hl7 medication and ukcprs julie james partner blue wave informatics

HL7 Medication and UKCPRS

Julie JamesPartner

Blue Wave Informatics

HL7 Medication and UKCPRS

• HL7 Medication – Messaging about Medicines• The Pharmacy D-MIM• Describing the Medicine• Using the dm+d (UKCPRS) to describe a Medicine in a

Message

HL7 Medication – Messaging about Medicines• Medication Information Special Interest Group (Med Info SIG)

– Messaging about the Patient-Clinician-Medicine interaction– Prescribing medicines– Dispensing and supplying medicines– Administering medicines– Querying about individual patient’s medication(s)

• Patient Safety Special Interest Group– Messaging about Adverse Events that Medicines may

cause (the “Yellow Card”) – the Individual Case Safety Report (ICSR)

• Regulatory and Clinical Research Information Management Technical Committee (RCRIM)– The “Structured Product Label” (representation of the

Summary of Product Characteristics [SmPC] in a structured format, for clinical and regulatory use

The Pharmacy DMIM

Institutional Supply Order( PORX_RM222000 )

Supply promise in an institutional setting

0..* subjectCoveragetypeCode*: <= PERT

pertainsTo

0..* alert

typeCode*: <= TRIGtriggerFor

0..* formulary

typeCode*: <= INSTdefinition

0..* justifyingObservationIndication

typeCode*: <= RSON

reason2

0..* encountertypeCode*: <= COMPcomponentOf1

Note:E.g. radioactive substance mustbe administered in secured location,

oral morphine in pharmacy

Note:This Act represents the core of the act ofordering a medication and administering to a

patient. It directly holds the route and dosageinstructions.

ObservationIndication

classCode*: <= OBS

moodCode *: <= EVNid: (used for future maintenance)statusCode: (Complete, Superceded)

effectiveTime:confidentialityCode:

value*: CE CWE [0..1] <= ObservationValue (e.g. ICD9)targetSiteCode:

Formulary

classCode*: <= SPLYmoodCode *: <= DEF

id*: [1..*] (catalogue #)

ObservationCriteria

classCode*: <= OBS

moodCode *: <= EVN.CRTcode: CE CWE <= ObservationType

text*:effectiveTime:value:

MedicationAdministration

classCode*: <= SBADM

moodCode*: <= ActMoodid*:text: (Summary of act)

effectiveTime:activityTime:

availabilityTime:priorityCode:confidentialityCode: "N"

routeCode: <= RouteOfAdministrationapproachSiteCode: <= ActSite

(Can't have this without a route)doseQuantity:

rateQuantity:doseCheckQuantity: SET<RTO<QTY,QTY>>maxDoseQuantity: SET<RTO<QTY,QTY>>

MedicationSupply

classCode*: <= SPLYmoodCode *: <= ActMood

id: (defaults to Sub_admin_order.id)code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used to indicate authorization

for trial/partial dispense)

text: (pharm. instructions)effectiveTime: (Earliest/last allowed dispense, frequencyrestrictions, etc.)

confidentialityCode:repeatNumber: INT "1" (ie this is issue 3 (of 5))

quantity*: [1..1]expectedUseTime: (days supply ordered)

CMET: (COV)A_Coverage

[universal]( COCT_MT180000 )

CMET: (ALRT)A_Alert

[universal]

( COCT_MT260000 )

CMET: (ENC )A_Encounter


CMET: (LOCE )

R_LocationLocatedEntity[universal]

( COCT_MT070000 )0..* playedRole

CMET: (ASSIGNED )

R_AssignedPerson[universal]

( COCT_MT090100 )

CMET: (LOCE)R_LocationLocatedEntity


0..* playedRole

CMET: (ASSIGNED)R_AssignedPerson


CMET: (ASSIGNED)


( COCT_MT090100 )

CMET: (ASSIGNED)

R_AssignedDevice[universal]

( COCT_MT090300 )

CMET: (ASSIGNED)R_AssignedPerson


CMET: (ASSIGNED)R_AssignedDevice

[universal]

( COCT_MT090300 )

0..* locatedEntity

typeCode*: <= DSTdestination

0..* assignedEntity

overseer

typeCode*: <= x_ParticipationVrfRespSprfWitmodeCode:signatureCode:signatureText:

0..* participant

author2

typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:

1..* participant *author2

typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:

