A current measure under development is looking to specify home medications active at the time of admission in FHIR. FHIR currently models Home Medications using the ‘MedicationRequest’ resource with a category of ‘community’, reported by ‘patient’, and intent of ‘order, plan’ (order for practitioner ordered; plan for patient requested such as over-the-counter medications). However, we are not sure how the "home medications" might be identified in a hospital EHR. Considerations have been active meds imported from the ambulatory EHR; e.g.:

• MedicationRequest.category = community and MedicationRequest.reported = patient

Note that US Core on which QI-Core is based does not include the base FHIR resource to indicate MedicationStatement.category = community

Additionally, how are new discharge medications stored in the EHR:

• Are discharge medications saved as orders to be filled in the community at discharge (MedicationRequest.category = community) on a discharge medication list
• Do the discharge medications from the last admission auto-populate as home medications for review on a subsequent admission to support reconciliation?
• Assumed that some discharge medications are ordered (MedicationRequest.intent = order) and others listed based on patient report because there is already a supply a home. How are these medications differentiated and displayed in the EHR and how would that information be retrieved?
  • What expression would most effectively retrieve the information for discharge medications?
  • How does this information change to populate as a home medication at the time of the next admission and what expression would we use to retrieve it?