the evolution of pharmacy messages hl7 uk conference 2 november 2004 hugh glover, bsc, phd partner,...

The Evolution of Pharmacy Messages HL7 UK Conference2 November 2004

Hugh Glover, BSc, PhDPartner, Blue Wave Informatics LLP

[email protected]

Basics

• Information for Health proposes using IT to better share patient record

• Must interface different systems together• How many interfaces do we need?

– 2 Systems = 1 Interface– 3 Systems = 3 Interfaces– 4 Systems = 6 Interfaces– n Systems = n*(n-1)/2 Interfaces– 15 GP Pharmacy Systems = 105 Interfaces– 250 Trusts = 31,125 Interfaces

• Something has to be done!

HL7 v3 as a “standard”

• NHS made a judgement that HL7 v3 was the way to go• No domains had passed ballot

BUT• The RIM was on the point of passing ballot

Do Domains Matter?dotORG Ballot

Basic• Refinement & Localisation• RIM• Vocabulary• Data Types: Abstract• XML ITS• UML ITS• Transport Specifications

– ebXML– MLLP– Web Services

• Gello• Common Terminology Services• Common Domains

– Shared Messages– CMETS

• Infrastructure Management– Transmission– Message Control Act– Query– Master File

UK MIMBasic• Infrastructure• CMETs• Data Types• VocabularyBusiness Process Specific• LRs• PDS• PSIS Query


• Admin Management– Account Billing– Claims & Reimbursement– Patient Administration– Personnel Management– Scheduling

• Health & Clinical Management– CDA– Blood Bank– Laboratory– Clinical Genomics– Medical Records– Care Provision– Pharmacy– Public Health reporting– Informative Public Health Specs– Regulated Studies– Therapeutic Devices

UK MIMMainstream• Accident & Emergency• Diagnostic Imaging• eBooking• Emergency Admissions• GP2GP• Medication Management• Mental Health• NHS Direct• OOP Appointments• Out of Hours• Provision of Care• Single Assessment

Pharmacy is a Domain Exemplar

• Giving a patient medicine is understood by all• It is the first example that springs to mind

– RIM Definitions are frequently in terms of drug administration

… What has happened?

Pharmacy DMIM 2002

DISPENSE EVENTDISPENSE INTENT

ADMIN INTENT

DISPENSE ORDER

ADMIN EVENT

ADMIN ORDER

DISPENSE PROPOSAL

ADMIN PROPOSAL

0..* a_Substance_admin_event

0..1 priorA_Substance_administration_order

typeCode*: <= FLFSinFulfillmentOf1 / fulfillment1

0..* a_Supply_event

0..1 priorA_Supply_order

typeCode*: <= FLFSinFulfillmentOf1 / fulfillment1

0..1 priorA_Other_admin_ord

typeCode*: <= FLFSinFulfillmentOf1

0..1 priorA_Other_supply_ordtypeCode*: <= FLFS

inFulfillmentOf1

0..* subjectA_ConfirmationtypeCode*: <= PERTpertainsTo1

0..* a_AlerttypeCode*: <= TRIGtriggerFor



0..1 a_Prescription

0..* a_Substance_administration_order

typeCode*: <= COMPcomponent / componentOf1

0..* pertinentA_ObservationSupporting

typeCode*: <= PERT

pertinentInformation

0..* a_SubstanceRoute *

typeCode*: <= OPTNoption1

0..* subjectA_ObservationAnnotationtypeCode*: <= PERTpertainsTo1

0..* a_Formulary

typeCode*: <= INSTdefinition

0..* priorA_Other_supply_int

typeCode*: <= SUCCpredecessor

0..* a_Other_supply_inttypeCode*: <= SUCCsuccessor

0..* subjectA_ObservationAnnotationtypeCode*: <= PERTpertainsTo


0..* a_Encounter

typeCode*: <= COMP

componentOf


typeCode*: <= COMPcomponent1

0..* a_EncountertypeCode*: <= COMP

componentOf

0..* a_Formulary


0..* justifyingA_Observation_indication

typeCode*: <= RSONreason



0..* a_Observation_criteriapreconditiontypeCode*: <= PRCN+OUTCcheckpointCode:negationInd:conjunctionCode:

0..* a_Sub_admin_order

component1typeCode*: <= COMPsequenceNumber*: [1..1]priorityNumber:pauseQuantity: (e.g. 1s)splitCode:joinCode:

0..* priorA_Other_admin_ord


0..* a_Other_admin_ordtypeCode*: <= SUCCsuccessor


typeCode*: <= PERT


0..* a_Observation_criteria

preconditiontypeCode*: <= PRCN+OUTCcheckpointCode:negationInd:conjunctionCode:

0..* a_Substance_admin_master


0..* a_EncountertypeCode*: <= COMPcomponentOf2


typeCode*: <= PERTpertinentInformation

0..* a_Sub_administration

component2typeCode*: <= COMPsequenceNumber*: [1..1]




