriptions are dispensed by 88,000 pharmacies in the US. Virtually every provider prescribes medications. A recent survey indicates that 55 percent of Americans regularly take medications. Dispense information is collected, accessed and used by Pharmacies, Payers and, where available, by providers.|
|Maturity of Use and Technical Specifications for Data Element|
|Additional Specifications||HL7 FHIR QI Core Implementation Guide STU4 based on FHIR R4 http://hl7.org/fhir/us/qicore/StructureDefinition-qicore-medicationdispense.html
HL7 C-CDA Release 2.0 (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492)
ePrescribing NCPDP SCRIPT Standard Implementation Guide Version 2017071
HL7 Da Vinci Payer Data Exchange FHIR Implementation Guide https://build.fhir.org/ig/HL7/davinci-epdx
|Current Use||This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders|
Level 2 – this information is routinely collected by all dispensing pharmacies and healthcare insurers. Annually 4.38 billion retail prescriptions are dispensed by 88,000 pharmacies in the us. E-prescribing applications can make this information available to the prescribing provider. (see NCPDP Script)
|Number of organizations/individuals with which this data element has been electronically exchanged||5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.|
Medication data is also routinely electronically exchanged with external organizations via C-CDA, as part of ONC’s CEHRT criteria, and a part of data exchange for electronic prescribing to support the continuum of care, particularly with prescribers, dispensers, intermediaries, and post-acute care settings. https://ecqi.healthit.gov/qrda http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7 https://www.healthit.gov/isa/section/electronic-prescribing https://confluence.hl7.org/display/FHIR/2020-09+Clinical+Reasoning
|Restrictions on Standardization (e.g. proprietary code)||No challenges anticipated. This data is available in standard terminology that can be publicly accessed via the VSAC and HL7.|
|Restrictions on Use (e.g. licensing, user fees)||None|
|Privacy and Security Concerns||This data, like any patient data should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data.|
|Estimate of Overall Burden||Medication dispense data is regularly captured in pharmacy, PBM, and payer systems. Since medication information is part of the clinical record for Payers that are covered under the CMS Interoperability Final Rule, MedicationDispense FHIR profiles will be used to make these medications available through the Patient Access API. There should be little or no additional work to make the same information available to providers. The EHR vendors will need to consume the dispense information and incorporate it into the patient’s record.|
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
State of a medication with regards to dispensing or other activity. (e.g., dispensed, partially dispensed, not dispensed)