Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.

Data Element
Medication experience
Submitted By: Maureen Layden, MD, MPH / United States Department of Veterans Affairs
Data Element Information
Data Element Description This element captures how the patient reacts to taking or not taking the medication. It includes efficacy (does it work very well, moderately well, or not at all). In SNOMED, these could be supported with these values:
• 266721009 |Absent response to treatment (situation)|
• 182988002 |Slight response to treatment (situation)|
• 182987007 |Fair response to treatment (situation)|
• 182986003 |Excellent response to treatment (situation)|
• 82334004 |Indeterminate (qualifier value)|
It also addresses side effects (none, mild, moderate, severe; critical). Potential codes:
• 408508002 |Has shown no side effects from medication (finding)|
• 401207004 |Medication side effects present (finding)|
• 170909007 |High risk drug side effect (finding)|
This information may affect discussions of medication adherence – both as explanations of non-adherence and as potential reasons to modify treatment.
This element should be coded to support consistency across organizations.
Use Case Description(s)
Use Case Description A clinician needs to know what a patient is taking in order to assess effectiveness with respect to a symptom or to assess whether other interventions may be advisable.
A pharmacist needs to know whether a patient is taking a medication in order to assess whether other alternatives may be advisable.
A CDS routine needs to know what a patient is taking in order to screen for drug interactions, allergic reactions, and other adverse events.
A payor needs to determine whether an ineffective treatment may be due to adherence.
A patient needs to confirm that the doctor understood and recorded his explanation of his medications.
A caregiver needs to reconcile medication expectations with what the patient is doing.
Estimate the breadth of applicability of the use case(s) for this data element All clinicians who need to understand what a patient is taking
All pharmacists who need to confirm suitability of an order
All payors who need to assess compliance
All patients who need to confirm their recorded data
All caregivers who need to reconcile a patient's medications
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) FHIR Resource: HL7 FHIR R4 MedicationStatement, aka R5 MedicationUsage
Data element: MedicationStatement.status; MedicationUsage.takenAsOrdered
Values in http://hl7.org/fhir/CodeSystem/medication-statement-status:
{active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken}
These are defined in terms of taking; i.e., “active” in MedicationRequest means that the prescription can be filled, but in MedicationStatement, means that the patient is taking it.
FHIR R5 target is to remove “status” and create “use,” with values { Taking | Taking as directed | Taking not as directed | Not Taking | Unknown (unable to obtain)}
AVS/PVS system uses “I am taking this med {As written | Differently | Not taking | Unsure}”

http://hl7.org/fhir/R4/valueset-medication-statement-status.html
Additional Specifications Pharmacy workgroup project on Medication List (work in process):
https://confluence.hl7.org/display/PHAR/Patient+Medication+List+Guidance
Current Use Extensively used in production environments
Supporting Artifacts The Joint Commission publishes National Patient Safety Goals NPSG.03.06.01: Maintain and communicate accurate medication information for the individual served. “Item 1: Obtain and/or update information on the medications the individual served is currently taking.”
VA providers consistently capture this information in notes. This compliance with the Joint Commission is required by VHA Directives 1345 & 1164.
The VA Pre Visit Summary & After Visit Summary (AVS & PVS) are in use at 95 VA facilities serving one million patients. The PVS form distinguishes among ‘as directed,’ ‘differently,’ ‘not taking,’ and ‘unsure.’
DoD has a similar capability in the OUTPATIENT MEDICATIONS REVIEW LIST (‘taking’ checkbox only).
Some VA facilities implement this information in the Clinical Reminder capability.
AllScripts’ DSTU2 FHIR API supports the wasNotTaken and reasonNotTaken values.
Cerner’s DSTU2 FHIR API provides the wasNotTaken and reasonNotTaken values. The R4 API does not support the resource that includes this value.
Epic’s DSTU2 and STU3 FHIR APIs provide the wasNotTaken (“taken” in STU3) and reasonNotTaken values. The R4 API does not support the resource that includes this value.
These vendors’ decisions not to include this element in R4 may be attributable to the FHIR US Core Guide’s removal of the supporting resource.
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts Medication use is captured in Notes for every visit, per Joint Commission mandate. These notes are accessible to providers in all VA and DoD facilities via the Joint Legacy Viewer integration point.
They can be accessed by all Veterans in the MyHealtheVet application and by the Blue Button CDA download.
The notes containing this information can be acquired by the 18 member organizations of the CommonWell health information exchange, supporting 95MM patients, and the members of the eHealth Exchange, supporting 120MM patients and 75% of US hospitals.
The PVS form is sometimes exchanged in document form.
This data is not exposed in a standard structured form because of the lack of a standard way to do so.

https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2020/npsg_chapter_ahc_jul2020.pdf
https://www.myhealth.va.gov/mhv-portal-web/my-healthevet-va-notes-learn-more
https://fhir.cerner.com/millennium/overview/
https://open.epic.com/Interface/FHIR
https://developer.allscripts.com/Content/fhir/

Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns Patient medication information is protected health information and should be kept as secure as the element naming the medication.
Estimate of Overall Burden Systems currently support reconciliation and capture of adherence and OTC medications: new functionality will not be necessary. The primary burden will be in identifying the appropriate exchange form to which to map these existing capabilities.
Other Implementation Challenges The primary challenge is coordination of design. The US Core DSTU3/R4 specification stipulates that all medication lists be constructed using order data only (MedicationRequest resources), and that reported usage (MedicationStatement) be converted into notional “requests.” The proposed data element seems best fit for the MedicationStatement resource; a requirement to support it in MedicationRequest may complicate the design unnecessarily.
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 0 - Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 1 - Use cases apply to several care settings or specialties.

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