0..* priorA_Other_supply_ord


0..* a_Other_supply_ordtypeCode*: <= SUCCsuccessor


0..* a_Sub_admin_intent


0..* priorA_Other_admin_int


0..* a_Other_admin_inttypeCode*: <= SUCCsuccessor





0..1 a_Substance_admin_order_dose *


0..1 a_Substance_admin_order_dose *

typeCode*: <= OPTNoption

0..1 a_Substance_admin_intent_dose *


0..1 a_Substance_admin_intent_dose *


0..* a_Substance_admin_intent


typeCode*: <= FLFSinFulfillmentOf / fulfillment2


0..* a_Substance_admin_event

0..1 priorA_Substance_admin_intent

typeCode*: <= FLFSinFulfillmentOf2 / fulfillment


0..* a_Supply_order

typeCode*: <= COMP

component2 /componentOf

0..* a_Supply_intent


typeCode*: <= FLFSinFulfillmentOf / fulfillment2

0..* a_Substance_admin_intent

0..* a_Supply_intent

typeCode*: <= COMP


0..* a_Supply_event

0..1 priorA_Supply_intent




0..1 a_Substance_admin_intent

typeCode*: <= TRIGtrigger




0..* a_Formulary


0..* justifyingA_Observation_indication

typeCode*: <= RSONreason




0..* a_Sub_admin_proposal



typeCode*: <= PERT






0..* a_EncountertypeCode*: <= COMPcomponentOf


0..1 a_Substance_admin_proposal_dose *


0..1 a_Substance_admin_proposal_dose *


0..* a_Substance_administration_proposal

0..* a_Supply_proposal

typeCode*: <= COMP



0..1 priorA_Substance_administration_proposal


0..* a_Supply_order

0..1 priorA_Supply_proposal


inFulfillmentOf3 / fulfillment30..* a_Substance_administration_order


typeCode*: <= FLFS

inFulfillmentOf3 / fulfillment30..* a_Supply_order


typeCode*: <= FLFS

component

0..* a_Sub_administration

typeCode*: <= COMPsequenceNumber*: [1..1]

component

0..* a_Sub_admin_intent

typeCode*: <= COMPsequenceNumber*: [1..1]priorityNumber:pauseQuantity: (e.g. 1s)splitCode:joinCode:

revisionOf / revision 0..* a_Substance_admin_intent

0..* priorA_Substance_admin_intent

typeCode*: <= RVSN

revisionOf / revision 0..* a_Supply_intent

0..* priorA_Supply_intent

typeCode*: <= RVSN

component

0..* a_Sub_admin_order


revisionOf / revision 0..* a_Supply_order

0..* priorA_Supply_order

typeCode*: <= RVSN

revisionOf / revision 0..* a_Substance_administration_order

0..* priorA_Substance_administration_order

typeCode*: <= RVSN

component

0..* a_Sub_admin_proposal


Note:Need to figure out howto represent proposalsto supercede/revise anorder.

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

Note:This Act represents the dosageinstructions for a substanceadministration order.

Note:Used to refererencepharmacy protocolsgoverning how a drugshould be prescribed/administered.

Note:Administration instructions providedat time of dispensing



Note:Body weight,Surface Area,Allergies,Medical conditions


Note:For 'change' orders:If Substance_admin_order.id is null,P_subject and Substance_admin_order.cdmust be specified.Otherwise, this information is notrequired. If specified, it mustcorrespond with the specifiedSubstance_admin_order.id.


Note:This Act represents the dosageinstructions for a substanceadministration order.



Constraint:must have at leastdose_qty or txt

Constraint:cd and value or txt mustnot be null


Constraint:Either 'qty' or'expected_use_period'must be present.







A_Other_admin_ordclassCode*: <= SBADMmoodCode*: <= ORDid*: [1..*]

A_Other_supply_ordclassCode*: <= SPLYmoodCode*: <= ORDid*: [1..*]

A_Other_supply_intclassCode*: <= SPLYmoodCode*: <= INTid*: [1..*]

A_Substance_admin_order_doseclassCode*: <= SBADMmoodCode*: <= ORDtext*: STeffectiveTime: (SIG timing)repeatNumber:doseQuantity: IVL<PQ>rateQuantity: IVL<PQ> (e.g. 1 s)doseCheckQuantity: SET<RTO<PQ,PQ>>maxDoseQuantity: SET<RTO<PQ,PQ>>

A_Substance_admin_intent_doseclassCode*: <= SBADMmoodCode*: <= INTtext*: STeffectiveTime: (SIG timing)repeatNumber:doseQuantity: UVP<PQ>rateQuantity: UVP<PQ> (e.g. 1 s)doseCheckQuantity: SET<RTO<PQ,PQ>>maxDoseQuantity: SET<RTO<PQ,PQ>>

A_PrescriptionclassCode*: <= ACTmoodCode*: <= ORDid*:

A_Supply_intentclassCode*: <= SPLYmoodCode*: <= INTid: (defaults to Sub_admin_order.id)code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used toindicate authorization for trial/partial dispense)text: (pharm. instructions)effectiveTime: (Earliest/last allowed dispense, frequencyrestrictions, etc.)confidentialityCode:repeatNumber: INT "1" (# refills + 1)quantity*: PQ [1..1]expectedUseTime: (days supply)

