HRSA 2023 Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+) FHIR IG
1.0.1 - STU1 Release 1 - Standard for Trial-Use International flag

This page is part of the HRSA Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+ or uds-plus) FHIR IG (v1.0.1: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: De-Identified UDS Plus MedicationStatement

Official URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-medicationstatement Version: 1.0.1
Standards status: Trial-use Maturity Level: 2 Computable Name: UDSPlusMedicationStatement

The UDS+ profile is based on the MedicationStatement resource and establishes the core elements, extensions, vocabularies and value sets for representing MedicationStatement for UDS+ program.

Introduction

This profile is used to represent de-identified MedicationStatement information. The de-identification process has to remove all data elements not explicitly identified as “SUPPORTED” in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes MedicationStatement.authoredOn.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a MedicationStatement resource text element may contain information such as the MedicationStatement date, patient information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original MedicationStatement resource id should not be included in the De-identified MedicationStatement instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original MedicationStatement. All resource references to the MedicationStatement submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

  • subject
  • encounter

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

  • effective[x]
  • dateAsserted

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MedicationStatement

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement 0..*MedicationStatementDe-Identified UDS Plus MedicationStatement
... id S0..1idThe de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
... text 0..0
... contained 0..0
... medication[x] S1..1CodeableConcept, Reference(Medication)What medication was taken
... subject S1..1Reference(De-Identified UDS Plus Patient)Who is/was taking the medication
.... display 0..0
... effective[x] S0..1dateTimeThe date/time or interval when the medication is/was/will be taken
... dateAsserted S0..1dateTimeWhen the statement was asserted?
... dosage S0..*DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement 0..*MedicationStatementDe-Identified UDS Plus MedicationStatement
... id SΣ0..1idThe de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... medication[x] SΣ1..1What medication was taken
Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject SΣ1..1Reference(De-Identified UDS Plus Patient)Who is/was taking the medication
... effective[x] SΣ0..1dateTimeThe date/time or interval when the medication is/was/will be taken
... dateAsserted SΣ0..1dateTimeWhen the statement was asserted?
... dosage S0..*DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationStatement.statusrequiredMedication Status Codes
MedicationStatement.medication[x]exampleSNOMEDCTMedicationCodes

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationStatementIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationStatementIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationStatementA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement 0..*MedicationStatementDe-Identified UDS Plus MedicationStatement
... id SΣ0..1idThe de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal identifier
... basedOn Σ0..*Reference(MedicationRequest | CarePlan | ServiceRequest)Fulfils plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation)Part of referenced event
... status ?!SΣ1..1codeactive | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.

... statusReason 0..*CodeableConceptReason for current status
Binding: SNOMEDCTDrugTherapyStatusCodes (example): A coded concept indicating the reason for the status of the statement.


... category Σ0..1CodeableConceptType of medication usage
Binding: Medication usage category codes (preferred): A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.

... medication[x] SΣ1..1What medication was taken
Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject SΣ1..1Reference(De-Identified UDS Plus Patient)Who is/was taking the medication
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
... context Σ0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with MedicationStatement
... effective[x] SΣ0..1dateTimeThe date/time or interval when the medication is/was/will be taken
... dateAsserted SΣ0..1dateTimeWhen the statement was asserted?
... informationSource 0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)Person or organization that provided the information about the taking of this medication
... derivedFrom 0..*Reference(Resource)Additional supporting information
... reasonCode 0..*CodeableConceptReason for why the medication is being/was taken
Binding: Condition/Problem/DiagnosisCodes (example): A coded concept identifying why the medication is being taken.


... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport)Condition or observation that supports why the medication is being/was taken
... note 0..*AnnotationFurther information about the statement
... dosage S0..*DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationStatement.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationStatement.statusrequiredMedication Status Codes
MedicationStatement.statusReasonexampleSNOMEDCTDrugTherapyStatusCodes
MedicationStatement.categorypreferredMedication usage category codes
MedicationStatement.medication[x]exampleSNOMEDCTMedicationCodes
MedicationStatement.subject.typeextensibleResourceType
MedicationStatement.reasonCodeexampleCondition/Problem/DiagnosisCodes

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationStatementIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationStatementIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationStatementA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from MedicationStatement

Summary

Mandatory: 3 elements
Must-Support: 7 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

Maturity: 2

Differential View

This structure is derived from MedicationStatement

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement 0..*MedicationStatementDe-Identified UDS Plus MedicationStatement
... id S0..1idThe de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
... text 0..0
... contained 0..0
... medication[x] S1..1CodeableConcept, Reference(Medication)What medication was taken
... subject S1..1Reference(De-Identified UDS Plus Patient)Who is/was taking the medication
.... display 0..0
... effective[x] S0..1dateTimeThe date/time or interval when the medication is/was/will be taken
... dateAsserted S0..1dateTimeWhen the statement was asserted?
... dosage S0..*DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement 0..*MedicationStatementDe-Identified UDS Plus MedicationStatement
... id SΣ0..1idThe de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... medication[x] SΣ1..1What medication was taken
Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject SΣ1..1Reference(De-Identified UDS Plus Patient)Who is/was taking the medication
... effective[x] SΣ0..1dateTimeThe date/time or interval when the medication is/was/will be taken
... dateAsserted SΣ0..1dateTimeWhen the statement was asserted?
... dosage S0..*DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationStatement.statusrequiredMedication Status Codes
MedicationStatement.medication[x]exampleSNOMEDCTMedicationCodes

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationStatementIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationStatementIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationStatementA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationStatement 0..*MedicationStatementDe-Identified UDS Plus MedicationStatement
... id SΣ0..1idThe de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal identifier
... basedOn Σ0..*Reference(MedicationRequest | CarePlan | ServiceRequest)Fulfils plan, proposal or order
... partOf Σ0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation)Part of referenced event
... status ?!SΣ1..1codeactive | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.

... statusReason 0..*CodeableConceptReason for current status
Binding: SNOMEDCTDrugTherapyStatusCodes (example): A coded concept indicating the reason for the status of the statement.


... category Σ0..1CodeableConceptType of medication usage
Binding: Medication usage category codes (preferred): A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.

... medication[x] SΣ1..1What medication was taken
Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.

.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject SΣ1..1Reference(De-Identified UDS Plus Patient)Who is/was taking the medication
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
... context Σ0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with MedicationStatement
... effective[x] SΣ0..1dateTimeThe date/time or interval when the medication is/was/will be taken
... dateAsserted SΣ0..1dateTimeWhen the statement was asserted?
... informationSource 0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)Person or organization that provided the information about the taking of this medication
... derivedFrom 0..*Reference(Resource)Additional supporting information
... reasonCode 0..*CodeableConceptReason for why the medication is being/was taken
Binding: Condition/Problem/DiagnosisCodes (example): A coded concept identifying why the medication is being taken.


... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport)Condition or observation that supports why the medication is being/was taken
... note 0..*AnnotationFurther information about the statement
... dosage S0..*DosageDetails of how medication is/was taken or should be taken

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationStatement.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationStatement.statusrequiredMedication Status Codes
MedicationStatement.statusReasonexampleSNOMEDCTDrugTherapyStatusCodes
MedicationStatement.categorypreferredMedication usage category codes
MedicationStatement.medication[x]exampleSNOMEDCTMedicationCodes
MedicationStatement.subject.typeextensibleResourceType
MedicationStatement.reasonCodeexampleCondition/Problem/DiagnosisCodes

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationStatementIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationStatementIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMedicationStatementIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationStatementA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from MedicationStatement

Summary

Mandatory: 3 elements
Must-Support: 7 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

Maturity: 2

 

Other representations of profile: CSV, Excel, Schematron