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{{StartUitgefaseerd|01-10-2021|Zie de [[Landingspagina_Medicatieproces|landingspagina Medicatieproces 9]] voor de actuele versie van de informatiestandaard.|Consult the [[overview page Medicatieproces 9]] for the current versions of the information standard.}}
  
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{{IssueBox|'''<big>This is an archived version. [[Landingspagina_Medicatieproces|Click here for current versions]].</big>'''}}
  
 
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{{#customtitle:Functional Design Medicatieproces 9.1.0 English version}}
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{{DISPLAYTITLE:Functional Design Medicatieproces 9.1.0 English version}}
 
For an overview of relevant wiki pages for Medication Process see [[Landingspagina_Medicatieproces]]
 
For an overview of relevant wiki pages for Medication Process see [[Landingspagina_Medicatieproces]]
  
=Inleiding=
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=Introduction=
  
 
This document is the functional design for the Medication Process Information Standard (in Dutch: Informatiestandaard Medicatieproces). It provides a general description as well as a description of specific practical situations. The recording and exchange of information is described for specific situations using actors (people, systems) and transactions (which information is exchanged when).  
 
This document is the functional design for the Medication Process Information Standard (in Dutch: Informatiestandaard Medicatieproces). It provides a general description as well as a description of specific practical situations. The recording and exchange of information is described for specific situations using actors (people, systems) and transactions (which information is exchanged when).  
Regel 27: Regel 30:
 
==Reading guide==
 
==Reading guide==
  
The following paragraph introduces the main building blocks and the terminology used in this document. Detailed descriptions of the various processes (prescribe, dispense, administer, use) are given in [[#Medicatieproces|Chapter 2]]. The purpose of the descriptions is to clarify how healthcare processes function in an ideal situation; which process steps are needed; which actors are participating; which information applies and which moments of exchange exist. The process descriptions follow a fixed format:  
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The following paragraph introduces the main building blocks and the terminology used in this document. Detailed descriptions of the various processes (prescribe, dispense, administer, use) are given in [[#Medication process|Chapter 2]]. The purpose of the descriptions is to clarify how healthcare processes function in an ideal situation; which process steps are needed; which actors are participating; which information applies and which moments of exchange exist. The process descriptions follow a fixed format:  
  
 
*Current situation <br />This paragraph describes the relevant differences between the current situation and the desired situation (“soll”) in accordance with this information standard. Any obstacles will be described here.  
 
*Current situation <br />This paragraph describes the relevant differences between the current situation and the desired situation (“soll”) in accordance with this information standard. Any obstacles will be described here.  
 
*Process description with the paragraphs:  
 
*Process description with the paragraphs:  
 
** ''Precondition''<br />The conditions that must be met before the process is started.  
 
** ''Precondition''<br />The conditions that must be met before the process is started.  
** ''Trigger Event''<br />The event that starts theprocess.  
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** ''Trigger Event''<br />The event that starts the process.  
 
** ''One or more process steps''<br />Description of part of the process.  
 
** ''One or more process steps''<br />Description of part of the process.  
 
**''Post-condition''<br />The conditions that are met after the process steps have been carried out.  
 
**''Post-condition''<br />The conditions that are met after the process steps have been carried out.  
 
**''Use cases''<br />List of use cases associated with a specific subprocess. The use cases are detailed in [[#Description of use cases|Chapter 4]].  
 
**''Use cases''<br />List of use cases associated with a specific subprocess. The use cases are detailed in [[#Description of use cases|Chapter 4]].  
**''Systems and transaction groups'',br />This paragraph describes the systems, system roles, transactions and transaction groups related to the process steps. All information concerning systems and transaction groups is also included in [[#Systems and transactions|Chapter 6]].  
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**''Systems and transaction groups'',<br />This paragraph describes the systems, system roles, transactions and transaction groups related to the process steps. All information concerning systems and transaction groups is also included in [[#Systems and transactions|Chapter 6]].  
  
[[# Domain-specific handling of the medication|Chapter 3]] describes a number of domain-specific interpretations of the medication process, for instance those of the thrombosis service and those related to service observation services in an ambulatory situation. [[#Description of use cases|Chapter 4]] describes several use cases in more detail. The practical situations are derived from general medical practice in a large number of cases but are illustrative of similar situations in a different setting. The use cases are classified according to subprocess, as indicated in [[#Medication process|Chapter 2]].  
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[[#Domain-specific handling of the medication process|Chapter 3]] describes a number of domain-specific interpretations of the medication process, for instance those of the thrombosis service and those related to service observation services in an ambulatory situation. [[#Description of use cases|Chapter 4]] describes several use cases in more detail. The practical situations are derived from general medical practice in a large number of cases but are illustrative of similar situations in a different setting. The use cases are classified according to subprocess, as indicated in [[#Medication process|Chapter 2]].<br>
Medication overview and inference rules|Chapter 5]] describes how a medication profile can be constructed from the different building blocks. [[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions and transaction groups. Guidelines for the functionality of the various systems have been detailed in [[#Functionality|Chapter 7]].  
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[[#Medication overview and inference rules|Chapter 5]] describes how a medication profile can be constructed from the different building blocks. [[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions and transaction groups. Guidelines for the functionality of the various systems have been detailed in [[#Functionality|Chapter 7]].
  
 
==Introduction of relevant terms==  
 
==Introduction of relevant terms==  
Regel 45: Regel 48:
 
===Therapeutic and logistical building blocks===
 
===Therapeutic and logistical building blocks===
  
The use cases include a description of the process and the data elements associated with it. Related data elements are grouped together in Clinical Building Blocks (CBB) (in Dutch: zorginformatiebouwstenen - ZIBs). The dataset details the data elements of which these ZIBs consist. The data set includes the complete set of definitions of the data elements of the building blocks. The building blocks together with their data elements can be used in various scenarios for arranging/modelling healthcare applications or for defining interfaces for data exchange. Clinical building blocks and building blocks are synonymous in this document.  
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The use cases include a description of the process and the data elements associated with it. Related data elements are grouped together in Clinical Information Models (CIM) (in Dutch: zorginformatiebouwstenen - ZIBs). The dataset details the data elements of which these ZIBs consist. The data set includes the complete set of definitions of the data elements of the building blocks. The building blocks together with their data elements can be used in various scenarios for arranging/modelling healthcare applications or for defining interfaces for data exchange. Clinical Information Models and building blocks are synonymous in this document.  
  
 
The different building blocks are shown in the figure below. They have been ordered according to process and subprocesses, and according to therapy versus logistics.  
 
The different building blocks are shown in the figure below. They have been ordered according to process and subprocesses, and according to therapy versus logistics.  
Regel 62: Regel 65:
 
| style="background-color: white;vertical-align:top;"| medicatieafspraak
 
| style="background-color: white;vertical-align:top;"| medicatieafspraak
 
|style="background-color: white;vertical-align:top;"| ma
 
|style="background-color: white;vertical-align:top;"| ma
| style="background-color: white;vertical-align:top;"| A medicatieafspraak is the prescriber’s proposal for medicatiegebruik with which the patient agrees. An agreement to discontinue medication is also a medicatieafspraak<ref>This document only uses the term medicatieafspraak, which therefore also indicates the clinical equivalent provisional medication order</ref>.
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| style="background-color: white;vertical-align:top;"| A medicatieafspraak is the prescriber’s proposal for use with which the patient agrees. An agreement to discontinue medication is also a medicatieafspraak<ref>This document only uses the term medicatieafspraak, which therefore also indicates the clinical equivalent provisional medication order</ref>.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| verstrekkingsverzoek
 
| style="background-color: white;vertical-align:top;"| verstrekkingsverzoek
Regel 70: Regel 73:
 
| style="background-color: white;vertical-align:top;"| toedieningsafspraak
 
| style="background-color: white;vertical-align:top;"| toedieningsafspraak
 
| style="background-color: white;vertical-align:top;"| ta
 
| style="background-color: white;vertical-align:top;"| ta
| style="background-color: white;vertical-align:top;"| An toedieningsafspraak contains the instructions for use (or administration) of the pharmacist to the patient (or his representative or administrator), adding to the medicatieafspraak<ref name="MO">A provisional medication order, as it is used in hospitals, is both the request from the physician to the administrator to administer medication to the patient as a verstrekkingsverzoek to the pharmacist to ensure that the medication is available for the administrator. This last part corresponds to the medicatieafspraak and the verstrekkingsverzoek from the first line. In addition, the hospital pharmacist usually carries out a validation of the administration request (this creates the final medication order which is called an toedieningsafspraak here). The provisional medication order is therefore not the same as a proposal from, for example, from a nurse on the basis of a protocol that has not yet been approved by a physician. </ref>.
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| style="background-color: white;vertical-align:top;"| A toedieningsafspraak contains the instructions for use (or administration) of the pharmacist to the patient (or his representative or administrator), adding to the medicatieafspraak<ref name="MO">A provisional medication order, as it is used in hospitals, is both the request from the physician to the administrator to administer medication to the patient as a verstrekkingsverzoek to the pharmacist to ensure that the medication is available for the administrator. This last part corresponds to the medicatieafspraak and the verstrekkingsverzoek from the first line. In addition, the hospital pharmacist usually carries out a validation of the administration request (this creates the final medication order which is called a toedieningsafspraak here). The provisional medication order is therefore not the same as a proposal from, for example, from a nurse on the basis of a protocol that has not yet been approved by a physician. </ref>.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| medicatieverstrekking
 
| style="background-color: white;vertical-align:top;"| medicatieverstrekking
Regel 99: Regel 102:
 
| style="background-color: white;vertical-align:top;"| avvv
 
| style="background-color: white;vertical-align:top;"| avvv
 
| style="background-color: white;vertical-align:top;"| The antwoord voorstel- verstrekkingsverzoek is a reply from the prescriber to the proposed verstrekkingsverzoek.  
 
| style="background-color: white;vertical-align:top;"| The antwoord voorstel- verstrekkingsverzoek is a reply from the prescriber to the proposed verstrekkingsverzoek.  
|}<small>Tabel 1 Bouwstenen beschrijving</small>
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|}<small>Table 1 Building blocks description</small>
  
 
===Medication overview===
 
===Medication overview===
Regel 119: Regel 122:
 
#Creating a new changed medicatieafspraak as part of the same medicamenteuze behandeling. The starting date of this new medicatieafspraak may also be in the future.  
 
#Creating a new changed medicatieafspraak as part of the same medicamenteuze behandeling. The starting date of this new medicatieafspraak may also be in the future.  
  
Prescribing a new medicinal product always results in a new medicatieafspraak. A medicatieafspraak is always related to a single medicamenteuze behandeling. For the time being, the PRK level (Prescription Code from the G-standard) of the medicinal product determines whether the medicatieafspraak belongs to a new or an existing medicamenteuze behandeling. This may be extended to the SNK level (Stam Naam Kode) in the future, which would mean that changes in strength or between medicinal products from the same group no longer lead to a new medicamenteuze behandeling. A detailed description can be found in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5 Process step: Creating a medicatieafspraak]].Process step: Creating a <br>
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Prescribing a new medicinal product always results in a new medicatieafspraak. A medicatieafspraak is always related to a single medicamenteuze behandeling. For the time being, the PRK level (Prescription Code from the G-standard) of the medicinal product determines whether the medicatieafspraak belongs to a new or an existing medicamenteuze behandeling. This may be extended to the SNK level (Stam Naam Kode) in the future, which would mean that changes in strength or between medicinal products from the same group no longer lead to a new medicamenteuze behandeling. A detailed description can be found in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5 Process step: Creating a medicatieafspraak]].
Exceptions:<br>
 
*Products without PRK (a non-medicine such as crutches or bandages). In this case
 
the HPK level (Trade Product Code from the G-Standard) determines if the medicatieafspraak will lead to a new medicamenteuze behandeling
 
*Medication without PRK (magistrals often consist of several substances that are not covered by the same
 
PRK, these substances are included separately as ingredients in the
 
medicatieafspraak). Every magisterial or adaptation to it falls under a medicamenteuze behandeling.
 
*Own articles without PRK (articles listed in the internal system under 90 million numbers
 
stored, such as half tablets, commonly used magistrals). Any item or
 
adaptation to this falls under a medicamenteuze behandeling.
 
*IVs (still be selected)<br>
 
 
 
  
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Exceptions:
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*Products without PRK (a non-medicine such as crutches or bandages). In this case the HPK level (Trade Product Code from the G-Standard) determines if the medicatieafspraak will lead to a new medicamenteuze behandeling
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*Medication without PRK (magistrals often consist of several substances that are not covered by the same PRK, these substances are included separately as ingredients in the medicatieafspraak). Every magisterial or adaptation to it falls under a medicamenteuze behandeling.
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*Own articles without PRK (articles listed in the internal system under 90 million numbers stored, such as half tablets, commonly used magistrals). Any item or adaptation to this falls under a medicamenteuze behandeling.
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*IVs (still be selected)
  
 
'''Examples'''<br>
 
'''Examples'''<br>
Regel 139: Regel 136:
 
*A gastroprotective drugs has been agreed upon in a treatment with prednisone: prednisone and gastroprotective drugs are two different medicinal products, which are used parallel to each other and their use can be modified and discontinued independently of each other. This means they are not part of the same medicamenteuze behandeling.  
 
*A gastroprotective drugs has been agreed upon in a treatment with prednisone: prednisone and gastroprotective drugs are two different medicinal products, which are used parallel to each other and their use can be modified and discontinued independently of each other. This means they are not part of the same medicamenteuze behandeling.  
 
*Switching from a beta blocker to an ACE inhibitor means a new PRK and this is achieved by discontinuing the medicamenteuze behandeling of the beta blocker and starting a new medicamenteuze behandeling for the ACE inhibitor.  
 
*Switching from a beta blocker to an ACE inhibitor means a new PRK and this is achieved by discontinuing the medicamenteuze behandeling of the beta blocker and starting a new medicamenteuze behandeling for the ACE inhibitor.  
*When there is no PRK and the composition of the medicinal products in the medicatieafspraak changes (any change in the ingredients), the existing medicamenteuze behandeling is discontinued and a new medicamenteuze behandeling is started. This applies, for example, to magisterial preparations, drips and proprietary products.<br>  
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*When there is no PRK and the composition of the medicinal products in the medicatieafspraak changes (any change in the ingredients), the existing medicamenteuze behandeling is discontinued and a new medicamenteuze behandeling is started. This applies, for example, to extemporaneous preparations, drips and proprietary products.<br>  
  
 
'''Setting up a medicamenteuze behandeling'''  
 
'''Setting up a medicamenteuze behandeling'''  
Regel 150: Regel 147:
 
<br>
 
<br>
 
'''Parallel medicatieafspraken'''<br>
 
'''Parallel medicatieafspraken'''<br>
Within a medicamenteuze behandeling, several medicatieafspraken may be active simultaneously. These are all medicatieafspraken that are valid (“current”) at this time or that will become valid in the future. In principle, only one medicatieafspraak is valid at any one time in a medicamenteuze. However, there are a number of situations where parallel medicatieafspraken are conceivable:  
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Within a medicamenteuze behandeling, several medicatieafspraken may be active simultaneously. These are all medicatieafspraken that are valid (“current”) at this time or that will become valid in the future. In principle, only one medicatieafspraak is valid at any time in a medicamenteuze. However, there are a number of situations where parallel medicatieafspraken are conceivable:  
 
#The same medicinal product, but a different strength, where the total strength should essentially be prescribed in one agreement.  
 
#The same medicinal product, but a different strength, where the total strength should essentially be prescribed in one agreement.  
 
#Related (different) medicinal products that are given together, but that should be considered as a whole when evaluating treatment.  
 
#Related (different) medicinal products that are given together, but that should be considered as a whole when evaluating treatment.  
 
#Technical omissions in systems. For example, in the case of complicated dosing schedules or combination drips.<br>  
 
#Technical omissions in systems. For example, in the case of complicated dosing schedules or combination drips.<br>  
  
'''Situation 1''' can be resolved by prescribing at a higher level (SNK). G-standard/Z-Index is working on this, but it is not yet possible. Until that time, 1 or more products can be combined in the same medicatieafspraak by entering the products as ingredients. This is comparable to magisterial preparations. However, the instructions for use for all these products must be identical.<ref>In practice several medicatieafspraken (with different PRKs) are often combined into a single product instead of a single medicatieafspraak with underlying the composition.</ref><br>
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'''Situation 1''' can be resolved by prescribing at a higher level (SNK). G-standard/Z-Index is working on this, but it is not yet possible. Until that time, 1 or more products can be combined in the same medicatieafspraak by entering the products as ingredients. This is comparable to extemporaneous preparations. However, the instructions for use for all these products must be identical.<ref>In practice several medicatieafspraken (with different PRKs) are often combined into a single product instead of a single medicatieafspraak with underlying the composition.</ref><br>
 
'''Situation 2''' is solved in different ways in different systems, each with their own grouping mechanisms. It concerns the correlation between different medicamenteuze behandelingmedicamenteuze behandelings. The information standard does not provide a universal grouping mechanism.<br>
 
'''Situation 2''' is solved in different ways in different systems, each with their own grouping mechanisms. It concerns the correlation between different medicamenteuze behandelingmedicamenteuze behandelings. The information standard does not provide a universal grouping mechanism.<br>
'''Situation 3''' is the only situation in which parallel medicatieafspraken are permitted under one medicamenteuze behandelingmedicamenteuze behandeling. Complex phasing-in and phasing-out schedules and combination drips may be included in one medicatieafspraak, but not all systems support this. For those systems it is permitted to create parallel medicatieafspraken within a single medicamenteuze behandelingmedicamenteuze behandeling.<br>
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'''Situation 3''' is the only situation in which parallel medicatieafspraken are permitted under one medicamenteuze behandelingmedicamenteuze behandeling. Complex phasing-in and phasing-out schedules and combination drips may be included in one medicatieafspraak, but not all systems support this. For those systems, it is permitted to create parallel medicatieafspraken within a single medicamenteuze behandelingmedicamenteuze behandeling.<br>
  
 
===Correlation between building blocks and medicamenteuze behandeling===  
 
===Correlation between building blocks and medicamenteuze behandeling===  
  
 
The figure below shows the correlations between building blocks and the medicamenteuze behandeling. The relations between building blocks and the medicamenteuze behandeling as well as the relations between the building blocks themselves are described as follows:  
 
The figure below shows the correlations between building blocks and the medicamenteuze behandeling. The relations between building blocks and the medicamenteuze behandeling as well as the relations between the building blocks themselves are described as follows:  
*Building blocks belong to a single medicamenteuze behandeling. A medicamenteuze behandeling includes at least one medicatieafspraak and may include 0 or more of the building blocks verstrekkingsverzoek, toedieningsafspraak, medicatieverstrekking, medicatiegebruik and medicatietoediening.   
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*Building blocks belong to a single medicamenteuze behandeling. A medicamenteuze behandeling includes at least one medicatieafspraak and may include 0 or more of the building blocks verstrekkingsverzoek, toedieningsafspraak, medicatieverstrekking, consumption and medicatietoediening.   
 
*Unless, for example, self-medication has been recorded with use or there  
 
*Unless, for example, self-medication has been recorded with use or there  
 
a paper prescription has been submitted, a drug treatment can exist without it  
 
a paper prescription has been submitted, a drug treatment can exist without it  
medication appointment, but with medication use or an administration appointment.  A MBH will never cease to exist, but it may no longer be effective when there are no current building blocks linked to it.  
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medication appointment, but with medication use or an administration appointment.  An MBH will never cease to exist, but it may no longer be effective when there are no current building blocks linked to it.  
A voorstel medicatieafspraak, voorstel verstrekkingsverzoek and antwoord voorstel-verstrekkingsverzoek are not yet part of a MBH as these are still a draft/proposal that may or may not lead to a final medicatieafspraak or verstrekkingsverzoek linked to a medicamenteuze behandeling. A voorstel medicatieafspraak may lead to zero (if the recommendation is not followed), one or more medicatieafspraken and a voostel verstrekkingsverzoek may lead to zero (if the proposal is not honoured), one or more verstrekkingsverzoeken.  
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A voorstel medicatieafspraak, voorstel verstrekkingsverzoek and antwoord voorstel-verstrekkingsverzoek are not yet part of an MBH as these are still a draft/proposal that may or may not lead to a final medicatieafspraak or verstrekkingsverzoek linked to a medicamenteuze behandeling. A voorstel medicatieafspraak may lead to zero (if the recommendation is not followed), one or more medicatieafspraken and a voostel verstrekkingsverzoek may lead to zero (if the proposal is not honoured), one or more verstrekkingsverzoeken.  
*A MBH may also only have a stop-MA in addition to, for example, a user building block. For example, in the event that a healthcare provider asks a patient to stop using an free available medicine (self-care medication or Over the Counter (OTC) medication ). The healthcare provider records the use of the self-care medication in a gebruiks building block and discontinues use by creating a stop medicatieafspraak (stop-MA belonging to the same MBH).  
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*An MBH may also only have a stop-MA in addition to, for example, a user building block. For example, in the event that a healthcare provider asks a patient to stop using free available medicine (self-care medication or Over the Counter (OTC) medication ). The healthcare provider records the use of the self-care medication in an MGB building block and discontinues use by creating a stop medicatieafspraak (stop-MA belonging to the same MBH).  
*An MA may refer to the previous MA or an TA or MGB on which it is based. This may also be an MA, TA or MGB that belongs to another medicamenteuze behandeling. It is possible that no digital MA is available (e.g. paper prescription (paragraph 4.1.17)). This MA must then be created. This MA may refer to the TA or MGB. A pharmacist is never the source of an MA but he may have a copy.  
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*An MA may refer to the previous MA or a TA or MGB on which it is based. This may also be an MA, TA or MGB that belongs to another medicamenteuze behandeling. It is possible that no digital MA is available (e.g. paper prescription [[#Paper prescription|paragraph 4.1.17]]). This MA must then be created. This MA may refer to the TA or MGB. A pharmacist is never the source of an MA but he may have a copy.  
 
*In principle, only one medicatieafspraak is valid at any one time in a medicamenteuze behandeling. Only when there are technical omissions in systems, for example in case of complicated dosing schedules or combination drips, are parallel medicatieafspraken allowed (see also the previous section).  
 
*In principle, only one medicatieafspraak is valid at any one time in a medicamenteuze behandeling. Only when there are technical omissions in systems, for example in case of complicated dosing schedules or combination drips, are parallel medicatieafspraken allowed (see also the previous section).  
 
*A medicatieafspraak is supported by zero (if there is still enough supply or if no medicatieverstrekking is needed), one or more (when there is, for example, continuous medication) verstrekkingsverzoeks.  
 
*A medicatieafspraak is supported by zero (if there is still enough supply or if no medicatieverstrekking is needed), one or more (when there is, for example, continuous medication) verstrekkingsverzoeks.  
Regel 174: Regel 171:
 
*A verstrekkingsverzoek refers to one or more MAs (for example, in the case of an interim dosage increase, a verstrekkingsverzoek can be made that replenishes the supply for the existing MA and also starts the supply for the future MA).  
 
*A verstrekkingsverzoek refers to one or more MAs (for example, in the case of an interim dosage increase, a verstrekkingsverzoek can be made that replenishes the supply for the existing MA and also starts the supply for the future MA).  
 
*A verstrekkingsverzoek may result in zero (for example when the patient does not pick up the medication) to several MVEs (medicatieverstrekkingen).  
 
*A verstrekkingsverzoek may result in zero (for example when the patient does not pick up the medication) to several MVEs (medicatieverstrekkingen).  
*Multiple (possibly parallel) toedieningsafspraken may be based on the same medicatieafspraak (for example, when a pharmacist switches to a different commercial product or when the medicinal product is supplied as two or more medicinal products with different strengths, with the total strength remaining the same). When a paper prescription is submitted and the medicatieafspraak and the verstrekkingsverzoek are not available in digital form, there is an toedieningsafspraak without a medicatieafspraak.  
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*Multiple (possibly parallel) toedieningsafspraken may be based on the same medicatieafspraak (for example, when a pharmacist switches to a different commercial product or when the medicinal product is supplied as two or more medicinal products with different strengths, with the total strength remaining the same). When a paper prescription is submitted and the medicatieafspraak and the verstrekkingsverzoek are not available in digital form, there is a toedieningsafspraak without a medicatieafspraak.  
*A medicatieafspraak does not always have to lead to an toedieningsafspraak, for example when no verstrekkingsverzoek is required with a short use MA, where the  
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*A medicatieafspraak does not always have to lead to a toedieningsafspraak, for example when no verstrekkingsverzoek is required with a short use MA, where the  
 
patient still has sufficient stock.  
 
patient still has sufficient stock.  
 
*A toedieningsafspraak is supported by zero (when there is enough supply), one or more occasions when medication is dispensed.  
 
*A toedieningsafspraak is supported by zero (when there is enough supply), one or more occasions when medication is dispensed.  
*A medicatieverstrekking is based on an toedieningsafspraak and, in an ambulatory situation, on a verstrekkingsverzoek. The exception are over-the-counter (OTC/self-medication) sales for the purpose of self-care medication: these have no medicatieafspraken and no verstrekkingsverzoeken. Self-care medication provided by the pharmacist may be recorded by that pharmacist as an toediendingsafspraak with medicatieverstrekking, or as medicatiegebruik by a random healthcare provider or by the patient himself.  
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*A medicatieverstrekking is based on a toedieningsafspraak and, in an ambulatory situation, on a verstrekkingsverzoek. The exception are over-the-counter (OTC/self-medication) sales for the purpose of self-care medication: these have no medicatieafspraken and no verstrekkingsverzoeken. Self-care medication provided by the pharmacist may be recorded by that pharmacist as a toediendingsafspraak with medicatieverstrekking, or as consumption by a random healthcare provider or by the patient himself.  
 
*A medicatieverstrekking may support multiple toedieningsafspraken.  
 
*A medicatieverstrekking may support multiple toedieningsafspraken.  
*A medicatie or toedieningsafspraak may be followed by a new medicatie or toedieningsafspraak. This may be the case when existing medication is changed (modification of MA and/or TA) or when medicatiegebruik is discontinued (stop-MA/TA).  
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*A medicatie or toedieningsafspraak may be followed by a new medicatie or toedieningsafspraak. This may be the case when existing medication is changed (modification of MA and/or TA) or when use is discontinued (stop-MA/TA).  
  
  
Regel 186: Regel 183:
 
[[Image: Datamodel_MP.PNG|800px|Figuur 2 - Datamodel Medicatieproces]]
 
[[Image: Datamodel_MP.PNG|800px|Figuur 2 - Datamodel Medicatieproces]]
  
=== Informing and (actively) making available===
+
===Informing and (actively) making available===
 
[[#Medication process|Chapter 2]] describes the medication process. This includes process steps labelled ‘Inform’ or ‘(actively) make available’. The table below includes a detailed description of the reason for this. [[#Medication process|Chapter 2]] further elaborates on situations in which information is actively sent or made available. <br>
 
[[#Medication process|Chapter 2]] describes the medication process. This includes process steps labelled ‘Inform’ or ‘(actively) make available’. The table below includes a detailed description of the reason for this. [[#Medication process|Chapter 2]] further elaborates on situations in which information is actively sent or made available. <br>
  
Regel 208: Regel 205:
  
 
Data are always made available. Additionally, the healthcare provider has the option to specifically inform fellow healthcare providers and/or the patient at any time during the process. In consultation with the patient, data can be sent to a healthcare provider of his choice (inform).  
 
Data are always made available. Additionally, the healthcare provider has the option to specifically inform fellow healthcare providers and/or the patient at any time during the process. In consultation with the patient, data can be sent to a healthcare provider of his choice (inform).  
|} <small>Tabel 2 Informing versus (actively) making available</small>
+
|} <small>Table 2 Informing versus (actively) making available</small>
  
Het technisch mechanisme (‘pull’, ‘publish and subscribe’, ‘push’, etc.) waarmee gegevens (actief) beschikbaar worden gesteld is infrastructuur afhankelijk en daarom niet in dit document uitgewerkt.
+
The technical mechanism (‘pull’, ‘publish and subscribe’, ‘push’, etc.) used to (actively) make data available, is infrastructure-dependent and is therefore not detailed in this document.<br>
  
Artsenfederatie KNMG beschrijft in zijn publicatie “Van wet naar praktijk: implementatie van de WGBO Deel 4. Toegang tot patiëntengegevens” wanneer er sprake is van veronderstelde toestemming en expliciete toestemming. Op de uitwisseling beschreven in deze informatiestandaard zijn de vigerende wettelijke kaders en richtlijnen rond toestemming en opt-in van toepassing en derhalve niet expliciet beschreven.
+
The Royal Dutch Medical Association (KNMG) describes in its publication Van wet naar praktijk: implementatie van de WGBO Deel 4. Toegang tot patiëntengegevens [From law to practice: implementation of the Dutch Medical Treatment Contracts Act Part 4. Access to patient data] when there is implicit consent and explicit consent. The exchange described in this information standard is subject to current legal frameworks and guidelines concerning consent and opt-in and these are therefore not explicitly described.
  
 
==Legend/Explanation==
 
==Legend/Explanation==
 
A manual for this Nictiz wiki documentation can be found at:<br>
 
A manual for this Nictiz wiki documentation can be found at:<br>
 
http://informatiestandaarden.nictiz.nl/wiki/Handleiding_Wiki_documentatie<br>
 
http://informatiestandaarden.nictiz.nl/wiki/Handleiding_Wiki_documentatie<br>
It also includes a legend for the various figures that appear in this document.  
+
It also includes a legend for the various figures that appear in this document.
  
 
=Medication process=
 
=Medication process=
This chapter describes the medication process in relation to the building blocks for first-line, second-line and third-line health care. The process is fundamentally the same in each case. The main difference is which pharmacy supplies the medication: a public pharmacy (including an outpatient pharmacy) or a hospital pharmacy.  
+
This chapter describes the medication process in relation to the building blocks for first-line, second-line and third-line health care. The process is fundamentally the same in each case. The main difference is which pharmacy supplies the medication: a community pharmacy (including an outpatient pharmacy) or a hospital pharmacy.  
 
Another difference is that in an ambulatory setting a verstrekkingsverzoek is required for the supply of medicinal products. This is not required in a hospital setting: the (hospital) pharmacist ensures that the medicinal products are available as long as the medicatieafspraak continues.  
 
Another difference is that in an ambulatory setting a verstrekkingsverzoek is required for the supply of medicinal products. This is not required in a hospital setting: the (hospital) pharmacist ensures that the medicinal products are available as long as the medicatieafspraak continues.  
  
The medication process is a cyclical process consisting of prescribing, dispensing, administering and using medication. The process starts when the patient/client visits a healthcare provider (general practitioner, hospital or other institution) for a treatment with a medicinal product and ends when the medication is no longer needed. The process is depicted in Figure 4. The yellow bar indicates the medication verification process, green prescription, purple dispensing, and orange administration and use. The blue bar indicates receipt or retrieval of data made available. This may occur in any of the subprocesses and is described in more detail in the continuation of this chapter for the relevant subprocesses. A larger version of the diagram can be found at the end of this document in Chapter 10.  
+
The medication process is a cyclical process consisting of prescribing, dispensing, administering and using medication. The process starts when the patient/client visits a healthcare provider (general practitioner, hospital or other institution) for a treatment with a medicinal product and ends when the medication is no longer needed. The process is depicted in Figure 4. The yellow bar indicates the medication verification process, green prescription, purple dispensing, and orange administration and use. The blue bar indicates receipt or retrieval of data made available. This may occur in any of the subprocesses and is described in more detail in the continuation of this chapter for the relevant subprocesses. A larger version of the diagram can be found at the end of this document in [[#Appendix: General Diagram Medicatioprocess|Chapter 12]].  
The following paragraphs describe the medication verification, prescription, dispensing, administration and medicatiegebruik processes.  
+
The following paragraphs describe the medication verification, prescription, dispensing, administration and consumption processes.  
  
 
{{anchor|figuur 3}}
 
{{anchor|figuur 3}}
 
[[Bestand:ActiviteitendiagramMP.png|Figuur 3 Activity diagram - medication process]]
 
[[Bestand:ActiviteitendiagramMP.png|Figuur 3 Activity diagram - medication process]]
<sub>Figuur 3 (MO = Medicatieoverzicht)</sub>
+
<sub>Figure 3 (MO = Medicatieoverzicht)</sub>
  
 
==Process: medication verification==
 
==Process: medication verification==
Prior to the prescription process, the patient’s actual medicatiegebruik is determined. This is done<ref>The patient may also verify his own medication. He then records ‘gebruik/use’, see [[#Recording medicatiegebruik by the patient|paragraph 2.5.4.1]].</ref>:  
+
Prior to the prescription process, the patient’s actual consumption is determined. This is done<ref>The patient may also verify his own medication. He then records ‘gebruik/use’, see [[#Recording medicatiegebruik by the patient|paragraph 2.5.4.1]].</ref>:  
 
*In the GP practice by the general practitioner during a consultation,  
 
*In the GP practice by the general practitioner during a consultation,  
 
*At the GP service, A&E department or mental health crisis service by the triage specialist or the treating healthcare provider, as soon as possible, upon arrival or admission,  
 
*At the GP service, A&E department or mental health crisis service by the triage specialist or the treating healthcare provider, as soon as possible, upon arrival or admission,  
Regel 243: Regel 240:
 
The patient comes in for a consultation/an outpatient consultation or is admitted (in the future).  
 
The patient comes in for a consultation/an outpatient consultation or is admitted (in the future).  
  
===Trigger event===
+
===Trigger event===
 
*Outpatient setting: consultation of and/or prescription to outpatients and patients residing in another healthcare institution<ref>This is about patients from a nursing home or a mental health institution who are going to the outpatient clinic of a hospital.</ref>. In this case, medication verification often occurs during treatment assessment (see [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4)]].  
 
*Outpatient setting: consultation of and/or prescription to outpatients and patients residing in another healthcare institution<ref>This is about patients from a nursing home or a mental health institution who are going to the outpatient clinic of a hospital.</ref>. In this case, medication verification often occurs during treatment assessment (see [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4)]].  
 
*Clinical setting: preparation of patient admission.  
 
*Clinical setting: preparation of patient admission.  
  
===Process===
+
===Process===
  
 
The healthcare provider collects the medication data from various sources, which may include:  
 
The healthcare provider collects the medication data from various sources, which may include:  
Regel 256: Regel 253:
 
*If necessary, information by telephone from the patient’s own pharmacist or general practitioner.<br>  
 
*If necessary, information by telephone from the patient’s own pharmacist or general practitioner.<br>  
  
The healthcare provider verifies the medication together with the patient and records the verified medication as medicatiegebruik (MGB, incl. self medication). This results in an updated medication profile; see also [[#Inference rules|paragraph 5.1]]. <br>
+
The healthcare provider verifies the medication together with the patient and records the verified medication as consumption (MGB, incl. self medication). This results in an updated medication profile; see also [[#Inference rules|paragraph 5.6]].<br>
  
In practice, only when it proves clinically relevant will the medication verification lead to recording of use and updating of the medication profile, particularly upon admission and discharge.  
+
In practice, medication verification will lead to recording of use, only when it proves clinically relevant followed by updating the medication profile, particularly upon admission and discharge.  
The medication overview and recorded data on medicatiegebruik are made available to fellow healthcare providers and the patient, so that they can access the data. The medication overview may also be sent to a specific healthcare provider.  
+
The medication overview and recorded data on consumption are made available to fellow healthcare providers and the patient, so that they can access the data. The medication overview may also be sent to a specific healthcare provider.
  
 
===Post-condition===
 
===Post-condition===
The patient’s medicatiegebruik is recorded and the resulting medication overview is made available if created. Medication data (medicatiegebruik) are made available.  
+
The patient’s use is recorded and the resulting medication overview is made available if created. Medication data (consumption) are made available.  
  
 
===Systems and transaction groups===
 
===Systems and transaction groups===
[[#6 Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. Those most important for the medication verification process are included in the overview below.  
+
[[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. Those most important for the medication verification process are included in the overview below.  
  
 
{{anchor|figuur 4}}
 
{{anchor|figuur 4}}
Regel 271: Regel 268:
  
 
==Process: prescribe==
 
==Process: prescribe==
This paragraph describes the prescription process. This includes all prescribers, such as general practitioners, specialists, other physicians and specialist nurse prescribers. The prescription process consists of an evaluation of existing medicamenteuze behandeling, if any. If necessary, a medicatieafspraak is created and, only in an ambulatory situation, possibly a verstrekkingsverzoek. Finally, the recorded data are (actively) made available. See [[#Appendix: General Diagram Medicatioprocess|chapter 10]] for a diagram depicting this process.
+
This paragraph describes the prescription process. This includes all prescribers, such as general practitioners, specialists, other physicians and specialist nurse prescribers. The prescription process consists of an evaluation of existing medicamenteuze behandeling, if any. If necessary, a medicatieafspraak is created and, only in an ambulatory situation, possibly a verstrekkingsverzoek. Finally, the recorded data are (actively) made available. See [[#Appendix: General Diagram Medicatioprocess|chapter 12]] for a diagram depicting this process.
  
 
===Current situation===
 
===Current situation===
Regel 277: Regel 274:
 
*The logistical process often determines whether information is recorded (and certainly if it is communicated). Changes in medication or discontinuation are insufficiently recorded and/or communicated, resulting in, among other things, inaccurate monitoring, incorrect use and incorrect medication profiles.  
 
*The logistical process often determines whether information is recorded (and certainly if it is communicated). Changes in medication or discontinuation are insufficiently recorded and/or communicated, resulting in, among other things, inaccurate monitoring, incorrect use and incorrect medication profiles.  
 
The pharmacotherapeutic policy should be leading, not the logistical process as is currently the case.  
 
The pharmacotherapeutic policy should be leading, not the logistical process as is currently the case.  
*Since the therapeutic intention is not communicated to the pharmacist, it is not possible to deduce from the available data whether a request for a repeat prescription falls within that therapeutic intention. Because of this, medicatiegebruik may be erroneously resumed or continued.  
+
*Since the therapeutic intention is not communicated to the pharmacist, it is not possible to deduce from the available data whether a request for a repeat prescription falls within that therapeutic intention. Because of this, use may be erroneously resumed or continued.  
 
*If a change is not communicated, a request for a repeat prescription (through the pharmacist) may be based on outdated instructions for use. This can easily lead to errors.  
 
*If a change is not communicated, a request for a repeat prescription (through the pharmacist) may be based on outdated instructions for use. This can easily lead to errors.  
 
*In an outpatient setting, medicatieafspraken and/or verstrekkingsverzoeken are usually not (electronically) sent to the pharmacist.  
 
*In an outpatient setting, medicatieafspraken and/or verstrekkingsverzoeken are usually not (electronically) sent to the pharmacist.  
  
===Precondition[edit]===
+
===Precondition===
There is a certain reason why a prescriber wants to start or evaluate/review a medicamenteuze behandeling.  
+
There is a certain reason why a prescriber wants to start or evaluate/review a medicamenteuze behandeling.
  
 
===Trigger event===
 
===Trigger event===
Regel 290: Regel 287:
 
===Process step: Evaluating a (pharmaceutical) treatment===
 
===Process step: Evaluating a (pharmaceutical) treatment===
  
In order to evaluate treatment, an up-to-date overview of medication data is required. The medical file from the healthcare provider is, where possible and if necessary, updated with data from external sources. In addition, the patient may be asked which medicinal products he is currently using. This medicatiegebruik can be recorded by the healthcare provider. If desired, a more extensive medication verification can be carried out (see [[#Process: medication verification|paragraph 2.1)]].<br>
+
In order to evaluate treatment, an up-to-date overview of medication data is required. The medical file from the healthcare provider is, where possible and if necessary, updated with data from external sources. In addition, the patient may be asked which medicinal products he is currently using. This consumption can be recorded by the healthcare provider. If desired, a more extensive medication verification can be carried out (see [[#Process: medication verification|paragraph 2.1)]].<br>
  
 
The treating physician<ref> This includes all healthcare providers who are authorised to prescribe: not only physicians, but also nurse practitioners and physician assistants, for example</ref> evaluates the (pharmaceutical) treatment and decides to:  
 
The treating physician<ref> This includes all healthcare providers who are authorised to prescribe: not only physicians, but also nurse practitioners and physician assistants, for example</ref> evaluates the (pharmaceutical) treatment and decides to:  
 
*start a new medicamenteuze behandeling by creating an initial medicatieafspraak and/or  
 
*start a new medicamenteuze behandeling by creating an initial medicatieafspraak and/or  
*continue, discontinue, temporarily halt or modify an existing medicatieafspraak (1 or more)[10] and/or  
+
*continue, discontinue, temporarily halt or modify an existing medicatieafspraak (1 or more)<ref>In the case of substitution, the existing medicatieafspraak is discontinued and a new medicatieafspraak is created under a new medicamenteuze behandeling.</ref> and/or  
 
*correct/cancel an existing medicatieafspraak and/or  
 
*correct/cancel an existing medicatieafspraak and/or  
 
*approve a voorstel medicatieafspraak or a voorstel verstrekkingsverzoek (including a reply via the reply voorstel verstrekkingsverzoek) <br>
 
*approve a voorstel medicatieafspraak or a voorstel verstrekkingsverzoek (including a reply via the reply voorstel verstrekkingsverzoek) <br>
  
These situations are further explained in the following paragraph. See also [[Medicamenteuze behandeling|paragraph 1.3.3]] for more information on the concept of medicamenteuze behandeling.  
+
These situations are further explained in the following paragraph. See also [[#Medicamenteuze behandeling|paragraph 1.3.3]] for more information on the concept of medicamenteuze behandeling.  
A new medication overview may be created to conclude the evaluation and the resulting new agreements and verstrekkingsverzoeks (see [[#Inference rules|paragraph 5.1]]).  
+
A new medication overview may be created to conclude the evaluation and the resulting new agreements and verstrekkingsverzoeks (see [[#Inference rules|paragraph 5.6]]).
  