0..* assignedEntitydataEnterer

typeCode*: <= ENT

0..* assignedEntity

author1

typeCode*: <= AUT

0..* assignedEntity

overseer

typeCode*: <= x_ParticipationVrfRespSprfWittime*: (verification or attestation)modeCode:signatureCode:signatureText:

0..* assignedEntity

dataEnterertypeCode*: <= ENT

0..* assignedEntity

author1

typeCode*: <= AUT

0..* orderedMedicine

typeCode*: <= CSM

consumable

1..* suppliedMedication *

typeCode*: <= PRD

product

0..* participant

typeCode*: <= PRFsignatureCode: <= ParticipationSignaturesignatureText:

performer

0..* locatedEntity

typeCode*: <= LOC

location

0..* pertinentCoverage

typeCode*: <= PERTpertinentInformation

0..* locatedEntity

typeCode*: <= ORG

origin

CMET: (ASSIGNED)


( COCT_MT090100 )

0..* assignedEntity

typeCode*: <= RCV

receiver

0..* a_SubstanceAdminMaster

typeCode*: <= INST

definition

Note:Used to refererencepharmacy protocols

governing how a drugshould be prescribed/

administered.

A_SubstanceAdminMaster

classCode*: <= SBADMmoodCode*: <= DEF

id*: [1..*] (catalogue #)

Pharmacy Domain ModelPORX_DM000000 v10.3

4 December 2003

Updated to Rim 2.01

Note:Eg: Use dose of 50mg

if pulse <40bpmor

Give medication untilpain relieved

0..* pertinentObservationDx

typeCode*: <= PERT

pertinentInformation

Note:Observations that supportthe decision on which medication

or what dose to use.Eg Body weight, Surface Area,

Allergies, Medical conditions

CMET: (OBS )A_ObservationDx

[minimal]( COCT_MT120104 )

CMET: (PAT)R_Patient


1..* patient *

subjecttypeCode*: <= SBJ

Note:

The medication ordered or administeredto the patient.

Eg Amoxicillin 250mg Tablets

Note:The patient who is going

to receive the medication

Note:The header for the visit

to the primary care physicianor a particular hospital stay.

Includes information on therelevant financial account

Note:The reason for the medfication order.

Eg Treatment of bronchitis

Note:

Who wrote the order,typically a doctor

Note:Who gave the medicationto the patient, typically unused in

community and a nurse insecondary care

Note:Who confirmed the order or the admin

Note:

Who entered the data sayingfor the order or the admin

Note:Who should be called for clarification

typically the same as the Author.

Note:Identifies information about an eligibilitycheck or authorization that has been

received in relation to an action. It is initiatedfrom the Supply and provides confirmation

back to the SubstanceAdministration

Note:Intended to identify problems or

warnings associated with an Actthat have previously been evaluated

and discounted.

This CMET is missing at presentand the mechanism will not work.

Note:Who confirmed the supply

typically a pharmacist

Note:

Who entered the data sayingwhat the supply is

Note:Who should be called for clarification

typically the same as the Author.

Note:Who wrote the supply requesttypically the doctor who wrote

the medication order,but could also be a nurse

or ward pharmacist

Note:

The formulary which governswhat can be supplied

Note:Who will receive the supply.

It may be the patient, a carer.

Note:The medication that is being suppliedeg Amoxil 250mg tables, 56 tablets

Note:For a supply, where the supply

came from and where it was sent to.Eg Pharmacy, Ward

Note:This act represents the act of supplying

medication to a patient or their representative.It does NOT deal with administering it to the patient.

component / componentOf2

0..* medicationAdministration1

0..* medicationAdministration2

typeCode*: <= COMPNote:Links together a series of

orders or administrations that formpart of a series whether scheduled

or not or where an order fulfills partof a previous order.

Also used for complex doses, ormultiple routes.

component / componentOf

0..* medicationSupply1

0..* medicationSupply2

typeCode*: <= COMPNote:Links together a series of

supply acts that formpart of a series whether scheduledor not or where an order fulfills part

of a previous order.

0..* participant

typeCode*: <= PRFsignatureCode: <= ParticipationSignature

signatureText:

performer

Note:Changed from

COCT_MT070103, but is the the correct CMET?