A_Sub_admin_intentclassCode*: <= SBADMmoodCode*: <= INTid: (sub-order id)code: <= drugTreatmenttext:priorityCode:independentInd:

A_Observation_criteriaclassCode*: <= OBSmoodCode*: <= EVN.CRTcode: CE <= ObservationTypetext*:effectiveTime:value:

A_Substance_admin_masterclassCode*: <= SBADMmoodCode*: <= DEFid*: [1..*] (catalogue #)

A_Other_admin_intclassCode*: <= SBADMmoodCode*: <= INTid*: [1..*]

A_Substance_admin_intentclassCode*: <= SBADMmoodCode*: <= INTid*: (placer number, filler number, etc.)code*: [1..1] <= ManufactureddrugTreatment (clinical drug)text: EDstatusCode: "ACTIVE"priorityCode:confidentialityCode: "N"independentInd: "FALSE"substitutionCode:

A_Substance_admin_eventclassCode*: <= SBADMmoodCode*: <= EVNid: (filler number.counter?)code*: <= ManufactureddrugTreatment (clinical drug)negationInd*: "False" (not administered)text: EDstatusCode: = COMPLETEDeffectiveTime*: (Admin. time)priorityCode:confidentialityCode:repeatNumber:doseQuantity*: PQrateQuantity: PQ (e.g. 1 s)substitutionCode:

A_Supply_eventclassCode*: <= SPLYmoodCode*: <= EVNcode: <= ActPharmacySupplyType (partial fill/trial/completion of trial, etc.)effectiveTime*: TS (dispense time.)confidentialityCode:quantity*: PQ [1..1]expectedUseTime: (days supply)

A_Observation_indicationclassCode*: <= OBSmoodCode*: <= EVNid: (used for future maintenance)code*: [1..1] <= DiagnosisCodes (admitting Dx, Billing Dx, family Hx, etc.)statusCode: (Complete, Superceded)effectiveTime:confidentialityCode:value*: UVP<CD> CWE (e.g. ICD9)targetSiteCode:

A_FormularyclassCode*: <= SPLYmoodCode*: <= DEFid*: [1..*] (catalogue #)

A_Sub_admin_orderclassCode*: <= SBADMmoodCode*: <= ORDid: (sub-order id)code: <= drugTreatmenttext:priorityCode:independentInd: "FALSE"



A_Sub_administrationclassCode*: <= SBADMmoodCode*: <= EVNcode*: <= ManufactureddrugTreatmentnegationInd*: "False" (not administered)text: EDeffectiveTime*: (admin. time)priorityCode:repeatNumber:doseQuantity*: PQrateQuantity: PQ (e.g. 1 s)A_Other_admin_ord

classCode*: <= SBADMmoodCode*: <= ORDid*: [1..*]

A_Substance_administration_orderclassCode*: <= SBADMmoodCode*: <= ORDid*: (placer number, etc.)code*: <= drugTreatment (clinical drug)text: EDstatusCode*: "ACTIVE"priorityCode:confidentialityCode: "N"substitutionCode:

A_Supply_orderclassCode*: <= SPLYmoodCode*: <= ORDid: (defaults to Sub_admin_order.id)code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used toindicate authorization for trial/partial dispense)text: (pharm. instructions)effectiveTime: (Earliest/last allowed dispense, frequencyrestrictions, etc.)confidentialityCode:repeatNumber: INT "1" (# refills + 1)quantity*: PQ [1..1]expectedUseTime: (days supply ordered)

A_Other_supply_ordclassCode*: <= SPLYmoodCode*: <= ORDid*: [1..*]


A_Substance_admin_proposal_doseclassCode*: <= SBADMmoodCode*: <= PRPtext*: STeffectiveTime: (SIG timing)repeatNumber:doseQuantity: IVL<PQ>rateQuantity: IVL<PQ> (e.g. 1 s)doseCheckQuantity: SET<RTO<PQ,PQ>>maxDoseQuantity: SET<RTO<PQ,PQ>>

A_Observation_indicationclassCode*: <= OBSmoodCode*: <= EVNid: (used for future maintenance)code*: [1..1] <= DiagnosisCodes (admitting Dx, Billing Dx, family Hx, etc.)statusCode: (Complete, Superceded)effectiveTime:confidentialityCode:value*: UVP<CD> CWE (e.g. ICD9)targetSiteCode:


A_Sub_admin_proposalclassCode*: <= SBADMmoodCode*: <= PRPid: (sub-order id)code: <= drugTreatmenttext:priorityCode:independentInd: "FALSE"



A_Substance_administration_proposalclassCode*: <= SBADMmoodCode*: <= PRPid*: (placer number, etc.)code*: <= drugTreatment (clinical drug)text: EDstatusCode*: "ACTIVE"priorityCode:confidentialityCode: "N"substitutionCode:

A_Supply_proposalclassCode*: <= SPLYmoodCode*: <= PRPid: (defaults to Sub_admin_order.id)code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used toindicate authorization for trial/partial dispense)text: (pharm. instructions)effectiveTime: (Earliest/last allowed dispense, frequencyrestrictions, etc.)confidentialityCode:repeatNumber: INT "1" (# refills + 1)quantity*: PQ [1..1]expectedUseTime: (days supply ordered)

Pharmacy Administration Intent(N/A)

Used as an entry-point when creatingor otherwise manipulating a pharmacyintent.