 
===Process step: Creating a medicatieafspraak===  
 
===Process step: Creating a medicatieafspraak===  
Regel 308: Regel 305:
 
Before the medicatieafspraak is created, medication monitoring will occur in accordance with current guidelines. This is a part of this process step.  
 
Before the medicatieafspraak is created, medication monitoring will occur in accordance with current guidelines. This is a part of this process step.  
  
The next paragraphs describe the different situations in which a medicatieafspraak is created, i.e. initial medicatieafspraak, continuing medication, discontinuing medication, temporarily halting medication or correcting/cancelling a medicatieafspraak. Information about medicamenteuze behandelingis assumed to be known (see [[#Medicamenteuze behandeling[|paragraph 1.3.3]]).  
+
The next paragraphs describe the different situations in which a medicatieafspraak is created, i.e. initial medicatieafspraak, continuing medication, discontinuing medication, temporarily halting medication or correcting/canceling a medicatieafspraak. Information about medicamenteuze behandelingis assumed to be known (see [[#Medicamenteuze behandeling|paragraph 1.3.3]]).  
  
 
====New medicatieafspraak====
 
====New medicatieafspraak====
  
A new medicatieafspraak is created at the start or modification of a medicamenteuze behandeling. When a new medicamenteuze behandeling is started, the prescriber should consider whether an existing medicamenteuze behandeling should be discontinued. The description in [[#Medicamenteuze behandeling[|paragraph 1.3.3]] is based on the most common process from prescription to administering or using. In a transitional situation or in the absence of digital data (e.g. when there is no opt-in or because of regional boundaries of the Dutch Landelijk Schakelpunt [LSP; national data exchange point]), it is also technically possible that a medicamenteuze behandeling could start with an toediendings afspraak, for example. This might occur for instance when a pharmacist has not received the medicatieafspraak with the corresponding medicamenteuze behandeling in digital form. The pharmacist will consequently start a new medicamenteuze behandeling when the toedieningsafspraak is created. This may also be the case for any other building block. A patient can, for example, start a medicamenteuze behandeling by recording medicatiegebruik, without having the original medicamenteuze behandeling.  
+
A new medicatieafspraak is created at the start or modification of a medicamenteuze behandeling. When a new medicamenteuze behandeling is started, the prescriber should consider whether an existing medicamenteuze behandeling should be discontinued. The description in [[#Medicamenteuze behandeling|paragraph 1.3.3]] is based on the most common process from prescription to administering or using. In a transitional situation or in the absence of digital data (e.g. when there is no opt-in or because of regional boundaries of the Dutch Landelijk Schakelpunt [LSP; national data exchange point]), it is also technically possible that a medicamenteuze behandeling could start with a toediendings afspraak, for example. This might occur for instance when a pharmacist has not received the medicatieafspraak with the corresponding medicamenteuze behandeling in digital form. The pharmacist will consequently start a new medicamenteuze behandeling when the toedieningsafspraak is created. This may also be the case for any other building block. A patient can, for example, start a medicamenteuze behandeling by recording consumption, without having the original medicamenteuze behandeling.
  
 
====Continuing medication====
 
====Continuing medication====
Regel 326: Regel 323:
 
Medication is discontinued by creating a new medicatieafspraak (stop-MA) within the same medicamenteuze behandeling. The reason for discontinuation is recorded in this medicatieafspraak. The medication may be discontinued immediately or in the future.  
 
Medication is discontinued by creating a new medicatieafspraak (stop-MA) within the same medicamenteuze behandeling. The reason for discontinuation is recorded in this medicatieafspraak. The medication may be discontinued immediately or in the future.  
 
The new stop medicatieafspraak (stop-MA) is a copy of the existing medicatieafspraak with:  
 
The new stop medicatieafspraak (stop-MA) is a copy of the existing medicatieafspraak with:  
*The period of use as endate on which the medicatieafspraak endse (may also be in the future),  
+
*The period of use as end date on which the medicatieafspraak ends (may also be in the future),  
 
*Its own author,  
 
*Its own author,  
 
*Its own agreement date,  
 
*Its own agreement date,  
Regel 334: Regel 331:
  
 
A medicatieafspraak in which an end date is immediately agreed upon, e.g. in the case of a course of treatment, is not an additionalystop-MA but a regular medicatieafspraak needed. When a medicatieafspraak with an end date in the future is extended, it will be considered as a normal change (see Changing medication ([[#Changing medication|paragraph 2.2.5.5]])). A stop-MA always has the ‘Discontinuation’ stop type, even if it is a stop-MA resulting from a change. In case of a change, the stop-MA is followed by a new medicatieafspraak. A stop-MA resulting from a change is not always relevant for end users. A stop-ma  
 
A medicatieafspraak in which an end date is immediately agreed upon, e.g. in the case of a course of treatment, is not an additionalystop-MA but a regular medicatieafspraak needed. When a medicatieafspraak with an end date in the future is extended, it will be considered as a normal change (see Changing medication ([[#Changing medication|paragraph 2.2.5.5]])). A stop-MA always has the ‘Discontinuation’ stop type, even if it is a stop-MA resulting from a change. In case of a change, the stop-MA is followed by a new medicatieafspraak. A stop-MA resulting from a change is not always relevant for end users. A stop-ma  
as a result of a change, it is also referred to as a technical stop-ma. The user interface must adequately support this. A prescriber will be less interested than a pharmacist who may need to adjust his logistical process because of the change.  
+
as a result of a change, it is also referred to as a technical stop-ma. The user interface must adequately support this. A prescriber will be less interested than a pharmacist who may need to adjust his logistical process because of the change.
  
 
====Temporarily halting and resuming medication====
 
====Temporarily halting and resuming medication====
  
Temporarily halting medication is the discontinuation of medication for a known or unknown period of time. Medication may be halted immediately or in the future. When medicatiegebruik is temporarily halted, the medication still remains relevant for monitoring because the medication may be resumed in the future. Temporary substitution with another medicinal product is not considered an interruption but rather a discontinuation of the original medication and the start of a new medicamenteuze behandeling with the substitute. Temporary halting medication is covered by two medicatieafspraken[12]: a medicatieafspraak (stop-MA) is created to stop medicatiegebruik in accordance with guidelines for a stop-MA (see previous paragraph) and a new medicatieafspraak is created for resuming the medication (including the reason for this, if any). All medicatieafspraken are part of the same medicamenteuze behandeling. The reason for the interruption is recorded in the stop-MA. A stop-MA either refers to an original medicatieafspraak or it does not refer to a medicatieafspraak in which case the entire medicamenteuze behandeling is discontinued. The stop type for the stop-MA is 'tijdelijk’.  
+
Temporarily halting medication is the discontinuation of medication for a known or unknown period of time. Medication may be halted immediately or in the future. When use is temporarily halted, the medication still remains relevant for monitoring because the medication may be resumed in the future. Temporary substitution with another medicinal product is not considered an interruption but rather a discontinuation of the original medication and the start of a new medicamenteuze behandeling with the substitute. Temporary halting medication is covered by two medicatieafspraken<ref>This does not mean that end users actually have to create two agreements. A user friendly presentation by the system is desired.</ref>: a medicatieafspraak (stop-MA) is created to stop use in accordance with guidelines for a stop-MA (see previous paragraph) and a new medicatieafspraak is created for resuming the medication (including the reason for this, if any). All medicatieafspraken are part of the same medicamenteuze behandeling. The reason for the interruption is recorded in the stop-MA. A stop-MA either refers to an original medicatieafspraak or it does not refer to a medicatieafspraak in which case the entire medicamenteuze behandeling is discontinued. The stop type for the stop-MA is 'tijdelijk’.
  
 
====Changing medication====
 
====Changing medication====
Regel 352: Regel 349:
 
:d) Duration of treatment (such as an extension of the therapy).<br>
 
:d) Duration of treatment (such as an extension of the therapy).<br>
  
Switching to a completely different medicinal product is technically a switch to a different medicamenteuze behandeling (see also [[#Medicamenteuze behandeling|paragraph 1.3.3]]). In that case, the physician will discontinue the existing treatment (see [[#Discontinuing medication|paragraph 2.2.5.3]]) and start a new one (see [[#1 New medicatieafspraak|paragraph 2.2.5.1]]).  
+
Switching to a completely different medicinal product is technically a switch to a different medicamenteuze behandeling (see also [[#Medicamenteuze behandeling|paragraph 1.3.3]]). In that case, the physician will discontinue the existing treatment (see [[#Discontinuing medication|paragraph 2.2.5.3]]) and start a new one (see [[#New medicatieafspraak|paragraph 2.2.5.1]]).  
 
If the PRK stays the same, changes will be recorded under the same medicamenteuze behandeling. When a modification needs to be made, a technical stop-MA is created (see [[#Discontinuing medication|paragraph 2.2.5.3]]) and , a new medicatieafspraak is made with the desired change. The appointment date of the technical stop-ma and the new medication appointment must be  
 
If the PRK stays the same, changes will be recorded under the same medicamenteuze behandeling. When a modification needs to be made, a technical stop-MA is created (see [[#Discontinuing medication|paragraph 2.2.5.3]]) and , a new medicatieafspraak is made with the desired change. The appointment date of the technical stop-ma and the new medication appointment must be  
 
always be the same. The reason for the modification is included in the new medicatieafspraak with a reference to the original medicatieafspraak, if possible. Modifications may take effect immediately or in the future. A technical stop-ma and the related new medicatieafspraak are made available simultaneously. In case of renewal of a medicatieafspraak of which the duration has already expired or the end date has already expired, then  
 
always be the same. The reason for the modification is included in the new medicatieafspraak with a reference to the original medicatieafspraak, if possible. Modifications may take effect immediately or in the future. A technical stop-ma and the related new medicatieafspraak are made available simultaneously. In case of renewal of a medicatieafspraak of which the duration has already expired or the end date has already expired, then  
 
this is not seen as a change (a stop-ma on the already automatically stopped  
 
this is not seen as a change (a stop-ma on the already automatically stopped  
medicatieafspraak is unnecessary). In this case,  a new MA under the same medicamenteuze behandeling can be made.  
+
medicatieafspraak is unnecessary). In this case,  a new MA under the same medicamenteuze behandeling can be made.
  
====Correcting/cancelling a medicatieafspraak<ref> Correcting/cancelling administration agreementtoedieningsafspraaks happens in the same way. XIS is a generic term for a random (health care) information system. PHR=personal health records.</ref>====
+
====Correcting/canceling a medicatieafspraak<ref> Correcting/canceling administration agreementtoedieningsafspraaks happens in the same way. XIS is a generic term for a random (health care) information system. PHR=personal health records.</ref>====
  
This paragraph describes correcting or cancelling a medicatieafspraak when the prescriber has made an error. The error may have been discovered by the prescriber himself or by a fellow healthcare provider.  
+
This paragraph describes correcting or canceling a medicatieafspraak when the prescriber has made an error. The error may have been discovered by the prescriber himself or by a fellow healthcare provider.  
For example, a physician who makes a typing error in the dosage of a medicatieafspraak: 10 inhalations, 2x daily, instead of 1 inhalation, 2x daily. If the medicatieafspraak has not yet been shared with other healthcare providers, the prescriber can personally correct that medicatieafspraak or delete (cancel) it from his own system. If the medicatieafspraak has already been shared with other healthcare providers, the prescriber will mark the incorrect medicatieafspraak as ‘cancelled’ and he will then create a new medicatieafspraak under the same medicamenteuze behandeling with the correct information. The prescriber will actively inform the pharmacist and any fellow healthcare providers about both the cancelled and new medicatieafspraak and will make both available (see [[#Process step: (Actively) making available|paragraph 2.2.7]]).  
+
For example, a physician who makes a typing error in the dosage of a medicatieafspraak: 10 inhalations, 2x daily, instead of 1 inhalation, 2x daily. If the medicatieafspraak has not yet been shared with other healthcare providers, the prescriber can personally correct that medicatieafspraak or delete (cancel) it from his own system. If the medicatieafspraak has already been shared with other healthcare providers, the prescriber will mark the incorrect medicatieafspraak as ‘cancelled’ and he will then create a new medicatieafspraak under the same medicamenteuze behandeling with the correct information. The prescriber will actively inform the pharmacist and any fellow healthcare providers about both the cancelled and new medicatieafspraak and will make both available (see [[#Process step: (Actively) making available|paragraph 2.2.8]]).
  
 
===Process step: Creating a verstrekkingsverzoek===
 
===Process step: Creating a verstrekkingsverzoek===
  
A verstrekkingsverzoek (besides a medicatieafspraak) only applies in an ambulatory situation. A verstrekkingsverzoek may be made when the medication supply of the patient needs to be replenished. This does not have to coincide with a medicatieafspraak. At the start of a medicamenteuze behandeling for which the patient still has a sufficient supply at home from a previous agreement, a verstrekkingsverzoek is not needed. When the dosage is reduced, the patient may also have a sufficient supply. In the case of a medicinal product that is used for a prolonged period of time (e.g. an antihypertensive drug), with a continous medicatieafspraak (meaning a period of use with only a start date), several verstrekkingsverzoeken may be made over time within the scope of this existing agreement.  
+
A verstrekkingsverzoek (besides a medicatieafspraak) only applies in an ambulatory situation. A verstrekkingsverzoek may be made when the medication supply of the patient needs to be replenished. This does not have to coincide with a medicatieafspraak. At the start of a medicamenteuze behandeling for which the patient still has a sufficient supply at home from a previous agreement, a verstrekkingsverzoek is not needed. When the dosage is reduced, the patient may also have a sufficient supply. In the case of a medicinal product that is used for a prolonged period of time (e.g. an antihypertensive drug), with a continuous medicatieafspraak (meaning a period of use with only a start date), several verstrekkingsverzoeken may be made over time within the scope of this existing agreement.  
 
Logistical and emergency instructions may be included in the verstrekkingsverzoek, such as dispense location, request to not include in the GDS (individualised distribution system, in Dutch Geindividiualiseerd Distributie Systeem), etc.  
 
Logistical and emergency instructions may be included in the verstrekkingsverzoek, such as dispense location, request to not include in the GDS (individualised distribution system, in Dutch Geindividiualiseerd Distributie Systeem), etc.  
  
Regel 376: Regel 373:
  
 
period of use end date: date on which the patient must stop the medication (this can be   
 
period of use end date: date on which the patient must stop the medication (this can be   
equal to the consumption period end date or further in the future).  
+
equal to the consumption period end date or further in the future).
  
 
===Process step: Sending renal function value with prescription===
 
===Process step: Sending renal function value with prescription===
  
Kidney function is important for some medicines. The renal function value then determines the choice of drug and / or drug dosage. It is legally stipulated that if a healthcare professional has further research performed on a patient according to renal function, he shares divergent kidney function values with the appropriate pharmacist, appointed by the patient (Article 6.10, regeling geneesmiddelenwet).  
+
Renalfunction is important for certain medicines. The renal function value determines the choice of drug and / or drug dosage. It is legally stipulated that if a healthcare professional has performed further research on a patient renal function, he should share abnormal renal function values with the appropriate pharmacist, appointed by the patient (Article 6.10, regeling geneesmiddelenwet).  
  
The renal function value is always sent in the prescription (using the building block  
+
The renal function value is always sent with the prescription (using the building block  
 
laboratory results) for medicines for which this is important (characteristic in the G standard), so that the pharmacist can perform proper medication monitoring. The renal function value  
 
laboratory results) for medicines for which this is important (characteristic in the G standard), so that the pharmacist can perform proper medication monitoring. The renal function value  
 
should not be older than 13 months, because with stable chronic renal impairment the  
 
should not be older than 13 months, because with stable chronic renal impairment the  
renal function should be checked once a year. 1 month has been added to this, so that
+
renal function should be checked at least once a year. 1 month has been added to allow some backlog in practice.  
there is some backlash in practice.
 
 
 
If at the time of sending a medicatieafspraak and / or verstrekkingsverzoek no renal function is known, that is the prescription policy of that time. Sending the laboratory result renal function value without a medicatieafspraak and / or verstrekkkingsverzoek outside the scope of this information standard.  
 
  
+
If at the time of sending a medicatieafspraak and / or verstrekkingsverzoek no renal function is known, then the prescription policy remains unchanged. Sending the laboratory result renal function value without a medicatieafspraak and / or verstrekkkingsverzoek is beyond the scope of this information standard.
  
 
===Process step: (Actively) making available===
 
===Process step: (Actively) making available===
Regel 400: Regel 394:
 
B. As an order for the pharmacist to implement a medication change (including stop-MA and staken-MA) that impacts or may impact current medicatieverstrekking by this pharmacist. A current medicatieverstrekking indicates an order (as in A) that has been accepted, but has not yet been completely filled. For example, when medication is still being dispensed or when a verstrekkingsverzoek dictates that medication should be dispensed multiple times, but not all have taken place yet, e.g. with the GDS.<br>
 
B. As an order for the pharmacist to implement a medication change (including stop-MA and staken-MA) that impacts or may impact current medicatieverstrekking by this pharmacist. A current medicatieverstrekking indicates an order (as in A) that has been accepted, but has not yet been completely filled. For example, when medication is still being dispensed or when a verstrekkingsverzoek dictates that medication should be dispensed multiple times, but not all have taken place yet, e.g. with the GDS.<br>
  
C. Making medication data (MA, VV, MGB) and possibly the medication overview available to allow fellow healthcare providers and/or patients to access these later, possibly in combination with prescription without a specified recipient (see [[#Prescription without specified recipient (ambulatory)|paragraph 7.5]]). <br>
+
C. Making medication data (MA, VV, MGB) and possibly the medication overview available to allow fellow healthcare providers and/or patients to access these later, possibly in combination with prescription without a specified recipient (see [[#Prescription without specified recipient (ambulatory)|paragraph 8.1]]). <br>
  
 
D. Actively sending (informing) medication data (one or more building blocks) to a specific healthcare provider at the request of the patient when in the presence of this healthcare provider or at discharge.<br>
 
D. Actively sending (informing) medication data (one or more building blocks) to a specific healthcare provider at the request of the patient when in the presence of this healthcare provider or at discharge.<br>
Regel 409: Regel 403:
 
See also [[#Informing and (actively) making available|paragraph 1.3.5]] for a further explanation on informing (situation A, B, D) and making available (situation C).  
 
See also [[#Informing and (actively) making available|paragraph 1.3.5]] for a further explanation on informing (situation A, B, D) and making available (situation C).  
  
====Post-condition[edit] ====
+
===Post-condition===
 
*A new medicatieafspraak may have been created (starting, changing or discontinuing medication)  
 
*A new medicatieafspraak may have been created (starting, changing or discontinuing medication)  
 
*A verstrekkingsverzoek may have been made (only outpatient)  
 
*A verstrekkingsverzoek may have been made (only outpatient)  
 
*An order may have been sent to the pharmacist to carry out medicatieverstrekking  
 
*An order may have been sent to the pharmacist to carry out medicatieverstrekking  
 
*An order may have been sent to the pharmacist to modify medicatieverstrekking  
 
*An order may have been sent to the pharmacist to modify medicatieverstrekking  
*Fellow healthcare providers and the patient have been informed or may inform themselves about the new medication data: medicatieafspraak, verstrekkingsverzoek, medicatiegebruik.  
+
*Fellow healthcare providers and the patient have been informed or may inform themselves about the new medication data: medicatieafspraak, verstrekkingsverzoek, consumption.  
*Fellow healthcare providers and the patient have been informed or may inform themselves about a medication overview.  
+
*Fellow healthcare providers and the patient have been informed or may inform themselves about a medication overview.
  
 
===Systems and transaction groups===
 
===Systems and transaction groups===
  
The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), an XIS and a PGO<ref> XIS is a generic term for a random (health care) information system. PHR=personal health records.</ref>. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.  
+
The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO<ref> XIS is a generic term for a random (health care) information system. PHR=personal health records.</ref>. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.  
 
[[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.  
 
[[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.  
  
Regel 426: Regel 420:
  
 
===Use cases===
 
===Use cases===
De volgende specifieke use cases van voorschrijven zijn uitgewerkt:
+
The following specific use cases have been elobarated:
*[[#Kortdurende_medicatie|Kortdurende medicatie (paragraaf 4.1.1)]]
+
*[[#Short-term medication|Short-term medication (paragraph 4.1.1)]]
*[[#Doorlopende medicatie|Doorlopende medicatie (paragraaf 4.1.2)]]
+
*[[#Continuing medication|Continuing medication (paragraph 4.1.2)]]
*[[#Harde einddatum gebruiksperiode| Harde einddatum gebruiksperiode (paragraaf 4.1.3)]]
+
*[[#Hard end date for period of use|Hard end date for period of use (paragraph 4.1.3)]]
*[[#Zonodig medicatie|Zonodig medicatie (paragraaf 4.1.4)]]
+
*[[#Medication as needed|Medication as needed (paragraph 4.1.4)]]
*[[#Kuur zo nodig startend in de toekomst|Kuur zo nodig startend in de toekomst (paragraaf 4.1.5)]]
+
*[[#Course of treatment as needed starting in future|Course of treatment as needed starting in future (paragraph 4.1.5)]]
*[[#Twee doseringen van hetzelfde geneesmiddel tegelijkertijd|Twee doseringen van hetzelfde geneesmiddel tegelijkertijd (paragraaf 4.1.6)]]
+
*[[#Two dosages of the same medication at the same time|Two dosages of the same medication at the same time (paragraph 4.1.6)]]
*[[#Hetzelfde geneesmiddel met verschillende sterkte tegelijkertijd|Hetzelfde geneesmiddel met verschillende sterkte tegelijkertijd (paragraaf 4.1.7)]]
+
*[[#The same medicinal product with different strengths at the same time|The same medicinal product with different strengths at the same time (paragraph 4.1.7)]]
*[[#Toelichting in medicatieafspraak bij bewust gekozen bijzonderheid|Toelichting in medicatieafspraak bij bewust gekozen bijzonderheid (paragraaf 4.1.8)]]
+
*[[#Explanation in medicatieafspraak with deliberately chosen special characteristic|Explanation in medicatieafspraak with deliberately chosen special characteristic (paragraph 4.1.8)]]
*[[#Nieuwe medicatieafspraak, geen verstrekkingsverzoek|Nieuwe medicatieafspraak, geen verstrekkingsverzoek (paragraaf 4.1.9)]]
+
*[[#New medicatieafspraak, no verstrekkingsverzoek|New medicatieafspraak, no verstrekkingsverzoek (paragraph 4.1.9)]]
*[[#Nieuw verstrekkingsverzoek onder bestaande medicatieafspraak|Nieuw verstrekkingsverzoek onder bestaande medicatieafspraak (paragraaf 4.1.10)]]
+
*[[#New verstrekkingsverzoek under existing medicatieafspraak|New verstrekkingsverzoek under existing medicatieafspraak (paragraph 4.1.10)]]
*[[#Wijziging in dosering (voldoende voorraad)|Wijziging in dosering (voldoende voorraad) (paragraaf 4.1.11)]]
+
*[[#Dosage change (sufficient supply)|Dosage change (sufficient supply) (paragraph 4.1.11)]]
*[[#Recept niet meer nodig na eerste verstrekkingsverzoek|Recept niet meer nodig na eerste verstrekkingsverzoek (paragraaf 4.1.12)]]
+
*[[#Prescription no longer needed after first verstrekkingsverzoek|Prescription no longer needed after first verstrekkingsverzoek (paragraph 4.1.12)]]
*[[#Stoppen medicatie|Stoppen medicatie (paragraaf 4.1.13)]]
+
*[[#4-1-13|Discontinuing medication (paragraph 4.1.13)]]
*[[#Onderbreken / hervatten medicatie|Onderbreken / hervatten medicatie (paragraaf 4.1.14)]]
+
*[[#Temporarily halting/resuming medication|Temporarily halting/resuming medication (paragraph 4.1.14)]]
*[[#Onderbreken voor een ingreep|Onderbreken voor een ingreep (paragraaf 4.1.15)]]
+
*[[#Temporarily halting for an intervention|Temporarily halting for an intervention (paragraph 4.1.15)]]
*[[#Substitutie|Substitutie (paragraaf 4.1.16)]]
+
*[[#Substitution|Substitution (paragraph 4.1.16)]]
*[[#Papieren recept|Papieren recept (paragraaf 4.1.17)]]
+
*[[#Paper prescription|Paper prescription (paragraph 4.1.17)]]
*[[#Uitvoeren medicatieverificatie en evaluatie bij buitenlandse of zelfzorgmedicatie|Uitvoeren medicatieverificatie en evaluatie bij buitenlandse of zelfzorgmedicatie (paragraaf 4.1.18)]]
+
*[[#Carrying out medication verification and evaluation of foreign or self-care medication|Carrying out medication verification and evaluation of foreign or self-care medication (paragraph 4.1.18)]]
*[[#Dagbehandeling|Dagbehandeling (paragraaf 4.1.19)]]
+
*[[#Day treatment|Day treatment (paragraph 4.1.19)]]
*[[#Starten met medicatie voor opname|Starten met medicatie voor opname (paragraaf 4.1.20)]]
+
*[[#Starting with medication before admission|Starting with medication before admission (paragraph 4.1.20)]]
*[[#Spoedopname|Spoedopname (paragraaf 4.1.21)]]
+
*[[#Emergency admission|Emergency admission (paragraph 4.1.21)]]
*[[#Ontslag|Ontslag (paragraaf 4.1.22)]]
+
*[[#Discharge|Discharge (paragraph 4.1.22)]]
*[[#Tussentijds ontslag|Tussentijds ontslag (paragraaf 4.1.23)]]
+
*[[#Interim discharge|Interim discharge (paragraph 4.1.23)]]
*[[#Ontslag naar andere instelling|Ontslag naar andere instelling (paragraaf 4.1.24)]]
+
*[[#Discharge to another institution|Discharge to another institution (paragraph 4.1.24)]]
*[[#Niet verstrekken voor|Niet verstrekken voor (paragraaf 4.1.25)]]
+
*[[#Do not dispense before|Do not dispense before (paragraph 4.1.25)]]
*[[#Stoppen van medicatie door derden|Stoppen van medicatie door derden (paragraaf 4.1.26)]]
+
*[[#Discontinuation of medication by third parties|Discontinuation of medication by third parties (paragraph 4.1.26)]]
*[[#Verschillende PRKs onder dezelfde medicamenteuze behandeling|Verschillende PRKs onder dezelfde medicamenteuze behandeling (paragraaf 4.1.27)]]
+
*[[#Two PRKs in a single medicamenteuze behandeling|Two PRKs in a single medicamenteuze behandeling (paragraph 4.1.27)]]
*[[#Achteraf vastleggen medicatieafspraak|Achteraf vastleggen medicatieafspraak (paragraaf 4.1.28)]]
+
*[[#Creating a medicatieafspraak after the fact|Creating a medicatieafspraak after the fact (paragraph 4.1.28)]]
*[[#Parallelle medicatieafspraken|Parallelle medicatieafspraken (paragraaf 4.1.29)]]
+
*[[#Parallel medicatieafspraken|Parallel medicatieafspraken (paragraph 4.1.29)]]
*[[#Eenmalig gebruik|Eenmalig gebruik (paragraaf 4.1.30)]]
+
*[[#Single use|Single use (paragraph 4.1.30)]]
*[[#Voorlopige en definitieve medicatieopdracht|Voorlopige en definitieve medicatieopdracht (paragraaf 4.1.31)]]
+
*[[#Provisional and final medication order|Provisional and final medication order (paragraph 4.1.31)]]
*[[#Onterecht openstaande medicatie of 'weeskinderen'|Onterecht openstaande medicatie of 'weeskinderen' (paragraaf 4.1.32)]]
+
*[[#Inadvertently ‘outstanding’ medication or 'orphans'|Inadvertently ‘outstanding’ medication or 'orphans' (paragraph 4.1.32)]]
*[[#Ontbreken digitale medicatieafspraak bij opname|Ontbreken digitale medicatieafspraak bij opname (paragraaf 4.1.33)]]
+
*[[#Missing digital medicatieafspraak at admission|Missing digital medicatieafspraak at admission (paragraph 4.1.33)]]
*[[#Eigen artikelen (90 miljoen nummers)|Eigen artikelen (90 miljoen nummers) (paragraaf 4.1.34)]]
+
*[[#Own articles (90 million numbers)|Own articles (90 million numbers) (paragraph 4.1.34)]]
*[[#Dosering met minimum interval|Dosering met minimum interval (paragraaf 4.1.35)]]
+
*[[#Dosing with minimum interval|Dosing with minimum interval (paragraph 4.1.35)]]
*[[#Verstrekkingsverzoek met aantal herhalingen|Verstrekkingsverzoek met aantal herhalingen (paragraaf 4.1.36)]]
+
*[[#Verstrekkingsverzoek with number of repetitions|Verstrekkingsverzoek with number of repetitions (paragraph 4.1.36)]]
*[[#Voorschrijven van niet geneesmiddelen (verbandmiddelen, krukken of andere hulpmiddelen)|Voorschrijven van niet geneesmiddelen (verbandmiddelen, krukken of andere hulpmiddelen) (paragraaf 4.1.37)]]
+
*[[#Prescribing non-medicines|Prescribing non-medicines (paragraph 4.1.37)]]
*[[#Nierfunctiewaarde sturen in het voorschrift|Nierfunctiewaarde sturen in het voorschrift (paragraaf 4.1.38)]]
+
*[[#Send renalfunction value in the prescription|Send renal function value in the prescription (paragraph 4.1.38)]]
  
 
==Process: dispense==
 
==Process: dispense==
  
This paragraph describes the process of dispensing medication, including repeat prescriptions and GDS. This process encompasses all actions a pharmacist must take for the patient to not only receive a medicinal product, but to also receive the associated pharmaceutical care ensuring a safe and effective use of the medicinal product by the pa tient. The dispense process starts with providing pharmaceutical care. If necessary, a toedienafspraakwill made and medication is dispensed. Medicatieverstrekking (i.e. handing out a medicinal product) does not always take place. This may be the case when the medicatieafspraak is changed (e.g., in case of dose reduction where the patient still has enough supply), when the medication is discontinued or, in an ambulatory situation, the medication is not picked up. When the medicatieafspraak and/or the verstrekkingsverzoek are not in order (see [[#Process step: Informing the prescriber|paragraph 2.3.5]]), the prescriber will be informed. Finally, the recorded data are (actively) made available. See [[#Appendix: General Diagram Medicatioprocess|Chapter 10]] for a diagram of the dispense process.  
+
This paragraph describes the process of dispensing medication, including repeat prescriptions and GDS. This process encompasses all actions a pharmacist must take for the patient to not only receive a medicinal product, but to also receive the associated pharmaceutical care ensuring a safe and effective use of the medicinal product by the pa tient. The dispense process starts with providing pharmaceutical care. If necessary, a toedienafspraakwill made and medication is dispensed. Medicatieverstrekking (i.e. handing out a medicinal product) does not always take place. This may be the case when the medicatieafspraak is changed (e.g., in case of dose reduction where the patient still has enough supply), when the medication is discontinued or, in an ambulatory situation, the medication is not picked up. When the medicatieafspraak and/or the verstrekkingsverzoek are not in order (see [[#Process step: Informing the prescriber|paragraph 2.3.5]]), the prescriber will be informed. Finally, the recorded data are (actively) made available. See [[#Appendix: General Diagram Medicatioprocess|Chapter 12]] for a diagram of the dispense process.  
  
 
Medication assessment is the process in which the physician and pharmacist consider all medication of the patient against the background of his condition, applicable treatment guidelines, the well-being of the patient, etc. Medication assessment is defined in this document as a combination of treatment evaluation (as described in the previous paragraphs) and pharmaceutical care. Depending on the findings, the previously described medication verification and prescription processes are followed, after which medicatieverstrekking takes place.  
 
Medication assessment is the process in which the physician and pharmacist consider all medication of the patient against the background of his condition, applicable treatment guidelines, the well-being of the patient, etc. Medication assessment is defined in this document as a combination of treatment evaluation (as described in the previous paragraphs) and pharmaceutical care. Depending on the findings, the previously described medication verification and prescription processes are followed, after which medicatieverstrekking takes place.  
  
For the GDS, many pharmacists work with another organisation that handles part of the pharmacists’ logistics. This then also requires data exchange with that party. Besides, not all medication can be included in the GDS packaging, which adds to the logistical complexity for the pharmacist. The internal logistics and communication between the pharmacist and his ‘subcontractor(s) are outside the scope of this information standard. It has been established however that with the provision of the current building blocks and the underlying data elements, this logistical process can be adequately supported.  
+
For the GDS, many pharmacists collaborate with another organisation that handles part of the pharmacists’ logistics. This then also requires data exchange with that party. Besides, not all medication can be included in the GDS packaging, which adds to the logistical complexity for the pharmacist. The internal logistics and communication between the pharmacist and his ‘subcontractor(s) are outside the scope of this information standard. It has been established however that with the provision of the current building blocks and the underlying data elements, this logistical process can be adequately supported.  
  
 
===Current situation===
 
===Current situation===
 
+
The following deviations (from the desired situation that) are currently observed:  
*The following deviations (from the desired situation that) are currently observed:  
+
*In the current situation, in the case of individualized distribution systems, the prescribing physician and other healthcare providers receive a large quantity of dispense messages. This becomes difficult to manage for these healthcare providers.  
*In the current situation, in the case of individualised distribution systems, the prescribing physician and other healthcare providers receive a large quantity of dispense messages. This becomes difficult to manage for these healthcare providers.  
+
*In the current situation, in the case of GDS (individualised distribution systems), pharmacists and general practitioners communicate via so-called authorisation lists. The pharmacist sends an overview of all the patient’s medication to the general practitioner for authorisation. This complicates matters for a general practitioner because he will need to verify all medicatieafspraken. This should not be necessary, as most medicatieafspraken/verstrekkingsverzoeks have already been authorised. It would be much more efficient if the general practitioner only needs to authorise those medicatieafspraken/verstrekkingsverzoeken that have not been authorised yet, e.g. a new verstrekkingsverzoek on the basis of an existing medicatieafspraak.  
*In the current situation, in the case of GDS (individualised distribution systems), pharmacists and general practitioners communicate via so-called authorisation lists. The pharmacist sends an overview of all the patient’s medication to the general practitioner for authorisation. This complicates matters for a general practitioner because he will need to verierify all medicatieafspraken. This should not be necessary, as most medicatieafspraken/verstrekkingsverzoeks have already been authorised. It would be much more efficient if the general practitioner only needs to authorise those medicatieafspraken/verstrekkingsverzoeken that have not been authorised yet, e.g. a new verstrekkingsverzoek on the basis of an existing medicatieafspraak.  
+
*In the current situation, a locum pharmacy often does not inform the regular general practitioner and regular pharmacy when medication is dispensed.  
*In the current situation, a service pharmacy often does not inform the regular general practitioner and regular pharmacy when medication is dispensed.  
+
*In the current situation, a voorstel medicatieafspraak may have been aligned with the prescriber over the phone and/or the pharmacist and prescriber have made an agreement about handling a warning from the medication monitoring system.  
*In the current situation, a voorstel medicatieafspraak is usually coordinated with the prescriber over the phone and/or the pharmacist and prescriber have made an agreement about handling a signal from the medication monitoring system.  
+
*The intention of the return message is not always clear: no distinction can be made in the return/delivery message between displaying a physical delivery and a transmission of information about a medication change.  
*The meaning of the return message is not always clear: no distinction can be made in the return/delivery message between displaying a physical delivery and a transmission of information about a medication change.  
+
*In the current situation, pharmacists sometimes register (and communicate) medicatieverstrekking when they are preparing the medication for the patient instead of at the time when the medication is actually dispensed to the patient. This means that medication that hasn’t been picked up, is sometimes erroneously registered as dispensed.
*In the current situation, pharmacists sometimes register (and communicate) medicatieverstrekking when they are readying the medication for the patient instead of at the time when the medication is actually dispensed to the patient. This means that medication that hasn’t been picked up, is sometimes erroneously registered as dispensed.  
 
  
 
===Precondition===
 
===Precondition===
Regel 495: Regel 488:
  
 
===Process step: Providing pharmaceutical care===
 
===Process step: Providing pharmaceutical care===
 +
Pharmaceutical care is provided by a community, outpatient (i.e. at the hospital) institutional pharmacy, depending on the healthcare provider who has created the medicatieafspraak:
 +
*Medicatieafspraak, possibly with a verstrekkingsverzoek from the general practitioner or specialist: care provided by an institutional or outpatient pharmacy,
 +
*Medicatieafspraak from specialists and other prescribers in hospitals/institutions: care provided by an institutional pharmacy or a community pharmacy that supplies the respective institution.
 +
Medication monitoring is also part of pharmaceutical care.
  
*Pharmaceutical care is provided by a public, outpatient or hospital pharmacy, depending on the healthcare provider who has created the medicatieafspraak:
+
Based on the received medicatieafspraak or a change in the situation of the patient, the pharmacist decides how to apply this by:  
*Medicatieafspraak, possibly with a verstrekkingsverzoek from the general practitioner or specialist: care provided by a public or outpatient pharmacy,
 
*Medicatieafspraak from specialists and other prescribers in hospitals/institutions: care provided by a hospital pharmacy or a public pharmacy that supplies the respective institution.
 
*Medication monitoring is also part of pharmaceutical care.
 
*Based on the received medicatieafspraak or a change in the situation of the patient, the pharmacist decides how to apply this by:  
 
 
*Making one or more new toedieningsafspraken,  
 
*Making one or more new toedieningsafspraken,  
 
*Continuing, permanently discontinuing, temporarily halting or modifying an existing medicatieafspraak.  
 
*Continuing, permanently discontinuing, temporarily halting or modifying an existing medicatieafspraak.  
 
*Rejecting the medicatieafspraak.  
 
*Rejecting the medicatieafspraak.  
 
*Proposing a new medicatieafspraak,  
 
*Proposing a new medicatieafspraak,  
*Proposing a new verstrekkingsverzoek. <br>
+
*Proposing a new verstrekkingsverzoek.
  
The last three situations are explained in the following paragraph. The first two situations are explained in [[#Process step: Creating an administration agreement|paragraph 2.3.6]].  
+
The last three situations are explained in the following paragraph. The first two situations are explained in [[#Process step: Creating a toedieningsafspraak|paragraph 2.3.6]].  
A new up-to-date medication overview may be compiled and made available in conclusion of provided pharmaceutical care with possible new agreements and medicatieverstrekking.  
+
A new up-to-date medication overview may be compiled and made available in conclusion of provided pharmaceutical care with possible new agreements and medicatieverstrekking.
  