Note:

Need to redo diagnosis code

0..* locatedEntity

typeCode*: <= DST

destination

1..1 manufacturedMedicine *

OrderedMedicine

0..1 playedOrderedMedicine *classCode*: <= THER

Medicine

classCode*: <= MMATdeterminerCode*: <= KINDcode*: [1..1] <= DrugEntity

(The main entry specified by the user. Use the equivalents for other more or les specific codes. EG AMP is th emain code, but

VTM, VMP and a set of AMPPs are also known)formCode*: <= MaterialForm

MaterialMedProduct( COCT_RM230000 )

CMET for Medication ordered

1..1 manufacturedSuppliedMedicine *

SuppliedMedication 0..* playedSuppliedMedication *

classCode*: <= THER

Manufacturer

classCode*: <= ORG

determinerCode*: <= INSTANCEcode: CE CWE [0..1] <= EntityCodename*:

0..1 scopingMedicine *

Equivalent1..* playedEquivalent *

classCode*: <= ROLcode: <= RoleCode

Note:This is only a link to theMedicinalMaterial entity

and carries no information

Note:This is anything from

an virtual therapeutic moeityto a virtual product pack to an

actual product or an actualproduct pack. It may hold multiple

IDs if say, VMP, AMP and AMPPhave been identified as partof the product selection process.

It isn’t a choice box because several

values may be required.

It doesn’t have an explicit name

because this is part of the code

0..1 ingredientIngredient *

IngredientStrength0..* scopedIngredientStrength

classCode*: <= INGRquantity: RTO<PQ,PQ> (Medicine strength)

Ingredient

classCode*: <= MMATdeterminerCode*: <= KIND

code: <= EntityCode

0..1 scopingPayor *

ReimbursementStatus

1..* playedReimbursementStatus *

classCode*: <= ROL

code*: [1..1] <= RoleCode

Payor

classCode*: <= ORG

determinerCode*: <= INSTANCEcode: <= EntityCodename:

SuppliedMedicine

classCode*: <= CONT

determinerCode*: <= KINDcode*: [1..1] <= PackagedDrugEntitylotNumberText:

expirationTime:stabilityTime:

1..1 containedSuppliedMedicine *

1..1 containerMedicine *

PackOf0..* scopedPackOf *

0..* playedPackOf *

classCode*: <= CONT

quantity: RTO<PQ,PQ> (Pack size)

0..1 justifiedMedicationAdministration *

0..* justifyingMedicationSupply *

typeCode*: <= RSON

reason1 /

reasonOf

MaterialMedProductPackaged( COCT_RM220000 )


inFulfillmentOf

0..* priorMedicationAdministration

typeCode*: <= FLFS

predecessor

0..* priorMedicationAdministration

typeCode*: <= SUCCNote:

Allows for modeling revisionof an order

Note:

Allows relation of differentmoods of the act.

inFulfillmentOf

0..* priorMedicationSupply

typeCode*: <= FLFS

predecessor

0..* priorMedicationSupply

typeCode*: <= SUCC

Note:Allows for modeling revision

of an order

Note:Allows relation of different

moods of the act.

0..1 manufacturedMedicine

0..1 manufacturerManufacturer

ManufacturedBy 0..1 scopedManufacturedBy

0..* playedManufacturedByclassCode*: <= THER

AssignedPractitionerOrDevice

AssignedPractitionerOrDevice

Note:

See Q&A 31

Note:See Q&A 31

MedicationAdministrationInstructions

classCode*: <= SBADMmoodCode*: <= ActMoodtext: (Additional free text instructions)

0..* medicationAdministrationInstructions

typeCode*: <= COMP

component1

Community Supply Event( PORX_RM124000 )

Supply Event in a community setting

Institutional Combined Order( PORX_RM232000 )

Administration and Supply Order

in an institutional setting

Institutional SupplyPromise( PORX_RM223000 )

Supply promise in an institutional setting

Institutional Supply Event( PORX_RM224000 )

Supply event in an institutional setting

Community Combined Order( PORX_RM132000 )

Administration and Supply Order

in a community setting

Institutional Administration Order( PORX_RM212000 )

Administration promise in an institutional setting

Institutional Administration Promise( PORX_RM213000 )

Administration promise in an institutional setting

Institutional Administration Event( PORX_RM214000 )

Administration event in an institutional setting

0..* outcomeObservationCriteria

outcome

typeCode*: <= OUTCcheckpointCode:negationInd:conjunctionCode:

0..* observationCriteria

precondition

typeCode*: <= PRCNcheckpointCode:negationInd:conjunctionCode:

Note:

Need to build a set ofdescriptions of equivalencesuch as:

- Generic - Allowed alternative brand

These will usually be Realm specific

Describing the Medicine

• The Importance of the correctly describing a Medicine• HL7 Information Model (the RIM) for messaging• Realm-specific (use case driven) Terminology Model for

description• The need for Harmonisation• The Medication CMETs (harmony, not melody)

