Main Question: how should medication references be managed?
DEEDS: Data Elements for Emergency Department Systems data set started by CDC 1994/1996
Heavily promoted/ used by the emergency department.
CDC was ready to update it but got redirected after 9/11 so plans were scrapped
Published at HL7 in 2011-2012, with a lot of reference to the original- It was published in a bad form because didn’t want to lose the ties.
In the historic DEEDS: medication were spread across history, physical, with physician, intake data… Our question is: should it be everywhere? Or just one area?
How we are going to structure medication?
Currently: if we search medication in this data set, we see that medications are spread around in different areas.
Pharmacy put 4 resources together for medication data into 4 big buckets: (5 & 6 used as well)
- Statement (this information can come from anybody: clinician, parent, patient…)
- (Medication: specify all the ingredients and specify how much of each ingredient into the medication)
- (Medication Knowledge: dealing with formularies/ knowledge base systems, drug-drug interactions. This resource is much larger that medication)
Clinicians write orders which need to be dispensed (sometimes this order will just be pulled from a shelf and doesn’t go to the pharmacy- but this doesn’t matter). What does matter is the ordering process and capturing the medication that was administered and its relationship to what was ordered.
Taking history information: Important to note that fuzzy data is also recorded.
(A patient can say that they are taking a “little pink pill” or they can show a bag of their medications. There is a range that can be captured)
Medication Statements by FHIR standards: What the patient is telling you that they have taken: over the counter, illegal, or prescribed.
Medication Order: Prescribed in the ED
→ These two are different because one is an order and one is what a patient is currently taking.
(There needs to be reconciliation: are you taking what is prescribed?)
Different states at the ED for representing meds:
- Prescribed at home (prescribed outpatient and supposed to be taking at home)
- Taken at home
- Given prior to arrival (taken before arrival/ given by paramedics)
- Ordered in ED
given in ED
Prescribed leaving ED
- Dispensed leaving ED (some pills sent home)
The prescription for the medication is an order, and the whether the patient actually took the medication/ how much medication the patient actually took is a medication statement (because its information coming from the patient/parent/clinician)
Old fragment: date/time ED medication ordered data → we might not need this anymore
There is a new way to look at medication now. (In the past, did DEEDS act like a registry?)
When presenting DEEDS with questions from the user: the questions should be clear enough so that it can be pinpointed that a specific query on a medication request/ medication statement would be able to pull that answer. And the results of those questions would bring back the right data.
If you query the database from disparate systems, it needs to be organized by question topic that you need answers for.
The main question: how do we want to rearrange our big buckets?