Medication Dispense Data Model

We will need to add a new "medication_dispense" table (and companion domain object MedicationDispense) modeled after the MedicationDispense FHIR resource:

https://www.hl7.org/fhir/medicationdispense.html#resource

The domain object should extend BaseOpenmrsData and provide the standard audit visits of that class.

Beyond that, the table/domain object should contain the fields below. (Note the "Phase 1" column, which denotes if this field should be added in the initial implementation. Fields with a "no" here are fields that will be delegated to a later phase. I have grouped those fields to the bottom of the table)

"Related Order/Drug Order Property" is a reference to the related fields on a DrugOrder domain object. (ie, theoretically, if you created a MedicationDispense from DrugOrder without any modifications, the values in these fields could be copied from the Drug Order to the MedicationDispense)

When we create the new domain object, we should make sure that for each property we add a comment noting which FHIR field it maps to (perhaps even with a link) so that we remember the reasoning behind each field.

Column Name	Column Datatype	Required	Foreign Key	Java Variable Name	Java Variable Class	Mapped FHIR Field	Related Order/Drug Order Property	Phase One?	Notes

Column Name	Column Datatype	Required	Foreign Key	Java Variable Name	Java Variable Class	Mapped FHIR Field	Related Order/Drug Order Property	Phase One?	Notes
concept_id	int	Yes	concept.concept_id	concept	Concept	medication.medicationCodeableConcept	Order.Concept	Yes
drug_id	int	No	drug.drug_id	drug	Drug	medication.reference(Medication)	DrugOrder.drug	Yes	May need to clarify how this actually gets transformed in FHIR
patient_id	int	Yes	patient.patient_id	patient	Patient	subject	Patient	Yes
location_id	int	No	location.location_id	location	Location	location	N/A	Yes	where the dispensed event occurred
encounter_id	int	No	encounter.encounter_id	encounter	Encounter	context	N/A	Yes	encounter when the dispensing event occurred
provider_id	int	No	provider.provider_id	provider	Provider	performer.actor	N/A_	Yes	Note that FHIR provides support for 0..x "performers" and each performer may have a "performer.function" where "function" is a codeable concept and reflects a role like "packager"or "checker"; we will start with support for just a single 0..1 "provider"
drug_order_id	int	No	drug_order.drug_order_id	drugOrder	DrugOrder	authorizingPrescription	Order.orderId	Yes	the drug order that led to this dispensing event; note that authorizing prescription maps to a "MedicationRequest" FHIR resource
status	int	Yes		status	Concept	status	N/A	Yes	preparation \| in-progress \| cancelled \| on-hold \| completed \| entered-in-error \| stopped \| declined \| unknown (see: https://www.hl7.org/fhir/valueset-medicationdispense-status.html)
statusReason	int	No	concept.concept_id	statusReason	Concept	statusReason.statusReasonCodeableConcept	N/A	Yes	For allowed coded answers, see: https://www.hl7.org/fhir/valueset-medicationdispense-status-reason.html Note that these include things like "Stock Out" which we will likely be building some business logic around them.
type	int	No	concept.concept_id	type	Concept	type.codeableConcept	N/A	Yes	For potential example concepts, see: https://www.hl7.org/fhir/v3/ActPharmacySupplyType/vs.html Note that these include things like "Refill" and "Partial Fill" which we will likely be building some business logic around them.
quantity	double	No		quantity	Double	quantity.value	DrugOrder.quantity	Yes	Not required by FHIR
quantity_units	int	No	concept.concept_id	quantityUnits	Concept	quantity.unit and/or quanity.code	DrugOrder.quantityUnits	Yes	See: Error rendering macro 'jira' : Unable to locate Jira server for this macro. It may be due to Application Link configuration.
dose	double	No		dose	Double	dosageInstructions.doseAndRate.dose.doseQuantity	DrugOrder.dose	Yes
