The CQI Workgroup is trying to determine the most appropriate way to address ordering and administration of blood products. It seems that the blood product is identified using BiologicallyDerivedProduct, order for blood product as SupplyRequest and administration of blood products as SupplyDelivery. Guidance in the Boundaries and Relationships should make that usage clear (or the recommended approach if different). Please, also identify if SupplyDelivery is intended only to address delivery and receipt of the supply element, or also to address the administration of the supply to the patient. The full workflow would be SupplyRequest, SupplyDelivery (similar to Medication dispensing) and SupplyStatement (similar to MedicationStatement about administration of the supply element).

Further, specific to SupplyRequest:

• It is modeled differently than other requests. There is no .intent metadata element consistent with other FHIR resources (e.g., proposed, draft, planned, requested, active, on-hold, completed, cancelled, entered-in-error). Such a distinction is important to addressing workflow for use in clinical decision support, and clinical quality measurement as well - really just tracking workflow through a process.

• Supply Request should also include a .notDoneReason - to support CDS and CQM, a documented (and potentially structured) reason for lack of compliance is significant.

• Unlike MedicationRequest, SupplyRequest does not address refills or frequency and there may be a need for such metadata depening upon the supply resource requested.

• Differentiation of SupplyRequest.category, and SupplyRequest.orderedItem.item[x] will be helpful - if the category is biological product, I suppose the orderedItem is a unit of blood (i.e., quantity = number)

SupplyDelivery also requires a .notDoneReason element. Once ordered, a reason for not administering a blood transfusion is important for the clinical record and, also for CDS and CQM evaluation.