Let’s learn from other CDMs. Why PCORnet has two tables? (dispensation and prescription). Because EHR sites have a use case for it.
So OMOP CDM has to decide if it is just like the others or claims to “know better” and wants to be better/different (and justify it very well).
Let’s say we don’t want death-by-too-many-tables. So if dispensation and prescription are similar, why not have just one table (drug_exposure) and have the type column serve as the “OMOP knows better” smart construct.
I argue we should embrace all records (even pill bottle sensor on the cap events (those are closest to patient experience)) and fully utilize the type concept. Let there be duplication! (two rows one for order and one for corresponding dispensation). (2 years ago, I posted this Kratos demo data idea to sandbox - see https://github.com/OHDSI/sandbox/tree/master/Kratos#days-of-supply-order-and-dispensation-1)
For analysis, it means that every drug table query must first declare the turf and stick to it. And one of the turfs can be only meds where I have order AND dispensation. (double events study)
So CDM table stays the same, type concept grows in significance and will require very specific and strong conventions and analytics will have to change to leave claims-heavy past and become claim+ehr futuristic.
So no change in CDM but change in analytics and conventions!
Once the specs are in place, I volunteer to write the first double events study. In fact I wanted for a long time do such a study but spec wise (and number of network studies in that turf)- our network did not mature there yet.
for the record: I disagree with Don. I agree with Malanie.
In fact, metadata should describe what turf a given dataset is using. (or Achilles and DQD and DataSources(atlas ) and prominently feature it to the research user of the dataset.