 
===Process step: Informing the prescriber===
 
===Process step: Informing the prescriber===
Regel 515: Regel 508:
 
*When a new or modified medicatieafspraak is needed  
 
*When a new or modified medicatieafspraak is needed  
 
*When a new verstrekkingsverzoek is needed  
 
*When a new verstrekkingsverzoek is needed  
*For more information about informing, see [[#Informing and (actively) making available|paragraph 1.3.5]].  
+
For more information about informing, see [[#Informing and (actively) making available|paragraph 1.3.5]].
*A new or modified medicatieafspraak is needed:  
+
 
 +
A new or modified medicatieafspraak is needed:  
 
*When a new toedieningsafspraak cannot be created based on the received medicatieafspraak because the pharmacist suspects an error in the medicatieafspraak, or  
 
*When a new toedieningsafspraak cannot be created based on the received medicatieafspraak because the pharmacist suspects an error in the medicatieafspraak, or  
 
*After a signal from the medication monitoring system as part of pharmaceutical care. The signal may indicate, for example, that the dosage should be lowered or increased, that it is advisable to select another medicinal product, that a product should be temporarily discontinued, that another additional product should be added, etc., or  
 
*After a signal from the medication monitoring system as part of pharmaceutical care. The signal may indicate, for example, that the dosage should be lowered or increased, that it is advisable to select another medicinal product, that a product should be temporarily discontinued, that another additional product should be added, etc., or  
*Based on medicatiegebruik as reported by the patient during pharmaceutical care, or  
+
*Based on consumption as reported by the patient during pharmaceutical care, or  
 
*When the temporarily halted medicamenteuze behandeling may be resumed.  
 
*When the temporarily halted medicamenteuze behandeling may be resumed.  
 
*A toedieningsafspraak is not yet created or modified in these situations.  
 
*A toedieningsafspraak is not yet created or modified in these situations.  
Instead, the pharmacist starts by contacting the prescriber by phone, informing him of the suspected error and proposing an alternative. The pharmacist may also send a digital voorstel medicatieafspraak to the prescriber. He recommends a specific medicatieafspraak in this proposal, together with the reason and arguments for that recommendation. The prescriber may approve the voorstel medicatieafspraak and make it into a final medicatieafspraak (see also [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4]]).<br>
+
Instead, the pharmacist starts by contacting the prescriber by phone, informing him of the suspected error and proposing an alternative. The pharmacist may also send a digital proposition called voorstel medicatieafspraak to the prescriber. He recommends a specific medicatieafspraak in this proposal, together with the reason and arguments for that recommendation. The prescriber may approve the voorstel medicatieafspraak and make it into a final medicatieafspraak (see also [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4]]).<br>
  
A new verstrekkingsverzoek is needed when the patient’s medication supply is used up or nearly used and the treatment may need to be continued (request repeat prescription). The patient either requests a repeat medicatieverstrekking from the pharmacist or has signed up in the past for proactive repeat medicatieverstrekking and a notification signal is generated by the repeat module of the AIS when the patient requires new medication<ref> The patient may also request a repeat directly from the prescriber: see [[#Process step: Informing the prescriber|paragraph 2.5.6]]. </ref>.  
+
A new verstrekkingsverzoek is needed when the patient’s medication stock is depleted or nearly used and the treatment may need to be continued (request repeat prescription). The patient either requests a repeat medicatieverstrekking from the pharmacist or has signed up in the past for proactive repeat medicatieverstrekking and a notification signal is generated by the repeat module of the AIS when the patient requires new medication<ref> The patient may also request a repeat directly from the prescriber: see [[#2-5-6|paragraph 2.5.6]].</ref>.  
When the existing verstrekkingsverzoek is not adequate, the pharmacist may communicate this request over the phone or send a digital voorstel verstrekkingsverzoek to the prescriber. The voorstel verstrekkingsverzoek may contain indications for the prescriber, such as urgency. The prescriber may approve the received proposal and make it into a final verstrekkingsverzoek. The prescriber informs the requestor via a antwoord voorstel verstrekkingsverzoek (see also [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4]] and subsequent paragraphs).  
+
When the existing verstrekkingsverzoek is not adequate, the pharmacist may communicate this request over the phone or send a digital voorstel verstrekkingsverzoek to the prescriber. The voorstel verstrekkingsverzoek may contain indications for the prescriber, such as urgency. The prescriber may approve the received proposal and alter it into a final verstrekkingsverzoek. The prescriber informs the requestor via a antwoord voorstel verstrekkingsverzoek (see also [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4]] and subsequent paragraphs).
  
 
===Process step: Creating a toedieningsafspraak===
 
===Process step: Creating a toedieningsafspraak===
  
If the medicatieafspraak and, if applicable, the corresponding verstrekkingsverzoek can be processed, an toedieningsafspraak will be created. By creating an toedieningsafspraak, the pharmacist fills to the medicatieafspraak. The toedieningsafspraak is communicated to the patient or the person administrating the medication. The toedieningsafspraakbelongs to the same medicamenteuze behandeling as the medicatieafspraak it fills. As is the case with the corresponding medicatieafspraak, an toedieningsafspraakmay start in the future. The dosage in the toedieningsafspraak may deviate from that in the medicatieafspraak, for example because a certain strength is not in stock. This means that another ‘PRK’ can become part of the medicamenteuze behandeling when, for example, 1 tablet of 20 mg is changed into 2 tablets of 10 mg.  
+
If the medicatieafspraak and, if applicable, the corresponding verstrekkingsverzoek can be processed, a toedieningsafspraak will be created. By creating a toedieningsafspraak, the pharmacist fulfills the medicatieafspraak. The toedieningsafspraak is communicated to the patient or the person administrating the medication. The toedieningsafspraakbelongs to the same medicamenteuze behandeling as the medicatieafspraak it fulfills. As is the case with the corresponding medicatieafspraak, a toedieningsafspraakmay start in the future. The dosage in the toedieningsafspraak may deviate from that in the medicatieafspraak, for example because a certain strength is not in stock. This means that another ‘PRK’ can become part of the medicamenteuze behandeling when, for example, 1 tablet of 20 mg is changed into 2 tablets of 10 mg.  
 
Before the toedieningsafspraak is created, medication monitoring will occur in accordance with applicable guidelines, as part of this process step.  
 
Before the toedieningsafspraak is created, medication monitoring will occur in accordance with applicable guidelines, as part of this process step.  
  
 
On the basis of the toedieningsafspraak, an administration list<ref> In this document, the administration list means both the digital and the paper version, unless otherwise indicated. Sublist and checklist are synonyms. </ref> can be compiled for home care or nursing staff, among others.  
 
On the basis of the toedieningsafspraak, an administration list<ref> In this document, the administration list means both the digital and the paper version, unless otherwise indicated. Sublist and checklist are synonyms. </ref> can be compiled for home care or nursing staff, among others.  
  
When creating an toedieningsafspraak, the same principle applies as for the medicatieafspraak: each change is recorded in a new toedieningsafspraak.  
+
When creating a toedieningsafspraak, the same principle applies as for the medicatieafspraak: each change is recorded in a new toedieningsafspraak.  
  
The following paragraphs describe the different situations in which an toedieningsafspraak is created: new toedieningsafspraak or continuing, permanently discontinuing, temporarily halting or modifying an existing toedieningsafspraak.  
+
The following paragraphs describe the different situations in which a toedieningsafspraak is created: new toedieningsafspraak or continuing, permanently discontinuing, temporarily halting or modifying an existing toedieningsafspraak.  
  
 
====New toedieningsafspraak====
 
====New toedieningsafspraak====
Regel 554: Regel 548:
 
====Discontinuing a toedieningsafspraak====
 
====Discontinuing a toedieningsafspraak====
  
A medicatieafspraak in which it has been agreed to discontinue permanently, medication leads to an stop toedieningsafspraak under the same medicamenteuze behandeling (this also applies in case of a stop-MA as a result of a change) with stoptype ‘definitief’. The stop TA prevents a new medicatieverstrekking of the discontinued medication.  
+
A medicatieafspraak in which it has been agreed to discontinue permanently, medication leads to a stop toedieningsafspraak under the same medicamenteuze behandeling (this also applies in case of a stop-MA as a result of a change) with stoptype ‘definitief’. The stop TA prevents a new medicatieverstrekking of the discontinued medication.  
 
In an ambulatory situation, the prescriber can indicate in the medicatieafspraak that the medication will be discontinued with the next roll (with GDS). In this case, the start date of the stop toedieningsafspraak may be later than indicated in the original stop medicatieafspraak.  
 
In an ambulatory situation, the prescriber can indicate in the medicatieafspraak that the medication will be discontinued with the next roll (with GDS). In this case, the start date of the stop toedieningsafspraak may be later than indicated in the original stop medicatieafspraak.  
  
 
====Temporarily interrupting a toedieningsafspraak====
 
====Temporarily interrupting a toedieningsafspraak====
  
Temporarily interrupting a medicatieafspraak results in an stop toedieningsafspraak (stop type: tijdelijk). Upon resuming, a new toedieningsafspraak is created. Both toedieningsafspraken belong to the same medicamenteuze behandeling as the medicatieafspraak.  
+
Temporarily interrupting a medicatieafspraak results in a stop toedieningsafspraak (stop type: tijdelijk). Upon resuming, a new toedieningsafspraak is created. Both toedieningsafspraken belong to the same medicamenteuze behandeling as the medicatieafspraak.  
  
 
====Modifying a toedieningsafspraak====
 
====Modifying a toedieningsafspraak====
  
A modified medicatieafspraak (leading to a new medicatieafspraak) leads to a new toedieningsafspraak under the same medicamenteuze behandeling. As with the medicatieafspraak, a change to an toedieningsafspraak means the termination of the existing toedieningsafspraak (a technical stop-TA) and the creation of a new toedieningsafspraak.  
+
A modified medicatieafspraak (leading to a new medicatieafspraak) leads to a new toedieningsafspraak under the same medicamenteuze behandeling. As with the medicatieafspraak, a change to a toedieningsafspraak means the termination of the existing toedieningsafspraak (a technical stop-TA) and the creation of a new toedieningsafspraak.
  
 
===Process step: Dispense===
 
===Process step: Dispense===
  
 
After creating the toedieningsafspraak, the pharmacist prepares the product and dispenses it to:  
 
After creating the toedieningsafspraak, the pharmacist prepares the product and dispenses it to:  
*The patient at home,  
+
*The patient in a community setting,  
 
*The patient admitted to a hospital, nursing home or other institution.  
 
*The patient admitted to a hospital, nursing home or other institution.  
*The pharmacist records medicatieverstrekking[17].  
+
The pharmacist records medicatieverstrekking<ref>In a clinical situation, product may be taken from the department’s own supply, after which administration takes place immediately and the administration is recorded.</ref>.
*Medicatieverstrekking to patients:  
+
 
 +
Medicatieverstrekking to patients:  
 
*In an ambulatory situation only occurs on the basis of a verstrekkingsverzoek or a repeat verstrekkingsverzoek,  
 
*In an ambulatory situation only occurs on the basis of a verstrekkingsverzoek or a repeat verstrekkingsverzoek,  
*In a clinical situation occurs on the basis of the medicatieafspraak without the need for a verstrekkingsverzoek.  
+
*In a clinical situation occurs on the basis of the medicatieafspraak without the need for a verstrekkingsverzoek.
  
 
===Process step: (Actively) making available===  
 
===Process step: (Actively) making available===  
Regel 579: Regel 574:
 
This step involves information exchange. Information can be sent or made available with different intentions:  
 
This step involves information exchange. Information can be sent or made available with different intentions:  
  
As a request to the prescriber to create a new medicatieafspraak (vma) or a new toedieningsafspraak (vvv).  
+
As a request to the prescriber to create a new medicatieafspraak (vma) or a new verstrekkingsverzoek (vvv).  
  
 
Informing the prescriber about the processing of the prescription (toedieningsafspraak and/or medicatieverstrekking).  
 
Informing the prescriber about the processing of the prescription (toedieningsafspraak and/or medicatieverstrekking).  
Regel 585: Regel 580:
 
Making medication data available (verstrekkingsverzoek and medicatieverstrekking) to allow fellow healthcare providers and/or patients to access these later.  
 
Making medication data available (verstrekkingsverzoek and medicatieverstrekking) to allow fellow healthcare providers and/or patients to access these later.  
  
Making a medication overview available to allow fellow healthcare providers and/or patients to access these later.  
+
Making a medication overview available to allow fellow healthcare providers and/or patients to access these later.
  
 
===Post-condition===
 
===Post-condition===
*A toedieningsafspraak have been created.  
+
*A toedieningsafspraak could have been created.  
*A medicatieverstrekking have taken place and, if necessary, the patient has received instructions on how to use the medicinal product.  
+
*A medicatieverstrekking could have taken place and, if necessary, the patient has received instructions on how to use the medicinal product.  
 
*Fellow healthcare providers have been informed or may inform themselves. The prescriber has been informed.  
 
*Fellow healthcare providers have been informed or may inform themselves. The prescriber has been informed.  
*If necessary, the prescribing physician has been requested to provide a new/modified medicatieafspraak or  voorstel verstrekkingsverzoek.  
+
*If necessary, the prescribing physician has been requested to provide a new/modified medicatieafspraak or  voorstel verstrekkingsverzoek.
  
 
===Systems and transaction groups===
 
===Systems and transaction groups===
  
The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), an XIS and a PGO<ref> XIS is a generic term for a random (health care) information system. PHR=personal health records. </ref>. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.  
+
The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO<ref> XIS is a generic term for a random (health care) information system. PHR=personal health records. </ref>. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.  
 
[[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.
 
[[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.
  
Regel 603: Regel 598:
 
===Use cases===
 
===Use cases===
 
De volgende specifieke use cases van ter hand stellen zijn uitgewerkt:
 
De volgende specifieke use cases van ter hand stellen zijn uitgewerkt:
*[[#Nieuwe medicatieafspraak, medicatieverstrekking zelfde product|Nieuwe medicatieafspraak, medicatieverstrekking zelfde product (paragraaf 4.2.1)]]
+
*[[#New medicatieafspraak, medicatieverstrekking of the same product|New medicatieafspraak, medicatieverstrekking of the same product (paragraph 4.2.1)]]
*[[#Nieuwe medicatieafspraak, nadere specificering product|Nieuwe medicatieafspraak, nadere specificering product (paragraaf 4.2.2)]]
+
*[[#New medicatieafspraak, more precise product specification|New medicatieafspraak, more precise product specification (paragraph 4.2.2)]]
*[[#Bestaande toedieningsafspraak voldoet|Bestaande toedieningsafspraak voldoet (paragraaf 4.2.3)]]
+
*[[#Existing toedieningsafpsraak is adequate|Existing toedieningsafpsraak is adequate (paragraph 4.2.3)]]
*[[#Medicatieafspraak nodig (Informeren voorschrijver)|Medicatieafspraak nodig (Informeren voorschrijver) (paragraaf 4.2.4)]]
+
*[[#Medicatieafspraak wanted (informing the prescriber)|Medicatieafspraak wanted (informing the prescriber) (paragraph 4.2.4)]]
*[[#Aanschrijven en verstrekken|Aanschrijven en verstrekken (paragraaf 4.2.5)]]
+
*[[#Request and dispense|Request and dispense (paragraph 4.2.5)]]
*[[#Patiënt vraagt herhaalrecept via arts (reactief herhalen)|Patiënt vraagt herhaalrecept via arts (reactief herhalen) (paragraaf 4.2.6)]]
+
*[[#Patient requests repeat prescription via physician (reactive repeat)|Patient requests repeat prescription via physician (reactive repeat) (paragraph 4.2.6)]]
*[[#Patiënt vraagt herhaalrecept via apotheker (Informeren voorschrijver)|Patiënt vraagt herhaalrecept via apotheker (Informeren voorschrijver) (paragraaf 4.2.7)]]
+
*[[#Patient requests repeat prescription via pharmacist (informing prescriber)|Patient requests repeat prescription via pharmacist (informing prescriber) (paragraph 4.2.7)]]
*[[#Proactief herhaalrecept door apotheker (Informeren voorschrijver)|Proactief herhaalrecept door apotheker (Informeren voorschrijver) (paragraaf 4.2.8)]]
+
*[[#Proactive repeat prescription by pharmacist (informing prescriber)|Proactive repeat prescription by pharmacist (informing prescriber) (paragraph 4.2.8)]]
*[[#Verstrekken op basis van bestaand verstrekkingsverzoek|Verstrekken op basis van bestaand verstrekkingsverzoek (paragraaf 4.2.9)]]
+
*[[#Dispense based on an existing verstrekkingsverzoek|Dispense based on an existing verstrekkingsverzoek (paragraph 4.2.9)]]
*[[#Knippen van recept|Knippen van recept (paragraaf 4.2.10)]]
+
*[[#Splitting a prescription|Splitting a prescription (paragraph 4.2.10)]]
*[[#Het opstarten en continueren van GDS|Het opstarten en continueren van GDS (paragraaf 4.2.11)]]
+
*[[#Starting and continuing a GDS|Starting and continuing a GDS (paragraph 4.2.11)]]
*[[#De apotheker wijzigt van handelsproduct|De apotheker wijzigt van handelsproduct (paragraaf 4.2.12)]]
+
*[[#The pharmacist changes commercial product|The pharmacist changes commercial product (paragraph 4.2.12)]]
*[[#Medicatie toevoegen aan GDS|Medicatie toevoegen aan GDS (paragraaf 4.2.13)]]
+
*[[#Adding medication to a GDS|Adding medication to a GDS (paragraph 4.2.13)]]
*[[#Medicatie in GDS stoppen|Medicatie in GDS stoppen (paragraaf 4.2.14)]]
+
*[[#Discontinuing medication in a GDS|Discontinuing medication in a GDS (paragraph 4.2.14)]]
*[[#GDS leverancier levert ander handelsproduct|GDS leverancier levert ander handelsproduct (paragraaf 4.2.15)]]
+
*[[#GDS supplier supplies other commercial product|GDS supplier supplies other commercial product (paragraph 4.2.15)]]
*[[#Afhandelen stop medicatieafspraak|Afhandelen stop medicatieafspraak (paragraaf 4.2.16)]]
+
*[[#Handling a stop medicatieafspraak|Handling a stop medicatieafspraak (paragraph 4.2.16)]]
*[[#Verstrekkingsverzoek met aantal herhalingen|Verstrekkingsverzoek met aantal herhalingen (paragraaf 4.1.36)]]
+
*[[#Verstrekkingsverzoek with number of repetitions|Verstrekkingsverzoek with number of repetitions (paragraph 4.1.36)]]
  
==Proces: toedienen==
+
==Process: Administer==
Deze paragraaf beschrijft het proces van toedienen. De medicatietoediening wordt gedaan door een zorgverlener en in dit geval wordt er bedoeld een professionele toedieningsbevoegde of de patiënt zelf. Professionele toedieners zijn bijvoorbeeld de artsen/verpleegkundige/verzorgende (thuiszorg/instelling) en de huisarts/huisartsassistent maar ook de anesthesioloog, verloskundige en tandarts. Toediening door bijvoorbeeld een mantelzorger wordt vastgelegd als gebruik (zie [[#Proces: gebruiken|paragraaf 2.5]]). Voor een plaat van dit proces zie [[#Bijlage: Diagram Medicatieproces algemeen|hoofdstuk 11]].
+
This paragraph describes the administration process. Medicatietoediening is carried out by the patient himself or by a healthcare provider, which in this case means a professional authorised to administer medication such as physicians/nurses/caregivers (home care/institution) as well as general practitioners/GP assistants, anaesthesiologists, midwives and dentists. Administration by, for example, an informal caregiver, is recorded as usage (see [[#Process: Use|paragraph 2.5]]). See [[#Appendix: General Diagram Medicatioprocess|Chapter 12]] for a diagram of this process.
  
===Huidige situatie===
+
===Current situation===
*Het komt vaak voor dat op de toedienlijst in de thuiszorg alleen toedientijden zijn vermeld van de medicatie die in GDS-verpakking (‘baxter’-medicatie) wordt geleverd. De verpleegkundige leidt de toedientijden van de overige medicatie dan af uit de informatie op het etiket. Daarnaast ontbreken regelmatig de zo nodig medicatie, bijspuitschema’s (bijv. insuline) en antistollingsdosering op de toedienlijst.
+
*It often happens that the administration list in home care only lists the scheduled administration time for medicatieverstrekking in GDS packaging (‘baxter’ medication). In that case, the nurse infers the administration times of the other medication from the information on the label. In addition, medication as needed, injection schedules (for example, for insulin) and anticoagulant dosages are often missing on the administration list.
*De verpleegkundige verifieert in de thuiszorg bij de cliënt of de toe te dienen medicatie op de toedienlijst nog klopt. Regelmatig verschijnen wijzigingen in de medicatie (incl. stop-afspraken) niet of niet tijdig op de toedienlijst. De verpleegkundige belt dan met de apotheker, huisarts of medisch specialist om te achterhalen wat er moet worden toegediend.
+
*While providing home care, the nurse verifies with the client whether the medication on the administration list is still correct. Medication changes (including stop-orders) often do not appear on the administration list, or not in time. The nurse will the phone the pharmacist, general practitioner or medical specialists to find out what has to be administered.
  
===Preconditie===
+
===Precondition===
De patiënt moet medicatie toegediend krijgen door een zorgverlener of de patiënt dient zichzelf medicatie toe.
+
The patient must either be administered medication by a healthcare provider or the patient administers medication to himself.
  
 
===Trigger event===
 
===Trigger event===
Het moment dat de medicijnen worden toegediend.
+
The moment the medicinal products are administered.
  
===Processtap: Toedienen===
+
===Process step: Administering===
De toediener ontvangt de gegevens die hij nodig heeft voor de medicatietoediening of hij vraagt deze gegevens op (bijv. toedienafspraken met bijbehorende medicatieafspraken en andere relevante patiëntkenmerken, condities, laboratoriumwaarden, eerdere toediengegevens). De toediener verifieert op basis van de aanwezige medicatie en de toediengegevens de toe te dienen medicatie. Indien afgesproken en nodig maakt de zorgverlener het geneesmiddel voor medicatietoediening gereed op basis van de instructies van de apotheker. De medicatie wordt toegediend en de toediener registreert het afhandelen van de medicatietoediening in zijn systeem of op de toedienlijst. Afwijkingen in de medicatietoediening (niet toedienen, gewijzigde dosering, weigering van de patiënt, slikproblemen, bijwerkingen, etc.) worden daarbij vastgelegd en zo nodig gecommuniceerd naar de voorschrijver en/of apotheker.
+
The administrator receives the data he needs for administering the medication or he accesses the data (for example, toedieningsafspraak with corresponding medicatieafspraken and other relevant patient characteristics, conditions, laboratory values, previous administration data). The administrator verifies the medication to be administered on the basis of the medication present and the administration data. If agreed and if necessary, the healthcare provider prepares the medication for administration, based on the instructions provided by the pharmacist. The medication is administered. The person who administered the medication registers in his system or on the administration list how the medicatietoediening was carried out. Any abnormalities (no administration, modified dosage, patient refusal, swallowing problems, side effects, etc.) are also recorded and communicated to the prescriber and/or the pharmacist.
  
===Processtap: (Actief) beschikbaarstellen===
+
===Process step: (Actively) making available===
De vastgelegde medicatiegegevens (medicatietoediening) kunnen ter kennisgeving worden verstuurd naar een medebehandelaar of beschikbaar worden gesteld zodat zij later opgevraagd kunnen worden. Bij bijvoorbeeld verplaatsing naar een andere afdeling of instelling kunnen de toedieningsgegevens dan worden opgevraagd.
+
The recorded medication data (medicatietoediening) may be sent for information to a fellow healthcare provider or be made available so that the data can be accessed later. For example, the administration data can be retrieved upon transfer of the patient to another department or institution.
  
===Postconditie===
+
===Post-condition===
De cliënt heeft medicijnen toegediend gekregen en dit is geregistreerd. Zo nodig zijn bevindingen gecommuniceerd met de verantwoordelijke arts en/of apotheker.
+
The client has been administered medicinal products and this has been registered. If necessary, findings have been communicated to the responsible physician and/or pharmacist.
  
===Systemen en transactiegroepen===
+
===Systems and transaction groups===
Zowel de ''voorschrijver'' als de ''apotheker'' als ''toedieners'' en ''gebruikers'' maken ieder gebruik van een informatiesysteem, respectievelijk een elektronisch voorschrijfsysteem (EVS), een apothekersinformatiesysteem (AIS, incl. ZAIS), een XIS en een PGO<ref>XIS is een generieke term voor een willekeurig (zorg)informatiesysteem. PGO=Persoonlijke GezondheidsOmgeving.</ref>. Deze systemen kennen ieder verschillende systeemrollen, die het uitwisselen van gegevens tussen deze systemen in het kader van het toedienproces mogelijk maken. <br>
+
The ''prescriber'' and the ''pharmacist'' as well as other ''healthcare providers'' and ''users'' all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO<ref>XIS is a generic term for a random (health care) information system. PHR=personal health records.</ref>. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.<br>
[[#Systemen en transacties|Hoofdstuk 6]] geeft een overzicht van alle systemen, systeemrollen, transacties, etc. De belangrijkste voor het proces van toedienen zijn in onderstaand overzicht opgenomen.
+
[[#Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.
  
 
{{anchor|figuur 7}}
 
{{anchor|figuur 7}}
Regel 651: Regel 646:
  
 
===Use cases===
 
===Use cases===
De volgende specifieke use cases van toedienen zijn uitgewerkt:
+
The following use cases for medicatietoediening have been worked out:
*[[#Dubbele controle|Dubbele controle (paragraaf 4.3.1)]]
+
*[[#Double check|Double check (paragraph 4.3.1)]]
*[[mp:V9.0.5_Ontwerp_medicatieproces#Toedienen_zonder_medicatieafspraak_of_toedieningsafspraak|Toedienen zonder medicatieafspraak of toedieningsafspraak (paragraaf 4.3.2)]]
+
*[[#Administering without medicatieafspraak or toedieningsafspraak|Administering without medicatieafspraak or toedieningsafspraak (paragraph 4.3.2)]]
  
==Proces: gebruiken==
+
==Process: Use==
Deze paragraaf beschrijft het proces van gebruiken van de medicatie inclusief de registratie van het gebruik door de patiënt of een zorgverlener. De door de patiënt of zorgverlener vastgelegde informatie kan onder andere worden gebruikt bij medicatieverificatie door de zorgverlener. Tijdens medicatieverificatie wordt het gebruik vastgelegd door de zorgverlener. Voor een plaat van dit proces zie [[#Bijlage: Diagram Medicatieproces algemeen|hoofdstuk 11]].
+
This paragraph describes the process of use including registration of consumption by the patient or a healthcare provider. The information recorded by the patient or healthcare provider may be used, among other things, for medication verification by the healthcare provider. During medication verification, use is established by the healthcare provider. See [[#Appendix: General Diagram Medicatioprocess|Chapter 12]] for a diagram of this process.
  
===Huidige situatie===
+
===Current situation===
*Er is op dit moment een beperkt aantal systemen beschikbaar waarin de patiënt zelf het gebruik van medicatie kan vastleggen. Ook de uitwisseling naar zorgverleners is sterk afhankelijk van het gebruikte systeem en beperkt zich veelal tot één specifieke zorgaanbieder via bijvoorbeeld één specifiek zorgaanbiedersplatform/app.
+
*There is currently a limited number of systems available in which the patient can record his own consumption. Exchange to healthcare providers is also highly dependent on the system used and is often limited to one specific healthcare provider via, for example, one specific platform/app.
 
*De huidige medicatieprofielen zijn vaak onvolledig en niet actueel.
 
*De huidige medicatieprofielen zijn vaak onvolledig en niet actueel.
  
===Preconditie===
+
===Precondition===
De patiënt heeft medicatie voorgeschreven gekregen.
+
The patient has been prescribed medication.
  
 
===Trigger event===
 
===Trigger event===
De patiënt heeft de medicatie gebruikt of gebruikt deze niet (meer).
+
The patient has used the medication or does not use it (anymore).
  
===Processtap: Gebruiken===
+
===Process step: Medicatiegebruik===
De patiënt gebruikt de voorgeschreven medicatie of zelfzorgmedicatie. Het medicatiegebruik kan worden vastgelegd door
+
The patient uses the prescribed medication, selfcare medication . consumption may be recorded by
*de patiënt zelf of zijn mantelzorger,  
+
*The patient himself or his informal caregiver,
*een thuiszorg- of instellingsverpleegkundige en/of
+
*A home care or institution nurse and/or
*een andere zorgverlener.
+
*Another healthcare provider.
Dit laatste vindt vaak plaats bij medicatieverificatie (zie [[#Proces: medicatieverificatie|paragraaf 2.1]]). Er zijn allerlei systemen beschikbaar om het gebruik vast te leggen: PGO, XIS, EPD/ECD, app, etc.
+
This third option often applies in the event of medication verification (see [[#Process: medication verification|paragraph 2.1]]). A variety of systems is available to record use: PHR, XIS, EPF [electronic patient file] / ECF [electronic client file], app, etc.
  
Als medicatiegebruik kunnen worden vastgelegd:  
+
The following can be recorded as use:
*zelfzorg en andere eigen medicatie,  
+
*Self-care and other proprietary medication,
*het aangeven van afwijkingen ten opzichte van de gemaakte afspraken,  
+
*Discrepancies compared to agreements made,
*bevestiging van gebruik (bevorderen therapietrouw),  
+
*Confirmation of use (promoting compliance),
*geverifieerde medicatie (zie [[#Proces: medicatieverificatie|paragraaf 2.1]]),
+
*Verified medication (see medication verification),
*wijzigingen als gevolg van bijvoorbeeld bijwerkingen (door de patiënt zelf; een zorgverlener zal dit op een andere wijze registreren).
+
*Changes as a result of, for example, side effects (by the patient himself; a healthcare provider will record this in a different way).
  
Patiënten die medicatie krijgen toegediend door een verpleegkundige nemen afhankelijk van de BEM score (Beoordeling Eigen beheer Medicatie) soms zelf later de medicatie in; de gegevens van de medicatietoediening kunnen dan afwijken van het medicatiegebruik.<br>
+
Patients who are being administered medication by a nurse sometimes take the medication by themselves at a later time, depending on the BEM score (assessment of medication self-management, in Dutch: Beoordeling Eigen Beheer Medicatie); in that case, medicatietoediening data may deviate from medicatiegebruik.<br>
Gedurende het gebruik wordt farmaceutische zorg uitgevoerd door de apotheker (zie [[#Processtap: Uitvoeren farmaceutische zorg|paragraaf 2.3.4]] bijv. in geval van nieuwe laboratoriumwaarden). Ook kan er een vervolgcontact plaatsvinden waarin de medicamenteuze behandeling wordt geëvalueerd (zie [[#Processtap: Evalueren (medicamenteuze) behandeling|paragraaf 2.2.4]]).
+
While medication is being used, pharmaceutical care is provided by the pharmacist (see [[#Process step: Providing pharmaceutical care|paragraph 2.3.4]], e.g. in case of new laboratory values). There may also be follow-up contact during which the medicamenteuze behandeling is evaluated (see [[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4]]).
  
====''Vastleggen medicatiegebruik door de patiënt''====
+
====''Recording medicatiegebruik by the patient''====
De patiënt maakt gebruik van een medicatieprofiel en geeft per medicijn, waarvoor dit relevant is, het daadwerkelijk gebruik aan. Daarbij kan de patiënt aangeven of hij het product wel of niet gebruikt en of dit 'gebruik volgens afspraak' is (waarbij de medicatieafspraak en/of toedieningsafspraak getoond is) en afwijkingen daarvan. Bij afwijkingen kan ingevoerd worden welke afwijking het betreft, dus volgens het werkelijk door de patiënt gevolgde schema, maar ook in algemenere termen (bijvoorbeeld ik neem de medicatie: 'af en toe', 'gemiddeld [x] keer per [dag/week]', '1x per dag in plaats van 2x', 'niet meer sinds 22-1-2015' of 'niet meer sinds ongeveer een maand'). Bij afwijking van de afspraken geeft de patiënt ook de reden van wijzigen of stoppen aan.<br>
+
The patients makes use of a medication profile and indicates actual use for each medicinal product for which this is relevant. The patient can indicate whether or not he is using the product and/or whether this is ‘use according to agreement’ (whereby the medicatieafspraak and/or toedieningsafspraak is displayed) or if there were deviations. In case of deviations, it is possible to enter specific deviations (i.e. with regard to the schedule actually followed by the patient), but deviations can also be entered in more general terms (for example, I take the medication: ‘from time to time’, [x] times per [days/week] on average’, ‘1x daily instead of 2x’, ‘not anymore since 22 January 2015’ or ‘not anymore since about a month’). In case of deviation from the agreements, the patient also indicates the reason for changing or discontinuing.<br>
Daarnaast kan de patiënt zijn eigen medicatie toevoegen aan het overzicht en eventuele bijwerkingen als reden voor wijzigingen opgeven.
+
The patient may also add his own medication to the overview and indicate any side effects as the reason for the changes.
  
Informatie over gebruik zal niet altijd aanwezig zijn. Daarnaast is er geen zekerheid over de betrouwbaarheid van de informatie. Soms zijn er afspraken tussen zorgverlener en patiënt over het bijhouden van medicatiegebruik, soms ligt het initiatief geheel bij de patiënt zelf.
+
Information about use will not always be present. There is also no certainty about the reliability of the information. Sometimes there are agreements between the healthcare provider and the patient about keeping track of consumption, and sometimes the initiative is the patient’s entirely.
  
====''Vastleggen medicatiegebruik door zorgverlener''====
+
====''Recording consumption by healthcare providers''====
Tijdens het proces van medicatieverificatie ([[#Proces: medicatieverificatie|paragraaf 2.1]]) of Evalueren van de medicamenteuze behandeling ([[#Processtap: Evalueren (medicamenteuze) behandeling|2.2.4]]) geeft de patiënt (of zijn mantelzorger) bijvoorbeeld aan dat hij medicatie niet of anders gebruikt dan afgesproken. Of dat hij ook nog andere medicatie gebruikt (zelfzorgmiddelen of buitenlandse medicatie). De zorgverlener kan deze gegevens vastleggen als medicatiegebruik. De gegevens over gebruik worden naast de primaire medicatiegegevens vastgelegd, de patiënt wordt daarbij als bron van de informatie vastgelegd, de zorgverlener als auteur.<br>
+
During the process of medication verification ([[#Process: medication verification|paragraph 2.1]]) or evaluating a medicamenteuze behandeling ([[#Process step: Evaluating a (pharmaceutical) treatment|2.2.4]]) the patient (or his informal caregiver) indicates, for example, that he does not use medication or uses it differently than was agreed. He may also indicate that he uses other medication as well (self-care products or foreign medication). The healthcare provider can record these data as consumption. The data about use are recorded in addition to the primary medication data with the patient being recorded as the source of the information and the healthcare provider as the author.<br>
In plaats van of naast het vastleggen van het gebruik kan een voorschrijver er ook voor kiezen om een nieuwe of gewijzigde medicatieafspraak te maken met de patiënt (conform proces beschreven in [[#Processtap: Maken medicatieafspraak|paragraaf 2.2.5]]). Dit gebeurt wanneer de voorschrijver reden ziet om de afspraak bij te stellen naar aanleiding van het gebruik door de patiënt. Wanneer de voorschrijver geen reden ziet de afspraak bij te stellen kan hij er voor kiezen alleen het gebruik vast te leggen, met eventueel de opmerking dat hij de patiënt heeft verzocht zich te houden aan de eerder gemaakte afspraken.
+
Instead of or in addition to recording the consumption, a prescriber may also choose to make a new or modified medicatieafspraak with the patient (in accordance with the process described in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]]). This may occur when the prescriber sees reasons to adjust the agreement in response to the patient’s actual consumption. When the prescriber sees no reasons to adjust the agreement, he may choose to only record the consumption, perhaps with the remark that he has requested the patient to comply with the existing agreements.
  
Bij afwijkend gebruik zal een apotheker mogelijk een voorstel-medicatieafspraak opstellen ten behoeve van de voorschrijver (zie [[#Processtap: Informeren voorschrijver|paragraaf 2.3.5]]) en/of de patiënt aanraden de voorschrijver te informeren over het afwijkende gebruik.
+
In case of deviations in consumption, a pharmacist may create a voorstel medicatieafspraak for the prescriber (see [[#Process step: Informing the prescriber|paragraph 2.3.5]]) and/or advise the patient to inform the prescriber about the deviations.
  
De verslaglegging rondom de evaluatie van gebruik (werking en bijwerking) zal de arts in de anamnese vastleggen of gebruiken als reden om een medicatieafspraak te wijzigen of te stoppen.
+
The assessment of useconsumption (effect and side effect) will be recorded by the physician in the medical history or used as a reason to modify or discontinue a medicatieafspraak.
  
===Processtap: (Actief) beschikbaarstellen===
+
===Process step: (Actively) making available===
De vastgelegde medicatiegegevens (gebruik) en eventueel het medicatieoverzicht kunnen ter kennisgeving worden verstuurd naar een medebehandelaar of beschikbaar worden gesteld zodat zij later opgevraagd kunnen worden.
+
The recorded medication data (consumption) and possibly the medication overview may be sent for information to a fellow healthcare provider or be made available so that the data can be accessed later.
  
===Processtap: Informeren voorschrijver===
+
{{Anchor|2-5-6}}
De patiënt kan de voorschrijver ook zelf informeren wanneer er een nieuwe of gewijzigde medicatieafspraak of een nieuw verstrekkingsverzoek nodig is. Het proces is analoog aan het proces van Informeren voorschrijver door de apotheker ([[#Processtap: Informeren voorschrijver|paragraaf 2.3.5]]).
+
===Process step: Informing the prescriber===
 +
The patient may also directly inform the prescriber when a new or modified medicatieafspraak or new verstrekkingsverzoek is needed. The process is similar to the process of the pharmacist informing the prescriber ([[#Process step: Informing the prescriber|paragraph 2.3.5]]).
  
===Postconditie===
+
===Post-condition===
De lijst met medicatie is door de patiënt bijgewerkt en het daadwerkelijk gebruik is toegevoegd. De patiënt heeft zo nodig de voorschrijver verzocht om een nieuwe of gewijzigde medicatieafspraak of verstrekkingsverzoek.
+
The medication list has been updated by the patient and actual use has been added. If necessary, the patient has asked the prescriber for a new or modified medicatieafspraak or verstrekkingsverzoek.
  
===Systemen en transactiegroepen===
+
===Systems and transaction groups===
Zowel de ''voorschrijver'' als de ''apotheker'' als andere ''medebehandelaars'' en ''gebruikers'' maken ieder gebruik van een informatiesysteem, respectievelijk een elektronisch voorschrijfsysteem (EVS), een apothekersinformatiesysteem (AIS, incl. ZAIS), een XIS en een PGO<ref>XIS is een generieke term voor een willekeurig (zorg)informatiesysteem. PGO=Persoonlijke GezondheidsOmgeving.</ref>. Deze systemen kennen ieder verschillende systeemrollen, die het uitwisselen van gegevens tussen deze systemen in het kader van het gebruiksproces mogelijk maken.  
+
The ''prescriber'' and the ''pharmacist'' as well as other ''healthcare providers'' and ''users'' all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO<ref>XIS is a generic term for a random (health care) information system. PHR=personal health records.</ref>. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.<br>
[[#Systemen en transacties|Hoofdstuk 6]] geeft een overzicht van alle systemen, systeemrollen, transacties, etc. De belangrijkste voor het proces van gebruiken zijn in onderstaand overzicht opgenomen.
+
[[#6 Systems and transactions|Chapter 6]] includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.
  
 
{{anchor|figuur 8}}
 
{{anchor|figuur 8}}
Regel 716: Regel 712:
  
 
===Use cases===
 
===Use cases===
De use cases voor Gebruiken zijn beschreven vanuit registratie door de patiënt. De voorschrijver kan het medicatiegebruik op dezelfde wijze vastleggen maar zal de verslaglegging rondom de evaluatie van gebruik (werking en bijwerking) eerder in de anamnese vastleggen of gebruiken als reden om een medicatieafspraak te wijzigen of te stoppen.
+
The use cases for consumption are described on the basis of registration by the patient. The prescriber may record consumption in the same way but will rather record the assessment of consumption (effect and side effect) in the medical history or use it as a reason to modify or discontinue a medicatieafspraak.
  