Material Medicinal Product - Universal


OrderedMedicine

0..1 playedOrderedMedicine *classCode *: <= THER

MedicineclassCode *: <= MMATdeterminerCode *: <= KIND

code *: [1..1] <= DrugEntity (The main entry specified by the user. Use the equivalents for

other more or les specific codes. EG AMP is th emain code, but

VTM, VMP and a set of AMPPs are also known)formCode*: <= MaterialForm

MaterialMedProduct(COCT_RM230000)


ManufacturerclassCode *: <= ORG

determinerCode *: <= INSTANCE

code: CE CWE [0..1] <= EntityCodename*:



classCode *: <= ROLcode: <= RoleCode

0..1 ingredientOfMedicine * IngredientStrength

1..* playedIngredientStrength *

classCode *: <= INGR

quantity: RTO<PQ,PQ> (medicine strength)

IngredientclassCode *: <= MMATdeterminerCode *: <= KIND

code: <= EntityCode

name: [1..*]




0..* playedManufacturedByclassCode *: <= THER

The medicine entity plays the role of

“ordered medicine”

Equivalent concepts (e.g. brand/generic) can be represented

here

The medicine’s ingredients can be represented using the role of “ingredient strength”

and “ingredient” entities

The medicine’s manufacturer can be represented using the

role of “manufactured by” and “manufacturer” entity

Material Medicinal Product - Identified


OrderedMedicine

0..1 playedOrderedMedicine *classCode*: <= THER

MedicineclassCode*: <= MMATdeterminerCode*: <= KINDcode*: [1..1] <= DrugEntity (The main entry specified by the user. Use the equivalents for other more or les specific codes. EG AMP is th emain code, but VTM, VMP and a set of AMPPs are also known)

MaterialMedProductIdentified(COCT_RM230001)


Just carry the dm+d identifier for the medicine in

here

Material Medicinal Product Pack - Universal

MedicineclassCode*: <= MMATdeterminerCode*: <= KINDcode*: [1..1] <= DrugEntity (The main entry specified by the user. Use the equivalents for other more or les specific codes. EG AMP is th emain code, but VTM, VMP and a set of AMPPs are also known)formCode*: <= MaterialForm


SuppliedMedication0..* playedSuppliedMedication *

classCode*: <= THER

ManufacturerclassCode *: <= ORGdeterminerCode*: <= INSTANCEcode: CE CWE [0..1] <= EntityCodename*:



classCode*: <= ROLcode: <= RoleCode

0..1 ingredientIngredient *

IngredientStrength0..* scopedIngredientStrength

classCode*: <= INGRquantity: RTO<PQ,PQ> (Medicine strength)

IngredientclassCode*: <= MMATdeterminerCode*: <= KINDcode: <= EntityCode

SuppliedMedicineclassCode *: <= CONTdeterminerCode *: <= KINDcode*: [1..1] <= PackagedDrugEntitylotNumberText:expirationTime:stabilityTime:

1..1 containedSuppliedMedicine *

1..1 containerMedicine *

PackOf0..* scopedPackOf *

0..* playedPackOf *classCode*: <= CONTquantity: RTO<PQ,PQ> (Pack size)




0..* playedManufacturedByclassCode*: <= THER

The supplied medicine entity plays the role of “supplied medication”

The supplied medicine entity has batch number and expiry information; it

will be a dm+d AMPP code

The supplied medicine entity scopes the role of

“pack of”

Material Medicinal Product Pack - Identified


SuppliedMedication 0..* playedSuppliedMedication *

classCode *: <= THERSuppliedMedicineclassCode*: <= CONTdeterminerCode*: <= KINDcode*: [1..1] <= PackagedDrugEntitylotNumberText:

MaterialMedProductPackagedIdentified(COCT_RM220001 )


Just carry the dm+d identifier for the AMPP in

here

Route of Administration & Dosage Information

MedicationAdministrationRequestclassCode*: <= SBADMmoodCode*: <= RQOid*: (placer number, etc.)text: (Summary of act)statusCode*: "ACTIVE"effectiveTime:priorityCode:confidentialityCode: "N"routeCode: <= RouteOfAdministrationapproachSiteCode: <= ActSite (Must have a route to go with)doseQuantity:rateQuantity:doseCheckQuantity: SET<RTO<QTY,QTY>>maxDoseQuantity: SET<RTO<QTY,QTY>>