Supply Intent(N/A)

Used as an entry-point for messagesthat revise or create a supply intent,independent of an administration intent.

Pharmacy Administration Order(N/A)

Used as an entry-point when creatingor otherwise manipulating a pharmacyorder.

Pharmacy Administration Event(N/A)

Used as an entry-point for messagesrelated to Administration events

Supply Event(N/A)

Used as an entry-point for messagesrelating to dispense (supply) events

Supply Order(N/A)

Used as an entry-point for messagesthat revise or create a supply order,independent of an administration order.

NOTE: This message is NOT used forbulk-supply scenarios

Pharmacy Administration Proposal(N/A)

Used as an entry-point when proposingthe creation or manipulation of a pharmacyorder.

Pharmacy Supply Proposal(N/A)

Used as an entry-point for messagesthat propose the revision or replacementof a supply order, independent of anadministration order. Generally usedfor requests to extend prescriptionend date or number of renewals

CMET: (PAT) R_Patient[universal]

(COCT_MT050000)


(COCT_MT050000)


(COCT_MT050000)CMET: (PAT) R_Patient[universal]

(COCT_MT050000)

CMET: (AUTH) A_Confirmation

[universal](COCT_MT270000)



CMET: (ALRT) A_Alert




CMET: (OBS) A_ObservationAnnotation

[detailed](COCT_MT120401)











CMET: (ASSIGNED) R_AssignedPerson

[identified](COCT_MT090102)


[detailed](COCT_MT090101) CMET: (MANU)

R_MaterialMedPackaged[universal]

(COCT_MT220000)

CMET: (ROL) R_Location

[hcfac](COCT_MT070103)

0..*

CMET: (CONT) R_MaterialMedProduct


0..*



0..*

CMET: (SBADM) A_SubstanceRoute










CMET: (ASSIGNED) R_AssignedDevice


CMET: (OBS) A_ObservationSupporting



(COCT_MT050000)

CMET: (ENC) A_Encounter






0..*

CMET: (MANU) R_MaterialMedPackaged




0..*









0..*









0..*



0..*















0..*








































(COCT_MT050000)








(COCT_MT050000)















0..*







0..*







0..*


















(COCT_MT050000)

1..* patient

subjecttypeCode*: <= SBJtime: (availability time)

1..* patient


1..* patient

subjecttypeCode*: <= SBJtime: (availability time)1..* patient


0..* content

typeCode*: <= CSMconsumable

1..* participant *

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

0..* participant

verifiertypeCode*: <= VRF+SPVtime*: (verification or attestation)modeCode:signatureCode:signatureText:

0..* participant

dataEnterertypeCode*: <= ENTtime: (time recorded)

0..* participant

callBackContacttypeCode*: <= CBCtime: (availability time)

0..* participant

typeCode*: <= DSTdestination

1..* manufacturedProduct *

typeCode*: <= PRDproduct

0..* participant


0..* participant


0..* participant


0..* participant


0..* participant


0..* participant


0..* participant

performertypeCode*: <= PRFsignatureCode:signatureText:

0..* participant

performertypeCode*: <= PRFsignatureCode:signatureText:

0..* participant


1..* participant *


0..* participant

typeCode*: <= RCVreceiver

0..* participant


0..* participant


0..* participant


1..* patient *subjecttypeCode*: <= SBJtime: (availability time) 0..* participant


0..* participant


0..* participant


0..* content


0..* participant

typeCode*: <= ORG+DSTorigin



0..* content


0..* participant

assistantPerformertypeCode*: <= ASS+VRF+WIT+SPVtime*: (time of verification or attestation)modeCode:signatureCode:signatureText:

0..* participant


0..* participant


0..* participant

assistantPerformertypeCode*: <= ASS+VRF+WIT+SPVtime*: (time of verification or attestation)modeCode:signatureCode:signatureText:

0..* participant


0..* participant


0..* participanttypeCode*: <= LOC

location



1..* patient *subjecttypeCode*: <= SBJtime: (availability time)

0..* participant


1..* patient


0..* participant


0..* participant


0..* participant


1..* participant *


0..* participant


0..* participant


0..* participant


1..* patient *subjecttypeCode*: <= SBJtime: (availability time) 0..* participant


0..* participant


0..* participant


0..* content




R_Assigned_practitioner_or_device

R_Assigned_practitioner



R_Assigned_practitioner_or_deviceR_Assigned_practitioner_or_device




R_Agent








Pharmacy DMIM 2003

Institutional Supply Order(PORX_RM222000)

Supply promise in an institutional setting

0..* subjectCoveragetypeCode*: <= PERTpertainsTo

0..* alerttypeCode*: <= TRIGtriggerFor

0..* formulary


0..* justifyingObservationIndication

typeCode*: <= RSONreason2

0..* encountertypeCode*: <= COMPcomponentOf1


Note:This Act represents the core of the act ofordering a medication and administering to apatient. It directly holds the route and dosageinstructions.