De volgende specifieke use cases van gebruik zijn uitgewerkt:
+
The following specific use cases for consumption have been worked out:
*[[#Zelfzorgmiddel|Zelfzorgmiddel (paragraaf 4.4.1)]]
+
*[[#Self-care product|Self-care product (paragraph 4.4.1)]]
*[[#Medicatie uit buitenland|Medicatie uit buitenland (paragraaf 4.4.2)]]
+
*[[#Medication from abroad|Medication from abroad (paragraph 4.4.2)]]
*[[#Wijziging op initiatief patiënt|Wijziging op initiatief patiënt (paragraaf 4.4.3)]]
+
*[[#Modification on the patient’s initiative|Modification at the patient’s initiative (paragraph 4.4.3)]]
*[[#Stoppen medicatie op initiatief patiënt|Stoppen medicatie op initiatief patiënt (paragraaf 4.4.4)]]
+
*[[#Discontinuation of medication on the patient’s initiative|Discontinuation of medication at the patient’s initiative (paragraph 4.4.4)]]
*[[#Geen voorraad meer|Geen voorraad meer (paragraaf 4.4.5)]]
+
*[[#No more supply|No more supply (paragraph 4.4.5)]]
*[[#Feedback aan patiënt via medicatiesignalering|Feedback aan patiënt via medicatiesignalering (paragraaf 4.4.6)]]
+
*[[#Feedback to patient through a medication adherence app|Feedback to patient through a medication adherence app (paragraph 4.4.6)]]
*[[#Bijwerkingen registreren door patiënt|Bijwerkingen registreren door patiënt (paragraaf 4.4.7)]]
+
*[[#Registration of side effects by the patient|Registration of side effects by the patient (paragraph 4.4.7)]]
*[[#Medicatieafspraak nodig (Informeren voorschrijver)|Medicatieafspraak nodig (Informeren voorschrijver) (zie ook paragraaf 4.2.4)]]
+
*[[#Register usage based on provision|Register usage based on provision (paragraph 4.4.8)]]
*[[#Patiënt vraagt herhaalrecept via arts (reactief herhalen)|Patiënt vraagt herhaalrecept via arts (reactief herhalen) (Informeren voorschrijver) (zie ook paragraaf 4.2.6)]]
+
*[[#Medicatieafspraak wanted (informing the prescriber)|Medicatieafspraak wanted (informing the prescriber) (see also paragraph 4.2.4)]]
*[[#Gebruik registreren op basis van verstrekking|Gebruik registreren op basis van verstrekking (paragraaf 4.4.8)]]
+
*[[#Patient requests repeat prescription via physician (reactive repeat)|Patient requests repeat prescription via physician (reactive repeat) (informing prescriber) (see also paragraph 4.2.6)]]
  
=Domeinspecifieke invulling medicatieproces=
+
=Domain-specific handling of the medication process=
  
==Dienstwaarneming door HAP==
+
==Locum GP ervice (HAP)==
De huisartsenpost (HAP) werkt in opdracht van de vaste huisarts. De huisartsenpost kan (onder andere) medicatieafspraken starten, wijzigen en stoppen conform het proces beschreven in [[#Proces: medicatieverificatie|paragraaf 2.1]]. De HAP zal zo nodig ook de bijbehorende verstrekkingsverzoeken doen.<br>
+
The locum GP service (LGP) works on behalf of the regular general practitioner. The GP service may (among other things) start, modify and discontinue medicatieafspraken in accordance with the process described in [[#Process: medication verification|paragraph 2.1]]. If necessary, the LGP will also create the corresponding verstrekkingsverzoeken.<br>
De HAP informeert de vaste huisarts over de waarneming. Bestaande afspraak is dat de HAP zelf geen bron is van informatie voor andere medebehandelaars van deze patiënt. Dit betekent dat de HAP de processtap ‘(Actief) beschikbaar stellen’ niet zal vervullen. In plaats daarvan stelt de vaste huisarts de betreffende informatie beschikbaar voor de medebehandelaars. Uitzondering hierop is het eventueel ongeadresseerd voorschrijven door een HAP, zie hiervoor [[#Ongeadresseerd voorschrijven (ambulant)|paragraaf 7.5]].<br>
+
The LGP will inform the regular general practitioner about the observation. Currently, it has been agreed that the LGP does not act as a source of information for other healthcare providers of this patient. This means that the LGP will not carry out the process step ‘(actively) making available’. Instead, the regular general practitioner will make the relevant information available to the fellow healthcare providers. An exception may be made for a prescription created by the LGP without a specified recipient, see [[#Prescription without specified recipient (ambulatory)|paragraph 8.1]].<br>
Dienstwaarneming volgt daarmee in principe het generieke proces van voorschrijven. Het verschil is dat een waarnemend arts sommige stappen uitvoert in opdracht van de vaste huisarts ('gedelegeerd').
+
In principle, the locum GP service service will follow the generic prescription process, except that a locum GP physician will carry out certain steps on behalf of the regular GP (‘delegated’).
  
==Trombosedienst==
+
==Thrombosis service==
  
===Huidige situatie===
+
===Current situation===
*Communicatie tussen trombosedienst en apotheek vindt plaats door middel van fax en/of beveiligde e-mail.
+
*Communication between thrombosis service and pharmacy is carried out by fax and/or secure e-mail.
*Communicatie tussen voorschrijver en trombosedienst vindt telefonisch plaats en initieel door middel van het aanmeldformulier.
+
*Communication between prescriber and thrombosis service is carried out by telephone and initially using the registration form.
*Om een compleet beeld van de medicatie die de patiënt gebruikt te krijgen vraagt de trombosedienst soms AMO’s (Actueel Medicatieoverzicht) op bij verschillende apotheken.
+
*In order to get a complete picture of the medication the patient uses, the thrombosis service may sometimes ask for an AMO (Actueel Medicatie Overzicht) overviews from different pharmacies.
  
===Proces===
+
===Process===
Wanneer een patiënt antistollingsmedicatie moet gaan gebruiken maakt de voorschrijvend arts (huisarts of specialist) een medicatieafspraak met de patiënt over de te gebruiken antistollingsmedicatie, conform het beschreven proces van voorschrijven ([[#Proces: medicatieverificatie|paragraaf 2.1]]). Medebehandelaars kunnen zich op de hoogte stellen van het gebruik van antistolling ‘volgens schema trombosedienst’.<br>
+
When a patient has to start using anticoagulant medication, the prescribing physician (general practitioner or specialist) creates a medicatieafspraak with the patient stating which anticoagulant medication will be used, in accordance with the prescription process as described in [[#Process: medication verification|paragraph 2.1]]. Fellow healthcare providers may inform themselves about anticoagulant use ‘in accordance with the thrombosis service schedule’.<br>
De voorschrijver bepaalt de therapeutische INR range (International Normalized Ratio, maat voor de stollingstijd van bloed) en meldt de patiënt aan bij de trombosedienst. De voorschrijvend arts blijft verantwoordelijk voor de verstrekkingsverzoeken. Echter, de trombosedienst bepaalt het specifieke doseerschema op basis van de therapeutische INR range en de gemeten INR. De trombosedienst maakt daarmee een nadere invulling van de medicatieafspraak (‘dosering volgens schema trombosedienst’). <br>
+
The prescriber determines the therapeutic INR range (International Normalised Ratio, a measure for blood clotting time) and refers the patient to the thrombosis service. The prescribing physician remains responsible for verstrekkingsverzoeken. The thrombosis service however determines the specific dosing schedule on the basis of the therapeutic INR range and the measured INR (. The thrombosis service uses this to further complete the medicatieafspraak (‘dosage in accordance with the thrombosis service schedule’) documented in the toedieningsafspraak. The thrombosis service also creates medicatieafspraken, including verstrekkingsverzoeken themselves, about the use of vitamin K and heparin, in accordance with the prescription process as described in [[#Process: medication verification|paragraph 2.1]].<br>
De trombosedienst maakt ook zelf medicatieafspraken, incl. verstrekkingsverzoeken, over het gebruik van vitamine K en heparine, conform het beschreven proces van voorschrijven ([[#Proces: medicatieverificatie|paragraaf 2.1]]). <br>
+
At the start of treatment and after each admission, the thrombosis service asks for current medication data (including allergies), receives notification signals from pharmacists about newly provided interacting medication and asks the patient at each visit for particulars, such as hospital admissions, illnesses and use of selfcare medication. Based on this information and possibly after consultation with the prescriber, interim dosage changes may be made.
De trombosedienst vraagt bij de start en na elke opname de actuele medicatiegegevens (incl. allergieën) op, krijgt signalen van apothekers over nieuw verstrekte interacterende medicatie en vraagt de patiënt bij elke controle naar bijzonderheden zoals opnames, ziektes en zelfzorgmedicatie. Op basis van deze informatie en eventueel na overleg met de voorschrijver kan de dosering tussentijds worden aangepast.  
 
  
De patiënt wordt via de post en/of een patiëntportaal op de hoogte gesteld van het doseerschema en eventueel gebruik van vitamine K en heparine. In geval van zelfmeting voert de patiënt zelf de INR en gebruikte medicatie in op een patiëntportaal en stelt deze beschikbaar.
+
The patient is informed via mail and/or a patient portal about the dosing schedule and possible use of vitamin K and heparin. In case of self-measurement, the patient enters their INR and consumption through a patient portal and makes it available.
  
Alle medicatie wordt ter hand gesteld door de apotheker; de apotheker is verantwoordelijk voor de medicatieverstrekkingen. Er zijn proeven om antistollingsmedicatie in GDS te leveren. Daarvoor krijgt de apotheker het doseerschema van de trombosedienst. Herhaling van de medicatie gaat via de huisarts, eventueel onder de medicatieafspraak van de specialist.
+
All medication is dispensed by the pharmacist; the pharmacist is responsible for medicatieverstrekkingen. There are pilots ongoing  to dispense anticoagulant medication in GDS. To facilitate this, the pharmacist receives the dosing schedule from the thrombosis service. Repeat prescriptions are handled by the general practitioner, possibly under the medicatieafspraak of the specialist.
  
Wanneer de antistollingsmedicatie gestopt kan worden maakt de arts een stop-medicatieafspraak met als stoptype 'definitief'. Antistollingsmedicatie kan ook tijdelijk worden onderbroken in geval van bijvoorbeeld een operatie.
+
When anticoagulant medication may be discontinued, the physician creates a stop-mediatieafspraak with stoptype ‘definitief’. Anticoagulant medication may also be temporarily halted, for example in case of surgery.
  
==GGZ==
+
==Mental health care==
In de GGZ komen maar weinig geplande opnames voor (eigenlijk alleen bij afdelingen als eetstoornissen, klinisch herstel, e.d.). De meeste opnames betreffen opnames t.g.v. acute crisissituaties en zijn daarmee vergelijkbaar met opnames via de SEH in ziekenhuizen (zie ook [[#Starten met medicatie voor opname|paragraaf 4.1.20]]).
+
There are only few planned admissions in mental health care (almost only in departments for eating disorders, clinical rehabilitation, etc.). Most admissions are admissions as a result of acute crisis situations and are therefore comparable to admissions via the emergency departments in hospitals (see also [[#Starting with medication before admission|paragraph 4.1.20]]).
  
===Huidige situatie===
+
===Current situation===
In de huidige situatie wordt aan de patiënt of de familie/mantelzorgers gevraagd welke medicatie zij gebruiken. In de meeste gevallen is de patiënt niet in staat om hier antwoord op te geven (dat is namelijk ook de reden voor opname). Familie/mantelzorgers (indien bekend) kunnen hier ook niet altijd antwoord op geven. De opnemend arts/psychiaters nemen contact op met huisarts of apotheek om de medicatie te achterhalen. Buiten kantooruren en in het weekend lukt dit slecht. En wanneer er gegevens binnen komen worden deze maar deels overgetypt in het systeem van de zorgverleners.
+
In the current situation, patient or family/informal caregivers are asked which medication the patient is using. In most cases, the patient is unable to give an answer (often the reason for admission). Family/informal caregivers (if known) are also not always able to answer this. If this is the case, the admitting physician/psychiatrists will contact the general practitioner or the pharmacist to find out the medication. This is difficult outside office hours and during weekends. When data do come in, only part of them is retyped in the system of the healthcare providers.
  
===Proces===
+
===Process===
In de nieuwe situatie kunnen de beschikbaargestelde medicatiegegevens en medicatieoverzichten worden opgevraagd. Op basis daarvan wordt gestart met medicatieverificatie en het evalueren van de medicamenteuze behandeling (zodra mogelijk) en het toedienen van medicatie (conform [[#Medicatieproces|hoofdstuk 2]]). De medicatieverstrekking wordt poliklinisch door de openbare apothekers gedaan en klinisch vaak door een gecontracteerde ziekenhuisapotheek.<br>
+
In the new situation, it will be possible to retrieve the available medication data and medication overviews. On this basis, medication verification, assessment of the medicamenteuze behandeling (as soon as possible) and medication administration (in accordance with [[#Medication process|Chapter 2]]) can be started. Medication dispense is carried out by public pharmacists on an outpatient basis and, in clinical practice, often by a contracted hospital pharmacy.<br>
Bij ontslag uit een GGZ-instelling wordt, net als in de ziekenhuizen, de medicamenteuze behandeling geëvalueerd ([[#Processtap: Evalueren (medicamenteuze) behandeling|paragraaf 2.2.4]]). Daarin wordt de klinische medicatie gestopt en wordt zo nodig nieuwe medicatie voorgeschreven of eerder tijdelijk onderbroken ambulante medicatie definitief gestopt of hervat. De arts/psychiater richt zich vooral op de psychiatrische medicatie, somatische medicatie blijft meestal ongemoeid.<br>
+
As is the case with hospital discharge, medicamenteuze behandeling will be assessed at discharge from a mental health institution ([[#Process step: Evaluating a (pharmaceutical) treatment|paragraph 2.2.4]] and subsequent). Clinical medication is discontinued and, if necessary, new medication is prescribed or temporarily halted outpatient medication is resumed or permanently discontinued. The physician/psychiatrist focuses mainly on psychiatric medication; somatic medication usually remains unaffected.<br>
Het vastleggen van medicatiegebruik door de psychiatrische patiënt kan ervaren worden als ongewenste controle in plaats van dat dit het gebruik stimuleert.<br>
+
Letting the psychiatric patient record his own medication usage may be experienced as undesirable control instead of it stimulating proper use.<br>
De medicatiegegevens worden beschikbaargesteld.
+
The medication data will be made available.
  
==VVT==
+
==Nursing, care and home care (VVT)==
Het medicatieproces in een VVT-instelling (Verpleeg-, Verzorgingshuizen en Thuiszorg) verloopt analoog aan die van de klinische situatie echter in de VVT-instelling is een specialist ouderengeneeskunde als voorschrijver verantwoordelijk voor de medicatie van de opgenomen cliënten en wordt de levering van medicatie door één of meerdere openbare apothekers gedaan, zo nodig in de vorm van GDS.
+
The medication process in a VVT institution (nursing home, care home and home care) is similar to that of the clinical situation. However, in a VVT institution, a geriatrics specialist is responsible for prescribing medication to admitted clients and medication is being dispensed by one or more community pharmacists, possibly as part of GDS if needed. VVT institutions and home care make use of administration lists, which are drawn up based on the toedieningafspraken. The administration list is used to check medication before administering it and to sign off actual consumption. Communication of the administration list between pharmacist, prescriber and nursing staff will be explained in more details further on in this information standard.
In de VVT-instelling en in de thuiszorg wordt met een toedienlijst gewerkt. Deze wordt samengesteld op basis van de toedieningsafspraken. De toedienlijst wordt gebruikt om controle te doen op de medicatie voorafgaand aan de medicatietoediening en om de daadwerkelijke medicatietoediening op af te tekenen. Het communiceren van de toedienlijst tussen apotheker, voorschrijver en verpleegkundige wordt in een later stadium in deze informatiestandaard  uitgewerkt.
 
  
=Beschrijving use cases=
+
=Description of use cases=
Dit hoofdstuk bevat een beschrijving van verschillende use cases. Er zijn concrete praktijksituaties beschreven voor de verschillende deelprocessen. De praktijksituaties zijn in een groot aantal gevallen ontleend aan de huisartsenpraktijk maar zijn illustratief voor vergelijkbare situaties in een andere setting. Dit hoofdstuk veronderstelt voorkennis zoals beschreven in [[#Medicatieproces|hoofdstuk 2]].
+
This chapter contains a description of various use cases. Specific practical situations have been described for the various subprocesses. A large number of the practical situations are based on general medical practice, but are illustrative of similar situations in a different setting. This chapter assumes the knowledge as previously described in [[#Medication process|Chapter 2]].
  
==Use cases Voorschrijven==
+
==Use cases, Prescribe==
  
===Kortdurende medicatie===
+
===Short-term medication===
Een 35-jarige vrouwelijke patiënt met urineweginfectie in de voorgeschiedenis, brengt haar urine naar de assistente aan de balie en vertelt dezelfde klachten als de vorige keren te hebben. De assistente vraagt nog naar andere klachten zoals koorts en pijn in de flank en kijkt de urine na. Er zijn geen andere klachten en uit de urine blijkt een urineweginfectie. Zij vertelt de patiënt dat de huisarts een kuur zal voorschrijven en dat ze die later bij de apotheker op kan halen. De huisarts kijkt naar de vorige kuren en een eventuele kweek en legt een medicatieafspraak vast. Op ''27 januari'' is afgesproken:  
+
A 35 year old female patient with a history of urinary tract infection brings her urine to the doctor’s assistant and tells her she has the same symptoms as the previous times. The assistant enquires about other symptoms such as fever and pain in the flank and checks the urine. There are no other symptoms and the urine reveals a urinary tract infection. She tells the patient that the general practitioner will prescribe a course of treatment and that she can pick it up from the pharmacist later. The General practitioner checks the previous courses of treatment and any cultures and records a medicatieafspraak. On ''27 January'' it was agreed:
:''Nitrofurantoïne capsule mga 100 mg, 2 maal daags 1 capsule, vanaf heden<ref>Zie ook [[#Harde einddatum gebruiksperiode|paragraaf 4.1.3]].</ref> gedurende 5 dagen.''  
+
:''Nitrofurantoin CR capsule, 100 mg, 2x daily, 1 capsule, from now on<ref>See also [[#Hard end date for period of use|paragraph 4.1.3]].</ref> for 5 days.''  
Hij legt deze medicatieafspraak vast in zijn systeem. Vervolgens maakt de huisarts direct ook een verstrekkingsverzoek voor de apotheker naar keuze van de patiënt:  
+
He records this medicatieafspraak in his system. The general practitioner then immediately also makes a verstrekkingsverzoek for the pharmacist chosen by the patient:
:''Nitrofurantoïne capsule mga 100mg; 10 stuks.''
+
:''Nitrofurantoin CR capsule, 100 mg; 10 capsules.''
De huisarts legt ook dit verstrekkingsverzoek vast in zijn systeem. <br>
+
The general practitioner also records this verstrekkingsverzoek in his system.<br>  
De huisarts overlegt met de patiënt bij welke apotheker zij de medicatie wil afhalen. De huisarts kan deze apotheker vervolgens informeren over het verstrekkingsverzoek én de medicatieafspraak. <br>
+
The general practitioner consults with the patient to find out from which pharmacist she wants to pick up the medication. The general practitioner can then inform this pharmacist about the verstrekkingsverzoek and the medicatieafspraak.<br>
Het systeem van de huisarts maakt de informatie (verstrekkingsverzoek en medicatieafspraak) beschikbaar voor de medebehandelaars van deze patiënt.<br>
+
The system of the general practitioner makes this information (verstrekkingsverzoek and medicatieafspraak) available to the other healthcare providers of this patient.<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.1.PNG|800px]]
 
[[Bestand:Uc4.1.1.PNG|800px]]
  
===Doorlopende medicatie===
+
===Continuing medication===
Het proces bij doorlopende medicatie is hetzelfde als bij kortdurende medicatie (zie [[#Kortdurende medicatie|paragraaf 4.1.1]]). Het verschil is dat bij doorlopende medicatie de medicatieafspraak voor onbepaalde tijd wordt gemaakt.
+
The process for continuing medication is practically the same as for short-term medication (see [[#Short-term medication|paragraph 4.1.1]]), except that in the case of continuing medication the medicatieafspraak is made for an indefinite period of time.
 +
 
 +
For example: the prescriber agrees with a patient who has hypertension that he should use a diuretic on a continuous basis. On ''30 March 2013'' it was agreed:
  
Bijvoorbeeld: de voorschrijver spreekt met een patiënt met hypertensie af een diureticum doorlopend te gebruiken. Op ''30 maart 2013'' is afgesproken:
+
:''Hydrochlorothiazide tablet, 12.5 mg; 1x daily, 1 tablet; from now on <u>for an indefinite period.</u>''
:''Hydrochloorthiazide tablet 12,5 mg; eenmaal daags een tablet; vanaf heden <u>voor onbepaalde duur.</u>''
+
''For example, the prescriber chooses in the verstrekkingsverzoek for an initial dispensing quantity of 100 pieces.''<br>
De voorschrijver kiest bijvoorbeeld in het verstrekkingsverzoek voor initieel een te verstrekken hoeveelheid van 100 stuks.<br>
 
 
<br>
 
<br>
 
[[Bestand:Uc4.1.2.PNG|800px]]
 
[[Bestand:Uc4.1.2.PNG|800px]]
  
===Harde einddatum gebruiksperiode===
+
===Hard end date for period of use===
In de gebruiksperiode van een medicatieafspraak kan een ingangsdatum, einddatum en/of duur worden meegegeven. Wanneer er een harde einddatum gewenst is, dient dit ook expliciet in de Toelichting te worden aangegeven. Het enkel opnemen van een einddatum is niet voldoende omdat dit niet genoeg duidelijkheid geeft over de intentie van de voorschrijver.<br>
+
A start date, end date and/or duration can be included in the period of use of a medicatieafspraak. If a hard end date is desired, this must also be explicitly stated in the explanation. Including an end date alone is not sufficient because this does not provide enough clarity about the intention of the prescriber.<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.3.PNG|800px]]
 
[[Bestand:Uc4.1.3.PNG|800px]]
  
===Zonodig medicatie===
+
===Medication as needed===
Een 31 jarige vrouwelijke patiënt heeft in een jaar een paar keer hoofdpijnaanvallen gehad, waarbij nu de diagnose migraine wordt gesteld. De huisarts schrijft voor:
+
A 31-year-old female patient has had headaches a few times in a year, with migraine now being diagnosed. The general practitioner prescribes:
:''Rizatriptan 10 mg tabletten <u>zo nodig</u> 1c1t onder de tong. Eerste tablet bij eerstvolgende duidelijke migraine aanval.''  
+
:''Rizatriptan tablets, 10 mg, <u>as needed</u> 1c1t under the tongue. First tablet at the next clear migraine attack.''  
 
De huisarts legt de medicatieafspraak vast en doet een verstrekkingsverzoek:
 
De huisarts legt de medicatieafspraak vast en doet een verstrekkingsverzoek:
:''6 Tabletten rizatriptan s.l. 10 mg.''
+
:''6 sublingual rizatriptan tablets, 10 mg.''
  
===Kuur zo nodig startend in de toekomst===
+
===Course of treatment as needed starting in future===
Een zestigjarige patiënt met een status na een trombosebeen heeft soms om het jaar, soms driemaal per jaar een erysipelas (ernstige infectie aan het been waarvoor als de medicatie niet snel begint opname nodig kan zijn). Op verzoek van de patiënt schrijft de huisarts een antibioticumkuur voor waar hij meteen mee kan beginnen bij een recidief erysipelas. De volgende medicatieafspraak wordt gemaakt:  
+
A 60-year-old patient with post-thrombotic syndrome experiences erysipelas (severe infection of the leg which can require admission if medication is not started quickly) sometimes every other year, sometimes three times a year. At the request of the patient, the general practitioner prescribes an antibiotic treatment the patient can start immediately in case of a recurrence of erysipelas. The following medicatieafspraak is created:  
:''Flucloxacilline 500mg capsules, 4d1 capsule, gedurende 10 dagen. In de medicatieafspraak wordt aangegeven (zo nodig): start zo nodig bij recidief.''
+
:''Flucloxacillin capsules, 500 mg, 1 capsule 4x daily, for 10 days. In the medicatieafspraak is indicated (if necessary): start in case of recurrence, as needed.''
De huisarts doet meteen een verstrekkingsverzoek:  
+
The general practitioner immediately creates a verstrekkingsverzoek:
 
:''Flucloxacilline 500mg capsules 40stuks.''<br>
 
:''Flucloxacilline 500mg capsules 40stuks.''<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.5.PNG|800px]]
 
[[Bestand:Uc4.1.5.PNG|800px]]
  
===Twee doseringen van hetzelfde geneesmiddel tegelijkertijd===
+
===Two dosages of the same medication at the same time===
Een 79 jarige man met uitgezaaide prostaatkanker heeft meer pijn en zijn medicatie wordt gewijzigd. De specialist schrijft (op 9 oktober) oxycodon 10 mg tabletten voor 4d1t en zo nodig bij pijn ’s nachts 1d1t. De specialist legt dit in één medicatieafspraak met twee doseerinstructies vast en doet een verstrekkingsverzoek voor 60 tabletten oxycodon 10 mg.<br>
+
A 79-year-old man with metastatic prostate cancer is increasingly suffering from pain and his medication is being changed. The specialist prescribes oxycodone tablets, 10 mg, 1 tablet 4x daily and as needed for pain during the night, 1 tablet 1x daily, on October 9. The specialist records this in one single medicatieafspraak with two dosing instructions and creates a verstrekkingsverzoek for 60 tablets of oxycodone of 10 mg.<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.6.PNG|800px]]
 
[[Bestand:Uc4.1.6.PNG|800px]]
  
===Hetzelfde geneesmiddel met verschillende sterkte tegelijkertijd===
+
===The same medicinal product with different strengths at the same time===
Dezelfde 79 jarige patiënt (zie [[#Twee doseringen van hetzelfde geneesmiddel tegelijkertijd|paragraaf 4.1.6]]) krijgt toch weer meer pijn. De specialist stopt op 16 oktober de oxycodon 10mg tabletten en schrijft oxycodon 20 mg retard tabletten voor 3d2t en oxycodon 20 mg tabletten (normale afgifte) zo nodig bij pijn ’s nachts 1d1t. De specialist legt dit in twee medicatieafspraken (bij vooralsnog twee separate medicamenteuze behandelingen) vast en doet voor beide medicatieafspraken een verstrekkingsverzoek, respectievelijk 45 retardtabletten oxycodon 20 mg en 30 tabletten oxycodon 20mg (normale afgifte).<br>
+
The same 79-year-old patient (see [[#Two dosages of the same medication at the same time|paragraph 4.1.6]]) is experiencing even more pain. The specialist discontinues the 10 mg tablets of oxycodone on October 16 and prescribes 20 mg retard tablets of oxycodone, 2 tablets 3x daily, and 20 mg normal release tablets of oxycodone as needed in case of nocturnal pain, 1 tablet 1x daily. The specialist records this in two medicatieafspraken (with, for the time being, two separate medicamenteuze behandelings) and creates a verstrekkingsverzoek for both medicatieafspraken, respectively 45 retard tablets of 20 mg oxycodone and 30 tablets of 20 mg oxycodone (normal release).<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.7.PNG|800px]]
 
[[Bestand:Uc4.1.7.PNG|800px]]
  
===Toelichting in medicatieafspraak bij bewust gekozen bijzonderheid===
+
===Explanation in medicatieafspraak with deliberately chosen special characteristic===
Deze use case wordt beschreven in de ZIB Medicatieafspraak/Aanvullende informatie. Hier ter informatie.
+
This use case is described in the ZIB medicatieafspraak/additional information. Here it is described for information purposes only. When selecting a medicinal product, it is possible to deviate from what is expected or standard. For example, when a hospital uses a different formulary than a community pharmacy. For reasons of efficiency the hospital has opted for a single gastric acid inhibitor: pantoprazole.<br>
Bij het kiezen van een geneesmiddel kan er worden afgeweken van wat er verwacht wordt of van wat de standaard is. Bijvoorbeeld wanneer het ziekenhuis een ander formularium hanteert dan de openbare apotheek. Uit efficiencyoverwegingen is in het ziekenhuis bijvoorbeeld gekozen voor één maagzuurremmer: pantoprazol. <br>
+
At admission, a patient with omeprazole is switched to pantoprazole for the duration of the hospitalization. At discharge, the patient returns to omeprazole.<br>
Bij opname wordt een patiënt met omeprazol omgezet naar pantoprazol voor de duur van het verblijf. Bij ontslag gaat de patiënt weer terug naar omeprazol.<br>
+
It is clear that this may sometimes go wrong and that the patient might end up taking both omeprazole and pantoprazole if nothing is done. In the medicatieafspraak of the hospital for pantoprazole, a remark can be made about this deviation in order to make it clear that pantoprazole is the replacement of omeprazole or that it has to be used in addition to omeprazole.
Het is duidelijk dat hier nog wel eens wat mis kan gaan en dat de patiënt zowel omeprazol als pantoprazol slikt als er niet ingegrepen wordt. In de medicatieafspraak van het ziekenhuis voor pantoprazol kan een opmerking worden gemaakt over de afwijking zodat duidelijk is dat pantoprazol de vervanger is van omeprazol of juist naast omeprazol moet worden gebruikt.<br>
 
 
<br>
 
<br>
Ander voorbeeld zijn de halve sterktes. Het ziekenhuis heeft soms de beschikking over tabletten met de halve sterkte van het normale handelspreparaat (eigen productie). Waar de patiënt het ziekenhuis ingaat met chlortalidon 25 mg, een maal daags een halve tablet krijgt hij intramuraal chlortalidon 12,5 mg, eenmaal daags één tablet. Dan hoeft de verpleging in dit geval geen tabletten te breken. Hier bestaat het risico dat de patiënt bij thuiskomst weer de 25 mg gaat gebruiken, maar dan een hele tablet per keer. Door een toelichting in de medicatieafspraak (Aanvullende informatie) van de laatste chlortalidon 25 mg kan worden aangegeven of dit een bewuste verhoging is geweest.<br>
 
 
<br>
 
<br>
Indien een voorgeschreven middel heel specifiek een bepaald handelsproduct dient te zijn (HPK), dan kan dit worden aangegeven met 'Medische noodzaak'.
+
Half-strengths are another example. The hospital sometimes as tablets available with half the strength of the normal commercial preparation (proprietary production). When a patient enters the hospital with a prescription of 25 mg of chlorthalidone, half a tablet 1x daily, he will receive 12.5 mg of chlorthalidone, 1 tablet 1x daily. In this specific case, this means that nursing staff does not have to break tablets in half. There is a risk that the patient will use the 25 mg again at home, but now a whole tablet at the time. An explanation in the medicatieafspraak (additional information) regarding the last 25 mg of chlorthalidone, makes it possible to indicate whether this was a deliberate increase.<br>
 +
<br>
 +
If a prescribed product has to be a very specific commercial product, this can be indicated with ‘medical necessity’.
  
===Nieuwe medicatieafspraak, geen verstrekkingsverzoek===
+
===New medicatieafspraak, no verstrekkingsverzoek===
Een 50-jarige man komt bij de huisarts met rugklachten. De klachten bestaan al 3 weken en hij gebruikt al paracetamol. De huisarts spreekt met de patiënt af aanvullend diclofenac te gebruiken:
+
A 50-year-old man comes to the general practitioner with back problems. The symptoms have been present for three weeks and he is already using paracetamol. The general practitioner agrees with the patient that he can additionally use diclofenac:
+
 
Op ''30 januari'' is afgesproken:  
+
On ''30 January'' it was agreed:
:''Diclofenac tablet 50 mg, 3 maal daags 1 tablet, vanaf heden gedurende 3 weken.''  
+
:''Diclofenac tablet, 50 mg, 1 tablet 3x daily, from now on for 3 weeks.''
Hij legt deze medicatieafspraak vast in zijn systeem. De patiënt geeft aan voldoende voorraad thuis te hebben: zijn vrouw heeft nog een ruime voorraad diclofenac over vanwege een ander probleem een jaar geleden.  
+
He records this medicatieafspraak in his system. The patient indicates there is sufficient supply at home: his wife still has an ample supply of diclofenac left because of a different problem a year ago.
+
 
Er is dus geen verstrekkingsverzoek nodig en de apotheker stelt dus ook geen medicatie ter hand. <br>
+
A verstrekkingsverzoek is therefore not needed and the pharmacist also does not dispense any medication.<br>
De huisarts stelt de nieuwe medicatieafspraak beschikbaar voor eventuele medebehandelaars van deze patiënt. De vaste apotheker kan zich informeren over deze nieuwe medicatieafspraak.<br>
+
The general practitioner makes the new medicatieafspraak available to any fellow healthcare providers of this patient. This allows the regular pharmacist to inform himself about this new medicatieafspraak.<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.9a.PNG|800px]]
 
[[Bestand:Uc4.1.9a.PNG|800px]]
  
Een ander voorbeeld:
+
Another example: Mr Simons receives medication from the pharmacy weekly. In the past there were many requests for extra medication, which led to clear agreements about the dispense policy.
Dhr Simons krijgt wekelijks zijn medicatie verstrekt door de apotheek. In het verleden waren er namelijk veel verzoeken om extra medicatie, wat leidde tot duidelijke afspraken over het afgiftebeleid.  
 
  
Het gaat om:  
+
This is about:
:''Medicatieafspraak: Diazepam 5mg 4 maal daags 1 tablet vanaf 1-1-2012 tot voor onbepaalde duur''
+
:''Medicatieafspraak: Diazepam, 5 mg, 1 tablet 4x daily, from 1 January 2012 for an indefinite period''
:''Verstrekkingsverzoek: 28 stuks iter 10; toelichting: wekelijkse medicatieverstrekkingen''
+
:''Verstrekkingsverzoek: 28 tablets with 10 repeats; remark: weekly medicatieverstrekking''
Het verstrekkingsverzoek wordt ongeveer iedere 11 weken herhaald.
+
The verstrekkingsverzoek is repeated approximately every 11 weeks.
 
+
The last verstrekkingsverzoek was on 3 March 2016:
Het laatste verstrekkingsverzoek was op 3-3-2016:  
+
:''one week (28 tablets) with 10 repeats''
:''een week (28 tabletten) met iter 10x ''
+
This way, the pharmacy can go on for 11 weeks.
zodat de apotheek er 11 weken mee vooruit kan.<br>
+
<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.9b.PNG|800px]]
 
[[Bestand:Uc4.1.9b.PNG|800px]]
  
De laatste jaren is het rustig. Hij vraagt niet meer om extra medicatie. Bij het laatste gesprek vertelde hij dat hij toe kan met 3 x daags diazepam. Dit wordt in een medicatieafspraak vastgelegd:
+
The last few years have been quiet. Mr. Simons is no longer asking for extra medication. At the last consultation he indicated that diazepam, 3x daily, is sufficient. This has been recorded in a medicatieafspraak:
:''1-4-2016 Diazepam 5mg 3x daags 1 tablet vanaf 1-4-2016 tot voor onbepaalde duur.''
+
:''1 April 2016 Diazepam, 5 mg, 1 tablet 3x daily, from 1 April 2016 for an indefinite period.''
De vorige medicatieafspraak wordt beëindigd per 31-3-2016 (zie stoppen van medicatie in [[#Processtap: Maken medicatieafspraak|paragraaf 2.2.5]]).
 
  
In de huidige situatie belde de huisarts de apotheek om te zorgen dat er bij de volgende medicatieverstrekkingen 21 tabletten diazepam worden meegegeven i.p.v. 28. Er was toen geen nieuwe verstrekkingsverzoek nodig.
+
The previous medicatieafspraak will be terminated as of 31 March 2016 (see discontinuation of medication in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]]).
  
In de nieuwe situatie stuurt de huisarts de nieuwe medicatieafspraak naar de apotheek. Op basis van de nieuwe medicatieafspraak verstrekt de apotheek 21 tabletten per week, het vorige verstrekkingsverzoek volstaat nog.
+
In the current situation, the general practitioner would have called the pharmacy to make sure that 21 tablets of diazepam would be given with the following medicatieverstrekking, instead of 28. No new verstrekkingsverzoek would have been needed at the time.
  
===Nieuw verstrekkingsverzoek onder bestaande medicatieafspraak===
+
In the new situation, the general practitioner sends the new medicatieafspraak to the pharmacy. Based on the new medicatieafspraak, the pharmacy provides 21 tablets per week, the previous verstrekkingsverzoek is still sufficient.
Een voorschrijver kan ook een nieuw verstrekkingsverzoek doen onder een bestaande medicatieafspraak. Deze medicatieafspraak kan gemaakt zijn door een andere voorschrijver bijvoorbeeld een psychiater of in geval van waarneming de vaste huisarts. Het betreft hier herhaalmedicatie. Deze use case is beschreven in [[#Patiënt vraag herhaalrecept via arts (reactief herhalen)|paragraaf 4.2.6]].
 
  
===Wijziging in dosering (voldoende voorraad)===
+
===New verstrekkingsverzoek under existing medicatieafspraak===
Patiënt (37 jaar, astma) is op 13 augustus 2013 bij de longarts voor controle van zijn astma. De longarts heeft vastgesteld dat de astma onvoldoende gereguleerd is.<br>
+
A prescriber may also create a new verstrekkingsverzoek as part of an existing medicatieafspraak. This medicatieafspraak may have been created by a different prescriber, for example a psychiatrist. This concerns repeat medication. This use case is described in [[#Patient requests repeat prescription via physician (reactive repeat)|paragraph 4.2.6]].
De patiënt gebruikt op dit moment Beclometason volgens een eerder gemaakte en geregistreerde medicatieafspraak: op 10 juni 2010 is afgesproken
+
 
:''Beclometason aerosol 100 microg/dosis inh; 2 maal daags 1 inhalatie; vanaf 10 juni 2010 voor onbepaalde duur.''  
+
===Dosage change (sufficient supply)===
De longarts spreekt op 13 augustus 2013 met de patiënt een verhoging van de dosering af:  
+
Patient (37 years old, asthma) visited the pulmonologist on 13 August 2013 for a check-up of his asthma. The pulmonologist has established that patient’s asthma is not adequately controlled.<br>
:''Beclometason aerosol 100 microg/dosis inh; 2 maal daags 2 inhalaties; van 13 augustus 2013 tot voor onbepaalde duur; reden van aanpassing: onvoldoende werking.''
+
The patient is currently using beclomethasone in accordance with a previously made and registered medicatieafspraak: on 10 June 2010 it was agreed:
De voorgaande medicatieafspraak van 10 juni 2010 geldt niet meer: deze wordt beëindigd (zie wijzigen van medicatie in [[#Processtap: Maken medicatieafspraak|paragraaf 2.2.5]]) . De patiënt heeft nog voldoende voorraad, er is dus geen verstrekkingsverzoek nodig. <br>
+
:''Beclomethasone aerosol, 100 microgram/dose, inhaler; 1 inhalation 2x daily; from 10 June 2010 for an indefinite period.''
 +
On 13 August 2013, the pulmonologist agrees with the patient on a dosage increase:
 +
:''Beclomethasone aerosol, 100 microgram/dose, inhaler; 2 inhalations 2x daily; from 13 August 2013 for an indefinite period; reason for adjustment: insufficient effect.''
 +
The previous medicatieafspraak of 10 June 2010 it is no longer valid: it is terminated (see Changing medication in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]]). The patient still has a sufficient supply, a verstrekkingsverzoek is therefore not needed.  
 +
<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.1.11.PNG|800px]]<br>
 
[[Bestand:Uc4.1.11.PNG|800px]]<br>
In het geval de patiënt geen voorraad meer zou hebben dan wordt er ook een nieuw verstrekkingsverzoek gemaakt.<br>
+
In case the patient has no more supply, a new verstrekkingsverzoek will be created.<br>
Het systeem van de longarts maakt de nieuwe medicatieafspraak beschikbaar voor de medebehandelaars van deze patiënt. Deze wijziging komt binnen bij de apotheker (medebehandelaar). De apotheker verwerkt de wijziging. De apotheker kan er ook voor kiezen om wijzigingen automatisch te accepteren.
+
The system of the pulmonologist makes the new medicatieafspraak available to the other healthcare providers of this patient. This modification is received by the pharmacist (fellow healthcare provider). The pharmacist processes the modification. The pharmacist may also choose to accept the modifications automatically.
  
