Encounter hook: this should not be needed because MAR is generally not connected to a patient visit in the hospital or nursing home facility. Meds are just passed with no respect to an appointment. So, my question is why create an encounter hook?
Are we going to discuss next the object model for this feature and are we going to use the Zend module framework?
Yes, we should discuss the object model first.
No need to use Zend at the moment, the object model will be just a regular PHP class.
We can hash out the Medication Object here: Medication Object · openemr/openemr Wiki · GitHub
and the MAR Object here: MAR Object · openemr/openemr Wiki · GitHub
Note, those links are on the github wiki, used basically just as a scratchpad that we both have access to 
I have been out in the field engineering retail systems. I am back now and
wish to catch up on this. I have read the entry for the Medication-Object.
I am understanding what I am reading. I am learning as we go because I have
never discussed with another how to design. Looking forward to getting this
going. What is our next move?
Didn’t want this to fall to the wayside. I am looking to you Robert to lead the way as I don’t really know what is all entailed in a MAR system.
Won’t let this fall away, just need to wrap up like 3 parallel pull requests I’ve got open. Luckily I think I closed 2 of them today so hopefully we can start putting together a real game plan here shortly. Will keep you updated
Late to this thread. One of the use case / integration is offices administering medications from inventory during a visit.
We have been using a LBF with plugin code for this routine activity.
Great idea. We’ll keep an eye out.
-m
Thanks.
There are some things to consider in the model:
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Drug-Drug Interactions - this would be meds in the MAR, Rx’d, and the patient’s med list
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Allergies/intolerances - would need to connect to the food and medication allergy list
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Listing next scheduled dose
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Ensure that scheduled meds are separate from PRN meds
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Signature for person administering all drugs. 2nd signature or witness only required for certain types of drugs
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Calculate administration rates for IV, Central Line, Intra-arterial drugs
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For routes of administration (ROA), will need a check to make sure the right route is selected. (This is a sophisticated feature.) For example, if the doctor ordered the medication to be given orally and the nurse has an IV medication. The system would alert the nurse they selected the wrong route.
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ROAs - (some that I remember, but we can look up to make sure all are covered)
- Oral (PO), Sublingual (SL), buccal, Inhaled, ET Tube
- Nasal
- PEG/G-tube, PEJ/J-tube,
- Intradermal (ID), Transdermal, Intramuscular (IM), Intravenous (IV)
- Central line - PICC, CL
- Intra-arterial
- Rectal (PR)
- Intravaginal
- Otic (ear)
- Ophthalmic (eye)
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When it comes to route and if it is IV make sure they person has an IV and the user can specify which IV the medication is being administered. There may be IV incompatibilities you need to be aware of and alert the user about (I don’t remember if we look these up or if the newer EHRs consider that. I haven’t worked in a hospital in awhile).
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Assessments before and after administration, e.g.:
*Tie pain assessments to pain meds.
*Tie heart rate assessments to certain BP meds.
*Tie BP assessments to BP meds.- Temperature after meds given for fevers or where body temperature is relevant
Labs for meds that require levels to be monitored for therapeutic or toxicity levels.
Robert, would there be separate modules for special administrations such Blood, FFP, High Risk meds (e.g. heparin), anti-epileptics, etc.
This may not be true for international hospitals but some have dispensing machines and the EHR MAR is tied to those dispensing machines to confirm meds dispensed match meds being administered. This would be a nice to have if a facility needed it.
That’s all I can think of right now. I hope it helps.
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Wow, thanks @jboyd13! You definitely took it way further than our initial look.
A typical workflow involves scanning the medication into the EHR just before Administration. I believe this ties a particular vial of medication or pill to the patient. As for the dispensing mechanism, we’d need a way to emit data from OpenEMR to that server (likely FHIR or HL7)
There’s probably more to it than this, but what a great start.
may I contact Medscape team in order to negotiate access to their API ?
That may be better coming from a project admin. I can reach out to them.
Sir
i have small senior living , i was looking for Medical Administration and Record , i have downloaded openemr but could not find the module
will be great if you can help me
thanks lot
What module are you looking for?
I read back through the thread. This module was not built. It is not available to install.
thanks lot for your reply
actually i am looking for MAR( medication administration record ) , if you can help me pls
thanks lot
The MAR has not been built to my knowledge or released to the public if it has been built.