dose_units	int	No	concept.concept_id	doseUnits	int	DosageInstructions.doseAndRate.dose.Quantity.unit and/or code	DrugOrder.doseUnits	Yes	See: Error rendering macro 'jira' : Unable to locate Jira server for this macro. It may be due to Application Link configuration.
route	int	No	concept.concept_id	route	int	DosageInstructions.route	DrugOrder.route	Yes
frequency	int	No	order_frequency.order_frequency_id	frequency	int	DosageInstructions.timing.repeat.frequency DosageInstructions.timing.repeat.period DosageInstructions.timing.repeat.periodUnit	DrugOrder.frequency	Yes	https://build.fhir.org/datatypes.html#Timing Note that we will continue to map this as a single "frequency" concept, although it doesn't map well to FHIR, to make consistent with DrugOrder in OpenMRS
as_needed	tinyint(1)	No		asNeeded	Boolean	DosageInstructions.AsNeeded.asNeededBoolean	DrugOrder.asNeeded	Yes
dosing_instructions	text	No		dosingInstructions	String	DosageInstructions.patientInstructions	DrugOrder.dosingInstructions_	Yes
date_prepared	datetime	No		datePrepared	Datetime	whenPrepared	N/A	Yes	From FHIR: "When product was packaged and reviewed" I used "datePrepared" instead of "whenPrepared" because it seemed more in-line with OpenMRS conventions. Happy to debate.
date_handed_over	datetime	No		dateHandedOver	Datetime	whenHandedOver	N/A	Yes	From FHIR: "When product was given out" I used "dateHandedOver" instead of "whenHandedOver" because it seemed more in-line with OpenMRS conventions. Happy to debate.
note	varchar(1024)	No		note	String	note.text	N/A	Yes	FHIR supports 0..n but we will only support 0..1 for starters? It also supports the author and the time via the "annotation" type. Should this be a clob, see comment from Ian below
was_substituted	tinyint(1)	No		wasSubstituted	Boolean	substitution.wasSubstituted	N/A	Yes	True/false whether a substitution was made during this dispense event
substitution_type_id	int	No	concept.concept_id	substitutionType	Concept	substitution.type	N/A	Yes	For valid FHIR concepts, see: https://www.hl7.org/fhir/v3/ActSubstanceAdminSubstitutionCode/vs.html We also could punt on building this in Phase 1, and make the distinction between enum and concept when we have an actual use case. Let @Andrew Kanter know if we need these as concepts.
substitution_reason_id	int	No	concept.concept_id	substitutionReason	Concept	substitution.reason	N/A	Yes	For valid FHIR concepts, see: https://www.hl7.org/fhir/v3/SubstanceAdminSubstitutionReason/vs.html We also could punt on building this in Phase 1, and make the distinction between enum and concept when we have an actual use case. Let @Andrew Kanter know if we need these as concepts.
						substitution.responsibleParty	N/A	No
days_supply	int	No		daysSupply	int	daysSupply.value	N/A	No	From FHIR: The amount of medication expressed as a timing amount. It might be best to drop support for this an only support quantity, at least at a first pass (technically quantity can have a units of days)
category_id	int	No	concept.concept_id	category	Concept	category	N/A	No	ie, Inpatient, Outpatient, Discharge, Community For valid FHIR concepts, see: https://www.hl7.org/fhir/valueset-medicationdispense-category.html Let @Andrew Kanter know if we need these as concepts.
destination_id	int	No	location.location_id	destination	Location	destination	N/A	No	From FHIR: "Where the medication was sent". Do we want this for "phase 1"?
receiver_id	int	No	person.person_id	receiver	Person	receiver	N/A	No	From FHIR: "Who collected the medication" Do we want this for "phase 1"? FHIR supports a receiver of a "Practioner" or "Patient", so "Person" is the only current way in OpenMRS to support this (0...n in FHIR, but we currently only support 0..1)
						identifier		No	External identifier
						partOf		No	Event that dispense is a part of (maps to a FHIR Procedure)
						supportingInformation		No
						detectedIssue		No
						eventHistory		No