===Recept niet meer nodig na eerste verstrekkingsverzoek===
+
===Prescription no longer needed after first verstrekkingsverzoek===
Een 16 jarige vrouw heeft een vriend en wil niet zwanger worden. Na uitleg kiest zij voor de pil. De huisarts schrijft ethinylestradiol/levonorgestrel tablet 20/100ug voor, 1d1t gedurende 21 dagen, vervolgens 7 dg geen pil nemen, dan weer 21 dagen wel. Start op de 1e dag van de volgende menstruatie. De huisarts legt de medicatieafspraak vast en doet een verstrekkingsverzoek voor 63 tabletten microgynon 20 tablet omhuld. Hij legt haar uit dat indien zij geen klachten heeft, zij de pil verder via de apotheek kan krijgen. <br>
+
A 16-year-old woman has a boyfriend and does not want to become pregnant. After explanation she opts for the pill. The general practitioner prescribes ethinylestradiol/levonorgestrel tablets of 20/100 µg, 1 tablet 1x daily for 21 days, then no tablet for 7 days, then another 21 days of taking a tablet once a day. Start on the first day of the next menstruation. The general practitioner records the medicatieafspraak and creates a verstrekkingsverzoek for 63 coated microgynon 20 tablets. He explains to her that if she does not experience any problems, she can continue to get the pill via the pharmacy.<br>
Drie maanden later doet de vrouw een voorstel tot herhaalverstrekking aan de apotheek. De apotheek verstrekt het middel en communiceert de medicatieverstrekking aan de huisarts.
+
Three months later, the woman sends a request for repeat supply to the pharmacy. The pharmacy provides the product and communicates the medicatieverstrekking to the general practitioner.
  
===Stoppen medicatie===
+
{{Anchor|4-1-13}}
Patiënt (37 jaar, astma) is op 13 augustus 2013 bij de longarts voor controle van zijn astma. De patiënt heeft last van een bijwerking.
+
===Discontinuing medication===
De patiënt gebruikt op dit moment Beclometason volgens een eerder gemaakte en geregistreerde medicatieafspraak. Op ''10 juni 2010'' is afgesproken:  
+
Patient (37 years old, asthma) visits the pulmonologist on 13 August 2013 for a check-up of his asthma. The patient is suffering from a side effect. The patient is currently using Beclomethasone in accordance with a previously made and registered medicatieafspraak. On ''10 June 2010'' it was agreed:
:''Beclometason aerosol 100 microg/dosis inh; 2 maal daags 1 inhalatie; vanaf 10 juni 2010 voor onbepaalde duur.''  
+
:''Beclometasone aerosol, 100 microgram/dose, inhaler; 1 inhalation 2x daily; from 10 June 2010 for an indefinite period.''
De longarts spreekt op 13 augustus 2013 met de patiënt af om de medicatie te stoppen (medicamenteuze behandeling wordt gestopt). Medicatieverificatie is ook hier van toepassing. Verder kan ook medicatiebewaking hierbij relevant zijn, bijvoorbeeld wanneer maagbeschermers geslikt worden vanwege gebruik van de te stoppen medicatie (het systeem zal dit niet altijd automatisch signaleren).<br>
+
On 13 August 2013, the pulmonologist agrees with the patient to discontinue the medication (medicamenteuze behandeling is discontinued). Medication verification is also applicable here. In addition, medication monitoring may also be relevant here, for example if gastroprotrective drugs are being used because of the use of the medication to be discontinued (the system will not always signal this automatically).<br>
De longarts legt vast:
+
The pulmonologist records:
:''Beclometason aerosol 100 microg/dosis inh; stoptype 'definitief'; vanaf 13 augustus 2013. Vanwege een bijwerking.''
+
:''Beclometasone aerosol, 100 microgram/dose, inhaler; stoptype ‘definite’; from 13 August 2013. Because of a side effect.''
Deze wijziging komt binnen bij de apotheker (medebehandelaar). De apotheker verwerkt de wijziging. De apotheker kan er ook voor kiezen om wijzigingen automatisch te accepteren.
+
This modification is received by the pharmacist (fellow healthcare provider). The pharmacist processes the modification. The pharmacist may also choose to accept the modifications automatically. The pulmonologist decides to also actively inform a fellow healthcare provider (such as a specialist) about this (part of the process step (actively) making available).<br>
De longarts besluit ook om een medebehandelaar (bijv. de huisarts) hierover actief te informeren (onderdeel van de processtap (Actief) Beschikbaarstellen).<br>
+
The system of the pulmonologist makes this information (agreement to discontinue) available to the other healthcare providers of this patient.  
Het systeem van de longarts maakt deze informatie (afspraak om te stoppen) beschikbaar voor alle medebehandelaars van deze patiënt. <br>
+
<br>
  
===Onderbreken / hervatten medicatie===
+
===Temporarily halting/resuming medication===
De patiënt wordt behandeld met Simvastatine (cholesterolverlager): 40mg 1D1T voor onbepaalde duur.  
+
A patient is being treated with simvastatin (cholesterol-lowering agent): 40 mg, 1 tablet 1x daily, for an indefinite period. Because of a throat infection in combination with an allergy for the first antibiotic of choice, Clarithromycin, 250 mg, 1 tablet 2x daily (antibiotic) is prescribed for 1 week. During that week, simvastatin is temporarily halted because of an interaction.<br>
Vanwege een keelontsteking in combinatie met een allergie voor het eerste keuze antibioticum wordt gedurende 1 week Claritromycine 250mg 2D1T (antibioticum) voorgeschreven. Gedurende die week wordt de simvastatine onderbroken vanwege een interactie.<br>
+
The general practitioner records:
De huisarts legt vast:
+
:''Simvastatin 40 mg; halt temporarily; for 1 week; reason: interaction''
:''Simvastatine 40 mg; tijdelijk onderbreken; gedurende 1 week; reden: interactie''
+
:''Clarithromycin, 250 mg; 1 tablet 2x daily; for 1 week (and a corresponding verstrekkingsverzoek)''
:''Claritromycine 250 mg; 2D1T; gedurende 1 week (en een bijbehorend verstrekkingsverzoek)''
+
The pharmacist is actively informed by the general practitioner about the temporary halt of simvastatin. A new medicatieafspraak is also created with which simvastatin is resumed after one week. The pharmacist will also receive the medicatieafspraak and the corresponding verstrekkingsverzoek for clarithromycin. See also Temporarily halting and resuming medication in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]].
De apotheker wordt over het tijdelijk onderbreken van de simvastatine door de huisarts actief geïnformeerd. Er wordt ook een nieuwe medicatieafspraak gemaakt waarmee de simvastatine na een week wordt hervat. Ook ontvangt de apotheker de medicatieafspraak en het bijbehorende verstrekkingsverzoek voor de claritromycine. Zie ook Tijdelijk onderbreken en hervatten van medicatie in [[#Processtap: Maken medicatieafspraak|paragraaf 2.2.5]].
 
  
===Onderbreken voor een ingreep===
+
===Temporarily halting for an intervention===
Een 62 jarige man gebruikt acetylsalicylzuur 100mg 1d1t wegens coronairlijden. Hij moet een darmpoliep laten verwijderen. De huisarts bespreekt met hem dat hij de acetylsalicylzuur drie dagen voor de ingreep moet stoppen en de dag na de ingreep moet hervatten. De huisarts legt het tijdelijk onderbreken in een stop-medicatieafspraak vast met als einddatum 3 dagen voor de ingreep; stoptype 'tijdelijk'; reden onderbreken ‘ingreep’. In de (tweede) medicatieafspraak voor het hervatten wordt als ingangsdatum 1 dag na de ingreep opgenomen. De huisarts informeert actief de apotheker en de maag-darm-leverarts over de medicatieafspraken.<br>
+
A 62-year-old man uses acetylsalicylic acid, 100 mg, 1 tablet 1x daily because of coronary disease. He has an intestinal polyp that must be removed. The general practitioner informs him that he should stop using acetylsalicylic acid three days before the intervention and resume the day after the intervention. The general practitioner records the temporary halt in a medicatieafspraak with an enddate 3 days before the intervention; stoptype ‘temporary’; reason for halting: ‘intervention’. In the (second) medicatieafspraak for presuming, 1 day after the intervention is used as the start date. The general practitioner actively informs the pharmacist and the gastroenterologist about the medicatieafspraken.<br>
Wanneer de datum van de ingreep niet bekend of onzeker is wordt in de toelichting aangegeven dat er 3 dagen voor de ingreep moet worden gestopt en na 1 dag wordt hervat. De duur van de onderbreking is dan 4 dagen. Zie ook Tijdelijk onderbreken en hervatten van medicatie in [[#Processtap: Maken medicatieafspraak|paragraaf 2.2.5]]).
+
When the date of the intervention is unknown or uncertain, the explanation will indicate that the medication should be halted three days before the intervention and resumed one day later. The duration of the temporary halt is then 4 days. See also Temporarily halting and resuming medication in [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]].
  
===Substitutie===
+
===Substitution===
Bij opname kan thuismedicatie worden omgezet naar medicatie uit het formularium van het ziekenhuis. De bestaande (thuismedicatie) medicatieafspraak wordt dan gestopt en er wordt een nieuwe (instellingsmedicatie) medicatieafspraak gemaakt onder een nieuwe medicamenteuze behandeling (zie verder [[#Medicamenteuze behandeling|paragraaf 1.3.3]]). Deze (instellingsmedicatie) medicatieafspraak verwijst naar de medicatieafspraak van de thuismedicatie. Bij ontslag wordt de instellingsmedicatie gestopt en wordt, zo nodig, de thuismedicatie onder de eerdere of een nieuwe medicamenteuze behandeling weer gestart door het maken van een nieuwe medicatieafspraak die verwijst naar de oorspronkelijke medicatieafspraak van de thuismedicatie.
+
Upon admission, home medication may be switched to medication from the hospital formulary. The existing (home medication) medicatieafspraak will then be discontinued and a new medicatieafspraak will be created under a new (institution medication) medicamenteuze behandeling (see also [[#Medicamenteuze behandeling|paragraph 1.3.3]]). This (institution medication) medicatieafspraak refers to the medicatieafspraak for the home medication. At discharge, the institutional medication is discontinued and, if necessary, the home medication under the previous or a new medicamenteuze behandeling will be restarted by creating a new medicatieafspraak that refers to the original medicatieafspraak for the home medication.
  
===Papieren recept===
+
===Paper prescription===
De arts geeft een papieren recept mee aan de patiënt<ref>Eenzelfde situatie doet zich voor wanneer de apotheker een fax ontvangt.</ref>. Een papieren recept bevat een medicatieafspraak en een verstrekkingsverzoek. De patiënt kan met dit recept bij een willekeurige apotheker de medicatie afhalen. De huisarts informeert de verstrekkende apotheker in dit geval niet zelf. Het proces is echter eigenlijk toch hetzelfde: de activiteit '(Actief) beschikbaar stellen' wordt nu alleen 'vervuld' door het papieren recept in handen van de patiënt. De verstrekkende apotheker zal deze papieren medicatieafspraak en verstrekkingsverzoek overnemen in het eigen systeem en deze invullen met een toedieningsafspraak. Ook kan de apotheker mogelijk de beschikbaar gestelde medicatieafspraak en verstrekkingsverzoek digitaal opvragen en zo verwerken in het eigen systeem.<br>
+
The physician gives the patient a paper prescription<ref>A similar situation occurs when the pharmacist receives a fax.</ref>. A paper prescription contains a medicatieafspraak and a verstrekkingsverzoek. The patient can use this prescription to pick up the medication from any pharmacist. The general practitioner does not inform the issuing pharmacist in this case. However, the process is actually the same: the activity ‘(actively) making available’ is now only ‘handled’ by the paper prescription in the hands of the patient. The supplying pharmacist will copy this paper medicatieafspraak and verstrekkingsverzoek in his own system and complete it with a toedieningsafspraak. The pharmacist may also retrieve the medicatieafspraak and verstrekkingsverzoek that were made available digitally and process them in his own system this way.<br>
Het systeem van de huisarts stelt de nieuwe medicatieafspraak en het verstrekkingsverzoek beschikbaar voor medebehandelaars.<br>
+
The system of the general practitioner makes the new medicatieafspraak and verstrekkingsverzoek available for fellow healthcare providers. When the system of the general practitioner has not made these available this may be because it concerns a toedieningsafpsraak without digitally available medicatieafspraak and verstrekkingsverzoek. The pharmacist will not make the medicatieafspraak and verstrekkingsverzoek obtained ‘from paper’ available because he is not the owner. Next to that, this could lead to, possibly only in the future, wrongful duplication of medicatieafspraken and verstrekkingsverzoeken.
Wanneer het systeem van de huisarts deze niet beschikbaar heeft gesteld kan er dus sprake zijn van een toedieningsafspraak zonder digitaal beschikbare medicatieafspraak en verstrekkingsverzoek. De apotheker stelt de ‘van papier’ verkregen medicatieafspraak en verstrekkingsverzoek niet beschikbaar omdat hij daar zelf geen eigenaar van is. Daarnaast zou dit er toe kunnen leiden dat er anders, mogelijk pas in de toekomst, onterecht dubbele medicatieafspraken en verstrekkingsverzoeken kunnen voorkomen.
 
  
===Uitvoeren medicatieverificatie en evaluatie bij buitenlandse of zelfzorgmedicatie===
+
===Carrying out medication verification and evaluation of foreign or self-care medication===
Wanneer medicatie niet in het systeem gevonden kan worden (bijvoorbeeld buitenlands medicatie en zelfzorgmedicatie) dan wordt deze medicatie vastgelegd als medicatiegebruik (zie [[#Proces: gebruiken|paragraaf 2.5]]).
+
When medication cannot be found in the system (such as foreign medication and self-care medication), this medication will be recorded as consumption (see [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]]).
  
===Dagbehandeling===
+
===Day treatment===
Een dagopname is te vergelijken met een poliklinisch consult of een spoedopname waarbij de medicatie door de ziekenhuisapotheker wordt geleverd. Bij dagopname vindt meestal geen uitgebreide medicatieverificatie plaats. Bij dagopname wordt vastgelegd welke medicatie wordt voorgeschreven (gebeurt vaak op basis van protocollen waarbij achteraf verificatie plaatsvindt) en toegediend.<br>
+
An admission for day treatment is comparable with an outpatient consultation or an emergency admission during which the medication is supplied by the hospital pharmacist. In the case of admission for a day, extensive medication verification does not usually occur. In the case of admission for a day, the medication prescribed is recorded (often on the basis of protocols according to which verification is carried out afterwards) and administered.<br>
Bij bijvoorbeeld cytostatica kuren is er wel een medicatieafspraak maar is niet altijd van te voren duidelijk wanneer de medicatieverstrekking/toediening plaatsvindt. Reden: vaak worden kuren uitgesteld en dan wordt pas later verstrekt en toegediend.
+
For treatments with cytostatics, for example, there is a medicatieafspraak, but it is not always clear in advance when the medicatieverstrekking/administration takes place. Reason: treatments are often postponed and then supplied and administered later.
  
===Starten met medicatie voor opname===
+
===Starting with medication before admission===
Bij een cataractoperatie wordt 3 dagen voor de behandeling gestart met Nevanac. Deze worden gebruikt tot 3 weken na de operatie (een totale gebruiksduur van 24 dagen). Er wordt door de specialist een medicatieafspraak gemaakt voor Nevanac, 1 druppel ’s morgens, gedurende 24 dagen. Wanneer de datum van de operatie niet bekend of onzeker is kan in de toelichting worden aangegeven dat er 3 dagen voor de operatie moet worden gestart.
+
Prior to cataract surgery, Nevanac is started three days before the surgery. The eye drops are used until three weeks after surgery (a total duration of use of 24 days). The specialist creates a medicatieafspraak for Nevanac, 1 drop in the morning, for 24 days. When the date of the surgery is unknown or uncertain, the explanation may indicate that Nevanac should be started 3 days before surgery takes place.
  
===Spoedopname===
+
===Emergency admission===
Bij een spoedopname vindt vooraf geen uitgebreide medicatieverificatie plaats zoals dat bij een klinische opname wel gebeurt. Ook het afspreken van medicatie met de patiënt is vaak niet mogelijk. De patiënt krijgt zo snel mogelijk de medicatie toegediend waarbij verificatie vaak achteraf plaatsvindt.
+
In the event of an emergency admission, extensive medication verification is not carried out beforehand as would normally be the case with clinical admissions. Agreeing on medication with the patient is also often not possible in the event of an emergency admission. Often, the patient is administered medication as soon as possible and verification only takes place afterward
  
===Ontslag===
+
===Discharge===
Bij ontslag naar huis wordt alle klinische medicatie gestopt. De medicamenteuze behandeling wordt geëvalueerd waarbij wordt bepaald welke medicatie de patiënt na ontslag gaat gebruiken:
+
When a patient is discharged from the hospital, all clinical medication is discontinued. The medicamenteuze behandeling is evaluated during which it is decided which medication the patient will use after discharge:
*eerdere bij opname gestopte ambulante medicatie wordt opnieuw gestart (nieuwe medicatieafspraak onder eerdere of nieuwe medicamenteuze behandeling) met eventuele verwijzing naar medicatie van voor de opname
+
*Previous outpatient medication that was discontinued at admission is started again (new medicatieafspraak under previous or new medicamenteuze behandeling) with possible reference to medication from before admission.
*eerdere bij opname tijdelijk onderbroken ambulante medicatie (zonder substitutie) wordt hervat middels een nieuwe medicatieafspraak onder dezelfde medicamenteuze behandeling
+
*Previous outpatient medication that was temporarily halted at admission (without substitution) is resumed using a new medicatieafspraak under the same medicamenteuze behandeling
*nieuwe ambulante medicatie wordt afgesproken: als ambulante vervanger van de klinische medicatie of als nieuwe therapie (nieuwe medicamenteuze behandeling met eventuele verwijzing naar instellingsmedicatie)
+
*New outpatient medication is agreed upon: as an outpatient replacement of clinical medication or as a new therapy (new medicamenteuze behandeling with possible reference to institutional medication)
Zie hiervoor [[#Processtap: Evalueren (medicamenteuze) behandeling|hoofdstuk 2.2.4]]. Het medicatieoverzicht en de medicatiegegevens worden (actief) beschikbaargesteld.
+
See [[#Process step: Evaluating a (pharmaceutical) treatment|Chapter 2.2.4]] for this. The medication overview and the medication data are (actively) made available.
  
===Tussentijds ontslag===
+
===Interim discharge===
Wanneer een patiënt tussentijds uit het ziekenhuis/de instelling naar huis gaat, bijvoorbeeld met weekendverlof, loopt de klinische medicatie door. Om de vaste huisarts op de hoogte te houden wordt het medicatieoverzicht meegegeven met de patiënt en worden de medicatiegegevens beschikbaar gesteld.
+
When a patient temporarily leaves the hospital/institution to go home, for example, for weekend leave, the clinical medication continues. In order to keep the patient’s own general practitioner informed, the medication overview is provided to the patient and the medication data are made available.
  
===Ontslag naar andere instelling===
+
===Transfe rto another institution===
Bij ontslag naar een andere instelling wordt de medicamenteuze behandeling geëvalueerd (zie [[#Processtap: Evalueren (medicamenteuze) behandeling|hoofdstuk 2.2.4]] en [[#Processtap: Maken medicatieafspraak|2.2.5]]). Medicatieoverzicht en medicatiegegevens worden (actief) beschikbaar gesteld. De nieuwe behandelend arts evalueert de medicamenteuze behandeling en bepaalt de instellingsmedicatie.
+
In case of a transfer to another institution, the medicamenteuze behandeling is evaluated (see [[#Process step: Evaluating a (pharmaceutical) treatment|Chapter 2.2.4]] and [[#Process step: Creating a medicatieafspraak|paragraph 2.2.5]]). Medication overview and medication data are (actively) made available. The new attending physician evaluates the medicamenteuze behandeling and determines the institutional medication.
  
===Niet verstrekken voor===
+
===Do not dispense before===
De voorschrijvend arts doet op 14 april 2017 een verstrekkingsverzoek, maar wil in datzelfde verstrekkingsverzoek aangeven dat er pas verstrekt mag worden op of vanaf een latere datum, bijvoorbeeld 23 april 2017. In het verstrekkingsverzoek kan dit niet gestructureerd worden vastgelegd maar wordt dit opgenomen in de toelichting (vrije tekst).
+
The prescribing physician creates a verstrekkingsverzoek on 14 April 2017, but wants to indicate in that same verstrekkingsverzoek the medicatieverstrekking may only take place on or from a later date, for example, 23 April 2017. This cannot be recorded in a structured manner in the verstrekkingsverzoek, but is included in the explanation (as free text).
  
===Stoppen van medicatie door derden===
+
===Discontinuation of medication by third parties===
Medicatie kan door de voorschrijver zelf gestopt worden (zie [[#Stoppen medicatie|Paragraaf 4.1.13]]) maar ook door een andere voorschrijver. Bijvoorbeeld de specialist kan  medicatieafspraken gemaakt door een huisarts stoppen die volgens het systeem weliswaar actueel zijn, maar - na bijvoorbeeld medicatieverificatie - dat toch niet blijken te zijn. Wanneer een zorgverlener medicatie stopt maakt hij een nieuwe stop-ma. De zorgverlener kan de medicatieafspraak van een ander niet aanpassen, alleen een stop-ma maken. Hij informeert daarom de zorgverlener van de originele medicatieafspraak actief over deze wijziging (zie [[#Informeren en (actief) beschikbaar stellen|Paragraaf 1.3.5]]). De zorgverlener van de originele medicatieafspraak past de einddatum aan in de bestaande medicatieafspraak. Dit kan desgewenst ook geautomatiseerd worden door het systeem. Hiermee wordt voorkomen dat na verloop van tijd de tweede zorgverlener geen gegevens meer hoeft op te leveren omdat de oplevertermijn is verstreken (ook geen stop-ma) terwijl de zorgverlener van de originele medicatieafspraak deze onterecht (zonder einddatum) wel blijft opleveren.
+
Medication can be discontinued by the prescriber himself (see [[#Discontinuing medication|paragraph 4.1.13]]) but also by another prescriber. For example, the specialist can end medicatieafspraken made by a general practitioner that are up to date according to the system, but that turn out not to be, for example after medication verification. When a healthcare provider discontinues medication, he creates a new stop-MA. The healthcare provider cannot modify someone else’s medicatieafspraak, only create a stop-MA. He therefore actively informs the healthcare provider of the original medicatieafspraak about this change. The healthcare provider of the original medicatieafspraak modifies the end date in the existing medicatieafspraak. If required, this may also be automated by the system. This prevents the second healthcare provider from not having to produce data after a period of time because the production period has expired (also no stop-MA), while the healthcare provider of the original medicatieafspraak continues to produce it for no reason (without an end date).
  
===Twee PRK's onder één medicamenteuze behandeling===
+
===Two PRKs in a single medicamenteuze behandeling===
Het is een apotheek, binnen bepaalde kaders, toegestaan om een andere PRK te kiezen voor de toedieningsafspraak dan is aangegeven in de medicatieafspraak gemaakt door een voorschrijver. Wanneer vervolgens alleen de toedieningsafspraak kan worden gecommuniceerd vanwege bijvoorbeeld een systeemstoring bij de voorschrijver dan heeft een volgende voorschrijver alleen deze toedieningsafspraak met nieuwe PRK. De volgende voorschrijver gaat er dan waarschijnlijk vanuit dat deze PRK ook de PRK van de medicatieafspraak is. Een wijziging in de medicatieafspraak zal dan ook een stop-ma (zonder verwijzing naar originele ma) en een nieuwe medicatieafspraak op basis van deze PRK tot gevolg hebben. Dit betekent dat er twee medicatieafspraken met verschillende PRK's voorkomen onder dezelfde medicamenteuze behandeling. Deze twee medicatieafspraken blijven bestaan. (Het systeem van) de voorschrijver moet na uitval controleren of er wijzigingen zijn geweest en deze zo nodig doorvoeren (zie ook [[#Stoppen van medicatie door derden|paragraaf 4.1.26]]).
+
In certain circumstances, the pharmacy is allowed to select a different PRK for the toedieningsafspraak than is indicated in the medicatieafspraak made by a prescriber. If for instance a failure of the prescriber’s system would result in only the communication of the toedieningsafspraak, a subsequent prescriber will only have this toedieningsafspraak with the new PRK. The next prescriber will then probably assume that this PRK is also the PRK of the medicatieafspraak. A modification of the medicatieafspraak will then also result in a stop-MA (without referring to the original MA) and a new medicatieafspraak on the basis of this PRK. This means that there are now two medicatieafspraken with different PRKs under the same medicamenteuze behandeling. These two medicatieafspraken continue to exist. After any system failure, (the system of) the prescriber must check whether there have been changes and implement them, if necessary (see also [[#Discontinuation of medication by third parties|paragraph 4.1.26]]).
  
===Achteraf vastleggen medicatieafspraak===
+
===Creating a medicatieafspraak after the fact===
In bijvoorbeeld spoedsituaties kan het voorkomen dat de medicatieafspraak pas wordt vastgelegd na het verstrekken of toedienen van de medicatie. Dit kan leiden tot conflicterende medicatieafspraken. Op basis hiervan moeten één of meerdere medicatieafspraken gestopt worden zodat er geen parallelle medicatieafspraken voorkomen. De enige uitzondering voor parallelle medicatieafspraken is beschreven in [[#Medicamenteuze behandeling|Paragraaf 1.3.3]].
+
In emergency situations, for example, it may happen that the medicatieafspraak is only created after the medication has been dispensed or administered. This may lead to conflicting medicatieafspraken. This means that one or more medicatieafspraken must be discontinued in order to prevent the occurrence of parallel medicatieafspraken. The only exception for parallel medicatieafspraken is described in [[#Medicamenteuze behandeling|paragraph 1.3.3]].
  
===Parallelle medicatieafspraken===
+
===Parallel medicatieafspraken===
Zie [[#Medicamenteuze behandeling|Paragraaf 1.3.3]].
+
See [[#Medicamenteuze behandeling|paragraph 1.3.3]].
  
===Eenmalig gebruik===
+
===Single use===
Bij medicatie die eenmalig moet worden gebruikt wordt in de gebruiksperiode alleen een einddatum opgenomen.
+
For medication meant for single use, only an end date is included in the period of use. An example would be a vaccination (for example, a tetanus shot) or a situation in which a patient should take a medication just once, for example 3 weeks before he leaves on holiday.
Denk aan vaccinaties (bijv. tetanusprik) of de situatie waarin gezegd wordt neem dit eenmalig 3 weken voordat je op vakantie gaat.
 
  
===Voorlopige en definitieve medicatieopdracht===
+
===Provisional and final medication order===
In de kliniek schrijft de voorschrijver medicatie voor. Dit wordt vastgelegd in een voorlopige medicatieopdracht oftewel, in termen van deze informatiestandaard, de medicatieafspraak. De ziekenhuisapotheker verifieert deze opdracht en legt dit vast als definitieve medicatieopdracht oftewel, in termen van deze informatiestandaard, de toedieningsafspraak.  
+
The prescriber at the clinic prescribes medication. This is recorded in a provisional medication order (the medicatieafspraak). The hospital pharmacist verifies this order and records it as a final medication order (the toedieningsafspraak). See also <ref name="MO"/>.
Zie ook <ref name="MO"/>.
 
  
===Onterecht openstaande medicatie of 'weeskinderen'===
+
===Inadvertently ‘outstanding’ medication or 'orphans'===
In de overgangssituatie en in een situatie waarin niet elk XIS is aangesloten kunnen er medicatieafspraken zijn bij dezelfde behandeling die door verschillende systemen zijn vastgelegd onder verschillende medicamenteuze behandelingen. Deze medicatieafspraken wil je eigenlijk samenvoegen onder één medicamenteuze behandeling. Dit probleem dient in ieder geval opgelost te worden voor medicatie met een open einddatum. Die medicatie kan namelijk onder een andere medicamenteuze behandeling zijn gestopt en daardoor open blijven staan en dus blijvend opgeleverd worden. Het betreft hier een ‘weeskind’ (dat wil zeggen: een bouwsteen die is vastgelegd, maar waarbij de zorgverlener op een gegeven moment geen actieve rol meer heeft en zijn systeem de bouwsteen dus blijft opleveren ook als deze elders al gestopt is). Voor medicatie met einddatum, sterft dit probleem vanzelf uit en wordt geen koppelingsactie ondernomen.  
+
In a transitional situation and in a situation where not every XIS is connected, medicatieafspraken for the same treatment may exist that have been created by different systems under different medicamenteuze behandelings. These medicatieafspraken should ideally be combined in a single medicamenteuze behandeling. This particularly applies to medication with an open end date, as this medication may have been discontinued under a different medicamenteuze behandeling. The medicatieafspraak therefore remains open, resulting in continued medicatieverstrekking. This is a so-called ‘orphan’ (a building block that has been registered, but in which, at a certain point, the healthcare provider no longer has an active role. However, his system continues to provide the building block, even if it has already been discontinued elsewhere). For medication with an end date, this problem will solve itself. Therefore, it is not necessary to take any action. When medication verification or medication assessment reveals that the medication is inappropriately still ‘open’, a stop-MA is created under the same medicamenteuze behandeling. The original prescriber is actively informed about this stop-MA and enters an end date for the medicatieafspraak in his own system. Depending on the supplier and the client’s wishes, setting this end date can be done automatically or through an intervention of the prescriber. See also [[#Discontinuation of medication by third parties|paragraph 4.1.26]].
Wanneer bij medicatieverificatie of -beoordeling wordt geconstateerd dat medicatie onterecht nog open staat wordt er een stop-MA gemaakt onder dezelfde medicamenteuze behandeling. De originele voorschrijver wordt actief geïnformeerd over deze stop-MA en voorziet de medicatieafspraak in zijn eigen systeem van een einddatum. Het zetten van de einddatum kan, afhankelijk van de leverancier en wensen van de klant, automatisch of met tussenkomst van de voorschrijver gebeuren.
 
Zie ook [[#Staken van medicatie door derden|paragraaf 4.1.26]].
 
  
===Ontbreken digitale medicatieafspraak bij opname===
+
===Missing digital medicatieafspraak at admission===
Wanneer bij medicatieverificatie geen digitale medicatieafspraak beschikbaar is wordt een nieuwe medicamenteuze behandeling gestart met het vastleggen van medicatiegebruik. Wanneer dit gebruik gestopt moet worden, wordt vervolgens een stop-medicatieafspraak gemaakt onder deze zelfde medicamenteuze behandeling die verwijst naar het vastgelegde medicatiegebruik. Zo mogelijk worden oorspronkelijke voorschrijver (bijv. huisarts) en apotheek actief geïnformeerd over het stoppen van deze medicatie.
+
If no digital medicatieafspraak is available when medication verification is carried out, a new medicamenteuze behandeling is started by recording consumption. When this use has to be discontinued, a stop-medicatieafspraak is created under the same medicamenteuze behandeling that refers to the recorded consumption. If possible, the original prescriber (for example, general practitioner) and the pharmacy are actively informed about the discontinuation of this medication.
  
===Eigen artikelen (90 miljoen nummers)===
+
===Own articles (90 million numbers)===
Het is mogelijk om een 90 miljoen nummer uit te wisselen. Voorwaarde is dat binnen een organisatie een eenmaal aangemaakt 90 miljoen nummer nooit aangepast mag worden. Bij de uitwisseling zorgt de root oid (unieke technische identificatie van de organisatie) in combinatie met het 90 miljoen nummer ervoor dat deze uniek is ten opzichte van alle 90 miljoen nummers vanuit andere organisaties.<br>
+
It is possible to exchange a 90 million number. The condition is that within an organization a 90 million number once created may never be modified. During the exchange, the root OID (unique technical identification of the organization) in combination with the 90 million number ensures that it is unique compared to all 90 million numbers form other organizations. The substances that make up this article are included as ingredients in the medicatieafspraak (at least one ingredient), as is the case with magistrals.  
De stoffen waaruit dit artikel bestaat worden als ingrediënten in de medicatieafspraak meegegeven (minimaal één ingrediënt) zoals dit ook het geval is bij magistralen.
 
  
===Dosering met minimum interval===
+
===Dosing with minimum interval ===
Medicatie kan voorgeschreven worden met een vast interval (bijvoorbeeld: elke 6 uur 2 tabletten). Het voorschrijven van medicatie met een minimum interval dient gedeeltelijk in vrije tekst te gebeuren.<br>
+
Medication can be prescribed at a fixed interval (for example: 2 tables every 6 hours). Prescribing medication with a minimum interval should be partly in free text. For example, if needed, a maximum of 3 times a day, a minimum of 6 hours between the intake moments: ''if needed, a maximum of 3 times a day'' is recorded in the standard way. The section “''at least 6 hours between intake times''” is recorded in free text as an Additional Instruction.  
Bijvoorbeeld zo nodig maximaal 3x per dag, minimaal 6 uur tussen de innamemomenten:<br>
 
Hierbij wordt ''zo nodig'' en ''maximaal 3x per dag'' op de standaard manier vastgelegd. Het onderdeel ''"minimaal 6 uur tussen de innamemomenten"'' wordt in vrije tekst als ''Aanvullende instructie'' vastgelegd.
 
  
===Verstrekkingsverzoek met aantal herhalingen===
+
===Verstrekkingsverzoek with number of repetitions ===
De voorschrijver maakt een verstrekkingsverzoek bij een medicatieafspraak waarin zij het aantal herhalingen invult.
+
The prescriber makes a verstrekkingsverzoek with a medicatieafspraak in which she enters the number of repetitions. The prescriber hereby indicates to the provider that it may make additional provisions. The number of repetitions in combination with the quantity to be dispensed results in: (Number of repetitions + 1) X quantity to be dispensed. In case of “number of repetitions =3” and “quantity to be supplied = 30 pieces” the provider may provide 4 times 30 pieces (total 120 pieces). The number of repetitions in combination with the duration of use period results in: (number of repetitions + 1)  x duration of use. The amount to be dispensed depends on the dosage. In case of “dosage = 3 x per day 2 pieces”, and “Duration of use period = 30 days” the provider may provide 180 pieces 4 times (6 pieces per day X 30 days = 180, 4 times = a total of 720 pieces).  
Hiermee geeft de voorschrijver bij de verstrekker aan dat deze additionele verstrekkingen mag doen.
 
  
Het aantal herhalingen in combinatie met de te verstrekken hoeveelheid resulteert in: (Aantal herhalingen + 1) x te verstrekken hoeveelheid.
+
===Prescribing non-medicines===
In geval van "Aantal herhalingen = 3" en "Te verstrekken hoeveelheid = 30 stuks", mag de verstrekker 4 maal 30 stuks verstrekken (in totaal 120 stuks).
+
Non medicines can be prescribed from the G-standard at HPK level. For example, this could be an inhaler (Aerochamber, HPK 1915185) as an aid to prescribed aerosols. Non-medicinal products are not applicable for the medication overview or medication monitoring.
  
Het aantal herhalingen in combinatie met de verbruiksperiode duur resulteert in: (Aantal herhalingen + 1) x verbruiksperiode duur.
+
===Send renal function value in the prescription===
De te verstrekken hoeveelheid is hierbij afhankelijk van de dosering.
 
In geval van "Dosering = 3x per dag 2 stuks", "Aantal herhalingen = 3" en "Verbruiksperiode duur = 30 dagen", mag de verstrekker 4 maal (6 stuks per dag x 30 dagen=) 180 stuks verstrekken (in totaal 720 stuks).
 
  
===Voorschrijven van niet geneesmiddelen (verbandmiddelen, krukken of andere hulpmiddelen)===
+
'''A) Renal function value with a new prescription:''' <br>
Niet geneesmiddelen kunnen vanuit de G-standaard voorgeschreven worden op HPK niveau.  
+
For the prevention of stroke, a patient (male, 65 years old) is prescribed Dabigatran for the first time. The patient has renal impairment and the prescriber has a recent renal function value available. Based on this renal function value, the prescriber deviates from the standard dose and makes a medicatieafspraak with a lower dosage of Dabigatran twice a day 1 capsule of 110 mg, starting from January 15, 2020. The prescriber also makes a verstrekkingsverzoek and sends the prescription (medicatieafspraak, verstrekkingsverzoek and the laboratory result of the renal function value) to the pharmacist.<br>
Dit kan bijvoorbeeld een inhalator (Aerochamber, HPK 1915185) als hulpmiddel voor voorgeschreven aerosolen zijn.
+
[[Bestand:Uc4.1.38A.PNG|800px]]
Niet geneesmiddelen zijn niet van toepassing voor het medicatieoverzicht of medicatiebewaking.
 
 
 
===Nierfunctiewaarde sturen in het voorschrift ===
 
  
'''A) Nierfunctiewaarde bij een nieuw voorschrift:''' <br>
+
'''B) Renal function value reason for a change:''' <br>
Ter preventie van een beroerte krijgt een patiënt (man, 65 jaar) voor het eerst Dabigatran voorgeschreven.
+
A 70-year-old man was prescribed 1 tablet of metformin 500 mg 3 times a day a few days ago (medicatie afspraak and verstrekkingsverzoek). At the same time, the doctor initiated a blood test to determine the renal function value of the patient. The value was not yet known at the time of prescription.
De patiënt heeft een verminderde nierfunctie en de voorschrijver heeft een recente nierfunctiewaarde beschikbaar.
 
Op basis van deze nierfunctiewaarde wijkt de voorschrijver af van de standaard dosering en maakt een medicatieafspraak aan met een lagere dosering van Dabigatran 2x daags 1 capsule van 110 mg vanaf 15 januari 2020.
 
De voorschrijver maakt ook een verstrekkingsverzoek en stuurt het voorschrift (medicatieafspraak, verstrekkingsverzoek en de laboratoriumuitslag nierfunctiewaarde) aan de apotheker.<br>
 
[[Bestand:Uc4.1.38A.PNG|800px]]
 
  
'''B) Nierfunctiewaarde reden voor een wijziging:''' <br>
 
Een man van 70 jaar heeft enkele dagen geleden 3x daags 1 tablet metformine 500 mg voorgeschreven gekregen (medicatieafspraak met verstrekkingsverzoek). De arts heeft tegelijkertijd een bloed onderzoek in gang gezet om de nierfunctiewaarde te bepalen van de patiënt. De waarde was nog niet bekend op het moment van voorschrijven.<br>
 
 
[[Bestand:Uc4.1.38B1.PNG|800px]]
 
[[Bestand:Uc4.1.38B1.PNG|800px]]
  
Uit het onderzoek blijkt dat de nierfunctie verminderd is en reden geeft tot aanpassing van de medicatieafspraak.
+
The blood test shows that renal function is impaired and gives reason to adjust the medicatieafspraak. The prescriber adjusts the dose on January 17, 2020 to 2 tablets metformin 500mg twice a day and discuss this with the patient. The new prescription (the 'technical' stop medicatieafspraak, new medicatieafsrpaak and the laboratory result of the renal function value) is sent to the pharmacy by the prescriber. Because the patient had already collected the medication and therefore has enough stock, no new verstrekkingsverzoek is sent along.
De voorschrijver past de dosering op 17 januari 2020 aan naar 2x daags 1 tablet metformine 500mg en bespreekt dit met de patiënt.
 
Het nieuwe voorschrift (de 'technische' stop-medicatieafspraak, nieuwe medicatieafspraak en de laboratoriumuitslag nierfunctiewaarde) wordt door de voorschrijver aan de apotheek gestuurd.
 
