Transaction: Pharmaceutical prescription

General information

STATUS:

Published

OWNER:

eHealth Platform

STANDARD:

KMEHR

VERSION:

2.3

DATE:

2018-03-01

DEFINITION:

The Pharmaceutical prescription transaction aims to prescribe any pharmaceutical or other complementary product and material.

The work presented here results from the project Be-Prescript 3.

Guidelines

Generalities

This transaction must, at least, be compliant with the KMEHR level 1. We recommend the use of a KMEHR message compliant with the KMEHR level 4 (see structure overview).

Transaction elements

id	id of the transaction according to the ID-KMEHR convention.
cd	You must use the value 'pharmaceuticalprescription' from CD-TRANSACTION. You can always add your own local codes.
date	This is the legal date of prescription by the physician.
time	This is the legal time of prescription by the physician.
author	This is the legal prescriber assuming the medical responsibility of the request. Only one physical healthcare party is allowed (possibly complemented by organisation and department). The ID-HCPARTY is mandatory. Additional information like name, address, phone are optional.
redactor	The redactor identifies the context of transcription or generation of the content of the transaction. It can identifiy a physicial person like a secretary, nurse, ... and possibly its department and/or organisation. It can also represent a robot for automatic content generation, an application for example.
iscomplete	A prescription should always be complete.
isvalidated	A prescription should always be validated.
expirationdate	This is the expiration date of the prescription/transaction, can be used to remove a prescription from a prescription server

Structure overview

You have the choice between:

text(s): to transfer your prescription as free text,
lnk(s): to encapsulate your prescription as a multimedia object (Word document for example),
heading(s) and/or item(s): to further structure your prescription.

We strongly recommend to use items to build the pharmaceutical prescription transaction.

Headings

Three headings may be used within the pharmaceutical prescription referring to the following values of CD-HEADING: prescription, medication and assessment

prescription	prescription should be used to gather the prescribed items
medication	medication could be used to transfer information about the current medication of the patient
assessment	could be used to transfer clinical information about the patient

Each heading can contain:

text(s): to transfer your paragraph as free text,
lnk(s): to encapsulate your paragraph as a multimedia object (Word document for example),
item(s): to further structure your paragraph.

Items

Any item of CD-ITEM could be used but we recommend more particularly:

Item type (cd)	Item purpose	Item structure
transactionreason	could possibly be used to specifies the indication(s) of the prescription.	-
reimbursementcertificate	can be used to identify the certificate justifying the reimbursement of a product or a procedure.	This item could be composed as free text but could also make use of many sub-elements like id for the certificate number, cd for the type of certificate, author, beginmoment and even lnk to encapsulate the image of the scanned certificate as an autolink.
complementaryproduct	This item should be used to prescribe pharmaceutical products other than typical medications: 'eau de Cologne', bandages,...	This item should be built in the exact way as medication.
medication	to describe each prescribed medication	The content should use one of the 3 following elements content (medicinalproduct \| substanceproduct \| compoundprescription)
		[beginmoment] Specifies the begin date (and time) of the treatment
		[endmoment] Specifies the end date (and time) of the treatment
		lifecyle Must refer to the fixed value prescribed of CD-LIFECYCLE. Within the heading ‘medication’, this element can have the value delivered or administrated when the product has been delivered/administrated by the prescriber
		[quantity] Specifies the number of packages as a decimal number combined with a unit from CD-UNIT
		[frequency] There are two ways to describe the prescribed frequency of administration : using the frequency element or a sequence of regimen elements. To use for 'simple' administration schedules. It supports 3 options: a combination of nominator/denominator (e.g. '1day/1week'), a free text or value from CD-PERIODICITY.
		[posology] Specifies the quantity of product to be taken (this information is complemented by the frequency/regimen). It may be expressed as free text or in a structurated way: - high Maximum number of product units per administration/intake - low Minimum number of product units per administration/intake - unit Reference unit (from CD-ADMINISTRATIONUNIT) - takes Number of takes in the given reference period, mostly daily. This is only possible when the the quantity of the product is the same for each of the takes. Default takes: 1. The takes element is built using the high element, complemented by the low element if a range must be specified.
		[duration] Specifies the duration of the treatment using a value from CD-TIMEUNIT.
		[temporality] Specifies the chronicity of the treatment using a value from CD-TEMPORALITY.
		[dayperiod] Specifies the period(s) of the day when the treatment should be taken, using a value from CD-DAYPERIOD.
		[regimen] This is one of the two ways to describe the frequency of administration and is intended for more 'sophisticated' administration schedules: each administration is described by one element of the sequence that specifies: - the day within the schedule through either a daynumber, a specified date or a weekday. - the quantity number of pharmaceutical product units per intake/administration (quantity element), - the daytime as the proposed time of administration and one or several dayperiod (eg 'Before noon')
		[deliverydate] Earliest allowed date of delivery. Please note if the transaction contains multiple medications with different <deliverydate>, the date nearest in the future will overrule all others and will be the earliest delivery date for all medications in this prescription.
		[renewal] The allowed renewals of the prescription can be described using one the 3 following options - decimal = number of possible renewals of that product. Default 0. - decimal + duration = in addition to the previous option, this defines the del ay before renewal - text = free text
		[route] Specifies the administration route using a value from CD-DRUG-ROUTE.
		[instructionforoverdosing] Medical justification when the product is overdosed.
		[instructionforpatient] Usage instructions for the patient.
		[instructionforreimbursement] Instructions for reimbursement based on medical justification. The reference to a reimbursement certificate could be placed in the 'certificateforreimburesment' item.
		[issubstitutionallowed] If the prescribing party has therapeutic objections concerning substitution, this element can be used with the value 'false'. This can also be used to explicitely define substitution is allowed with the value 'true'.