MedicationAdministrationInstructionsclassCode*: <= SBADMmoodCode*: <= RQOtext: (Additional free text instructions)

0..* medicationAdministrationInstructions

typeCode *: <= COMP

component3

Mood = RequestEffective time = when to give

(frequency)Route code = dm+d route of

administration codeDose quantity = how much

of the medicine to give[Rate quantity – for a rate,

rather than a unit dose]

Additional textual instructions, if required

The UKCPRS Programme

• The “dm+d” – the NHS Dictionary of Medicines and Devices– Modelled vocabulary of medicinal product concepts– Supporting vocabulary of ingredient, dose forms, suppliers– Supporting vocabulary of dosage syntax (separate

deliverable)

dm+d – a modelled vocabulary

VMP_Form

Links a VMP to its dose form.

Every VMP that is a drug has exactly

one dose form.

A dose form may not be linked to a

VMP or it may be linked to oneor many

VMP_VTM

Links a set of VMPs to a VTM

A VMP that is a drug may not

be linked to a VTM or it may

be linked to one VTM.

Each VTM must be attached to

one or more VMPs

10/11/2003Blue WaveInformatics

ver 2.0c

dm +d Object Model

Change History:V2.0a - First version in this layout

v2.0b - Added constituent pack concepts

v2.0c - Removed incorrect coments on history from

suppliers and supplier llink

A VMP is the conceptual representation of one or more clinically equivalent Actual

Medicinal Products the purpose of which is to support the representation of thefundamental reality of the concept. Its core description requires product name, strength

and dosage form, but is devoid of explicit or implicit information attributable to

manufacturer or pack.

A VMP cannot exist unless it is linked to one or more AMPs and to one or more VMPPs

Name

The current name in full and short Semantic Normal Form together with the official

source of the name, a previous name and reasons for change

HideName

If this flag is set the name is hidden from view

Prescribability

Indicates if product should not be prescribed by VMP

Freeness

A set of flags indicating if VMP is sugar free, CFC free etc.

Regulation

Information on regulatory restrictions and rules about the product such as Controlled

Drug Schedule

Component FlagIndicates if the product is normal, a compound product or a constituent product.

VMP

A VTM is the abstract conceptual

representation of the material defining the

prescriber's therapeutic intent, divorced fromformulation, dose or strength.

A VTM cannot exist unless it is linked to a VMP

Name

The current name in short and full forms

VTM

Dictionary of terms for the

physical conformation of thedrug as normally dispensed.

A Dose Form may be

orphaned from any VMP

NameA description of the dose form.

DoseForm

List of ingredients and excipients .

Note Within the file of ingredient substances will

be entries relating to the following:-

1) Complete substances which act as actual

ingredients of medicinal products. For example:

heparin sodium or cyclizine lactate (as distinct from

heparin and cyclizine). This class of substances

may or may not be a salt or other type ofderivative.-

2) Base substances which may or may not be

available as actual ingredients. For example,

heparin or cyclizine.

An ingredient may be orphaned from any VMP or

AMP or from another parent or base ingredient.

Name

Name of the ingredient - no history or short forms

Base Ingredient

For salts etc a recursive pointer to the base

ingredient.

Ingredients

VMP_Ingredient

Links VMP to the set of active ingredientscommon to the AMPs linked to the VMP

For each link the quantity of the ingredient or

of its base is stored.

A VMP may have no ingredients attached orit may have one or more.

An ingredient may not be be attached to any

VMP or it may be attached to one or more.

StrengthAn indication of the quantity of the ingredient

in the product

Strength Basis

An indication of whether the strength refers

to the ingredient or its base

An AMP is the representation of a single unit dose of a medicinal product that is (or has

been) made or marketed by a specific manufacturer or supplier. Its core description

requires product name, strength, dosage form and manufacturer, but is devoid of

explicit information attributable to pack size.

The unit dose is the smallest single entity of the product that can be physically

handled with the following defined deviations:

Continuous liquids excluding eye-drops : where the unit dose is expressed in

terms of the accepted normal sub-unit used as the basis of administration

Continuous solids: where the unit dose is expressed in terms of the acceptednormal sub-unit used as the basis of administration

Continuous semi-solids and eye-drops : where a consistent, physically

measurable unit or sub-unit cannot be defined and which is therefore not

instantiated.

An AMP cannot exist unless it is linked to one or more AMPPs

NameThe current name in full and short Semantic Normal Form, a previous value and reason

for change. Each flavour of a AMP has a separate entry.

Availability

The licence and “specials” status.