Omdat de patiënt de medicatie al had opgehaald en daardoor voldoende voorraad heeft, wordt er geen nieuw verstrekkingsverzoek meegestuurd.<br>
 
[[Bestand:Uc4.1.38B2.PNG|800px]]
 
  
'''C) Nierfunctiewaarde van toepassing vanwege geneesmiddel:''' <br>
+
'''C) Renal function value due to drug:''' <br>
Patiënte krijgt vanwege een blaasontsteking Nitrofurantoine 100 mg, 2x daags 1 capsule voorgeschreven als kuur van 5 dagen en moet meteen starten op 6 januari 2020. Bij dit geneesmiddel moet de nierfunctie waarde (indien bekend en niet ouder dan 13 maanden) meegestuurd worden. De voorschrijver heeft voor deze patiënte een nierfunctie waarde beschikbaar, welke echter geen aanleiding geeft tot een aangepaste dosering.
+
The patient is prescribed Nitrofurantoin 100 mg, 1 capsule twice daily as a 5-day course due to a bladder infection and must start immediately on January 6, 2020. With this drug, the renal function value (if known and not older than 13 months) needs to be sent along. The prescriber has a renal function value available for this patient, but this does not lead to an adjusted dosage. The prescriber sends the prescription (medicatieafspraak, verstrekkingsverzoek and the laboratory result of the renal function value) to the pharmacist. <br>
De voorschrijver stuurt het voorschrift (medicatieafspraak, verstrekkingsverzoek én de laboratoriumuitslag nierfunctiewaarde) naar de apotheker.<br>
 
 
[[Bestand:Uc4.1.38C.PNG|800px]]
 
[[Bestand:Uc4.1.38C.PNG|800px]]
  
==Use cases Ter hand stellen==
+
==Use case, Dispense==
  
===Nieuwe medicatieafspraak, medicatieverstrekking zelfde product===
+
===New medicatieafspraak, medicatieverstrekking of the same product===
De patiënt is op 27 januari 2013 bij de apotheker om medicatie af te halen. De apotheker opent het dossier van de patiënt en verifieert het medicatiedossier. Het betreft een nieuwe medicatieafspraak voor deze patiënt. De relevante informatie van de voorschrijvende arts is weergegeven op het scherm van de apotheker:<br>
+
The patient is at the pharmacist on 27 January 2013 to collect his medication. The pharmacist opens the file of the patient and verifies the medication file. It is a new medicatieafspraak for this patient. The relevant information of the prescribing physician is displayed on the screen of the pharmacist.<br>
Medicatieafspraak: ''Nitrofurantoïne capsule mga 100 mg, 2 maal daags 1 capsule, vanaf heden gedurende 5 dagen.'' <br>
+
Medicatieafspraak: ''Nitrofurantoin CR capsule, 100 mg, 1 capsule 2x daily, from now on for 5 days.''<br>
Verstrekkingsverzoek: ''Nitrofurantoïne capsule mga 100mg; 10 stuks.''
+
Verstrekkingsverzoek: ''Nitrofurantoin CR capsule, 100 mg; 10 capsules.''<br>
 
+
The pharmacist selects a product on the basis of the medicatieafspraak and other factors (such as the pharmacist’s stock and the preference policy of the healthcare insurer):<br>
De apotheker kiest een product op basis van de medicatieafspraak en andere factoren (zoals bijvoorbeeld de voorraad van de apotheker, preferentiebeleid zorgverzekeraar): <br>
+
''FURABID CR CAPSULE, 100 MG''. The pharmacist carries out medication monitoring using the system, no (warning) signals are given.<br>
''FURABID CAPSULE MGA 100MG''
+
The pharmacist carries out pharmaceutical care (compliance, education, et cetera) and agrees with the patient on how she will use the medication. This toedieningsafspraak on 27 January 2013 reads:<br>
De apotheker voert medicatiebewaking uit met behulp van het systeem, er zijn geen signalen.<br>
+
''FURABID CR CAPSULE, 100MG; 1 capsule 2x daily; from now on for 5 days''. The pharmacist provides the medication to the patient:<br>
De apotheker voert farmaceutische zorg (therapietrouw, voorlichting, etcetera) uit en spreekt met de patiënt af hoe zij de medicatie zal gebruiken. Deze toedieningsafspraak op 27 januari 2013 luidt: <br>
+
''on 27 January 2013, FURABID CR CAPSULE, 100 MG; 10 capsules.'' The pharmacist actively informs the prescribing physician about the medicatieafspraak and the medicatieverstrekking.<br>
''FURABID CAPSULE MGA 100MG; 2 maal daags 1 capsule; vanaf heden gedurende 5 dagen.''
+
The system of the pharmacist makes the new toedieningsafspraak and medicatieverstrekking available to the other healthcare providers of this patient.
De apotheker verstrekt de medicatie aan de patiënt: <br>
+
<br>
''op 27 januari 2013, FURABID CAPSULE MGA 100MG; 10 stuks.''
 
De apotheker informeert de voorschrijvende arts actief over de toedieningsafspraak en de medicatieverstrekking. <br>
 
Het systeem van de apotheker maakt de nieuwe toedieningsafspraak en medicatieverstrekking beschikbaar voor de medebehandelaars van deze patiënt.<br>
 
 
<br>
 
<br>
 
[[Bestand:Uc4.2.1.PNG|800px]]
 
[[Bestand:Uc4.2.1.PNG|800px]]
  
===Nieuwe medicatieafspraak, nadere specificering product===
+
===New medicatieafspraak, more precise product specification===
Het verschil bij het specificeren van het product is dat de afspraak over toediening en ook de medicatieverstrekking afwijkt van de afspraak die de patiënt met de voorschrijvende arts heeft gemaakt. Verder is het proces hetzelfde als beschreven in de voorgaande paragraaf.
+
Here, the difference when specifying the product is that the toedieningsafpsraak and also the medicatieverstrekking deviates from the medicatieafspraak the patient has made with the prescribing physician. The process is otherwise the same as described in the previous paragraph.
  
<u>'''Voorbeeld'''</u><br>
+
<u>'''Example'''</u><br>
Medicatieafspraak: ''Nitrofurantoïne capsule mga <u>100 mg</u>, 2 maal daags 1 capsule, vanaf heden gedurende 5 dagen.'' <br><br>
+
''Medicatieafspraak: Nitrofurantoin capsule mga 100 mg, 1 capsule 2 times a day from today for 5 days.''
  
De apotheker specificeert een ander product:  
+
The pharmacist specifies a different product:<br>
:''Nitrofurantoïne MC Actavis capsule <u>50</u> mg.''
+
''Nitrofurantoine MC Actavis capsule <u>50</u> mg.''
De apotheker spreekt met de patiënt af hoe zij de medicatie zal gebruiken. Deze toedieningsafspraak op 27 januari 2013 luidt:  
+
The pharmacist agrees with the patient on how she will use the medication. This toedieningsafspraak on 27 January 2013 reads:<br>
:''Nitrofurantoïne MC Actavis capsule 50 mg; <u>4</u> maal daags 1 capsule; vanaf heden gedurende 5 dagen.''
+
''Nitrofurantoin MC CR capsule 50 mg, 1 capsule 2x daily, from now on for 5 days.''<br>
De apotheker verstrekt de medicatie aan de patiënt:  
+
The pharmacist provides the medication to the patient:<br>
:''op 27 januari 2013, Nitrofurantoïne MC Actavis capsule <u>50</u> mg; <u>20</u> stuks.''<br>
+
''on 27 January 2013, Nitrofurantoin MC Actavis capsule 50 mg; 20 pieces.''
 +
<br>
 
<br>
 
<br>
 
[[Bestand:Uc4.2.2.PNG|800px]]
 
[[Bestand:Uc4.2.2.PNG|800px]]
  
===Bestaande toedieningsafspraak voldoet===
+
===Existing toedieningsafpsraak is adequate===
Het proces van het doen van een nieuwe medicatieverstrekking op basis van een bestaande medicatieafspraak, evt. bestaand verstrekkingsverzoek én toedieningsafspraak komt voor bij herhalen en is beschreven in paragraaf [[#Knippen van recept|4.2.10]], situatie 2.
+
The process of repeat medicatieverstrekking on the basis of an existing medicatieafspraak and possibly existing verstrekkingsverzoek and toedieningsafsrpaak occurs in case of repeat prescriptions and is described in [[#Splitting a prescription|paragraph 4.2.10]], situation 2.
  
===Medicatieafspraak gewenst (Informeren voorschrijver)===
+
===Medicatieafspraak wanted (informing the prescriber)===
<u>'''Voorbeeld 1 - dosering aanpassen:'''</u><br>
+
<u>'''Example 1 - adjusting dosage:'''</u><br>
De apotheker voert bij een patiënt van 70 jaar met creatinineklaring 45 ml/min een toedieningsafspraak in voor gabapentine tablet 600 mg 3x per dag 1 tablet. In de apotheek is de nierfunctie vastgelegd in het patiëntendossier, en op basis daarvan verschijnt er een signaal dat de maximale dosering 900 mg per dag is. De apotheker stuurt een voorstel-medicatieafspraak met een aangepaste dosering van 300 mg 3x per dag en de reden voor dit voorstel (maximale dosering overschreden) naar de voorschrijver. De voorschrijver ontvangt het voorstel-medicatieafspraak in zijn EVS en stuurt een aangepaste medicatieafspraak terug naar de apotheker.
+
For a 70-year-old patient with a creatinine clearance of 45 mL/min, the pharmacist enters a toedieningsafspraak for gabapentin tablets of 600 mg, 1 tablet 3x daily. Renal function has been recorded in the patient’s file at the pharmacy, and based on this a signal appears that the maximum dosage is 900 mg daily. The pharmacist sends the prescriber a proposed medicatieafspraak with an adjusted dosage of 300 mg, 3x daily, and the reason for this proposal (maximum dosage exceeded). The prescriber receives the proposed medicatieafspraak in his EVS and sends an adjusted medicatieafspraak back to the pharmacist.
  
<u>'''Voorbeeld 2 – geneesmiddel tijdelijk stoppen:'''</u><br>
+
<u>'''Example 2 – temporarily halting a medicinal product:'''</u><br>
De apotheker voert bij een patiënt van 50 jaar met een kuur fluconazol oraal in de actuele medicatie, een toedieningsafspraak in voor simvastatine. Er verschijnt een melding met het advies om te overwegen simvastatine tijdelijk te stoppen. De apotheker kan een voorstel-medicatieafspraak voor het stoppen van simvastatine maken (stoptype 'tijdelijk'). Voor verdere stappen zie voorbeeld 1.
+
For a 50-year-old patient with on oral fluconazole as part of his current medication, the pharmacist enters a toedieningsafspraak for simvastatin. A message appears with the advice to consider temporarily halting simvastatin. The pharmacist can make a proposed medicatieafspraak for halting the simvastatin (stoptype ‘temporary’). See example 1 for further steps.
  
<u>'''Voorbeeld 3 – geneesmiddel toevoegen:'''</u><br>
+
<u>'''Example 3 – adding a medicinal product:'''</u><br>
De apotheker voert bij een vrouw van 55 jaar een toedieningsafspraak in voor prednison 10 mg per dag gedurende 3 maanden. De patiënt gebruikt geen osteoporoseprofylaxe. Er verschijnt een melding met het advies om een bisfosfonaat toe te voegen en na te gaan of de patiënt calcium en vitamine D gebruikt. Wanneer de patiënt deze middelen niet gebruikt kan de apotheker een voorstel-medicatieafspraak voor deze middelen maken. Voor verdere stappen zie voorbeeld 1.
+
For a 55-year-old woman, the pharmacist enters a toedieningsafspraak for prednisone, 10 mg daily for three months. The patient is not using osteoporosis prophylaxis. A message appears with the advice to add a biphosphonate drug and to check whether the patient is taking calcium and vitamin D. If the patient is not, the pharmacist can make a proposed medicatieafspraak for these products. See example 1 for further steps.
  
LET OP: het zal van de situatie afhangen of het zinvol is geautomatiseerd een voorstel voor aanpassing/toevoeging van een MA te doen. Als het advies complex is, kan het nog steeds zinvol zijn om te bellen en te overleggen, i.p.v. een digitaal voorstel te sturen.<br>
+
PLEASE NOTE: it will depend on the situation whether it is useful to create an automated proposal for adjustment/addition of a MA. If the advice is complex, it may still be useful to phone and to consult instead of sending a digital proposal.<br>
De voorstel-medicatieafspraak kan de voorschrijver helpen deze wijziging in de registratie door te voeren. Dit laatste is van belang wanneer medicatieafspraken worden geraadpleegd zoals in de dienstwaarneming huisartsen.
+
The proposed medicatieafspraak may help the prescriber to enter this change in the system. The latter is important when medicatieafspraken are consulted, for example, by service observation general practitioners.
  
===Aanschrijven en verstrekken===
+
===Request and dispense ===
Wanneer een medicatieafspraak met verstrekkingsverzoek bij de apotheek binnen komt wordt deze verwerkt in het apotheek systeem tot een voorgenomen uitgifte. Dit wordt het moment van aanschrijven genoemd, welke als aanschrijfdatum in de medicatieverstrekking wordt vastgelegd. De verstrekkingsdatum wordt gevuld bij afhalen of overhandigen. De apotheker informeert de voorschrijver over de afhandeling van het voorschrift (toedieningsafspraak en/of medicatieverstrekking).  
+
When a medicatieafspraak and verstrekkingsverzoek arrives at the pharmacy, it is processed by the pharmacy system as an intended medicatieverstrekking. This is called the request date, which is captured as the request date of the medication dispensing The date of dispensing is only registered at the moment of pick up or hand over of the medication. The pharmacist informs the prescriber about the handling of the prescription (toedieningsafspraak and/or medicatieverstrekking).
  
Het is mogelijk om meerdere verstrekkingen onder dezelfde TA aan te maken:
+
It is possible to create multiple dispensings under the same toedieningsafpsraak:
*Er komt een verstrekkingsverzoek binnen met een medicatieafspraak met een gebruiksperiode van een jaar.
+
*A verstrekkingsverzoek comes in with a medicatieafspraak with a one-year use period
*Er vindt een eerste verstrekking plaats met een nieuwe TA en een medicatieverstrekking welke voldoende is voor bijvoorbeeld een periode van 4 maanden.
+
*There will be a first provision with a new toedieningsafspraak and a medication supply that is sufficient for, for example, a period of 4 months.
 
<br>
 
<br>
 
[[Bestand:Uc4.2.5a.PNG|800px]]
 
[[Bestand:Uc4.2.5a.PNG|800px]]
 
<br>
 
<br>
*De tweede verstrekking wordt op basis van de bestaande medicatieafspraak, verstrekkingsverzoek en toedieningsafspraak uitgevoerd (er is geen nieuw voorschrift of een nieuwe toedieningsafspraak nodig). De nieuwe tweede medicatieverstrekking (met nieuwe aanschrijfdatum en de reeds bestaande bijbehorende toedieningsafspraak) wordt verstuurd naar de voorschrijver wanneer de verstrekkingsdatum geregistreerd is.
+
*The second dispensing is performed based on the existing medicatieafpsraak, verstrekkingsverzoek and toedieningsafspraak (no new prescription or new administration appointment is needed). The new second medication dispensing (with new write-up date and the pre-existing associated toedieningsafspraak) is sent to the prescriber when the dispensing date is registered.
 
<br>
 
<br>
 
[[Bestand:Uc4.2.5b.PNG|800px]]
 
[[Bestand:Uc4.2.5b.PNG|800px]]
  
===Patiënt vraagt herhaalrecept via arts (reactief herhalen)===
+
===Patient requests repeat prescription via physician (reactive repeat)===
Een arts heeft eerder hypertensie geconstateerd bij een patiënt (57 jaar) en heeft de patiënt hiervoor medicatie voorgeschreven. De patiënt gebruikt deze medicatie en de medicatie raakt op. De patiënt doet een verzoek om de medicatie te herhalen via bijvoorbeeld de herhaallijn, telefonisch, per e-mail aan de praktijk, balie/doosjes, website, app of portaal van de arts. De arts geeft toestemming voor herhaling. Dit leidt tot een nieuw verstrekkingsverzoek. <br>
+
A physician has previously diagnosed hypertension in a patient (57 years old) and has prescribed the patient medication for this. The patient uses this medication and the medication is running out. The patient makes a request to repeat the medication, for example through the repeat line, by phone, by email to the practice, counter/boxes, website, app or portal of the physician. The physician approves the repeat. This leads to a new verstrekkingsverzoek.<br>  
<u>Bijvoorbeeld:</u>
+
<u>For example:</u>
:De huisarts doet, in het kader van de medicatieafspraak van 30 maart 2010:  
+
The general practitioner makes, in the context of the medicatieafspraak of 30 March 2010:
:''Nifedipine mga 30mg; 1 maal daags 1 tablet vanaf 30 maart 2010 tot <u>voor onbepaalde duur</u>''
+
:''Nifedipine CR 30 mg; 1 tablet 1x daily, from 30 March 2010 <u>for an indefinite period</u>''
:op 13 april 2013 een verstrekkingsverzoek aan een apotheker naar keuze van de patiënt:
+
on 13 April 2013 a verstrekkingsverzoek to a pharmacist chosen by the patient:
:''Nifedipine tablet mga 30 mg; ‘voor drie maanden’.''
+
:''Nifedipine, CR tablet, 30 mg; ‘for three months’.''
In overleg met de patiënt kan de voorschrijver het verstrekkingsverzoek met de bijbehorende medicatieafspraken en toedieningsafspraken als opdracht versturen naar de apotheker naar keuze van de patiënt. Daarnaast stelt de voorschrijver het nieuwe verstrekkingsverzoek beschikbaar aan medebehandelaars en patiënt. De bestaande medicatieafspraken waren reeds eerder beschikbaar gesteld.<br>
+
In consultation with the patient, the prescriber can send the verstrekkingsverzoek with the corresponding medicatieafspraken and toedieningsafspraken as an order to a pharmacy of the patient’s choice. The prescriber also makes the new verstrekkingsverzoek available to fellow healthcare providers and the patient. The existing medicatieafspraken had already been made available.<br>
De apotheker ontvangt het verstrekkingsverzoek tezamen met de medicatieafspraak en handelt het af conform het proces van ter hand stellen en start met de processtap farmaceutische zorg.<br><br>
+
The pharmacist receives the verstrekkingsverzoek together with the medicatieafspraak and processes it in accordance with the dispense process and starts with the pharmaceutical care process step.
Wanneer de patiënt op basis van een toedieningsafspraak of op basis van zijn gebruik om een herhaalrecept vraagt, waarbij de medicatieafspraak niet digitaal beschikbaar is, maakt de arts een nieuwe medicatieafspraak die gebaseerd is op deze toedieningsafspraak of gebruik van de patiënt. Er vindt dan geen verwijzing plaats naar de bestaande medicatieafspraak.
+
 
 +
When the patient, on the basis of a toedieningsafspraak or on the basis of his use asks for a repeat prescription, and the medicatieafspraak is not digitally available, the physician creates a new medicatieafspraak based on this toedieningsafspraakor the patient’s use of the medication. No reference is made to the existing medicatieafspraak in that case.
 +
 
 +
===Patient requests repeat prescription via pharmacist (informing prescriber)===
 +
The patient requests a repeat medication from the pharmacist, for example through repeat line, by phone, email, counter/boxes, website, app or portal of the pharmacist.<br>
 +
The pharmacist sends a proposed verstrekkingsverzoek including a copy of the existing medicatieafspraak for authorisation to the prescriber. The physician evaluates the proposed verstrekkingsverzoek and approves it. He informs the pharmacist via the reply proposed verstrekkingsverzoek and sends a new verstrekkingsverzoek together with the current agreements to the pharmacist. The pharmacist continues the dispense process and starts with the pharmaceutical care process step.<br>
 +
If the prescriber does not provide a verstrekkingsverzoek, he informs the pharmacist via the answer proposed verstrekkingsverzoek.
 +
 
 +
===Proactive repeat prescription by pharmacist (informing prescriber)===
 +
The patient has signed up in the past for proactive repeats and the pharmacist has registered this in his proprietary pharmacist information system (PIS). The repeat module of this system will generate a signal when a patient needs new medication. When a new verstrekkingsverzoek is needed, this is similar to the process described in the previous paragraph, only the trigger is not the patient but the pharmacist (or his system). Proactive repeats are also used for GDS, see [[#Starting and continuing a GDS|paragraph 4.2.11]].
 +
 
 +
===Dispense based on an existing verstrekkingsverzoek===
 +
The patient submits a repeat prescription to the pharmacist. In this case, it is a request for medicatieverstrekking on the basis of an existing, still valid, verstrekkingsverzoek. See [[#Splitting a prescription|paragraph 4.2.10]] situation (3).
  
===Patiënt vraagt herhaalrecept via apotheker (Informeren voorschrijver)===
+
===Splitting a prescription===
De patiënt vraagt herhaling van medicatie aan bij apotheker, bijvoorbeeld via herhaallijn, telefonisch, e-mail, balie/doosjes, website, app of portaal van de apotheker. <br>
+
The patient has been using the same medication for a number of years, which means that the medicatieafspraak can be created for an indefinite period. The toedieningsafspraak is also valid for an indefinite period. In such a case, the patient can be given a prescription for a year. This single year prescription will be split into several prescriptions by the pharmacist. These split prescriptions are commonly called ‘repeat prescriptions’, even though strictly speaking this is not true.
De apotheker stuurt een voorstel-verstrekkingsverzoek inclusief een kopie van de bestaande medicatieafspraak ter autorisatie aan de voorschrijver. De arts beoordeelt het voorstel-verstrekkingsverzoek en accordeert deze. Hij informeert de apotheker via het antwoord voorstel-verstrekkingsverzoek en stuurt een nieuw verstrekkingsverzoek samen met de actuele afspraken naar de apotheker. De apotheker vervolgt het proces van ter hand stellen en start met de processtap farmaceutische zorg.<br>
 
Als de voorschrijver geen verstrekkingsverzoek afgeeft informeert hij de apotheker via het antwoord voorstel-verstrekkingsverzoek hierover.
 
  
===Proactief herhaalrecept door apotheker (Informeren voorschrijver)===
+
There are three possible situations:<br>
De patiënt heeft zich in het verleden aangemeld voor proactief herhalen en de apotheker heeft dit geregistreerd in het eigen apotheek informatiesysteem (AIS). De herhaalmodule van dit systeem zal een signaal genereren wanneer een patiënt nieuwe medicatie nodig heeft. Als er een nieuw verstrekkingsverzoek nodig is komt dit overeen met het proces beschreven in de vorige paragraaf, alleen de trigger is niet de patiënt maar de apotheker (of zijn systeem) zelf. Proactief herhalen wordt ook gebruikt voor GDS, zie [[#Het opstarten en continueren van GDS|paragraaf 4.2.11]].
+
1) The patient returns to his attending physician still suffering from the same symptoms. The prescriber prescribes the same medication (in the case of an expired medicatieafspraak, a new medicatieafspraak is created with a new verstrekkingsverzoek and in the case of a medicatieafspraak that is still valid, only a new verstrekkingsverzoek is created).<br>
 +
2) Prescriber and patient initially agree on 90 tablets with 3 repeat prescriptions. The patient receives the first 90 tablets. The next time the patient visits the pharmacist, a medicatieverstrekking is made under the existing agreements.<br>
 +
3) Prescriber and patient initially agree on 360 tablets for one year. The pharmacist splits this into 4 separate occasions of medicatieverstrekking. The patient is initially dispensed 90 tablets and without a new verstrekkingsverzoek, can go to the pharmacist 3 more times to pick up another 90 tablets each time.<br>
 +
Situation 3 best describes the way in which a pharmacist splits a year prescription.
  
===Verstrekken op basis van bestaand verstrekkingsverzoek===
+
===Starting and continuing a GDS===
De patiënt levert een herhaalrecept in bij de apotheker. Het betreft in dit geval een verzoek tot medicatieverstrekking op basis van een bestaand, nog geldig, verstrekkingsverzoek. Zie hiervoor [[#Knippen van recept|paragraaf 4.2.10 situatie (3)]].
+
The following example shows the process for one medicinal product used by the patient for an indefinite period of time. The system of the general practitioner and the pharmacist contains (among other things) the following data on a patient:
 +
*The medicatieafspraak of 2 January 2013 reads: Metoprolol, CR tablet, 100 mg (succinate); 1x tablet daily; from 2 January 2013 for an indefinite period.
 +
*The toedieningsafspraak of 2 January 2013 reads: Metoprolol PCH retard, 100 CR tablets of 95 mg; 1x tablet 1x daily; from 2 January 2013 for an indefinite period.
 +
This elderly patient is taking so much medication that he has problems overseeing it all: a potentially dangerous situation. On 6 February, the pharmacist and the general practitioner agree that the medicatieverstrekking of medicinal products to this patient will take place via GDS.
  
===Knippen van recept===
+
The GDS is started: the pharmacist sends a proposed verstrekkingsverzoek (a similar event to the current combined prescription or authorisation form).
Een patiënt gebruikt al jaren dezelfde medicatie. De medicatieafspraak kan voor onbepaalde duur worden gemaakt. Ook de toedieningsafspraak volstaat voor onbepaalde duur. De patiënt komt dan in aanmerking voor een jaarrecept. Wanneer de patiënt een jaarrecept krijgt dan moet er geknipt worden door de apotheker. De geknipte recepten zijn feitelijk geen 'herhaalrecept' maar we noemen het in de wandelgangen wel zo. <br>
 
Er zijn drie situaties:<br>
 
1) Patiënt komt terug bij behandelend arts en de klachten zijn nog niet over. De voorschrijver schrijft hetzelfde voor (bij een verlopen medicatieafspraak wordt een nieuwe medicatieafspraak met nieuw verstrekkingsverzoek gemaakt en bij een nog lopende medicatieafspraak wordt alleen een nieuw verstrekkingsverzoek gemaakt).<br>
 
2) Voorschrijver en patiënt spreken initieel af: 90 stuks met 3x herhalen. De patiënt krijgt initieel 90 stuks verstrekt. De volgende keer dat de patiënt bij de apotheker komt wordt er een medicatieverstrekking gedaan onder de bestaande afspraken.<br>
 
3) Voorschrijver en patiënt spreken initieel af: 360 stuks gedurende een jaar. De apotheker knipt dit in 4 deelverstrekkingen. De patiënt krijgt dan initieel 90 stuks verstrekt en kan zonder nieuw verstrekkingsverzoek daarna nog 3x bij de apotheker een medicatieverstrekking afhalen van 90 stuks.<br>
 
Deze laatste situatie beschrijft feitelijk de situatie van het knippen van een jaarrecept door de apotheker.
 
  
===Het opstarten en continueren van GDS===
+
The proposed verstrekkingsverzoek of 6 February reads:
Het voorbeeld hierna toont het proces rondom één geneesmiddel dat door de patiënt voor onbepaalde duur wordt gebruikt. In het systeem van de huisarts en de apotheker staan (onder andere) de volgende gegevens over een patiënt:
+
*Verstrekkingsverzoek for the medicatieafspraak of 2 January 2013: Metoprolol, CR tablet, 100 mg (succinate), and a period of use to ensure enough stock up to and including 1 May 2013.
*De medicatieafspraak op 2 januari 2013 luidt: Metoprolol tablet mga 100 mg (succinaat); een maal daags een tablet; van 2 januari 2013 voor onbepaalde duur.
+
The pharmacist sends the proposal to the general practitioner. The general practitioner approves the proposal on February 6 and sends it unchanged to the pharmacist as a verstrekkingsverzoek. The GDS indicator is switched on in the system of the general practitioner as well as in the pharmacist’s system.
*De toedieningsafspraak op 2 januari 2013 luidt: Metoprolol PCH retard 100 tablet mga 95 mg; een maal daags een tablet; van 2 januari 2013 voor onbepaalde duur.  
 
Deze bejaarde patiënt heeft zoveel medicatie dat hij geen overzicht meer heeft: een potentieel gevaar. Op 6 februari spreken de apotheker en de huisarts af dat de medicatieverstrekking van geneesmiddelen aan deze patiënt gebeurt via GDS.  
 
  
De GDS wordt opgestart: de apotheker stuurt een voorstel-verstrekkingsverzoek (qua gebeurtenis vergelijkbaar met het huidige verzamelrecept of autorisatieformulier).  
+
The pharmacist and the patient select a partial duration for the product. This toedieningsafspraak reads as follows:
 +
*On 7 February it was agreed: Metoprolol PCH retard, 100 CR tablets of 95 mg, 1 tablet in the morning, from 11 February (week 6), for an indefinite period.
  
Het voorstel‐verstrekkingsverzoek van 6 februari luidt:  
+
Every second week, the pharmacist dispenses a Baxter medication roll containing (among other things) the metoprolol:
*Verstrekkingsverzoek ten behoeve van de medicatieafspraak van 2 januari 2013: Metoprolol tablet mga 100 mg (succinaat), en een verbruiksperiode voor voldoende voorraad tot en met 1 mei 2013.  
+
*Medicatieverstrekking 1: The pharmacist dispenses, on Friday, 8 February 2013: 14 tablets, scheduled for weeks 6 and 7 (a period of use of 2 weeks).
De apotheker stuurt het voorstel naar de huisarts. De huisarts fiatteert het voorstel op 6 februari en stuurt het als verstrekkingsverzoek ongewijzigd naar de apotheker. In zowel het systeem van de huisarts als de apotheker wordt bij de patiënt het kenmerk GDS aangezet.
+
*Medicatieverstrekking 2: The pharmacist dispenses, on Friday, 22 February: 14 tablets, scheduled for weeks 8 and 9.
 +
*Medicatieverstrekking 3, 4, 5, etc.
 +
With each medicatieverstrekking, it is indicated that medicatieverstrekking was carried out via GDS.
 +
After three months, there is a new proposed verstrekkingsverzoek from the pharmacy to the general practitioner, etc.
  
De apotheker kiest met de patiënt een deeltijd voor het middel. Deze toedieningsafspraak luidt als volgt:
+
'''Consideration ''' <br>
*Op 7 februari is afgesproken: Metoprolol PCH retard 100 tabl mga 95 mg; 1 tablet ‘s morgens; vanaf 11 februari (week 6) voor onbepaalde duur.  
+
*The application of a proposed verstrekkingsverzoek instead of an authorisation form makes its meaning unambiguous.
De apotheker verstrekt iedere tweede week een baxterrol medicatie met (onder andere) de Metoprolol:
+
*In the current situation, toedieningsafspraken and medicatieverstrekkingen are registered as a single dispense. This makes it difficult to find useful information in the large number of messages. By dividing the dispense order into two building blocks, the overview is easier to understand: there are no new medicatieafspraken and only one new toedieningsafpsraak is created. There are no hidden surprises in the remaining logistical data and the general practitioner does not have to monitor  the multiple medicatieverstrekkingen.  
*Verstrekking 1: De apotheker verstrekt op vrijdag 8 februari 2013: 14 tabletten; gepland voor week 6 en 7 (een verbruiksduur van 2 weken).  
+
*This way of registering and exchanging prevents double registration, and errors caused by this.
*Verstrekking 2: De apotheker verstrekt op vrijdag 22 februari: 14 tabletten; gepland voor week 8 en 9.
+
*The toedieningsafspraken are the basis for the administration list and checklists of nursing homes and care homes. Signing them corresponds to the administration(s).
*Verstrekking 3, 4, 5, enzovoorts...  
 
Bij elke medicatieverstrekking wordt aangegeven dat deze via GDS geleverd is.<br>
 
Na drie maanden volgt opnieuw een voorstel‐verstrekkingsverzoek van de apotheek aan de huisarts, enzovoorts.  
 
  
'''Beschouwing''' <br>
+
===The pharmacist changes commercial product===
*Het toepassen van een voorstel-verstrekkingsverzoek in plaats van een autorisatieformulier maakt de betekenis ervan eenduidig.
+
This scenario builds on the previous scenario: after half a year a different commercial product is agreed with the patient (toedieningsafspraak), because the original product is not available. No new medicatieafspraak is made, as there is no change needed on that level. The toedieningsafspraak is changed:
*Doordat in de huidige situatie toedieningsafspraken en medicatieverstrekkingen als één aflevering wordt geregistreerd, is het moeilijk om in de grote hoeveelheid berichten zinvolle informatie te vinden. Het scheiden van het afleverbericht in twee bouwstenen maakt het overzicht eenvoudiger te overzien: er zijn géén nieuwe medicatieafspraken en er is één nieuwe toedieningsafspraak gemaakt. De resterende logistieke gegevens bevatten geen verrassingen. De medicatieverstrekkingen hoeven in dit scenario niet onder de aandacht van de huisarts te komen.
+
*On 1 July it was agreed: Metoprolol Sandoz ret, 100 CR tablets, 95 mg, 1 tablet in the morning; from 3 July, for an indefinite period. Reason: not available.
*Deze wijze van registreren en uitwisselen voorkomt dubbele registratie, en fouten ten gevolge daarvan.  
+
The toedieningsafspraak is a modification of the toedieningsafspraak of 7 February, which stops on 2 July (11:59 p.m.) and is an actual handling of the medicatieafspraak of 2 January. The pharmacist informs the general practitioner about this.
*De toedieningsafspraken vormen de basis voor toedienlijst en aftekenlijsten van verpleeg- en verzorgingshuizen. Het aftekenen ervan komt overeen met de toediening(en).
 
  
===De apotheker wijzigt van handelsproduct===
 
Dit scenario bouwt voort op het vorige scenario: na een half jaar wordt een ander handelsproduct afgesproken met de patiënt (toedieningsafspraak), omdat het andere product niet leverbaar is. Er wordt geen nieuwe medicatieafspraak gemaakt, op dat niveau vindt geen wijziging plaats. De toedieningsafspraak wordt gewijzigd:
 
*Op 1 juli is afgesproken: Metoprolol Sandoz ret 100 tabl mga 95 mg; 1 tablet ‘s morgens; vanaf 3 juli voor onbepaalde duur. Reden: niet leverbaar.
 
De toedieningsafspraak is een wijziging van de toedieningsafspraak van 7 februari (welke stopt op 2 juli (23.59u)) en is een concrete invulling van de medicatieafspraak van 2 januari. De apotheker informeert de huisarts over deze gegevens.
 
  
'''Beschouwing''' <br>
+
'''Consideration ''' <br>
Deze wijziging in de concrete invulling van de medicatieafspraak door middel van een toedieningsafspraak, verandert niets aan de geldigheid van de medicatieafspraak. Dit komt het overzicht ten goede. Aanvullend kan, doordat de apotheker de reden van aanpassing vastlegt en uitwisselt, de voorschrijver beter inschatten of de informatie relevant is.
+
This change in the actual handling of the medicatieafspraak using a toedieningsafspraak, changes nothing to the validity of the medicatieafspraak itself, improving the overall view for all parties. In addition, since the pharmacist records and communicates the reason for the adjustment, the prescriber is better able to assess whether the information is relevant.
  
 
[[Bestand:Uc4.2.12.PNG|900px]]
 
[[Bestand:Uc4.2.12.PNG|900px]]
  
===Medicatie toevoegen aan GDS===
+
===Adding medication to a GDS===
Wanneer nieuwe medicatie wordt toegevoegd aan bestaande GDS kan de voorschrijver kiezen voor directe toevoeging aan de rol (Wijziging in GDS per direct) of met ingang van de volgende rol (Wijziging in GDS per rolwissel). Dit geeft de voorschrijver aan in de medicatieafspraak (Aanvullende informatie). Wanneer gekozen wordt voor ‘Wijziging in GDS per rolwissel’ zal de apotheker de medicatie eerst los, naast de bestaande GDS leveren. Dit betekent dat er een toedieningsafspraak door de apotheker wordt gemaakt voor de overbruggingsperiode. Met ingang van de nieuwe rol wordt de nieuwe medicatie toegevoegd aan de rol. Met ingang van de ingangsdatum van de nieuwe rol kan er een toedieningsafspraak worden gemaakt door de apotheker met specifieke toedientijden. Wanneer de 'overbruggings-toedieningsafspraak' al de juiste toedientijden bevat wordt er geen nieuwe toedieningsafspraak gemaakt bij opname in de rol.
+
When new medication is added to an existing GDS, the prescriber may opt for immediate addition to the current medicatieverstrekking roll (Change in GDS immediately) or for addition starting from the next roll (Change in GDS per change of roll). The prescriber indicates this in the medicatieafspraak (additional information). If ‘Modification in GDS when rolls are changed’ is chosen, the pharmacist will first dispense the medication separately, in addition to the existing GDS. This means that a toedieningsafspraak is created by the pharmacist for the bridging period. Starting with the new roll, the new medication is added to the roll. Starting with the start date of the new roll, a toedieningsafspraak can be made by the pharmacists with specific administration times. If the ‘bridging-toedieningsafspraak’ already includes the correct administration times, no new toedieningsafspraak is created at the date of inclusion in the roll.
 
 
===Medicatie in GDS stoppen===
 
Wanneer medicatie wordt gestopt wordt er een stop-medicatieafspraak gemaakt door de voorschrijver. De apotheker wordt conform het proces geïnformeerd over deze stop-medicatieafspraak en kan de levering daarop aanpassen. De apotheker zal een stop-toedieningsafspraak maken. Zie hiervoor paragraaf [[#Stoppen medicatie|2.2.5.3]] en [[#Stoppen toedieningsafspraak|2.3.6.3]].
 
  
===GDS leverancier levert ander handelsproduct===
+
===Discontinuing medication in a GDS===
Het kan zijn dat een GDS leverancier een ander handelsproduct levert dan door de apotheek in de TA is opgenomen.
+
When medication is discontinued, the prescriber creates a discontinuation-medicatieafspraak. In accordance with the process, the pharmacist is informed about this stop-MA and can adjust the medicatieverstrekking accordingly. The pharmacist will create a staken toedieningsafspraak . See [[#Discontinuing medication|paragraphs 2.2.5.3]] and [[#Discontinuing a toedieningsafspraak|2.3.6.3]].
Hier is dus sprake van een wijziging in de HPK welke zorgt voor een gewijzigde TA.
 
Eventueel is dit pas achteraf, na terugkoppeling van de GDS leverancier van de definitieve invulling.
 
  
===Afhandelen stoppen medicatieafspraak===
+
===GDS supplier supplies other commercial product===
Wanneer er door de voorschrijver afgesproken wordt medicatie te stoppen wordt een stop-ma gemaakt. Deze stop-ma wordt bij de apotheker ingevuld door het stoppen van de toedieningsafspraak.
+
It is possible that a GDS supplier delivers a different commercial product than that which is included in the toedieningsafspraak by the pharmacy. This is therefore a change in the HPK which results in a changed toedieningsafpsraak. This may only be afterwards, after feedback from the GDS supplier of the filling details.
  
==Use cases Toedienen==
+
===Handling a stop medicatieafspraak===
 +
When the prescriber agrees to discontinue medication, a stop medicatieafspraak is created. This stop-MA this processed by the pharmacist by discontinuing the corresponding toedieningsafspraak.
  
===Dubbele controle===
+
==Use cases, Administer==
Bij bepaalde risicovolle medicijnen (bv. insuline, antistolling, orale cytostatica, alle parenteralia) wordt de medicatietoediening en/of eventueel het gereed maken gecontroleerd door een ander (wettelijk een willekeurige voorbijganger, in de praktijk vaak een verpleegkundige) dan degene die het medicament gereed gemaakt heeft, dit wordt ook op de toedienlijst ingevuld. De apotheker zorgt dat de dubbel te controleren geneesmiddelen gemarkeerd zijn in de toedienlijst. Bij het beschikbaarstellen van de medicatietoediening wordt de informatie van dubbele controle op de medicatietoediening ook meegegeven.
 
  
===Toedienen zonder medicatieafspraak of toedieningsafspraak===
+
===Double check===
In sommige gevallen wordt de medicatietoediening gedaan op basis van een mondelinge medicatieafspraak. Pas na de medicatietoediening leggen de voorschrijver respectievelijk apotheker dan de medicatieafspraak respectievelijk toedieningsafspraak vast. Soms is er wel een medicatieafspraak vastgelegd maar nog geen toedieningsafspraak. De apotheker legt dan pas na de medicatietoediening de toedieningsafspraak vast.<br>
+
For a number of high-risk medicinal products (for example, insulin, anticoagulants, oral cytostatics, all parenterals) the medicatietoediening and/or any preparations are checked by another person (from a legal point of view this should be a random passer-by, but in practice this is often a nurse) than the person who has prepared the medication. This is also entered in the administration list. The pharmacist ensures that medications that have to be double-checked are marked in the administration list. When the medicatietoediening is made available, the information of the double check on the medicatietoediening is also provided.
Bij een eenmalige medicatietoediening zonder toedieningsafspraak moet door de toediener een allergie-controle en doseringscontrole gedaan worden.
 
  
==Use cases Gebruiken==
+
===Administering without medicatieafspraak or toedieningsafspraak===
 +
Sometimes, medicatietoediening is carried out on the basis of an oral medicatieafspraak. In such cases, the prescriber/pharmacist records the medicatieafspraak toedieningsafspraak, only after the medicatietoediening. In other cases a medicatieafspraak has been made, but no toedieningsafspraak exists yet. In such a case, the pharmacist only records the toedieningsafspraak after the medicatietoediening.<br>
 +
In the case of a single medicatietoediening without toedieningsafspraak, the administrator must carry out an allergy check as well as a dosage check.
  
===Zelfzorgmiddel===
+
==Use cases, Use==
Een patiënt heeft bij de drogist Ibuprofen aangeschaft, en neemt dagelijks 1200 mg. De patiënt voert het middel op als gebruik, met gegevens als ingangsdatum en dosering, en eventueel de reden van gebruik.
 
  
===Medicatie uit buitenland===
+
===Self-care product===
Een patiënt heeft op vakantie medicatie voorgeschreven gekregen en neemt deze in. De patiënt voert de medicatie op als gebruik, met gegevens als ingangsdatum en dosering, en eventueel de reden van gebruik. Indien bekend worden ook de naam van de voorschrijver en apotheker vastgelegd.
+
A patient has acquired Ibuprofen from the drugstore and takes 1200 mg every day. The patient enters this product as gebruik, with such data as starting dates and dosage, and possibly the reason for use.
  
