Guidance Needed: Should OpenMRS allow providers to schedule medications to start at a future date?

Hi everyone,

We are seeking your input on this pull request, which proposes enabling future dates when placing medication orders in the patient chart.

The idea is to allow providers to schedule medications that are intended to start at a future date. For example, a clinician might want to prescribe a drug that starts after the completion of an existing regimen.

We’d greatly appreciate your guidance on the following points:

  1. Are there any clinical or implementation concerns with allowing medication orders to have a future start date?
  2. Should the system support this as a configurable option?
  3. How should the dispensing process treat medications with future start dates? Should they be available for dispensing immediately or only on/after the scheduled start date?
  4. Has anyone implemented a similar support in their OpenMRS setup? If so, what considerations came up?

We welcome any feedback on this issue.

3 Likes

Hi @veronica, thanks for bringing this up here. In my opinion, it might be helpful to make the start date and time optional but configurable, just in case someone needs to set it for a future time. For example, in a hospital setting, a clinician might want a patient to start medication tomorrow afternoon or after a certain procedure. It’s just a small thought, but I feel it could add some flexibility for those who need it, while still keeping things simple for everyone else. So I vote for having the future start date for dispensing.

2 Likes

I feel it is required.

Along with it, we also need to figure out the tapering dose prescribed to the patient. example:

Tab Prednisolone 5 mg Oral Two time a day for 5 days Then Tab Prednisone 2.5 mg Oral Two time a day for 5 days Then Tab Prednisone 2.5 mg Oral once daily for 5 days Then Stop.

2 Likes

I don’t see an issue with allowing orders with a future start date. Doesn’t seem like the sort of thing we should prevent people from doing. That said, how this relates to dispensing is difficult. Without a proper set of rules to implement, the safest option seems to be to just make it available for dispensing and rely on the pharmacist for the legal implications (maybe with some kind of visual cue that the order is not for today). I suspect the real answer is very highly dependent on the drug in question, the amount of time the order is in advance for, etc.

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Thanks, Ian. To move this forward, there seem to be two key components based on your suggestion:

  • Relaxing the medication rule to permit orders with a future start date
  • Introducing a visual cue to indicate when an order is not intended for today

@cduffy @pauladams — would love to hear your thoughts on how best to approach the visual cue aspect.

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Tangential. From @dennis 's PR comment:

Should we allow medications to be ordered with start dates in the past? If not, what are the clinical/compliance implications we should consider?

My guy instinct would be to allow it, but maybe keep it behind a role based permission? Feedback on this appreciated. Thanks.

1 Like