Regulation

Information on reglatory restrictions and rules about the product such as CSM

notification.

Reimbursement

Information on reimbursement

Component Flag

Indicates if the product is normal, a compound product or a constituent product.

AMP

AMP_Ingredient

Links AMPs to ingredients marked as

“Interesting Excipients”.

The quantity of ingredient is not stored.

An AMP may be linked to no ingredientsor to one or more.

An ingredient may not be linked to any

AMP or it may be linked to one or more.

AMP_VMP

Links a set of AMPs to their corresponding VMP

An AMP must have a VMP but only one VMP

A VMP must be linked to at least one AMP and can be linked to several AMPs

A licensed route of administration

of a medicinal product.

A route may be orphaned from any

VMP or AMP.

NameDescription of the route of

administration

Route

VMP_Route

Links VMP to the set of licensed routes

common to the AMPs linked to the VMP.

A VMP may have no routes linked, or itmay be linked to one o r more routes.

A route may not be linked to any VMP or

it may be linked to one or more VMPs

AMP_Route

Links an AMP to the set of routes that have

been licensed for the product.

An AMP may have no linked Routes or it may

have one or more routes.

A route may not be linked to any AMP or

it may be linked to one or more AMPs

A list of Suppliers of medicinal products. The name

used will be that which appears on the productpackage and may be a manufacturer, a wholesaler

or a marketing agent.

A supplier may be an orphan with no link to anAMP or to another supplier.

Name

The name of the supplier together with a previous

name for that company

Suppliers

AMP_Suppliers

Links a set of AMPs to the company that

supplies them.

Each AMP is supplied by one and

only one supplier.

A Supplier may not have any AMPs or it may

have one or more products.

An AMPP is the representation of each and every saleable/available pack (container of

dose units) of an AMP, in terms of description of quantity, of how many 'dose units' of

the AMP (or weight, for solids and semi-solids) are present in the pack.

An AMPP may also be the representation of the number of “dose units” of an AMPpresent as a constituent of a compound pack. This constituent pack may exist only in a

conceptual form or it may also be a saleable/available AMPP.

An AMPP cannot exist without a parent AMP

NameThe current name in full and short Semantic Normal Form.

Availability


RegulationInformation on regulatory restrictions and rules about the product such as Legal

Category, restrictive formularies, allowed prescription forms etc.

Reimbursement

Information on reimbursement including indicative price

Component FlagIndicates if the pack is normal, a compound pack or a constituent pack.

AMPP

AMPP_AMP

Links a set of AMPPs to

their “parent” AMP.

Each AMPP must link to

one and only one AMP.

Each AMP must have one

or more AMPPs

A VMPP is the conceptual representation of each and every AMPP that exists for the

linked AMPs. This includes a conceptual representation of AMPPs that exist to

represent the components of a compound AMPP.

A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP

Name

A description of the pack in full and shortened Semantic Normal Forms.

Size

The size of the pack is described in quantity and units.

Reimbursement

Information on reimbursement including “official” reimbursement price where it exists.

Component Flag

Indicates if the pack is normal, a compound pack or a constituent pack.

VMPP

AMPP_VMPP

Links a set of AMPPs to the corresponding VMPP

Each AMPP must have one and only one VMPP

Each VMPP may be linked to one or more AMPPs

VMPP_VMP

A VMPP is linked to one and

only one VMP

A VMP must have one or

more VMPPs

ChildVMPP_ParentVMPP

A recursive link from a constituent child VMPP to the corresponding parent

compound VMPP

Each Child VMPP must have one and only one Parent VMPP

Each Parent VMPP may be linked to one or more CHILD VMPPs

ChildAMPP_ParentAMPP

A recursive link from a constituent child AMPP to the corresponding parentcompound AMPP

Each Child AMPP must have one and only one Parent AMPP

Each Parent AMPP may be linked to one or more CHILD AMPPs

The “Five Core Classes” of dm+d

VMP_VTM



be linked to a VTM or it maybe linked to one VTM.


one or more VMPs

A VMP is the conceptual representation of one or more clinically equivalent ActualMedicinal Products the purpose of which is to support the representation of thefundamental reality of the concept. Its core description requires product name, strength

and dosage form, but is devoid of explicit or implicit information attributable tomanufacturer or pack.


NameThe current name in full and short Semantic Normal Form together with the officialsource of the name, a previous name and reasons for change

HideNameIf this flag is set the name is hidden from view

PrescribabilityIndicates if product should not be prescribed by VMP

Freeness


RegulationInformation on regulatory restrictions and rules about the product such as Controlled

Drug Schedule


VMP

A VTM is the abstract conceptualrepresentation of the material defining theprescriber's therapeutic intent, divorced fromformulation, dose or strength.