===Wijziging op initiatief patiënt===
+
===Medication from abroad===
Een patiënt heeft medicatie propranolol voorgeschreven gekregen. De patiënt slaapt er erg slecht door, en heeft zelf de medicatie geminderd. De patiënt legt gebruik vast met de gewijzigde dosering en de datum sinds wanneer deze verlaagde dosis wordt genomen. Daarbij geeft de patiënt als reden aan dat dit op eigen initiatief is.<br>
+
A patient has been prescribed medication on holiday and is taking this. The patient enters the medication as gebruik, with data such as start date and dosage, and possibly the reason for use. If known, the name of the prescriber and the pharmacist are also recorded.
Bij bijvoorbeeld een dosisverlaging op eigen initiatief kan de patiënt langer doorgaan dan afgesproken omdat zij nog voorraad heeft. Dit kan de patiënt als aanvullend gebruik opgeven. <br>
 
Bij bijvoorbeeld een dosisverhoging op eigen initiatief kan de voorraad van de patiënt eerder op zijn. De patiënt komt dan mogelijk eerder dan verwacht terug bij de arts.
 
  
===Stoppen medicatie op initiatief patiënt===
+
===Modification on the patient’s initiative===
Sinds het gebruik van propranolol heeft een patiënt last van slapeloosheid. Hij besluit te stoppen zonder daarbij direct de voorschrijvend arts te informeren. De patiënt legt vast dat hij gestopt is, per wanneer en geeft als reden slapeloosheid op.
+
The patient has been prescribed propranolol. The patient is having severe problems sleeping because of this and has reduced the medication herself. The patient records gebruik with the modified dosage and the start date for this lower dose. The patient also indicates that she initiated this change herself.<br> In the case where a patient initiates a dose reduction, the patient can keep on using the medication for a longer period than initially agreed because she still has a supply. The patient can indicate this as additional gebruik.<br>
 +
In the case where a patients initiates a dosage increase, the patient’s supply may run out sooner. The patient may then have to return to the physician earlier than expected.
  
===Geen voorraad meer===
+
===Discontinuation of medication on the patient’s initiative===
Een patiënt heeft 'zo nodig' medicatie gekregen ter bestrijding van huidklachten. De medicatie staat nog op actief in het medicatieprofiel maar is al op. De patiënt geeft aan dat de medicatie gestopt is, met als reden dat deze niet meer voorradig is, eventueel met de toevoeging dat de klachten verholpen zijn. De patiënt kan ook een voorstel-verstrekkingsverzoek doen om zijn voorraad aan te vullen. Het antwoord voorstel-verstrekkingsverzoek komt in dit geval bij de patiënt terug (en indien geaccordeerd gaat er van de voorschrijver tevens een verstrekkingsverzoek naar de apotheker).
+
Since he started using propranolol, the patient suffers from insomnia. He decides to stop without immediately informing the prescribing physician. The patient himself records that he has discontinued medication, indicating the date and giving insomnia as the reason for discontinuing.
  
===Feedback aan patiënt via medicatiesignalering===
+
===No more supply===
De patiënt gebruikt bijvoorbeeld zijn mobiele app als medicatiesignaleringtoepassing. Daartoe heeft de apotheker of de patiënt zelf een toedienschema ingesteld op de gewenste innamemomenten (al dan niet met applicatie-intelligentie om uit de medicatieverstrekkingen/toedienafspraken toedienmomenten voor te stellen). Op de toedienmomenten ontvangt de patiënt een signaal dat hem eraan herinnert om de medicatie in te nemen. De patiënt geeft aan of hij het geneesmiddel heeft ingenomen of niet (bijv. omdat de patiënt het geneesmiddel vergeten heeft mee te nemen). Wanneer de app gekoppeld is aan bijvoorbeeld het PGO van de patiënt wordt dan de therapietrouw automatisch bijgehouden.
+
A patient has received medication ‘as needed’ for his skin problems. The medication is still active in the medication profile, but is no longer available at the pharmacist. The patient indicates that the medication has been discontinued because it is no longer available, possibly with the addition that the symptoms have disappeared. The patient may also make a proposed verstrekkingsverzoek to replenish his supply In this case, the reply proposed verstrekkingsverzoek comes back to the patient (and if approved, a verstrekkingsverzoek is also sent from the prescriber to the pharmacist).
  
===Bijwerkingen registreren door patiënt===
+
===Feedback to patient through a medication adherence app===
Sinds het gebruik van propranolol heeft een patiënt last van slapeloosheid. De patiënt legt de bijwerking vast in de toelichting bij het medicatiegebruik. Wanneer de patient de medicatie anders gebruikt dan afgesproken, bijvoorbeeld minder tabletten, dan kan hij de bijwerking als reden opgeven van deze wijziging. Wanneer de klachten verminderen of ophouden legt de patiënt dit vast in de toelichting van het medicatiegebruik.<br>
+
In this example the patient uses an app on his mobile phone to help manage his medication. The patient or the pharmacist has created an administration schedule with reminder times (where possible using the app to obtain the toedieningsafspraken from the medicatietoediening). When it is time to take his medication, the patient receives a reminder signal from the app. The patient then records in the app whether or not he has taken his medication (for instance because he forgot to bring it along with him). If the app is linked, for example, to the patient’s PGO [personal health file, medication adherence is tracked automatically.
Het kan zijn dat de patiënt last heeft van bijwerkingen zonder precies te weten welk geneesmiddel daarvan de oorzaak is. Er is (nog) geen voorziening binnen medicatieproces om dat vast te leggen.
 
  
===Gebruik registreren op basis van verstrekking===
+
===Registration of side effects by the patient===
 +
Since he started taking propranolol, a patient has been suffering from insomnia. The patient records this side effect in the explanatory notes to the consumption. When the patient changes the use of this medication from what was previously agreed, for example when he takes less tablets, he can give the side effect as a reason for this change. When his symptoms diminish or cease, the patient records this in the explanation for consumption.<br>
 +
It is possible that the patient is suffering from side effects without exactly knowing which medicinal products cause them. There is no provision within medication process to record this (yet).
  
Dit is van toepassing in de transitie periode van de oude medicatieproces standaard 6.12 naar deze medicatieproces informatiestandaard.  
+
===Register usage based on provision===
 +
This applies in the transition period from the old medication process standard 6.12 to this medication process information standard.
  
Digitaal is alleen een verstrekking beschikbaar (volgens medicatieproces versie 6.12). Het systeem van de gebruiker biedt echter wel de mogelijkheid om al medicatiegebruik vast te leggen.
+
Only verstrekking (dispensing) is available digitally (according to medication process version 6.12). However, the user's system offers the possibility to record all medication use. In that case, the medication use can be recorded with reference to the ID of the version 6.12 verstrekking.
Het medicatiegebruik kan in dat geval vastgelegd worden met verwijzing naar het id van de versie 6.12 verstrekking.
 
  
=Medicatieoverzicht en afleidingsregels=
+
=Medication overview and inference rules=
 +
This chapter shows a sample medication overview and also specifies inference rules for 'The most current relevant building block', Verification for each medicamenteuze behandeling, etc.
  
Dit hoofdstuk toont een voorbeeld medicatieoverzicht en specificeert daarnaast afleidingsregels voor 'De laatst relevante bouwsteen', Verificatie per medicamenteuze behandeling etc.
+
==Introduction==
==Inleiding==
+
The term 'current medication overview' has been replaced by the term 'basisset medicatiegegevens’ (basic set of medication data): the medication overview in combination with additional information that is required (at least) to be able to prescribe, change, stop or safely provide medication in a safe and responsible manner in the Transfer of Medication Data in the Chain (Leidraad Overdracht van Medicatiegegevens in de keten, final draft 2017).
  
De term 'actueel medicatieoverzicht' is vervangen door de term 'basisset medicatiegegevens':
+
This page contains an example of a medication overview. This example was developed in the Medication Process Information Standard program and serves as an example of how data can be displayed in an application. The data numbered in the pictures below are normative, they are mandatory to show. The other (unnumbered) data in the example is optional and may be added as normative in the future. The layout of the overview in a system can differ per target group and per device. For pharmacists, for example, only toedieningsafspraken are initially visible, after which it is possible to click further to get to the corresponding medicatieafspraak and the medicatiegebruik. If only consumption or a medicatieafspraak is known, this will of course be shown immediately. The basic principle is that the overview shows all medication of the patient, not just the medication that is registered in the patient's own system.
het medicatieoverzicht in combinatie met aanvullende gegevens die (minimaal) nodig zijn om veilig en verantwoord medicatie te kunnen voorschrijven, wijzigen, stoppen of veilig ter hand te stellen in de Leidraad Overdracht van Medicatiegegevens in de keten (definitief concept 2017).
 
  
Deze pagina bevat een voorbeeld van een medicatieoverzicht. Dit voorbeeld is ontwikkeld in het programma Informatiestandaard Medicatieproces en dient als voorbeeld voor de manier waarop gegevens getoond kunnen worden in een applicatie. De in onderstaande plaatjes genummerde gegevens zijn daarbij normatief, deze zijn verplicht om te tonen. De andere (ongenummerde) gegevens in het voorbeeld zijn optioneel en worden mogelijk in de toekomst als normatief toegevoegd. De lay-out van het overzicht in een systeem kan verschillen per doelgroep en per device. Voor apothekers zijn bijvoorbeeld in eerste instantie alleen toedieningsafspraken zichtbaar waarbij vervolgens kan worden doorgeklikt naar de bijbehorende medicatieafspraak en het medicatiegebruik. Wanneer er alleen medicatiegebruik of een medicatieafspraak bekend is wordt deze uiteraard wel direct getoond. Uitgangspunt is dat op het overzicht alle medicatie van de patiënt getoond wordt, dus niet alleen de medicatie die in het eigen systeem is vastgelegd.
+
The overview is described generically and therefore the same for all suppliers. The requirements of the end users are included on this page and no statements are made about the technical realization or implementation. The existing KNMP specification “User requirements specification Medication overview 2.0”, final concept “Guidance Transfer of Medication data in the chain (Leidraad OVerdracht van Medicatiegegevens in de keten)” and the new insights from the Medication process program have been incorporated in this.
  
Het overzicht is generiek beschreven en daarmee voor alle leveranciers gelijk. Op deze pagina zijn de eisen van de eindgebruikers opgenomen en worden geen uitspraken gedaan over de technische realisatie of implementatie. De bestaande KNMP-specificatie “User requirements specification Medicatieoverzicht 2.0”, definitieve concept “Leidraad Overdracht van Medicatiegegevens in de keten” en de nieuwe inzichten uit het programma Medicatieproces zijn hierin verwerkt.
+
Principles for the overview are:
 +
*Healthcare providers want to see a distinction between the therapeutic building blocks on a medication overview:
 +
**Medicatieafspraak
 +
**Toedieningsafpsraak
 +
**Medicatiegebruik
 +
*Logistical building blocks (verstrekkingsverzoek, dispensing) and the medicatietoedieningbuilding block are not relevant for the medication overview.
  
Uitgangspunten voor het overzicht zijn:
 
* Zorgverleners willen op een medicatieoverzicht onderscheid zien tussen de therapeutische bouwstenen:
 
** Medicatieafspraak
 
** Toedieningsafspraak
 
** Medicatiegebruik
 
* Logistieke bouwstenen (verstrekkingsverzoek, verstrekking) en de bouwsteen medicatietoediening zijn niet relevant voor het medicatieoverzicht.
 
  
 
[[Bestand:Medicatieoverzicht_1_v0.5.PNG|Medicatieoverzicht v0.5]]
 
[[Bestand:Medicatieoverzicht_1_v0.5.PNG|Medicatieoverzicht v0.5]]
 
[[Bestand:Medicatieoverzicht_2_v0.5.PNG|Medicatieoverzicht v0.5]]
 
[[Bestand:Medicatieoverzicht_2_v0.5.PNG|Medicatieoverzicht v0.5]]
  
==Functionele specificatie==
+
==Functional specification==
In de figuren hieronder zijn de onderdelen opgenomen met normatieve gegevens. De andere onderdelen zijn nog niet normatief.  
+
In the figures below the parts with normative data are included. The other parts are not yet normative. The numbered elements in the table are normative, other elements are optional for the time being.
De in de tabel genummerde elementen zijn normatief, overige elementen vooralsnog optioneel.
 
  
===Kop en Algemeen===
+
===Heading and General===
 
[[Bestand:Medicatieoverzicht_KopAlgemeen_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_KopAlgemeen_v0.5.PNG]]
  
Filter: n.v.t.
+
Filter: N/A
 +
 
 +
Sort: N/A
  
Sorteren: n.v.t.
+
Medication Overview Date: This is the date that the last change to a medicatieafspraak, toedieningsafspraak or consumption was recorded within the system providing the medication overview.
  
Datum medicatieoverzicht: dit is de datum dat de laatste wijziging in een medicatieafspraak, toedieningsafspraak of medicatiegebruik is vastgelegd binnen het systeem dat het medicatieoverzicht oplevert.
+
NOTE: In the viewer, all dates are shown with the month in characters, so that there is no confusion between day-month and month-day (American format).
  
N.B. in de viewer worden alle datums getoond met de maand in letters, zodat geen verwarring kan ontstaan tussen dag-maand en maand-dag (Amerikaans formaat).
 
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Nr !! Kop !! Dataset !! Toelichting
+
! No !! Header !! Dataset !! Explanation
 
|-
 
|-
| 1 || Naam || Patient – Naamgegevens (Initialen, Geslachtsnaam, GeslachtsnaamPartner), Geboortedatum, Geslacht ||  
+
| 1 || Name || Patient – Name data (Initials, Surname, PartnerSurname), Date of Birth, Gender ||  
 
|-
 
|-
| 2 || Telefoon || Patient – Contactgegevens Telefoonnummers || Door patiënt als preferent opgegeven telefoonnummer
+
| 2 || Telephone || Patient – Contact data Telephone numbers || Primary telephone number of patient
 
|-
 
|-
| 3 || BSN || Patient – Patientidentificatienummer || Altijd BSN
+
| 3 || BSN || Patient – Patient identification number || Always BSN
 
|-
 
|-
| 4 || Adres || Patient – Adresgegevens ||  
+
| 4 || Adress || Patient – Address data ||  
 
|-
 
|-
| 5 || Naam zorgaanbieder || Zorgaanbieder Organisatienaam || Zorgaanbieder die het medicatieoverzicht heeft samengesteld
+
| 5 || Healthcare Provider Name || Healthcare Provider Organization name || Healthcare provider who has compiled the medication overview
 
|-
 
|-
| 6 || Zorgaanbieder Adres || Zorgaanbieder Adres Adresgegevens ||  
+
| 6 || Healthcare Provider Adress || Healthcare Provider Address Address data || Healthcare provider who has compiled the medication overview
 
|-
 
|-
| 7 || Zorgaanbieder Telefoon || Zorgaanbieder TelefoonMail Contactgegevens Telefoonnummers ||  
+
| 7 || Healthcare Provider Telephone || Healthcare Provider TelephoneMail Contact data Telephone numbers || Healthcare provider who has compiled the medication overview
 
|-
 
|-
| 8 || Zorgaanbieder Email || Zorgaanbieder TelefoonMail Contactgegevens Emailadressen ||  
+
| 8 || Healthcare Provider Email || Healthcare Provider TelephoneMail Contact data Email addresses || Healthcare provider who has compiled the medication overview
 
|-
 
|-
| 9 || Datum medicatieoverzicht || Documentgegevens Documentdatum ||  
+
| 9 || Date of Medication Overview || Document data Document date ||  
 
|-
 
|-
|  || Lengte || Lichaamslengte LengteWaarde, LengteDatumTijd ||  
+
|  || Height|| Body height HeightValue, HeightDateTime ||  
 
|-
 
|-
|  || Gewicht || Lichaamsgewicht GewichtWaarde, GewichtDatumTijd ||  
+
|  || Weight|| Bodyweight WeightValue, WeightDateTime ||  
 
|-
 
|-
|  || Gecontroleerd door zorgverlener || Documentgegevens Verificatie zorgverlener ||  
+
|  || Checked by Healthcare Provider || Document data Verification by healthcare provider ||  
 
|-
 
|-
|  || Geverifieerd met patient/mantelzorger || Documentgegevens Verificatie patient ||  
+
|  || Verified with Patient/Informal Caregiver || Document data Verification by patient ||  
 
|}
 
|}
Elementen 5 tot en met 8 worden niet getoond als de patiënt de opsteller van het medicatieoverzicht is.
+
Elements 5 through 8 are not shown if the patient is the creator of the medication summary.
  
===Intoleranties, contra-indicaties, allergieën (ICA)===
+
===Intolerances, contraindications, allergies (ICA)===
 
[[Bestand:Medicatieoverzicht_ICA_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_ICA_v0.5.PNG]]
  
Actieve intoleranties, contra-indicaties en allergieën.
+
Active intolerances, contraindications and allergies.
  
Filter: einddatum is niet gevuld, ligt in de toekomst of is minder dan een jaar geleden bij het samenstellen van het overzicht.
+
Filter: end date is not filled, is in the future or was less than a year ago when compiling the overview.
  
Sorteren: meest recente ingangsdatum bovenaan.
+
Sort: most recent effective date at the top.
  
Dit onderdeel wordt op een later moment uitgewerkt en is nog niet normatief.
+
This part will be elaborated at a later time and is not yet normative.
  
===Huidige medicatie===
+
===Current medication===
 
[[Bestand:Medicatieoverzicht_HuidigeMedicatie_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_HuidigeMedicatie_v0.5.PNG]]
  
Filter: alle huidige medicatie, dat wil zeggen alle medicatieafspraken en toedieningsafspraken die van toepassing zijn op het moment dat het overzicht wordt samengesteld en het daarbij behorende medicatiegebruik per bron. Ook de tijdelijk onderbroken medicatie wordt in deze categorie getoond.  
+
Filter: all current medication, i.e. all medicatieafspraken and toedieningsafspraken that apply at the time the overview is compiled and the associated medicatiegebruik per source. The temporarily interrupted medication is also shown in this category. When only consumption is known, it is shown if it is not older than three months. When consumption is recorded by both a healthcare provider and a patient, the last registered medication use is shown for both.
Wanneer er alleen medicatiegebruik bekend is wordt deze getoond als deze niet ouder is dan drie maanden. Wanneer medicatiegebruik is vastgelegd door zowel een zorgverlener als een patiënt wordt van beide het laatst geregistreerde medicatiegebruik getoond.  
 
  
Sorteren: per medicamenteuze behandeling: medicatieafspraak, toedieningsafspraak, medicatiegebruik (vastgelegd door patiënt, zorgverlener). Medicamenteuze behandelingen worden gesorteerd op ingangsdatum ma / ta / gb aflopend.
+
Sorting: by medicamenteuze behandeling (MBH): medicatieafpsraak, toedieningsafsrpaak, medicatiegebruik (recorded by patient, care provider). Medicamenteuze behandelingen are sorted in descending order by startdate medicatieafspraak, toedieningsafspraak, medicatiegebruik.
  
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
! style="text-align:left;"| '''Nr'''
+
! style="text-align:left;"| '''No'''
! style="text-align:left;"| '''Kop'''
+
! style="text-align:left;"| '''Header'''
 
! style="text-align:left;" colspan="3"| '''Dataset'''
 
! style="text-align:left;" colspan="3"| '''Dataset'''
 
|-
 
|-
Regel 1.311: Regel 1.276:
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="2"|2
 
|style="background-color: white;vertical-align:top;" rowspan="2"|2
|style="background-color: white;vertical-align:top;" rowspan="2"|Geneesmiddel
+
|style="background-color: white;vertical-align:top;" rowspan="2"|Medicinal product
|style="background-color: white;vertical-align:top; text-align:center;"|Afgesproken geneesmiddel-
+
|style="background-color: white;vertical-align:top; text-align:center;"|Agreed medicinal product-
|style="background-color: white;vertical-align:top; text-align:center;"|Geneesmiddel bij Toedieningsafspraak-
+
|style="background-color: white;vertical-align:top; text-align:center;"|Medicinal product belonging to Toedieningsafspraak-
|style="background-color: white;vertical-align:top; text-align:center;"|Gebruiksproduct-
+
|style="background-color: white;vertical-align:top; text-align:center;"|Device-
 
|-
 
|-
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Product – ProductCode (als afwezig: ProductSpecificatie, ProductNaam)
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Product – ProductCode (if absent: ProductSpecification, ProductName)
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|3
 
|style="background-color: white;vertical-align:top;"|3
|style="background-color: white;vertical-align:top;"|Ingangsdatum
+
|style="background-color: white;vertical-align:top;"|Start date
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Ingangsdatum
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Start date
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|4
 
|style="background-color: white;vertical-align:top;"|4
|style="background-color: white;vertical-align:top;"|Einddatum/Duur
+
|style="background-color: white;vertical-align:top;"|End date/duration
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Einddatum (als afwezig: Duur)
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|End date (if not available: Duration)
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|5
 
|style="background-color: white;vertical-align:top;"|5
|style="background-color: white;vertical-align:top;"|Dosering
+
|style="background-color: white;vertical-align:top;"|Dosage
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Gebruiksinstructie Omschrijving
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Instructions for use Description
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|6
 
|style="background-color: white;vertical-align:top;"|6
|style="background-color: white;vertical-align:top;"|Toedieningsweg
+
|style="background-color: white;vertical-align:top;"|Route of toediening
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Gebruiksinstructie Toedieningsweg
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Instructions for use Route of toediening
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|7
 
|style="background-color: white;vertical-align:top;"|7
|style="background-color: white;vertical-align:top;"|Reden
+
|style="background-color: white;vertical-align:top;"|Reason
|style="background-color: white;vertical-align:top; text-align:center;"|Reden van voorschrijven & evt. <br>Reden van staken/onderbreken
+
|style="background-color: white;vertical-align:top; text-align:center;"|Reason for prescribing &
|style="background-color: white;vertical-align:top; text-align:center;"|Reden van staken/onderbreken
+
if applicable reason for discontinuing/suspending medication
|style="background-color: white;vertical-align:top; text-align:center;"|Reden van staken/onderbreken
+
|style="background-color: white;vertical-align:top; text-align:center;"|Reason for discontinuing/suspending medication
 +
|style="background-color: white;vertical-align:top; text-align:center;"|Reason for discontinuing/suspending medication
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|8
 
|style="background-color: white;vertical-align:top;"|8
|style="background-color: white;vertical-align:top;"|Toelichting
+
|style="background-color: white;vertical-align:top;"|Explanation
|style="background-color: white;vertical-align:top; text-align:center;" colspan="2"|Toelichting & Aanvullende Informatie
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="2"|Explanation & additional information
|style="background-color: white;vertical-align:top; text-align:center;"|Toelichting
+
|style="background-color: white;vertical-align:top; text-align:center;"|Explanation
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="3"|9
 
|style="background-color: white;vertical-align:top;" rowspan="3"|9
|style="background-color: white;vertical-align:top;" rowspan="3"|Bron
+
|style="background-color: white;vertical-align:top;" rowspan="3"|Source
|style="background-color: white;vertical-align:top; text-align:center;"|Voorschrijver-
+
|style="background-color: white;vertical-align:top; text-align:center;"|Prescriber-
|style="background-color: white;vertical-align:top; text-align:center;"|Verstrekker-
+
|style="background-color: white;vertical-align:top; text-align:center;"|Provider-
|style="background-color: white;vertical-align:top; text-align:center;"|Auteur-
+
|style="background-color: white;vertical-align:top; text-align:center;"|Author-
 
|-
 
|-
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Zorgverlener Zorgverlenernaam, Specialisme
+
|style="background-color: white;vertical-align:top; text-align:center;" colspan="3"|Healthcare provider Name healthcare provider, specialty
 
|-
 
|-
|style="background-color: white;vertical-align:top; text-align:center;"|n.v.t
+
|style="background-color: white;vertical-align:top; text-align:center;"|n/a
|style="background-color: white;vertical-align:top; text-align:center;"|n.v.t
+
|style="background-color: white;vertical-align:top; text-align:center;"|n/a
|style="background-color: white;vertical-align:top; text-align:center;"|of "Patient"
+
|style="background-color: white;vertical-align:top; text-align:center;"|or “Patient”
 
|}
 
|}
  
===Toekomstige medicatie===
+
===Future medication===
 
[[Bestand:Medicatieoverzicht_ToekomstigeMedicatie_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_ToekomstigeMedicatie_v0.5.PNG]]
  
Filter: alle medicatie die in de komende 3 maanden actueel wordt. Dit is inclusief voorgenomen medicatiegebruik.
+
Filter: all medication that will become actual in the next 3 months. This includes intended medication use.
 
+
For a description of the mapping, the same applies as with the current medication, see [[#Current medication|Current medication]].
Voor een beschrijving van de mapping geldt hetzelfde als bij de huidige medicatie, zie [[mp:V9.0_Voorbeeld_medicatieoverzicht#Huidige_medicatie|Huidige medicatie]].
 
  
===Recent beëindigde medicatie===
+
===Recently discontinued medication===
 
[[Bestand:Medicatieoverzicht_RecentBeeindigde_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_RecentBeeindigde_v0.5.PNG]]
  
Filter: alle medicatie die in de afgelopen 2 maanden geëindigd of gestopt is.  
+
Filter: any medication that has ended or stopped in the past 2 months.
  
Voor een beschrijving van de mapping geldt hetzelfde als bij de huidige medicatie, zie [[mp:V9.0_Voorbeeld_medicatieoverzicht#Huidige_medicatie|Huidige medicatie]].
+
For a description of the mapping, the same applies as with the current medication, see [[#Current medication|Current medication]].
  
===Aanvullende labwaarden===
+
===Additional lab values ===
 
[[Bestand:Medicatieoverzicht_Labwaarden_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_Labwaarden_v0.5.PNG]]
  
Meest recente labwaarden en afwijkende nierfunctiewaarden.
+
Most recent lab values and abnormal renal function values.
  
Dit onderdeel wordt op een later moment uitgewerkt en is nog niet normatief.
+
This part will be elaborated at a later time and is not yet normative.
  
===Opmerkingen===
+
===Remarks ===
 
[[Bestand:Medicatieoverzicht_Opmerkingen_v0.5.PNG]]
 
[[Bestand:Medicatieoverzicht_Opmerkingen_v0.5.PNG]]
  
Bijvoorbeeld relevante (beperkte) gezondheidsvaardigheden (competenties: geletterdheid, reken- en digitale vaardigheden) die impact kunnen hebben op medicatiegebruik/behandeling.
+
For example, relevant (limited) health skills (competences: literacy, calculation and digital skills) that can have an impact on medication use / treatment.
 +
 
 +
This part will be elaborated at a later time and is not yet normative.
  
Dit onderdeel wordt op een later moment uitgewerkt en is nog niet normatief.
+
==Building block instantiations==
 +
This section describes which instantiations of the building blocks belong to the medication overview. This concerns 'own' and 'other people's' building blocks ([[#GP observation service (HAP)|section 3.1]]) and then only the latest, relevant instantiations of this ([[#Thrombosis service|section 3.2]]).
  
==Bouwsteen instantiaties==
+
===Own and other people===
Deze paragraaf beschrijft welke instantiaties van de bouwstenen horen bij het medicatieoverzicht. Dit gaat om ‘eigen’ én ‘andermans’ bouwstenen ([[mp:V9.0_Voorbeeld_medicatieoverzicht#Eigen_.C3.A9n_andermans|paragraaf 3.1]]) en dan alleen de laatste, relevante instantiaties hiervan ([[mp:V9.0_Voorbeeld_medicatieoverzicht#Laatste_relevante|paragraaf 3.2]]).
+
Both the own and a copy of (known to the sender) building blocks from other sources are included in the medication overview. This so that the medication overview is as complete as possible for the recipient. This ensures that recipients can start using it immediately and that they are not dependent on other sources. The technical representation of someone else's building block may differ from that of the real source. It is important that the recipient is aware of this. The original OID of someone else's building block should simply be given. The recipient can then choose to also collect the building block from its source in its original form.
  
===Eigen én andermans===
+
The medicatieafspraak, toedieningsafspraak and consumption building blocks have been extended with a feature that indicates whether:
Zowel de eigen als een kopie van (bij de verzender bekende) bouwstenen van andere bronnen gaan mee in het medicatieoverzicht. Dit zodat het medicatieoverzicht zo compleet mogelijk is voor de ontvanger. Dit zorgt ervoor dat ontvangers er direct mee aan de slag kunnen en niet afhankelijk zijn van andere bronnen.
+
*there is an 'own' building block or
De technische representatie van andermans bouwsteen kan ánders zijn dan die van de echte bron. Het is belangrijk dat de ontvanger hiervan op de hoogte is. De originele OID van andermans bouwsteen moet gewoon meegegeven worden. De ontvanger kan er dan voor kiezen om de bouwsteen ook in zijn originele vorm bij de bron op te halen.<br>
+
*that of "someone else" (an ''accent'' building block: MA’, TA’, MGB’)
De bouwstenen medicatieafspraak, toedieningsafspraak en medicatiegebruik zijn uitgebreid met een kenmerk dat aangeeft of:
+
This attribute only applies in the medication overview transaction, because that is the only transaction where other people's building blocks may be delivered.
* er sprake is van een ‘eigen’ bouwsteen of
 
* die van ‘iemand anders’ (een ''accent'' bouwsteen: MA’, TA’, MGB’)
 
Dit kenmerk is alleen van toepassing in de transactie voor het medicatieoverzicht, omdat dat de enige transactie is waar andermans bouwstenen opgeleverd mogen worden.
 
  
Het kenmerk 'bouwsteen van iemand anders' bevind zich op twee niveaus:  
+
The 'building block of someone else' attribute is on two levels:
* Het template ID van een MA’, TA’, MGB’ verschilt van een MA, TA en MGB.
+
*The template ID of an MA’, TA’, MGB’ differs from an MA, TA and MGB.
* Daarnaast wordt het element kopie indicator altijd meegestuurd met waarde '''true''' in MA’, TA’, MGB’.  
+
*In addition, the element copy indicator is always sent with value '''true''' in MA’, TA’, MGB’.
 +
For the medication overview, it is permitted to offer the medicatieafspraken, toedieningsafspraken and consumption via a system-generated MGB or MGB '(Healthcare provider is author MGB). This must have a reference to an MA, TA or MGB.
  
Het is toegestaan om voor het medicatieoverzicht de medicatieafspraken, toedienafspraken en medicatiegebruik via een door het systeem gegenereerd MGB of MGB’ (Zorgaanbieder is auteur MGB) aan te bieden. Deze dient wel een referentie te hebben naar een MA, TA of MGB.
+
====Medication overview and derivation rules====
 +
An overview of medication that the patient is using (or should be using) can be put together in a system in two ways:<br>
 +
1) displaying a current medication overview (or overviews) obtained from another source (or sources)<br>
 +
2) showing coherent medication building blocks obtained from one's own system and from other sources.<br>
 +
In both cases, this overview of medication consists of the information as included in the building blocks  medicatieafspraak, toedieningsafspraak and medicatiegebruik.
  
====Medicatieoverzicht en afleidingsregels====
+
Re 1) When this document refers to a current medication overview, this means a coherent overview in which current medicatieafspraken, toedieningsafspraken and medicatiegebruik are included. This current medication overview is built up by the source on the basis of the data known at that time at the source. This overview can be exchanged with the transaction group Medicatieoverzicht (Medication overview) (PULL or PUSH).
Een overzicht van medicatie die de patiënt gebruikt (of zou moeten gebruiken) kan op twee manieren in een systeem worden samengesteld:<br>
 
1) tonen van een actueel medicatieoverzicht (of overzichten) verkregen uit andere bron (of bronnen)<br>
 
2) in samenhang tonen van losse medicatiebouwstenen verkregen uit het eigen systeem en uit andere bronnen.<br>
 
Dit overzicht van medicatie bestaat in beide gevallen uit de informatie zoals opgenomen in de bouwstenen medicatieafspraak, toedieningsafspraak en medicatiegebruik.
 
  
Ad 1) Wanneer in dit document gesproken wordt over een actueel medicatieoverzicht wordt daarmee een samenhangend overzicht bedoeld waarin actuele medicatieafspraken, toedieningsafspraken en medicatiegebruik is opgenomen. Dit actuele medicatieoverzicht wordt opgebouwd door de bron op basis van de op dat moment bij de bron bekende gegevens. Dit overzicht kan worden uitgewisseld met de transactiegroep Medicatieoverzicht (PULL of PUSH).
+
The data and building blocks that are known at the source, but originating from another source, are supplied in the transaction with the 'accent' indicator so that they are recognizable as building blocks from someone else (MA accent, TA accent, MGB accent).
  
De gegevens en bouwstenen die bekend zijn bij de bron, maar afkomstig uit een andere bron, worden in de transactie opgeleverd met de 'accent' indicator zodat ze herkenbaar zijn als andermans bouwstenen (MA accent, TA accent, MGB accent). <br>
+
Re 2) It is also possible for a system to compile an overview by combining own and other people's separate individual medication building blocks. The transaction group Medicatiegegevens (medication data) (PULL) is used to request individual building blocks.
  
Ad 2) Het is ook mogelijk dat een systeem een overzicht samen stelt door het samenvoegen van eigen en andermans losse medicatiebouwstenen. Voor het opvragen van losse bouwstenen wordt de transactiegroep medicatiegegevens (PULL) gebruikt.
+
With the transaction group Medicatiegegevens (medication data) (PUSH), separate building blocks can also be sent directly to another healthcare provider or the patient (so without requests). This happens, for example, at discharge or at the request of a co-practitioner who has the patient in front of him (e.g. patient appears to a GP or pharmacist outside the region, where this GP or pharmacist requests the data by telephone from the patient's own GP and receives it digitally).
  
Met de transactiegroep medicatiegegevens (PUSH) kunnen losse bouwstenen ook direct aan een andere zorgverlener of de patiënt worden verstuurd (dus zonder opvragen). Dit gebeurt bijvoorbeeld bij ontslag of op verzoek van een medebehandelaar die de patiënt voor zich heeft (bijv. patiënt verschijnt bij huisarts of apotheker buiten de regio waarbij deze huisarts of apotheker bij de eigen huisarts van de patiënt de gegevens telefonisch opvraagt en digitaal ontvangt).<br>
+
Both Medicatiegegevens (medication data) PUSH and PULL should not provide data obtained from other sources.
Bij zowel medicatiegegevens PUSH als PULL mogen gegevens die uit andere bron zijn verkregen niet worden opgeleverd.
 
<br>
 
  
===Laatste relevante===
+
===Last relevant===
Alleen de laatste relevante bouwstenen (per medicamenteuze behandeling) zijn onderdeel van het medicatieoverzicht. Deze paragraaf beschrijft wat dan precies die laatst relevante bouwstenen zijn voor een medicatieoverzicht. Allereerst voor medicatie op voorschrift (paragraaf 3.2.1), dan voor ‘over the counter’ medicatie (paragraaf 3.2.2). De hierop volgende paragraaf 3.2.3 gaat nog in op de bijzondere situatie dat er behalve een huidige, ook een toekomstige medicatieafspraak binnen dezelfde medicamenteuze behandeling geldig is. Tenslotte vat de laatste paragraaf de te hanteren regels samen.<br>
+
Only the last relevant building blocks (per medicamenteuze behandeling) are part of the medication overview. This section describes what exactly those last relevant building blocks are for a medication overview. Firstly for prescription medication (section 3.2.1), then for "over the counter" medication (section 3.2.2). The following section 3.2.3 further discusses the special situation that, in addition to a current, a future medicatieafspraak within the same medicamenteuze behandeling is valid. Finally, the last paragraph summarizes the rules to be applied.<br>
Noot: De (technische) stop-medicatieafspraken zijn niet afgebeeld in de voorbeelden, maar impliciet verondersteld.
+
Note: The (technical) stop-medicatieafspraken are not shown in the examples, but are implicitly assumed.
  
====Medicatie op voorschrift====
+
====Prescription medication====
=====Meest eenvoudige ‘happy flow’=====
+
=====Most simple "happy flow"=====
In een medicamenteuze behandeling ontstaat er in de meest eenvoudige ‘happy flow’ een opeenvolging van:
+
In a medicamenteuze behandeling, the simplest "happy flow" results in a sequence of:
 
* ''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''.
 
* ''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''.
Normaal gesproken begint een medicamenteuze behandeling met een medicatieafspraak. Een toedieningsafspraak vult de medicatieafspraak concreet in. Medicatiegebruik zegt iets over het daadwerkelijk gebruik van de patiënt in deze medicamenteuze behandeling. Alle drie de bouwstenen zijn in zo’n geval relevant en horen bij de oplevering van een medicatieoverzicht, zoals aangegeven in groen  hieronder.
+
Usually, medicamenteuze behandeling (drug treatment) starts with a medicatieafspraak. A toedieningsafspraak concretely completes the medicatieafspraak. medicatiegebruik says something about the actual use of the patient in this medicamenteuze behandeling. All three building blocks are relevant in such a case and are part of the delivery of a medication overview, as indicated in green below.
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik</font>.
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik</font>.
Een toedieningsafspraak verwijst naar de medicatieafspraak die hij invult. Als er geen verwijzing beschikbaar is in de toedieningsafspraak dan moet de afspraakdatum (toedieningsafspraak) later zijn dan die van de medicatieafspraak om relevant te zijn voor oplevering.<br>
+
A toedieningsafspraak refers to the medicatieafspraak he enters. If no referral is available in the toedieningsafspraak, the appointment date (administration appointment) must be later than that of the medicatieafspraak to be relevant to delivery.<br>
Medicatiegebruik kán verwijzen naar een medicatieafspraak óf toedieningsafspraak. Als er geen verwijzing beschikbaar is in het medicatiegebruik, dan moet de registratiedatum (medicatiegebruik) later zijn dan die van de medicatieafspraak om relevant te zijn voor oplevering.
+
use medicatiegebruik can refer to a medicatieafspraak or toedieningsafspraak. If no referral is available in the medicatiegebruik, the registration date (medicatiegebruik) must be later than that of the medicatieafspraak to be relevant for delivery.
  
=====Nieuwe medicatieafspraak in de medicamenteuze behandeling=====
+
=====New medicatieafspraak in medicamenteuze behandeling=====
Als je een nieuwe medicatieafspraak aanmaakt in een bestaande medicamenteuze behandeling zijn de op dát moment reeds bestaande medicatieafspraken, toedieningsafspraken en vastleggingen van medicatiegebruik niet meer relevant voor het medicatieoverzicht. Het idee is dat alle oudere bouwstenen dan de huidige medicatieafspraak per definitie ‘overruled’ zijn door deze nieuwe medicatieafspraak en dientengevolge niet meer relevant voor het medicatieoverzicht.
+
If you create a new medicatieafspraak in an existing medicamenteuze behandeling (drug treatment), the currently existing medicatieafspraken, toedieningsafspraken and records of medicatiegebruik are no longer relevant for the medication overview. The idea is that all older building blocks than the current medicatieafspraak are by definition "overruled" by this new medicatieafspraak and consequently no longer relevant for the medication overview.
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> - <font color="00CC00">Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> - <font color="00CC00">Medicatieafspraak</font>
  
Wanneer er volgend op een dergelijke medicatieafspraak een toedieningsafspraak en eventueel ook medicatiegebruik aangemaakt en beschikbaar zijn, worden deze wél weer meegeleverd in het medicatieoverzicht.  
+
If a toedieningsafspraak and possibly also medicatiegebruik are created and available following such a medicatieafspraak medication appointment, these will be included in the medication overview.  
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak – Toedieningsafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak – Toedieningsafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik</font>
  
=====Medicatiegebruik eerder dan toedieningsafspraak=====
+
=====Medicatiegebruik earlier than toedieningsafspraak =====
Het kan gebeuren dat je medicatiegebruik hebt vastgelegd voordat de toedieningsafspraak aangemaakt is. Ook hier is het idee dat de nieuwere toedieningsafspraak de oudere vastlegging van toedieningsafspraak én medicatiegebruik ‘overrulet’. Het oudere medicatiegebruik is dan dus niet meer relevant voor het medicatieoverzicht.
+
It is possible that you have registered medicatiegebruik before the toedieningsafspraak has been made. Here too, the idea is that the newer toedieningsafspraak "overrules" the older registration of toedieningsafspraak and medicatiegebruik. The older medicatiegebruik is therefore no longer relevant for the medication overview.
 