ObservationIndicationclassCode*: <= OBSmoodCode*: <= EVNid: (used for future maintenance)statusCode: (Complete, Superceded)effectiveTime:confidentialityCode:value*: CE CWE [0..1] <= ObservationValue (e.g. ICD9)targetSiteCode:

FormularyclassCode*: <= SPLYmoodCode*: <= DEFid*: [1..*] (catalogue #)

ObservationCriteriaclassCode*: <= OBSmoodCode*: <= EVN.CRTcode: CE CWE <= ObservationTypetext*:effectiveTime:value:

MedicationAdministrationclassCode*: <= SBADMmoodCode*: <= 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>>

MedicationSupplyclassCode*: <= SPLYmoodCode*: <= ActMoodid: (defaults to Sub_admin_order.id)code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used to indicate authorizationfor 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






CMET: (LOCE) R_LocationLocatedEntity


0..* playedRole





0..* playedRole











0..* locatedEntity


0..* assignedEntity

overseertypeCode*: <= x_ParticipationVrfRespSprfWitmodeCode:signatureCode:signatureText:

0..* participant

author2typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:

1..* participant *

author2typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:

0..* assignedEntity

dataEnterertypeCode*: <= ENT

0..* assignedEntity

author1typeCode*: <= AUT

0..* assignedEntity

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

0..* assignedEntity

dataEnterertypeCode*: <= ENT

0..* assignedEntity

author1typeCode*: <= AUT

0..* medication


1..* aRole *


0..* participant

typeCode*: <= PRFsignatureCode: <= ParticipationSignaturesignatureText:

performer

0..* locatedEntity

typeCode*: <= LOClocation

0..* pertinentCoverage


0..* locatedEntity

typeCode*: <= ORGorigin



0..* assignedEntity


0..* a_SubstanceAdminMaster



A_SubstanceAdminMasterclassCode*: <= SBADMmoodCode*: <= DEFid*: [1..*] (catalogue #)

Pharmacy Domain ModelPORX_DM000000 v11.1

20 March 2003

Updated to Rim 2.02

Note:Eg: Use dose of 50mgif pulse <40bpmorGive medication untilpain relieved

0..* pertinentObservationDx


Note:Observations that supportthe decision on which medicationor what dose to use.Eg Body weight, Surface Area,Allergies, Medical conditions

CMET: (OBS) A_ObservationDx

[minimal](COCT_MT120104)


(COCT_MT050000)

1..* patient *

subjecttypeCode*: <= SBJ

Note:The medication ordered or administeredto the patient.Eg Amoxicillin 250mg Tablets.

Will normally be specialised to Kind

Note:The patient who is goingto receive the medication

Note:The header for the visitto 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 incommunity 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 clarificationtypically the same as the Author.

Note:Identifies information about an eligibilitycheck or authorization that has beenreceived in relation to an action. It is initiatedfrom the Supply and provides confirmationback to the SubstanceAdministration

Note:Intended to identify problems orwarnings associated with an Actthat have previously been evaluatedand discounted.

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

Note:Who confirmed the supplytypically a pharmacist

Note:Who entered the data sayingwhat the supply is

Note:Who should be called for clarificationtypically the same as the Author.

Note:Who wrote the supply requesttypically the doctor who wrotethe medication order,but could also be a nurseor 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

Will normally be specialised to instance

Note:For a supply, where the supplycame from and where it was sent to.Eg Pharmacy, Ward

Note:This act represents the act of supplyingmedication 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 oforders or administrations that formpart of a series whether scheduledor 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 ofsupply acts that formpart of a series whether scheduledor not or where an order fulfills partof a previous order.

0..* participant

typeCode*: <= PRFsignatureCode: <= ParticipationSignaturesignatureText:

performer

Note:Changed fromCOCT_MT070103, but is the the correct CMET?

Note:Need to redo diagnosis code

0..* locatedEntity


0..1 justifiedMedicationAdministration *

0..* justifyingMedicationSupply *

typeCode*: <= RSON

reason1 /reasonOf

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 revisionof an order

Note:Allows relation of differentmoods of the act.

AssignedPractitionerOrDevice

AssignedPractitionerOrDevice

Note:See Q&A 31

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

0..* medicationAdministrationInstructions


Community Supply Event(PORX_RM124000)

Supply Event in a community setting

Institutional Combined Order(PORX_RM232000)

Administration and Supply Orderin 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 Orderin 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

outcometypeCode*: <= OUTCcheckpointCode:negationInd:conjunctionCode:

0..* observationCriteria

preconditiontypeCode*: <= PRCNcheckpointCode:negationInd:conjunctionCode:

CMET: (MMAT) E_Medication


1..1 manufacturedMedication

MedicationclassCode*: <= MANU


MedicationDispensedclassCode*: <= MANU



Pharmacy Combined Order RMIM 2004

0..* subjectCoveragetypeCode*: <= PERTpertainsTo

0..* encountertypeCode*: <= COMPcomponentOf


Note:This Act represents the core of the act ofordering a medication and administering to apatient. It directly holds the route and dosageinstructions.

