This problem affects the following products:
- All versions of HealthShare Unified Care Record®
- All versions of HealthShare® Health Connect
- All versions of InterSystems IRIS® for Health
Requirements:
- HL7® v2 input and FHIR® output of medication orders
The HL7 to SDA to FHIR medication transformation maps two different HL7 v2fields:
- RXE-7 (Pharmacy/Treatment Encoded Order - Provider's Administration Instructions)
- RXR-1 (Pharmacy/Treatment Route - Route)
to the same Route property in HS.SDA3.Medication. In FHIR, this is emitted as a single MedicationRequest.extension with the URL http://intersystems.com/fhir/extn/sda3/lib/medication- route.
When both HL7 fields are present, the value from RXR-1 overwrites RXE-7 in the SDA transformation, silently discarding the Provider's Administration Instructions.
This defect manifests only when all of the following are true:
- The system processes RDE_O11 medication orders, or other messages that carry RXE and RXR segments.
- The incoming message contains a value in RXE-7 and/or RXR-1.
- The default transformations shipped with the product are in use. In other words, no custom override of HS.Gateway.HL7.HL7ToSDA3 or OnMedication() has been deployed.
Loss of critical clinical context can lead to wrong-route administration, loss of dilution or timing warnings, or misinterpretation of epidural vs IV routes.
The correction for this defect is identified as HSIEC-11332, which is scheduled to be included in version 2025.2 of each affected product (and in all future product releases). It is also available for older versions via ad hoc change file (patch) or full kit distribution by contacting the Worldwide Response Center (WRC).
With HSIEC-11332 in place, the HL7 to SDA3 transformation maps RXE-7 to the TextInstruction property in HS.SDA3.Medication. The RXR-1 mapping is unchanged.