Compound Medications

[dstarh]

Is there a standards based means of describing a compound medication within ccda?

The FHIR docs mention it but I do not see anything in ccda that directly correlates.

[brettmarquard]

Great question.

Unfortunately, no guidance in current spec -- best fall back is probably free text, but happy to have someone else chime in. Do you have an example med for two for us to consider?

[dstarh]

I've got 3 real world examples from our physicians:

1. 40% Urea 2% Fluconazole 0.2% Mometasone in gel
2. 5% Imiquimod 5% Fluorouracil 5% Cimetidine 15% Salicylic Acid 0.2% Deoxy-D-Glucose
3. 1% Fluticasone 2% Levocetirizine 0.5% Pentoxifylline 3% Prilocaine 15% Gabapentin in silicone gel

[jddamore]

@dstarh @brettmarquard

So I would start with the way that medications are typically represented. See an example here: https://github.com/HL7/C-CDA-Examples/blob/master/Medications/Med%20oral%20QID%20with%20PRN/Med%20oral%20QID%20with%20PRN(C-CDA2.1).xml

Then I would sub line 70 for <code nullFlavor="OTH" >

And then place whatever information you have on compound medication as text or code references. For the text reference, you would provide a tag to the human readable narrative: <originalText><reference value="#YourTagHere" /></originalText>

Being ambitious, I went to see if there was a concept in RxNorm for the first compound...there wasn't so below is an example of how you could just map ingredients as translation elements:

<translation code="11002" displayName="Urea" codeSystem="2.16.840.1.113883.6.88" />
<translation code="4450" displayName="fluconazole" codeSystem="2.16.840.1.113883.6.88" />
<translation code="108118" displayName="Mometasone " codeSystem="2.16.840.1.113883.6.88" /> 

The translation mappings may not be something that everyone in HL7 would agree with, so as Brett suggested, the human readable reference is probably safer in that circumstance.

Cheers, John