MedicationAdministrationRequestclassCode*: <= SBADMmoodCode*: <= RQOid*: (placer number, etc.)text: (Summary of act - special instructions are in a separate component 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>>

MedicationSupplyclassCode*: <= SPLYmoodCode*: <= RQOid:code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used to indicate authorization for trial/partial dispense)text: (pharm. instructions)effectiveTime: (Date & time of dispensing)confidentialityCode:repeatNumber: INT "1" (ie this is issue 3 (of 5)quantity*: [1..1]expectedUseTime: (days supply ordered)

CMET: (COV) A_Coverage






0..* playedRole



0..* playedRole





0..* locatedEntity


0..* assignedEntity

verifiertypeCode*: <= VRFmodeCode:signatureCode:signatureText:

1..* assignedEntity *


0..* medication

typeCode*: <= TPAtherapeuticAgent

1..* medicationDispensed *


0..* locatedEntity

typeCode*: <= LOClocation

0..* pertinentCoverage


0..* locatedEntity

typeCode*: <= ORGorigin



0..* assignedEntity


0..* pertinentObservationDx


Note:Observations that supportthe decision on which medicationor what dose to use.Eg Body weight, Surface Area,Allergies, Medical conditions

CMET: (OBS) A_ObservationDx

[minimal](COCT_MT120104)


(COCT_MT050000)

1..* patient *


PrescriptionHeaderclassCode*: <= SBADMmoodCode*: <= RQOid*: [1..1]text:

Note:The medication to be administeredto the patient.Eg Amoxicillin 250mg Tablets

Note:The patient who is goingto receive the medication

Note:The header for the visitto the primary care physicianor a particular hospital stay.Includes information on therelevant financial account

Note:Who wrote the order,typically a doctor

Note:Identifies information about an eligibilitycheck or authorization that has beenreceived in relation to an action. It is initiatedfrom the Supply and provides confirmationback to the SubstanceAdministration

Note:Who confirmed the supplytypically a pharmacist

Note:Who receives 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 supplycame from and where it was sent to.Eg Pharmacy, Ward

Note:This act represents the act of supplyingmedication to a patient or their representative.It does NOT deal with administering it to the patient.

0..* locatedEntity


0..* justifyingMedicationSupply *

typeCode*: <= RSON

reason

Community Combined Request - RMIMPORX_RM132000

20th March 2004

Updated to Rim 2.01

0..* medicationAdministrationRequest

typeCode*: <= COMPcomponent

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



CombinedCommunityRequest(PORX_RM132000)


MedicationSupplyInstructionsclassCode*: <= SPLYmoodCode*: <= RQOtext: (Additional free text instructions)

0..* medicationSupplyInstructions



0..* priorPriorPrescriptionHeaderRequest


PriorPrescriptionHeaderRequestclassCode*: <= SBADMmoodCode*: <= RQOid*: [1..1]


0..* priorPriorMedicationAdministrationRequest


PriorMedicationAdministrationRequestclassCode*: <= SBADMmoodCode*: <= RQOid*: [1..1]


0..* priorPriorMedicationSupplyOrder


PriorMedicationSupplyOrderclassCode*: <= SBADMmoodCode*: <= RQOid*: [1..1]

CMET: (MMAT) E_Medication[identifiedKind](COCT_MT231101)




MedicationDispensedclassCode*: <= MANU


[identifiedInstance](COCT_MT231201)

NPfIT MIM 3.1.01 – Parent Prescription

MedicationAdministrationRequestclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1] (item ID)effectiveTime: GTS [0..1]routeCode: CV CNE [0..1] <= SnomedRouteOfAdministration (VOCAB VARIANT)approachSiteCode: CV CNE [0..1] <= SnomedActSite (Must have a route to go with) (VOCAB VARIANT)doseQuantity: IVL<PQ> [0..1]rateQuantity: IVL<PQ> [0..1]

MedicationSupplyclassCode*: <= SPLYmoodCode*: <= RQOrepeatNumber: IVL<INT> [0..1]quantity*: PQ [1..1]expectedUseTime: IVL<TS> [0..1] (days supply ordered)


[prescriber](COCT_MT090110UK02)

1..1 assignedEntity *

authortypeCode*: <= AUT

time*: TS [1..1] (time of creation)signatureText*: ED [1..1]

1..1 medication *

typeCode*: <= TPAtherapeuticAgent

CMET: (PAT) R_Patient

[identifiedETP](COCT_MT050012UK02)

1..1 patient *


PrescriptionHeaderclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1] (Prescription ID)code*: CV CNE [1..1] <= PrescriptionTypereasonCode*: CV CNE [1..1] <= PrescriptionTreatmentType (NEW VOCAB)

1..1 justifiedMedicationSupply *

typeCode*: <= RSON

reasonOf

1..* medicationAdministrationRequest *


CMET: (MMAT) E_MedicationKind

[identifiedKind](COCT_MT230101UK02)