Medication

There are three differents ways to describe the content of a medication:

- Medicinal product

Element

Purpose

Structure

medicinalproduct

0-*

The element medicinalproduct identifies the medicinal product prescribed.

intendedcd

Built using CD-DRUG-CNK (please note when using SAM: this is the Dmpp code).

In the future, there will be instructions here how and when to use a national medecine code from CD-AMP. However for now: the use of CD-DRUG-CNK is still recommended.

intendedname

Textual description of the product.

Example:

<medicinalproduct>
    <intendedcd SV="2011" S="CD-DRUG-CNK">0895540</intendedcd>
    <intendedname>Medrol 32</intendedname>
</medicinalproduct>

- Substance product

Element

Purpose

Structure

substanceproduct

0-*

The element substanceproduct describes the INN or substance based cluster prescribed.

intendedcd

It is built using a INN cluster from CD-INNCLUSTER

or using a VOS/DCI cluster from CD-VMPGROUP

intendedname

Textual description of the substance.

Example 1:
<substanceproduct>
<intendedcd SV='20100701' S="CD-INNCLUSTER">8038747</intendedcd>
</substanceproduct>

Example 2:
<substanceproduct>
<intendedcd SV='1609A' S="CD-VMPGROUP'>24745</intendedcd>
</substanceproduct>

- Compound Prescription

The element compoundprescription describes the magistral preparation of a medication.

It's built of

Either compound(s), formularyreference or magistraltext
galenicform
quantity

Compound

Element		Purpose	Structure
compound	0-*	Describes medication (in this case a magistral prescription)	id Identifies the compound. this should be an ID-KMEHR.
			medicinalproduct(intendedcd\|deliveredcd\| intendedname\|deliveredname) When using a medicinalproduct, the product will be defined here. This has the same structure as the medicinalproduct on the item level.
			Substance(cd/substancename) When using a substance, identifies the substance with the substance code using CD-SUBSTANCE-CNK.
			[quantityprefix(cd)] A value from the table CD-QUANTITYPREFIX.
			[quantity(decimal[unit(cd)])] The quantity of medicinalproduct or substance needed.

Example:

<compound>
    <id SV='1.0' S="ID-KMEHR">1</id>
    <medicinalproduct>
        <intendedcd SV="2010-07" S="CD-DRUG-CNK">2379709</intendedcd>
        <intendedname>Furosemide Sandoz tab 100x 40mg</intendedname>
    </medicinalproduct>
    <quantityprefix>
        <cd S="CD-QUANTITYPREFIX" SV="1.0">ad</cd>
    </quantityprefix>
    <quantity>
        <decimal>100</decimal>
        <unit>
            <cd SV="1.3" S="CD-UNIT">ml</cd>
        </unit>
    </quantity>
</compound>

Example using a substance:
<compound>
	<id SV='1.0' S="ID-KMEHR">1</id>
	<substance>
		<cd S="CD-SUBSTANCE-CNK" SV="1.0" L="nl" DN="HERBAE TINCTURA">539320</cd>
	</substance>
    <quantity>
        <decimal>30</decimal>
        <unit>
            <cd SV="1.3" S="CD-UNIT">ml</cd>
        </unit>
    </quantity>
</compound>

Formulary reference

formularyreference

0-1

A reference to an official formulary for magistral preparations. Use one or two cd elements referring CD-FORMULARY, CD-FORMULARYREFERENCE or both.

(cd | formularyname)

(Refer to the formulary by using CD-FORMULARY and/or refer to a concrete formula within a formulary by using CD-FORMULARYREFERENCE |

Alternatively refer to a formulary using formularyname (text.)

Example:

<formularyreference>
	<cd S="CD-FORMULARY" SV="1.0">TMF2</cd>
	<cd S="CD-FORMULARYREFERENCE" SV="1.0" L="fr" DN="ERYTHROMYCINE SOL. HYDRO-ALC. 4% FTM2">0589028</cd>
</formularyreference>

Magistral text

magistraltext

0-1

A magistral preparation is described in free text. (Some pharmacies have their own specific preparations: these should also be expressed here.)

Example:

<magistraltext L="fr">Recette à effectuer</magistraltext>

The following items are mandatory

galenicform	0-1	Used to specify the galenic form of the result of the magistral preparation. If galenicform is specified it can be defined via cd or via text or both.	[cd] Describes the galenic form. This is a value from the CD-MAGISTRALFORM table.
			[Galenicformtext] Galenic form as free text
quantity	0-1	The produced quantity that is expected from the preparation of the magistral preparation	Decimal Decimal number that defines the quantity
			[unit(cd)] Describes the unit. Can be omitted in some cases.