Name


VTM

An AMP is the representation of a single unit dose of a medicinal product that is (or hasbeen) made or marketed by a specific manufacturer or supplier. Its core descriptionrequires product name, strength, dosage form and manufacturer, but is devoid ofexplicit information attributable to pack size.

The unit dose is the smallest single entity of the product that can be physicallyhandled with the following defined deviations:

Continuous liquids excluding eye-drops : where the unit dose is expressed interms of the accepted normal sub-unit used as the basis of administration



measurable unit or sub-unit cannot be defined and which is therefore notinstantiated.


NameThe current name in full and short Semantic Normal Form, a previous value and reasonfor change. Each flavour of a AMP has a separate entry.

AvailabilityThe licence and “specials” status.

Regulation

Information on reglatory restrictions and rules about the product such as CSMnotification.

Reimbursement



AMP

AMP_VMP




An AMPP is the representation of each and every saleable/available pack (container ofdose units) of an AMP, in terms of description of quantity, of how many 'dose units' ofthe AMP (or weight, for solids and semi-solids) are present in the pack.

An AMPP may also be the representation of the number of “dose units” of an AMPpresent as a constituent of a compound pack. This constituent pack may exist only in aconceptual form or it may also be a saleable/available AMPP.



Availability




Reimbursement



AMPP

AMPP_AMP

Links a set of AMPPs totheir “parent” AMP.



Each AMP must have oneor more AMPPs

A VMPP is the conceptual representation of each and every AMPP that exists for thelinked AMPs. This includes a conceptual representation of AMPPs that exist torepresent the components of a compound AMPP.


Name


SizeThe size of the pack is described in quantity and units.

ReimbursementInformation on reimbursement including “official” reimbursement price where it exists.


VMPP

AMPP_VMPP




VMPP_VMP

A VMPP is linked to one andonly one VMP


more VMPPs


A recursive link from a constituent child VMPP to the corresponding parentcompound VMPP


Each Parent VMPP may be linked to one or more CHILD VMPPsChildAMPP_ParentAMPP




Using the dm+d codes for Pharmacy CMETs

Propose Promise Request Event

Medicine Entity Code (Ordered Medicine)

VTM, VMP, VMPP, AMP, AMPP



AMPP

Supplied Medicine Entity Code (Supplied Medication)

AMPP AMPP AMPP AMPP

dm+d – Supporting Attribute Vocabulary

VMP_Form

Links a VMP to its dose form.

Every VMP that is a drug has exactly

one dose form.

A dose form may not be linked to a

VMP or it may be linked to oneor many

VMP_VTM



be linked to a VTM or it may

be linked to one VTM.


one or more VMPs

10/11/2003Blue WaveInformatics

ver 2.0c

dm +d Object Model

Change History:V2.0a - First version in this layout

v2.0b - Added constituent pack concepts

v2.0c - Removed incorrect coments on history from

suppliers and supplier llink

A VMP is the conceptual representation of one or more clinically equivalent Actual

Medicinal Products the purpose of which is to support the representation of thefundamental reality of the concept. Its core description requires product name, strength

and dosage form, but is devoid of explicit or implicit information attributable to

manufacturer or pack.


Name

The current name in full and short Semantic Normal Form together with the official

source of the name, a previous name and reasons for change

HideName

If this flag is set the name is hidden from view

Prescribability

Indicates if product should not be prescribed by VMP

Freeness


Regulation

Information on regulatory restrictions and rules about the product such as Controlled

Drug Schedule


VMP

A VTM is the abstract conceptual

representation of the material defining the

prescriber's therapeutic intent, divorced fromformulation, dose or strength.


Name


VTM

Dictionary of terms for the

physical conformation of thedrug as normally dispensed.

A Dose Form may be

orphaned from any VMP

NameA description of the dose form.

DoseForm

List of ingredients and excipients .

Note Within the file of ingredient substances will

be entries relating to the following:-

1) Complete substances which act as actual

ingredients of medicinal products. For example:

heparin sodium or cyclizine lactate (as distinct from

heparin and cyclizine). This class of substances

may or may not be a salt or other type ofderivative.-

2) Base substances which may or may not be

available as actual ingredients. For example,

heparin or cyclizine.

An ingredient may be orphaned from any VMP or

AMP or from another parent or base ingredient.

