Data Element
Submitted By: Shelly Spiro / Pharmacy HIT Collaborative
Data Element Information
Data Element Description This is a record indicating that a patient may be taking a medication now, has taken the medication in the past, or will be taking the medication in the future. The source for this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. A medication statement is not a part of the prescribe->dispense->administer sequence, but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication. It may be used to construct a patients 'Current Medications' list. https://www.hl7.org/fhir/medicationstatement.html
Rationale for Separate Consideration These foundational FHIR resources are part of a suite of resources and should all be under USCDI Medication as they are needed for eCare Plans, including but not limited to the Pharmacist eCare Plan.
Use Case Description(s)
Use Case Description These foundational FHIR resources are part of a suite of resources and should all be under USCDI Medication as they are needed for eCare Plans, including but not limited to the Pharmacist eCare Plan.
Estimate the breadth of applicability of the use case(s) for this data element At least 21 pharmacy system vendors are FHIR enabled and are created millions of Pharmacist eCare Plans throughout the US.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) RxNorm and SNOMED CT
Additional Specifications https://www.hl7.org/fhir/medications-module.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts https://www.ecareplaninitiative.com/
https://216b2f95-65cb-4e7e-bd94-a9b066b0a193.filesusr.com/ugd/b303f5_a66df3115abd40a58659bae8f51b4aad.pdf
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.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) MedicationKnowledge resource is draft
Restrictions on Use (e.g. licensing, user fees) None known.
Privacy and Security Concerns None known.
Estimate of Overall Burden Burden is on the EHR and pharmacy system vendors to implement.
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 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by pwilson@ncpdp.org on

NCPDP Comment

NCPDP recommends replacing the data element definition from, “Statement of whether a medication has been consumed according to instructions” to, “Medication is consumed according to instructions as captured by the provider, pharmacist or clinician.”

Submitted by pwilson@ncpdp.org on

NCPDP Comments on USCDI draft v5

NCPDP recommends replacing the data element definition to “Medication is consumed according to instructions as captured by the provider, pharmacist or clinician” instead of “Statement of whether a medication has been consumed according to instructions”.

Submitted by kelly.clarke@j… on

Comment

Highly support and agree with the addition of this new data element. This will ensure patient treatment plan adherence and patient care outcomes.

Submitted by pwilson@ncpdp.org on

NCPDP Comment

NCPDP recommends updating the data element definition to “Medication is consumed according to instructions as captured by the provider, pharmacist or clinician”. Examples include but are not limited to taking as directed, taking not as directed, and not taking.

Submitted by hswmin on

THIA Comment on Medications: Medication Adherence

The Texas Health Informatics Alliance (THIA) Policy and Standards Working Group supports the proposal for medication adherence; however, we recognize that it is going to take a lot of time and effort to properly establish. Associated/relevant vocabulary should be clearly defined (i.e. taking as directed, not taking as directed, not taking). Medication adherence calculations should be accurate, timely, and transparent.

Medication adherence is now a metric for Primary Care Providers (PCPs). PCPs are measured by the Centers for Medicaid and Medicare Services (CMS, which affects value-based metric scores through accountable care organizations (ACOs).

How medication adherence is getting calculated should be clear. Currently, medication adherence is claims-based and it is difficult to measure within ACOs. If one’s ACO is going to utilize a certain form/method to measure medication adherence, providers want it to be accurate and timely.

Capturing the costs of medication adherence is difficult. Medications can be expensive and it is hard to know where patients get their medications from and/or if they use services, such as GoodRx.

Capturing the cadence of medication adherence is difficult. Refills count if one is done within a 6-month interval. If a patient falls off compliance, it takes about 18 months post-refill to get them back onto compliance. Notably, the patient’s physician gets dinged throughout the 18 months of “non-compliance”.

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