Medications section — scope question (O3-5672)
I am currently working on the MedicationsSection and hit a design question I’d value input on.
What should “Medications” show?
- All medications the patient is currently active on, or
- Only the medications ordered during this specific visit
For context, here’s how the other sections are currently scoped:
- Visit-scoped (this visit’s encounters): Vitals, Diagnoses
- Patient-level: Conditions (active only, per our earlier discussion) and Allergies — though these are patient-level mainly because the data model is, not a deliberate choice
Medications can go either way: orders are linked to encounters, so getOrders(patient, visit, …) gives me exactly this visit’s prescriptions, while getActiveOrders(patient, …) gives the full current list.
Why the full active list is tempting: say a patient is on long-term metformin + amlodipine and comes in for an acute issue, leaving with a new amoxicillin prescription. If the summary shows only amoxicillin, a referral provider doesn’t see what they’re already on — which matters for interactions and safety.
Why visit-scoped is tempting: a visit summary is fundamentally a record of what happened at that visit. If I print the summary of a visit from a month ago, the “active now” approach shows what the patient is on today, not what was prescribed at that visit — so a short course (say a 15-day antibiotic) prescribed at that visit has since ended and doesn’t appear at all, leaving the section blank even though a medication was very much part of that encounter. For a document meant to describe a specific visit, that’s a real gap. It also matches how we scope Diagnoses and Vitals to the visit — a prescription, like a diagnosis, is arguably a visit-specific event.
So the two options really serve two different documents: a referral/hand-off (where “what is the patient on right now” is what matters) vs. a record of one encounter (where “what was done at this visit” is what matters). I don’t think there’s an obviously correct answer without knowing how implementers actually use the printed summary, so I’d really value the community’s perspective on which use case should drive the default — or whether both need to be supported (e.g. a config option or two modes).
Thanks!