Name

Name of the ingredient - no history or short forms

Base Ingredient

For salts etc a recursive pointer to the base

ingredient.

Ingredients

VMP_Ingredient

Links VMP to the set of active ingredientscommon to the AMPs linked to the VMP

For each link the quantity of the ingredient or

of its base is stored.

A VMP may have no ingredients attached orit may have one or more.

An ingredient may not be be attached to any

VMP or it may be attached to one or more.

StrengthAn indication of the quantity of the ingredient

in the product

Strength Basis

An indication of whether the strength refers

to the ingredient or its base

An AMP is the representation of a single unit dose of a medicinal product that is (or has

been) made or marketed by a specific manufacturer or supplier. Its core description

requires product name, strength, dosage form and manufacturer, but is devoid of

explicit information attributable to pack size.

The unit dose is the smallest single entity of the product that can be physically

handled with the following defined deviations:

Continuous liquids excluding eye-drops : where the unit dose is expressed in

terms of the accepted normal sub-unit used as the basis of administration



measurable unit or sub-unit cannot be defined and which is therefore not

instantiated.


NameThe current name in full and short Semantic Normal Form, a previous value and reason

for change. Each flavour of a AMP has a separate entry.

Availability


Regulation

Information on reglatory restrictions and rules about the product such as CSM

notification.

Reimbursement


Component Flag

Indicates if the product is normal, a compound product or a constituent product.

AMP

AMP_Ingredient

Links AMPs to ingredients marked as

“Interesting Excipients”.

The quantity of ingredient is not stored.

An AMP may be linked to no ingredientsor to one or more.

An ingredient may not be linked to any

AMP or it may be linked to one or more.

AMP_VMP




A licensed route of administration

of a medicinal product.

A route may be orphaned from any

VMP or AMP.

NameDescription of the route of

administration

Route

VMP_Route

Links VMP to the set of licensed routes

common to the AMPs linked to the VMP.

A VMP may have no routes linked, or itmay be linked to one o r more routes.

A route may not be linked to any VMP or

it may be linked to one or more VMPs

AMP_Route

Links an AMP to the set of routes that have

been licensed for the product.

An AMP may have no linked Routes or it may

have one or more routes.

A route may not be linked to any AMP or

it may be linked to one or more AMPs

A list of Suppliers of medicinal products. The name

used will be that which appears on the productpackage and may be a manufacturer, a wholesaler

or a marketing agent.

A supplier may be an orphan with no link to anAMP or to another supplier.

Name

The name of the supplier together with a previous

name for that company

Suppliers

AMP_Suppliers

Links a set of AMPs to the company that

supplies them.

Each AMP is supplied by one and

only one supplier.

A Supplier may not have any AMPs or it may

have one or more products.

An AMPP is the representation of each and every saleable/available pack (container of

dose units) of an AMP, in terms of description of quantity, of how many 'dose units' of

the AMP (or weight, for solids and semi-solids) are present in the pack.

An AMPP may also be the representation of the number of “dose units” of an AMPpresent as a constituent of a compound pack. This constituent pack may exist only in a

conceptual form or it may also be a saleable/available AMPP.



Availability




Reimbursement



AMPP

AMPP_AMP

Links a set of AMPPs to

their “parent” AMP.



Each AMP must have one

or more AMPPs

A VMPP is the conceptual representation of each and every AMPP that exists for the

linked AMPs. This includes a conceptual representation of AMPPs that exist to

represent the components of a compound AMPP.


Name


Size

The size of the pack is described in quantity and units.

Reimbursement

Information on reimbursement including “official” reimbursement price where it exists.

Component Flag

Indicates if the pack is normal, a compound pack or a constituent pack.

VMPP

AMPP_VMPP




VMPP_VMP

A VMPP is linked to one and

only one VMP


more VMPPs


A recursive link from a constituent child VMPP to the corresponding parent

compound VMPP


Each Parent VMPP may be linked to one or more CHILD VMPPs

ChildAMPP_ParentAMPP




Dose Form vocabulary

Ingredient vocabulary

Route of Administrati

on vocabulary

Manufacturer or

supplier vocabulary

Dosage Syntax

• A deliverable from a separate UKCPRS/HL7 Med Info SIG workstream– A standardised, modelled structure and vocabulary to

describe medication dosage for electronic systems– Will “fit” into the Substance Administration act sections to

message dosage instructions

Questions???

Thank you

hl7 medication and ukcprs julie james partner blue wave informatics

Documents