MedicationAdministrationInstructionsclassCode*: <= SBADMmoodCode*: <= PRMScode*: CV CNE [1..1] <= PrescriptionAnnotation"AI"text*: ST [1..1] (Additional free text instructions)

ParentPrescription(PORX_RM132004UK03)


0..* encountertypeCode*: <= COMPcomponentOf

CMET: (ENC) A_Encounter[identifiedETP]

(COCT_MT010011UK02)

1..1 manufacturedMedicationKind *


MedicationSupplyHeaderclassCode*: <= SPLYmoodCode*: <= RQOeffectiveTime: IVL<TS> [0..1]repeatNumber: IVL<INT> [0..1]expectedUseTime: IVL<TS> [0..1]

0..1 justifiedMedicationSupplyHeader

typeCode*: <= RSON

reasonOf

repeatNumber,eEffectiveTime,ExpectedUseTime:Mandatory forRepeat Dispensing Prescriptionsabsent otherwise

Constraint:

Relevant only forRepeat Dispensing Prescriptionsabsent otherwise

Constraint:

DoseInstructionsclassCode*: <= SBADMmoodCode*: <= RQOcode*: CV CNE [1..1] <= PrescriptionAnnotation ""DI""text*: ST [1..1]

1..1 doseInstructions *


Provides an alternative tothe coded form

Constraint:OriginalItemclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1]

OriginalPrescriptionclassCode*: <= SBADMmoodCode*: <= EVNid*: II [1..1]

0..1 priorOriginalItem *

typeCode*: <= FLFSinFulfillmentOf

1..1 originalPrescription *


Repeatprescriptionsonly

Constraint:

For RepeatPrescriptions use low and high value,for Repeat dispensing use only high value,for acutes doo not use.

Constraint: repeatNumber

1..1 agent *

typeCode*: <= PRFperformer

1..1 agentOrganization *

AgentclassCode*: <= AGNT



EndorsementclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation ""PE" or "JU""text: ST [0..1]value: CV [0..1] <= PrescriberEndorsement

0..* pertinentEndorsement


Required for Parentprescription but not forMedication Update

Constraint: Medication UpdateRequired for Parentprescription but not forMedication Update

Constraint: Medication Update

ExemptionStatusclassCode*: <= OBSmoodCode*: <= EVNid*: II [1..1]code: CV CNE [0..1] <= ExemptionDateType (NEW VOCAB)value*: TS [1..1]

1..2 pertinentExemptionStatus


OrganizationclassCode*: <= ORGdeterminerCode*: <= INSTANCEid*: II [1..1] (OCS code)

1..32Constraint: Cardinality

0..1 assignedEntity

typeCode*: <= LAtime*: TS [1..1]signatureText*: ED [1..1]

legalAuthenticator

0..1 reviewDate


ReviewDateclassCode*: <= OBSmoodCode*: <= INTeffectiveTime*: TS [1..1]

NPfIT MIM 3.1.06 – Parent Prescription

1..1 patient *

recordTargettypeCode*: <= RCT

ParentPrescriptionclassCode*: <= INFOmoodCode*: <= EVNid*: II [1..1]code*: CD CNE [1..1] <= SnomedCTeffectiveTime*: TS [1..1]

1..1 pertinentCareRecordElementCategory

pertinentInformation2typeCode*: <= PERTtemplateId*: II [1..1] "CSAB_RM-NPfITUK10.pertinentInformation1"

CareRecordElementCategoryclassCode*: <= CATEGORYmoodCode*: <= EVNcode*: CV CNE [1..1] <= CREType

1..* actRef

typeCode*: <= COMP

component

PrescriptionclassCode*: <= SBADMmoodCode*: <= RQOid*: LIST<II> [2..2] (1 Prescription ID, 2 Prescription ID + Check Digit)code*: CD CNE [1..1] <= SnomedCT-AdministrationrepeatNumber: IVL<INT> [0..1]

1..1 participant *

authortypeCode*: <= AUT

contextControlCode*: CS CNE [1..1] <= OPtime*: TS [1..1] (time of creation)

signatureText*: ED [1..1]

0..1 participant

typeCode*: <= LAcontextControlCode*: CS CNE [1..1] <= OP

time*: TS [1..1]signatureText*: ED [1..1]

legalAuthenticator

0..1 participant *

typeCode*: <= PRFcontextControlCode*: CS CNE [1..1] <= OP

performerCMET: (ROL) R_AgentNPFITOrganizationSDS

[universal](UKCT_MT120501UK02)

0..1 pertinentTemporaryExemptionInfo

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)

pertinentInformation3 TemporaryExemptionInfoclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "EX" (Fixed)effectiveTime*: IVL<TS> [1..1]value*: CV [1..1] <= PrescriptionChargeExemption

ReviewDateclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "RD" (Fixed)effectiveTime*: TS [1..1]

LineItemclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1] (item ID)code*: CD CNE [1..1] <= SnomedCT-Administration (Route of and approach site)effectiveTime: GTS (3 times a day etc.)repeatNumber: IVL<INT>doseQuantity: IVL<PQ>rateQuantity: IVL<PQ>

PrescriberEndorsementclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "PE" (Fixed)text: STvalue*: CV [1..1] <= PrescriberEndorsement (Justification)

0..1 pertinentReviewDate


pertinentInformation11

1..* pertinentLineItem *

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf2"


RequestedMaterialclassCode*: <= MMATdeterminerCode*: <= KINDcode*: CE CNE [1..1] <= ManufacturedMaterialSnCT

1..1 manufacturedRequestedMaterial

ManufacturedProductclassCode*: <= MANU

1..1 manufacturedProduct *

producttypeCode*: <= PRDcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"

0..* pertinentPrescriberEndorsement



0..1 priorOriginalItemRef

typeCode*: <= FLFSinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "false" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"

inFulfillmentOfOriginalItemRefclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1]

0..1 priorOriginalPrescriptionRef

typeCode*: <= FLFSinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "false" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"

inFulfillmentOf OriginalPrescriptionRefclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1]

ActRefclassCode*: <= ACTmoodCode*: <= ActMoodid*: II [1..1]

Note:Nominated Pharm

Note:Charlie to add effective time tostatement commentary (change name?)

Note:Dose Instructionswill be here in the originaltext part of the CD code

Parent Prescription(PORX_RM132004UK04)

Description


Constraint:


Constraint:

Absent for Acute PrescriptionsMandatory otherwise


Relevant only forRepeat Dispensing Prescriptionsabsent otherwise

Constraint:

For RepeatPrescriptions use low and high value,for Repeat dispensing use only high value,for acute do not use.


1..1 pertinentPrescriptionType *


pertinentInformation4 PrescriptionTypeclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "PT" (Fixed)value*: CV [1..1] <= PrescriptionType

1..1 pertinentPrescriptionTreatmentType *


pertinentInformation5 PrescriptionTreatmentTypeclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "PTT" (Fixed)value*: CV [1..1] <= PrescriptionTreatmentType

1..1 pertinentPrescription *

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.pertinentInformation"


CMET: (ROL) R_AgentNPFITPerson

[universal](UKCT_MT120201UK02)

Note:Add PTT & PT to PrescriptionAnnotation Vocab

Note:As this CMET carries the Patient IDit is a valid according to the CSMP

1..1 participant *

typeCode*: <= RESPcontextControlCode*: CS CNE [1..1] <= OP

responsibleParty

LineItemQuantityclassCode*: <= SPLYmoodCode*: <= RQOcode*: CD CNE [1..1] <= SnomedCT-Supplyquantity*: PQ [1..1]

DaysSupplyclassCode*: <= SPLYmoodCode*: <= RQOeffectiveTime*: IVL<TS> [1..1] (Dispensing window)expectedUseTime*: IVL<TS> [1..1] (Prescription duration)

Mandatory forRepeat Dispensing Prescriptionsabsent otherwise

Constraint: effectiveTime

1..1 pertinentDosageInstructions *



1..1 pertinentLineItemQuantity *



0..1 pertinentDaysSupply



CareEventRefclassCode*: <= ACTmoodCode*: <= ActMoodid*: II [1..1]

1..1 pertinentCareEventRef

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "false" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"


Note:PoC Event that resulted in thisprescription being generated

Note:The quantity can beeither days to supplyor amount

optionional butonly for Repeat Dispensing

Constraint: expectedUseTime

CMET: (PAT) R_Patient

[identifiedETP](COCT_MT050012UK04)

0..1 roleName

DosageInstructionsclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "DI" (Fixed)value*: ST [1..1] (Dose Instructions)

AdditionalInstructionsclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "AI" (Fixed)value*: ST [1..1] (Additional Instructions)

0..1 pertinentAdditionalInstructions



1..1 pertinentDispensingSitePreference *

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)

contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)

seperatableInd*: BL [1..1] "true" (Fixed)

pertinentInformation1DispensingSitePreferenceclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "DSP" (Fixed)value*: CV [1..1] <= DispensingSitePreference

Development & Harmonisation

Pharmacy DMIM 2002

Pharmacy DMIM 2003

Pharmacy DMIM 2005

UK Development

Dutch Development

Canadian DevelopmentPharmacy RMIM 2004Pharmacy RMIM 2004

Toronto Harmonisation Meeting


• Admin Management– Account Billing– Claims & Reimbursement– Patient Administration– Personnel Management– Scheduling

• Health & Clinical Management– CDA– Blood Bank– Laboratory– Clinical Genomics– Medical Records– Care Provision– Pharmacy– Public Health reporting– Informative Public Health Specs– Regulated Studies– Therapeutic Devices

UK MIMMainstream• Accident & Emergency• Diagnostic Imaging• eBooking• Emergency Admissions• GP2GP• Medication Management• Mental Health• NHS Direct• OOP Appointments• Out of Hours• Provision of Care• Single Assessment

Challenges for HL7

• Absorbing new domains• Making ballot processes work• Defining conformance

the evolution of pharmacy messages hl7 uk conference 2 november 2004 hugh glover, bsc, phd partner,...

Documents

ballot slide

gp pharmacy systems

parent prescription

interfaces n systems

domains matter

npfit mim

new domains

different systems