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Multiple drug_type_concept_ID values and records for the same Rx

We are looking for advice on whether to capture multiple stages in the process of ordering, dispensing or administering medications on each Rx. The rationale for considering this idea is this:
Overall, orders are more indicative than dispenses of what clinicians attempt to do and might therefore be better indicators for things like guideline adherence. Dispenses, fills, and administration are better indications of what gets into patient’s bodies - we don’t have fills but this thread might inform those that do.
So, the question is whether it is possible or a good idea to capture more than one step in the process of Order -> Dispense -> Fill/Administer in order to support both analyses focused on guideline adherence and analyses focused on medication exposure.
The kinds of data we have depend on location. The question is further complicated because is the different meaning of the concepts of Order, Dispense, Administer, etc. in outpatient vs. inpatient settings.

All thoughts and advice will be greatly appreciated.

Hi Andrew,

I’m currently working on building new tools for exploring various aspects of drug utilization. Some of my users are definitely interested in the issue you bring up, but at this point I only have access to dispensing records. In a few months I think I may also have access to orders and possibly administration records. I don’t know what will be involved in tying an order to a dispensing, whether there will be links to follow or (probably) the links will have to be inferred.

Sorry I don’t have any advice at the moment, but I share your interest in knowing if anyone else does. And, as we each progress in our projects, it sounds likely that we might be able to help each other out. So feel free to contact me anytime.

Best of luck!

Hi @Andrew, my vote is that YES, you should capture as much of the process
as you can, and the DRUG_TYPE_CONCEPT_ID field is there explicitly to allow
you to differentiate the various steps along the way for your particular
use case. For any data source with multiple steps along this chain of
custody, I think there’s very exciting research we can do to see what
information is lost along this game of telephone…

t