How to store cancelled order records for medication (due to system) into DRUG_EXPOSURE table

[jiawei-qian]

How to store cancelled order records for medication (due to system) into DRUG_EXPOSURE table

CDM or THEMIS convention?

THEMIS

Table or Field level?

Table

Is this a general convention?

Yes

Summary of issues

1. In OHDSI Forum, someone said they have a use case that they need to be able to record instances of when a medication was prescribed and the order was cancelled due to an alert generated by the decision support system. She was thinking of using the DRUG_EXPOSURE table to capture the prescription record and record the stop_reason being "Cancelled due to CDS alert". Is this approach valid?

Summary of answer

1. Exposures should be drugs that you think actually happened. If you know the exposure started, but then canceled shortly after, set the drug exposure end date to when it was canceled.
2. If it is a prescription but was canceled before it began, don't put anything in the drug exposure table (since you know the patient wasn't actually exposed).
3. If you want to record the cancellation event, the OBSERVATION table would be the place to store observed events such as 'medication canceled' (full disclosure, not sure if this concept actually exists), but if it does, you can use the concept ID for drug cancelation and the 'value_as_concept' can be the drug concept that was being canceled.

Related links

OHDSI Forum: https://forums.ohdsi.org/t/approach-on-recording-medication-orders-that-are-cancelled-due-to-cds-alerts/1613

Other comments/notes

The convention is not confirmed by Christian. It is replied by Chris Knoll.
In another issue #649 created by me, Christian and Patrick said we should store ordered, prescribed, dispensed and administrated drugs in DRUG_EXPOSURE table. However, in this issue situation, the drug order is cancelled due to system reason. Thus, may need to have some consideration on if we need to discard or store cancelled drug order records into DRUG_EXPOSURE table.

[MelaniePhilofsky]

This issue hasn't had any comments since 2016. I am moving it to the "needs more work" column. The Themis WG will take it from there.