* <font color="00CC00">Medicatieafspraak – Medicatiegebruik</font>
 
* <font color="00CC00">Medicatieafspraak – Medicatiegebruik</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Medicatiegebruik''</small> – <font color="00CC00">Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Medicatiegebruik''</small> – <font color="00CC00">Toedieningsafspraak</font>
  
Natuurlijk kan er daarna weer een nieuwe vastlegging van medicatiegebruik plaatsvinden, die dan ook weer relevant is voor het medicatieoverzicht.
+
Of course, a new record of medicatiegebruik can then be made, which is also relevant for the medication overview.
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Medicatiegebruik''</small> – <font color="00CC00">Toedieningsafspraak - Medicatiegebruik</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Medicatiegebruik''</small> – <font color="00CC00">Toedieningsafspraak - Medicatiegebruik</font>
  
=====Nieuwe toedieningsafspraak=====
+
=====New toedieningsafspraak =====
Soms maak je een nieuwe toedieningsafspraak onder een bestaande medicatieafspraak. Bijvoorbeeld omdat er een ander product verstrekt moet worden (ten gevolge van preferentiebeleid of voorraad). Ook dan geldt dat een dergelijke nieuwe toedieningsafspraak eventueel oudere toedieningsafspraken en medicatiegebruik ‘overrulet’.
+
Sometimes you make a new toedieningsafspraak under an existing medicatieafspraak. For example, because another product must be provided (as a result of preference policy or stock). In that case, too, such a new toedieningsafspraak may overrule older medicatieafspraken and medicatiegebruik.
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak – Medicatiegebruik''</small> - <font color="00CC00">Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak – Medicatiegebruik''</small> - <font color="00CC00">Toedieningsafspraak</font>
  
Natuurlijk kan je daarna medicatiegebruik vastleggen, die is dan ook weer relevant voor het medicatieoverzicht.
+
Of course you can then record medicatiegebruik, which is also relevant for the medication overview.
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">Toedieningsafspraak - Medicatiegebruik</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">Toedieningsafspraak - Medicatiegebruik</font>
  
 
====Over the counter====
 
====Over the counter====
Soms gebruikt een patiënt medicatie waarvoor er geen voorschrift is. Dit geldt bijvoorbeeld voor pijnstillers als paracetamol of ibuprofen, die verkrijgbaar zijn zonder recept. We noemen dit “over the counter” medicatie.
+
Sometimes a patient uses medication for which there is no prescription. This applies, for example, to painkillers such as paracetamol or ibuprofen, which are available without a prescription. We call this “over the counter” medication. Such use of "over the counter" medication can be recorded with the medicatiegebruik building block. This is also relevant for the medication overview.
Dergelijk gebruik van ‘over the counter’ medicatie kan vastgelegd worden met de bouwsteen medicatiegebruik. Ook dit is relevant voor het medicatieoverzicht.
 
 
* <font color="00CC00">Medicatiegebruik</font>
 
* <font color="00CC00">Medicatiegebruik</font>
  
Een nieuwe vastlegging van medicatiegebruik door dezelfde type auteur (type auteur is patiënt of zorgverlener) ‘overrulet’ eventuele oudere vastleggingen van medicatiegebruik. Hieronder uitgewerkt, op volgorde van registratiedatum:  
+
A new record of medicatiegebruik by the same type of author (type of author is patient or healthcare provider) "overrules" any older records of medicatiegebruik. Elaborated below, in order of registration date:
 
* <small>''Medicatiegebruik''</small> - <font color="00CC00">Medicatiegebruik</font>
 
* <small>''Medicatiegebruik''</small> - <font color="00CC00">Medicatiegebruik</font>
  
Wanneer een voorschrijver beslist om deze medicamenteuze behandeling te formaliseren met een medicatieafspraak, gelden daarna de regels zoals hiervoor beschreven. Hieronder uitgewerkt, op volgorde van afspraakdatum (medicatie- of toedieningsafspraak)/registratiedatum (medicatiegebruik):
+
When a prescriber decides to formalize this medicamenteuze behandeling with a medicatieafspraak the rules as described above apply. Elaborated below, in order of appointment date (medicatieafspraak or toedieningsafspraak) / registration date (medicatiegebruik):
 
* <small>''Medicatiegebruik – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak</font>
 
* <small>''Medicatiegebruik – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak</font>
 
* <small>''Medicatiegebruik – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak - Medicatiegebruik</font>
 
* <small>''Medicatiegebruik – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak - Medicatiegebruik</font>
Regel 1.470: Regel 1.433:
 
* <small>''Medicatiegebruik – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak</font> - <small>''Medicatiegebruik''</small> - <font color="00CC00">Medicatiegebruik</font>
 
* <small>''Medicatiegebruik – Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak</font> - <small>''Medicatiegebruik''</small> - <font color="00CC00">Medicatiegebruik</font>
  
====Toekomstige medicatieafspraken en toedieningsafspraken====
+
====Future medicatieafspraken and toedieningsafspraken====
Een medicamenteuze behandeling kan meer dan één actuele medicatieafspraak en toedieningsafspraak bevatten. Namelijk één voor de huidige situatie en één of meer voor de toekomstige situatie. Deze paragraaf beschrijft een voorbeeld met één huidige en één toekomstige. De toekomstige bouwstenen hebben in de voorbeelden voor de duidelijkheid een “T-. Zowel huidige als toekomstige bouwstenen zijn relevant voor het medicatieoverzicht. De bouwstenen voor toedieningsafspraak en medicatiegebruik moeten wel adequate verwijzingen hebben naar ofwel de huidige ofwel de toekomstige afspraak. Hieronder drie voorbeelden, op volgorde van afspraakdatum/registratiedatum (indien deze gelijk zijn, dan gesorteerd op gebruiksperiode):
+
A medicamenteuze behandeling may include more than one topical medicatieafspraak and toedieningsafspraak. Namely one for the current situation and one or more for the future situation. This section describes an example with one current and one future. For clarity, the future building blocks have a “T-” in the examples. Both current and future building blocks are relevant for the medication overview. The building blocks for toedieningsafspraak and medicatiegebruik must have adequate references to either the current or future appointments. Below are three examples, in order of appointment date / registration date (if these are equal, then sorted by period of use):
 
* <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – T Medicatieafspraak – T Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – T Medicatieafspraak – T Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik</font>
Stel dat de toedieningsafspraak wijzigt omdat de verstrekker een andere sterkte levert (2x 500mg tabletten ipv. 1x 1000mg tabletten) en de patiënt nog voldoende voorraad heeft voor twee weken obv. de eerste toedieningsafspraak:
+
Suppose that the toedieningsafspraak changes because the provider provides a different strength (2x 500mg tablets instead of 1x 1000mg tablets) and the patient still has enough stock for two weeks based on the first toedieningsafspraak:  
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T Toedieningsafspraak – T Medicatiegebruik</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T Toedieningsafspraak – T Medicatiegebruik</font>
  
=====Nieuwe medicatieafspraak=====
+
=====New medicatieafspraak =====
Als je in deze situatie een nieuwe medicatieafspraak maakt, maak je ook altijd een (technische) stop-medicatieafspraak. Deze stop-medicatieafspraak kent twee verschijningsvormen:<br>
+
If you make a new medicatieafspraak in this situation, you always make a (technical) stop-medicatieafspraak. This stop-medicatieafspraak has two manifestations:<br>
1) met verwijzing naar een specifieke medicatieafspraak die je stopt<br>
+
1) with reference to a specific medicatieafspraak that you stop<br>
2) zonder verwijzing, en daarmee stop je de hele medicamenteuze behandeling
+
2) without a referral, and with that you stop the entire medicamenteuze behandeling (drug treatment)
  
Ad 1) Stop-medicatieafspraak voor één actuele medicatieafspraak. Met deze stop-medicatieafspraak stop je één specifieke medicatieafspraak. Je maakt voor die medicatieafspraak ook weer een nieuwe.  
+
Ad 1) Stop medicatieafspraak for one current medicatieafspraak. With this stop medicatieafspraak you stop one specific medicatieafspraak. You also make a new one for that medicatieafspraak. Suppose you only want to change the current medicatieafspraak, then this applies to the examples above, in order of appointment date:
Stel dat je alleen de huidige medicatieafspraak wilt wijzigen, dan geeft dit toegepast op de voorbeelden hierboven, op volgorde van afspraakdatum::
 
 
* <small>''Medicatieafspraak''</small> – <font color="00CC00">T Medicatieafspraak – Medicatieafspraak </font>
 
* <small>''Medicatieafspraak''</small> – <font color="00CC00">T Medicatieafspraak – Medicatieafspraak </font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak''</small> – <font color="00CC00">T Medicatieafspraak – T Toedieningsafspraak – Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak''</small> – <font color="00CC00">T Medicatieafspraak – T Toedieningsafspraak – Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik – Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik – Medicatieafspraak</font>
  
Stel dat je alleen de toekomstige medicatieafspraak wilt wijzigen, dan geeft dit toegepast op de voorbeelden hierboven, op volgorde van afspraakdatum:
+
Suppose you only want to change the future medicatieafspraak, then this applies to the examples above, in order of appointment date:
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''T Medicatieafspraak''</small> – <font color="00CC00">T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''T Medicatieafspraak''</small> – <font color="00CC00">T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak</font> – <small>''T Medicatieafspraak – T Toedieningsafspraak''</small> – <font color="00CC00">T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak</font> – <small>''T Medicatieafspraak – T Toedieningsafspraak''</small> – <font color="00CC00">T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik</font> – <small>''T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik''</small> – <font color="00CC00">T Medicatieafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik</font> – <small>''T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik''</small> – <font color="00CC00">T Medicatieafspraak</font>
  
Ad 2) Stop-medicatieafspraak voor de hele medicamenteuze behandeling.
+
Ad 2) Stop medicatieafspraak for the entire medicamenteuze behandeling. With this stop medicatieafspraak you stop all existing (current and future) medicatieafspraken in the medicamenteuze behandeling. If you now want to make a medicatieafspraak for the future in addition to a current one, you must also make it again. Elaborated below for the same three examples as above, in order of appointment date.
Met deze stop-medicatieafspraak stop je alle bestaande (huidige en toekomstige) medicatieafspraken in de medicamenteuze behandeling. Als je nu – naast een huidige - ook weer een medicatieafspraak voor de toekomst wilt maken, moet je ook deze dus opnieuw maken. Hieronder uitgewerkt voor dezelfde drie voorbeelden als bovenstaand, op volgorde van afspraakdatum.
 
 
* <small>''Medicatieafspraak – T-Medicatieafspraak''</small> – <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – T-Medicatieafspraak''</small> – <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – T-Medicatieafspraak – T-Toedieningsafspraak''</small> – <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – T-Medicatieafspraak – T-Toedieningsafspraak''</small> – <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T-Medicatieafspraak – T-Toedieningsafspraak – T Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
 
* <small>''Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T-Medicatieafspraak – T-Toedieningsafspraak – T Medicatiegebruik''</small> – <font color="00CC00">Medicatieafspraak – T Medicatieafspraak</font>
  
=====Nieuwe toedieningsafspraak=====
+
=====New toedieningsafspraak=====
Je kunt echter ook een nieuwe toedieningsafspraak maken voor alleen de huidige medicatieafspraak. Deze nieuwe toedieningsafspraak moet dan een verwijzing naar die huidige medicatieafspraak hebben. Hieronder uitgewerkt voor drie voorbeelden, op volgorde van afspraakdatum.
+
However, you can also make a new toedieningsafspraak for the current medicatieafspraak only. This new toedieningsafspraak must then have a reference to that current medicatieafspraak. Elaborated below for three examples, in order of appointment date.
 
* <font color="00CC00">Medicatieafspraak – T Medicatieafspraak – Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – T Medicatieafspraak – Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak''</small>– <font color="00CC00">T-Medicatieafspraak – T Toedieningsafspraak – Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak''</small>– <font color="00CC00">T-Medicatieafspraak – T Toedieningsafspraak – Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">T Medicatieafspraak – T-Toedieningsafspraak – T Medicatiegebruik – Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak</font> – <small>''Toedieningsafspraak – Medicatiegebruik''</small> – <font color="00CC00">T Medicatieafspraak – T-Toedieningsafspraak – T Medicatiegebruik – Toedieningsafspraak</font>
  
Een nieuwe toedieningsafspraak met een verwijzing naar de toekomstige medicatieafspraak ziet er als volgt uit.
+
A new toedieningsafspraak with a reference to the future medicatieafspraak looks like this.
 
* <font color="00CC00">Medicatieafspraak – T Medicatieafspraak – Toedieningsafspraak – T-Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak – T Medicatieafspraak – Toedieningsafspraak – T-Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak –Toedieningsafspraak – T-Medicatieafspraak</font> – <small>''T Toedieningsafspraak''</small> –  <font color="00CC00">T Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak –Toedieningsafspraak – T-Medicatieafspraak</font> – <small>''T Toedieningsafspraak''</small> –  <font color="00CC00">T Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak –Toedieningsafspraak – Medicatiegebruik – T Medicatieafspraak</font> – <small>''T Toedieningsafspraak – T Medicatiegebruik''</small> – <font color="00CC00">T-Toedieningsafspraak</font>
 
* <font color="00CC00">Medicatieafspraak –Toedieningsafspraak – Medicatiegebruik – T Medicatieafspraak</font> – <small>''T Toedieningsafspraak – T Medicatiegebruik''</small> – <font color="00CC00">T-Toedieningsafspraak</font>
  
====Regels van het overrulen opgesomd====
+
====Rules of overruling listed====
Op basis van bovenstaande beschrijving/voorbeelden zijn de volgende algemene regels voor het overrulen af te leiden. Het gaat hier om de regels om te bepalen of een bouwsteen relevant is voor oplevering in het medicatieoverzicht.
+
Based on the above description / examples, the following general rules for overruling can be derived. This concerns the rules for determining whether a building block is relevant for delivery in the medication overview. Within a medicamenteuze behandeling:
Binnen een medicamenteuze behandeling:
+
*A new medicatieafspraak overrules all older building blocks (medicatieafspraak, toedieningsafspraak, medicatiegebruik) belonging to the medicatieafspraak /medicatieafspraken that this medicatieafspraak has stopped.
* Een nieuwe medicatieafspraak overrulet alle oudere bouwstenen (medicatieafspraak, toedieningsafspraak, medicatiegebruik) behorende bij de medicatieafspraak/-afspraken die deze medicatieafspraak gestopt heeft.  
+
*A new toedieningsafspraak overrules all older building blocks of the type of toedieningsafspraak or medicatiegebruik that belong to the same medicatieafspraak as the new toedieningsafspraak.
* Een nieuwe toedieningsafspraak overrulet alle oudere bouwstenen van type toedieningsafspraak of medicatiegebruik die horen bij dezelfde medicatieafspraak als de nieuwe toedieningsafspraak.
+
*In principle, a new record of medicatiegebruik overrules (see exception below) older records of medicatiegebruik that belong to the same medicatieafspraak as the new medicatiegebruik.
* Een nieuwe vastlegging van medicatiegebruik overrulet in principe (zie uitzondering hieronder) oudere vastleggingen van medicatiegebruik die horen bij dezelfde medicatieafspraak als het nieuwe medicatiegebruik.
+
**Exception to this rule: medicatiegebruik with the author as a patient DOES NOT overrule an older record of medicatiegebruik with the care provider as author and vice versa. Both are therefore relevant to the medication overview.
** Uitzondering op deze regel: medicatiegebruik met als auteur patiënt overrulet NIET een oudere vastlegging van medicatiegebruik met als auteur zorgverlener en vice versa. Beide zijn dan dus relevant voor het medicatieoverzicht.
+
The latter exception applied to a number of situations:
  
 
Deze laatste uitzondering toegepast op een aantal situaties:
 
Deze laatste uitzondering toegepast op een aantal situaties:
Regel 1.526: Regel 1.487:
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak</font> – <small>''Medicatiegebruik-ZVL – Medicatiegebruik-PAT''</small> – <font color="00CC00">Medicatiegebruik PAT – Medicatiegebruik-ZVL</font>
 
* <font color="00CC00">Medicatieafspraak – Toedieningsafspraak</font> – <small>''Medicatiegebruik-ZVL – Medicatiegebruik-PAT''</small> – <font color="00CC00">Medicatiegebruik PAT – Medicatiegebruik-ZVL</font>
  
==Verificatie per medicamenteuze behandeling==
+
==Verification by medicamenteuze behandeling ==
Een zorgverlener legt verificatie per medicamenteuze behandeling vast met de bouwsteen medicatiegebruik:
+
A healthcare provider records verification per medicamenteuze behandeling with the medicatiegebruik building block:
* Auteur = Zorgverlener
+
*Author = Healthcare provider
* Eventuele informant: de patiënt, een zorgverlener of een andere persoon
+
*Possible informant: the patient, a care provider or another person
* Eventueel kenmerk ‘volgens afspraak’: is het medicatiegebruik volgens de auteur conform medicatieafspraak of toedieningsafspraak?  
+
*Possible characteristic "according to agreement": according to the author, is the medicatiegebruik in accordance with the medicatieafspraak or toedieningsafspraak?
* Eventuele link naar medicatieafspraak óf toedieningsafspraak:  
+
*Possible link to medicatieafspraak or toedieningsafspraak:
** Medicatie- of toedieningsafspraak die de referentie is geweest voor het opgeven van dit gebruik.  
+
**Medicatieafspraak or toedieningsafspraak that has been the reference for recording this use.
** Wanneer er wordt aangegeven ‘volgens afspraak’ dan staat hier de medicatie- of toedieningsafspraak conform welke de patiënt gebruikt.
+
**When it is indicated "by appointment", this is the medicatieafspraak or toedieningsafspraak according to which the patient uses.
Een dergelijke vastlegging van medicatiegebruik betekent: “Volgens mij gebruikt de patiënt dit medicament als volgt:...<br>
+
Such a record of medicatiegebruik means: "I think the patient uses this drug as follows: ... ..".
Bekend: het is nu niet voorzien in de informatiestandaard om aan te geven dat een medicatieafspraak of toedieningsafspraak klopt, los van of de patiënt het ook zo gebruikt.
 
  
==Proces van het medicatieoverzicht uitwisselen==
+
Known: it is not currently provided in the information standard to indicate that a medicatieafspraak or toedieningsafspraak is correct, regardless of whether the patient uses it as such.
Naast de inhoud en de verificatie is ook het proces rondom het medicatieoverzicht van belang.
 
  
===Wie, wanneer, met welke informatie===
+
==Process of the medication overview exchange==
De betrouwbaarheid en de compleetheid van een medicatieoverzicht hangt af van:
+
In addition to the content and verification, the process surrounding the medication overview is also important.
* wie het heeft samengesteld,
 
* op welk moment en
 
* met welke basisinformatie.
 
  
Daarover kunnen we afspraken maken, bijvoorbeeld:
+
===Who, when, with what information===
* een medicatieoverzicht pas uitwisselen/beschikbaar stellen zodra deze enige vorm van betrouwbaarheid heeft
+
The reliability and completeness of a medication overview depends on:
** na een expliciete actie van een zorgverlener of
+
*who composed it,
** automatisch als aan bepaalde voorwaarden is voldaan.
+
*at what time and
* medicatieoverzicht volledig automatisch uitwisselen/beschikbaar stellen zonder voorwaarden
+
*with what basic information.
* medicatieoverzicht volledig automatisch beschikbaar maken zonder dat een nieuwe gegevenssoort nodig is (dus bij aanmelding van één van de andere medicatie gegevenssoorten ben je automatisch ook bron voor een medicatieoverzicht).
+
We can make agreements about this, for example:
 +
*only exchange/make available a medication overview once it has some form of reliability
 +
**after an explicit action by a healthcare provider or
 +
**automatically if certain conditions are met.
 +
*fully automatically exchange/make available medication overview without conditions
 +
*make medication overview fully automatically available without the need for a new data type (so when registering one of the other medication data types you are automatically also the source of a medication overview).
  
====Besluit====
+
====Decision====
Bovenstaande vragen zijn nog niet beantwoord. Besloten is dat tijdens de Proof-Of-Concept alle partijen die een medicatieoverzicht kunnen opleveren dit ook doen.
+
The above questions have not yet been answered. It has been decided that during the Proof-Of-Concept all parties that can provide a medication overview will do the same.
  
===Verantwoordelijkheden opvrager en bron===
+
===Responsibilities applicant and source===
De opvrager krijgt medicatieoverzichten uit meerdere bronnen. Het verwerken hiervan is de verantwoordelijkheid van de ontvanger. De actualiteit van een medicatieoverzicht is hierbij van belang.<br>
+
The applicant receives medication overviews from multiple sources. Processing this is the responsibility of the recipient. The topicality of a medication overview is important here.
'''Actie:''' de transactie medicatieoverzicht moet de meest recente datum bevatten van de verzameling van beschikbare afspraakdatums/registratiedatums van de opgeleverde instantiaties van bouwstenen. De samensteller (bron) van het medicatieoverzicht moet deze datum dus opleveren. Dit helpt de ontvanger om de actualiteit van het medicatieoverzicht beter in te schatten.
 
  
===Afspraken vervolg===
+
'''Action''': the transaction Medicatieoverzicht (medication record) must contain the most recent date of the collection of available appointment dates / registration dates of the delivered building block instantiations. The compiler (source) of the medication overview must therefore provide this date. This helps the recipient to better estimate the topicality of the medication overview.
Met de uitkomsten van de Proof-Of-Concept vervolgen we de analyse om te komen tot een goed proces voor het medicatieoverzicht.
 
  
 +
===Agreements continued===
 +
We continue the analysis with the results of the Proof-Of-Concept to arrive at a good process for the medication overview.
  
==Afleidingsregels==
+
==Inference rules==
Het is van belang dat iedere partij de arts, apotheker, verpleging en ook de patiënt uit de medicatiebouwstenen kan opmaken wat de bedoeling is (c.q. wat de actuele afspraken zijn). Die bedoeling mag niet per systeem verschillen. Daarom moeten systemen volgens dezelfde afleidingsregels de actuele situatie kunnen berekenen.
+
It is important that all parties, physician, pharmacist, nurse as well as patient can infer from the medication building blocks what is intended (i.e. what the current agreements are) and that this should be the same for all systems. For that reason, systems must be able to calculate the current situation using the same inference rules.
  
De actuele therapeutische situatie wordt berekend aan de hand van zowel medicatie- als toedieningsafspraken. Toedieningsafspraken hebben een relatie met de medicatieafspraak die zij concreet invullen. Toedieningsafspraken zijn daardoor te koppelen aan de medicatieafspraak die zij invullen.<br>
+
The current therapeutic situation is calculated on the basis of medicatieafspraken and toedieningsafspraken. Toedieningsafspraken have a relationship with the medicatieafspraak that they were added to. For this reason, toedieningsafspraken can be linked to the medicatieafspraak that they belong to.<br>
Het medicatiegebruik is uiteraard ook zinvol om te weten. Het geeft echter niet weer wat de bedoeling van de zorgverlener is, maar wat de patiënt heeft gebruikt. Onderstaande regels nemen daarom niet het ‘gebruik’ mee. Het gebruik is wel onderdeel van een medicatieprofiel maar wordt apart getoond onder de betreffende medicamenteuze behandeling.
+
Of course it is also useful to have information about medicatiegebruik. However, this does not indicate the aim of the healthcare provider, only what medication the patient has used. For that reason, the rules below do not take ‘Use/gebruik’ in consideration. However, ‘gebruik’ is part of a medication profile but is shown separately under the medicamenteuze behandeling concerned.
  
===Effectieve periode===
+
===Effective period===
De effectieve periode bestaat uit een ''effectieve ingangsdatum'' en een ''effectieve einddatum.''
+
The effective period lies between an ''effective start date'' and an ''effective end date''.<br>
:''De effectieve periode beschrijft de periode waarin een medicatie- of toedieningsafspraak (uiteindelijk) geldt /van toepassing is.''  
+
:''The effective period describes the period to which a medicatieafspraak or toedieningsafspraak (ultimately) applies.''<br>
De effectieve periode is afhankelijk van aanpassingen (wijzigen / staken / onderbreken / hervatten) van medicatie en door de ‘concrete invulling’ van een medicatieafspraak door een toedieningsafspraak. De effectieve periode is niet beschreven in de dataset, omdat het een afgeleid gegeven is dat alleen wordt gebruikt om de actuele situatie te bepalen. De ''effectieve ingangsdatum'', ''effectieve einddatum'' en ''effectieve periode'' zijn geen gegevens om aan de eindgebruiker te tonen.<br>
+
The effective period depends on adjustments (modifying/discontinuing/halting/resuming) of medication and by the ‘actual handling of a medicatieafspraak by a toedieningsafspraak. The effective period is not described in the dataset, because it is inferred which is only used to determine the current situation. The ''effective start date, effective end date'' and ''effective period'' are not data to be shown to the end user. Medication for an indefinite period has an effective end date that is in the future, but at a time that cannot be distracted (yet). It is only known that it is 'somewhere' in the future.
Medicatie voor onbepaalde duur heeft een ''effectieve einddatum'' die in de toekomst ligt, maar op een (nog) niet af te leiden moment. Het is alleen bekend dat hij 'ergens' in de toekomst ligt.
 
  
===Actuele en huidige medicatie===
+
===Actual and current medication===
*''Actuele (medicatie– en toedienings)afspraken:'' de afspraken waarvan de effectieve einddatum in de toekomst ligt.
+
*''Actual (medicatieafspraken en toedieningsafspraken)'': the agreements of which the effective end date lies in the future.
*''Huidige (medicatie– en toedienings)afspraken:'' de afspraken waarvan het heden tussen de effectieve ingangsdatum en de effectieve einddatum ligt.
+
*''Current (medicatieafspraken en toedieningsafspraken) agreements'': the agreements for which the present date lies between their effective start date and the effective end date.
*''Actuele medicatie:'' de verzameling van actuele (huidige en toekomstige) medicatie- en toedieningsafspraken en het actuele gebruik. Voorbehoud hierbij is dat nooit met zekerheid te zeggen is in hoeverre de patiënt zich aan de afspraken houdt en het daadwerkelijk gebruik meldt.
+
*''Actual medication'': the collection of actual (current and future) medication and toedieningsafspraaks as well as current medicatiegebruik. It should be taken into account that it is never possible to say with certainty to what extent the patient complies with the agreements and/or reports actual gebruik.
  
===Uitwerking===
+
===Details===
'''Aanpak'''<br>
+
'''Approach'''<br>
Aan de hand van een aantal situaties worden de afleidingsregels beschreven om te komen tot de effectieve therapeutische periode in een medicatieprofiel:<br>
+
Using a number of different situations the inference rules are described for arriving at the effective therapeutic period in a medication profile:<br>
:1) Medicatie starten
+
:1) Starting medication
:2) Maken toedieningsafspraak  
+
:2) Creating a toedieningsafspraak  
:3) Medicatie wijzigen
+
:3) Changing medication
:4) Medicatie definitief stoppen
+
:4) Discontinuing medication
:5) Medicatie tijdelijk onderbreken en hervatten
+
:5) Temporarily halting and resuming medication
  
Hieronder worden de afleidingsregels beschreven. Het nummer bij iedere afleidingsregel staat voor de volgorde waarin de regels moeten worden uitgevoerd.  
+
The inference rules are described below. The number for each inference rule indicates the order in which the rules must be executed.
  
'''1) Medicatie starten'''<br>
+
'''1) Starting medication'''<br>
Medicatie wordt gestart door het maken van een nieuwe medicatieafspraak. De medicatieafspraak kent een:  
+
Medication is started by creating a new medicatieafspraak. The medicatieafspraak has:
*Afspraakdatum - de datum waarop de afspraak is gemaakt met de patiënt.
+
*An agreement date - the date on which the agreement was made with the patient.
*Gebruiksperiode - de periode bestaat uit:  
+
*A period of use - this period is consists of:
**ingangsdatum - de ingangsdatum van de medicatieafspraak kan in de toekomst liggen;
+
**A start date - the start date of the medicatieafspraak may be in the future;
**gebruiksduur;
+
**The duration of use;
**einddatum - tot wanneer geldt de medicatieafspraak.
+
**The end date – the date until which the medicatieafspraak is valid.
  
  1a: De effectieve periode van een ''nieuwe'' medicatieafspraak is gelijk aan diens gebruiksperiode
+
  1a: The effective period of a new medicatieafspraak is equal to its period of use.
  
'''2) Maken toedieningsafspraak'''<br>
+
'''2) Creating a toedieningsafspraak '''<br>
Een toedieningsafspraak vult een medicatieafspraak concreet in. In zekere zin, door de ogen van de patiënt gezien, zou je kunnen zeggen dat een toedieningsafspraak een medicatieafspraak vervangt. Dat is immers dichter bij wat hij zou moeten gebruiken.  
+
A toedieningsafspraak specifically fulfils a medicatieafspraak. From a patient perspective, the toedieningsafspraak, in a way, replaces a medicatieafspraak, as the toedieningsafspraak is a more specific indication of what the patient should be using.
  
Afleidingsregel 1 wordt uitgebreid:  
+
Inference rule 1 is extended:
  
  1b: De effectieve periode van een nieuwe toedieningsafspraak is gelijk aan diens gebruiksperiode
+
  1b: The effective period of a new toedieningsafspraak is equal to its period of use
  
Afleidingsregel 2 is van toepassing als een medicatieafspraak onderliggende toedieningsafspraken kent (zie afleidingsregel 2b voor nadere toelichting):
+
Inference rule 2 is applicable when a medicatieafspraak has underlying toedieningsafspraken (see inference rule 2b for further explanation):
  
  2a: De effectieve periode van een medicatieafspraak is gelijk aan de effectieve periode van de onderliggende toedieningsafspraak.
+
  2a: The effective period of a medicatieafspraak is equal to the effective period of the toedieningsafspraak.
  
'''3) Medicatie wijzigen'''
+
'''3) Changing medication'''
:'''a) Door een medicatieafspraak'''
+
:'''a) By means of a medicatieafspraak'''
De voorschrijver wijzigt medicatie (c.q. de medicamenteuze behandeling) door het maken van een nieuwe medicatieafspraak (en het beëindigen van de bestaande) binnen een bestaande medicamenteuze behandeling. <br>
+
The prescriber changes the medication (or the medicamenteuze behandeling) by creating a new medicatieafspraak (and discontinuing the existing one) within an existing medicamenteuze behandeling.  
Doordat de ingangsdatum van een medicatieafspraak in de toekomst kan liggen kunnen er meerdere medicatieafspraken tegelijk actueel zijn. Bijvoorbeeld wanneer een medicatieafspraak geldt ‘voor onbepaalde duur’ (ma1) en er wordt afgesproken over twee weken de dosering te wijzigen (ma2) blijft de eerste medicatieafspraak (ma1) nog twee weken geldig, daarna gaat de tweede medicatieafspraak (ma2) in.  
+
Because the start date of a medicatieafspraak may lie in the future, several medicatieafspraken may be actual at the same time. For example, when a medicatieafspraak applies ‘for an indefinite period’ (ma1) and it is agreed to change the dosage in two weeks (ma2), the first medicatieafspraak (ma1) remains valid for two weeks, after which the second medicatieafspraak (ma2) becomes effective. The previous inference rules do not change because of this.
De voorgaande afleidingsregels veranderen hierdoor niet.
 
  
:'''b) Door een toedieningsafspraak'''
+
:'''b) By means of a toedieningsafspraak '''
Een medicatieafspraak wordt concreet ingevuld door een toedieningsafspraak. Op deze toedieningsafspraak kan een wijziging plaatsvinden. Bijvoorbeeld wanneer deeltijden veranderen (wanneer GDS wordt geïnitieerd), of wanneer er van handelsproduct wordt gewijzigd (door bijvoorbeeld een preferentiebeleid). Er kunnen dus meerdere achtereenvolgende toedieningsafspraken onder één medicatieafspraak worden gemaakt. Daarom wordt regel 2 uitgebreid zodat effectieve periode van de medicatieafspraak wordt bepaald door de gehele reeks onderliggende toedieningsafspraken.
+
An toedieningsafspraak specifically fulfils a medicatieafspraak. This toedieningsafspraak may be modified. For example, when administration schedules are changed (when GDS is initiated), or when a commercial product is changed (for example, as a result of a preference policy). Several successive toedieningsafspraken can therefore be created under a single medicatieafspraak. Hence, rule 2 is expanded so that the effective period of the medicatieafspraak is determined by the entire series of underlying toedieningsafspraken.
  
  2b: Wanneer er meerdere toedieningsafspraken onder een medicatieafspraak gemaakt worden dan is de effectieve ingangsdatum van de medicatieafspraak gelijk aan de meest vroege ingangsdatum van de onderliggende toedieningsafspraken en de einddatum van de laatste toedieningsafspraak.
+
  2b: When several toedieningsafspraken are made under a single medicatieafspraak, the effective start date of the medicatieafspraak is then equal to the earliest start date of the underlying toedieningsafspraak and the end date of the last toedieningsafspraak.
  
Er kunnen parallelle toedieningsafspraken onder één medicatieafspraak zijn waarvan de afspraakdatum en ingangsdatum gelijk zijn. Beide zijn dan tegelijk geldig en daarmee wijzigt regel 2b niet.
+
Parallel toedieningsafspraken may exist under a single medicatieafspraak of which the agreement date and the start date are the same. Both are then valid at the same time and this does not change rule 2b.
  
In onderstaande figuur is een zeer eenvoudig voorbeeld opgenomen van een actueel profiel samengesteld uit de verschillende bouwstenen. De patiënt-, verificatie-, ICA- en labgegevens zijn in dit overzicht geheel buiten beschouwing gelaten. Er is verder een zeer beperkt aantal gegevens opgenomen om vooral de werking van de effectieve periode te tonen. Regels met een ‘-‘ zijn detailregels en kunnen desgewenst ‘ingeklapt’ worden in het medicatieprofiel. In de eerste regel is de effectieve periode getoond voor de onderliggende ma en ta’s. Daaronder is ook gebruik zichtbaar, deze heeft geen invloed op de berekening van de effectieve therapeutische periode in de eerste regel.
+
The diagram below includes a simplified example of an actual profile composed of different building blocks. The patient, verification, ICA (intolerances, contraindications, allergies) and lab data have been excluded from this overview. Only limited data has been included, mainly to demonstrate the way in which the effective period works. Lines starting with ‘-’ are detail lines which can be  hidden in the medication profile, if required. The first line shows the effective period for the underlying MAs and TAs. The ‘gebruik/Use” is also displayed, but this does not influence the calculation of the effective therapeutic period on the first line.  
  
 
{{anchor|figuur 9}}
 
{{anchor|figuur 9}}
 
[[Bestand:Voorbeeldeffectieveperioden.png|Figuur 9 Voorbeeld effectieve periode]]
 
[[Bestand:Voorbeeldeffectieveperioden.png|Figuur 9 Voorbeeld effectieve periode]]
  
'''4) Medicatie definitief stoppen'''<br>
+
'''4) Discontinuing medication'''<br>
Het stoppen van medicatie (c.q. medicamenteuze behandeling) gebeurt door het maken van een medicatieafspraak, waarin stoptype 'definitief' is aangegeven. De ingangsdatum van deze medicatieafspraak is de datum waarop de originele medicatieafspraak inging. De einddatum is de datum waarop de medicatie gestopt wordt. De effectieve periode van de originele medicatieafspraak is daarmee vervangen door de effectieve periode van deze nieuwe stop-ma.
+
Discontinuing medication (i.e medicamenteuze behandeling) is done by creating a new medicatieafspraak in which stoptype ‘definite’ is indicated. The start date of this medicatieafspraak is the date on which the original medicatieafspraak started. The end date is the date on which the medication is discontinued. The effective period of the original medicatieafspraak is so replaced by the effective period of this new stop-MA.
  
  1c: Wanneer een medicatieafspraak gestopt wordt dan is de effectieve periode van de medicatieafspraak de effectieve periode van de stop-ma.
+
  1c: When a medicatieafspraak is discontinued, the effective period of the medicatieafspraak is then the effective period of the stop-MA.
  
Een stop-toedieningsafspraak kan een stop-medicatieafspraak concreet invullen. Zo kan bijvoorbeeld worden uitgedrukt dat het stoppen ingaat met de volgende GDS uitgifte.  
+
An stop-toedieningsafspraak fulfils the stop-medicatieafspraak. In this way, for example, it is possible to indicate that the discontinuation starts when the next GDS roll is dispensed.
  
'''5) Medicatie tijdelijk onderbreken en hervatten'''<br>
+
'''5) Temporarily halting and resuming medication'''<br>
Het onderbreken van medicatie gebeurt op dezelfde wijze als medicatie stoppen. Er wordt een stop-ma gemaakt (stoptype 'tijdelijk') met dezelfde ingangsdatum als de originele medicatieafspraak. De einddatum van de stop-ma is het moment van tijdelijk onderbreken, het stoptype is 'tijdelijk'. Hervatten gebeurt door een medicatieafspraak te maken met de oude (of aangepaste) dosering waarbij de ingangsdatum de hervattingsdatum is. Een aansprekende reden (bijvoorbeeld: hervat eerder gemaakt beleid) kan e.e.a. verduidelijken. Als niet hervat wordt kan 'medicatie stoppen (stoptype 'definitief')' worden uitgevoerd om de medicamenteuze behandeling definitief te beëindigen waarmee het niet meer actuele medicatie is. Medicatie die onderbroken wordt blijft actueel zodat deze op het medicatieprofiel zichtbaar blijft.
+
Temporarily halting medication is carried out in the same way as discontinuing medication. A stop-MA is created (stoptype ‘temporary’) with the same start date as that of the original medicatieafspraak. The end date of the stop-MA is the timing of the temporary halt, the stop type is ‘temporary’. Resuming medication is done by creating a new medicatieafspraak with the old (or adjusted) dosage with the date of resuming as the start date. A meaningful reason (example: resume previous policy) may serve to clarify matters. If the medication is not resumed, ‘discontinue medication’ (stoptype ‘definite’) can be executed in order to permanently end the medicamenteuze behandeling, which means the medication is no longer valid. Medication that is halted remains valid, and so remains visible in the medication profile.
  
  1d: Wanneer medicatie tijdelijk wordt onderbroken wordt de effectieve periode daardoor niet beïnvloed. De effectieve periode wordt bepaald door de effectieve periode van de originele medicatieafspraak.  
+
  1d: When medication is temporarily halted, the effective period is not affected. The effective period is determined by the effective period of the original medicatieafspraak.  
  
Deze afleidingsregels vormen de basis voor het bepalen van de actuele afspraken. Er zijn uitzonderingssituaties denkbaar die gerelateerd zijn aan het slechts deels beschikbaar hebben van medicatiegegevens. Deze zijn niet uitgewerkt.
+
These inference rules are the basis for determining the current agreements. It is possible to conceive exceptional situations relating to a partial availability of medication data. These situations have not been elaborated. All inference rules are included and implemented in the open source medication viewer.
In de open-source beschikbare medicatie-viewer zijn alle afleidingsregels opgenomen en geïmplementeerd.
 
  
==Gegevens die niet getoond hoeven te worden==
+
==Data that need not be shown==
Diverse gegevens zijn belangrijk voor het correct kunnen verwerken van informatie, maar zijn voor de eindgebruiker niet relevant:
+
Various data are important for the correct processing of information, but are not relevant to the end user:
*Een applicatie hoeft niet de (technische) identificatie van een MBH te tonen (noch die van de bouwstenen zelf), maar wel de uitwerking daarvan: namelijk in samenhang getoonde bouwsteen instantiaties.
+
*An application does not have to show the (technical) identification of a medicamenteuze behandeling (MBH) (nor that of the building blocks themselves), but the elaboration thereof: namely, building blocks shown in coherence.
*De kopie-indicator bij de MA, TA en MGB bij het raadplegen van medicatieoverzicht. Of een bouwsteen een kopie betreft, is voor een gebruiker niet zo belangrijk en kan afgeleid worden door andere gegevens uit die bouwsteen (zoals auteur van de bouwsteen). Het is dus niet zo belangrijk dat een gebruiker kan zien dat dit 'als kopie' is opgeleverd en vermoedelijk alleen maar verwarrend. Voor leveranciers is dit gegeven echter wél belangrijk, bijvoorbeeld omdat zij soms met de gegevens willen rekenen en het dan veiliger is om het gegeven bij de échte bron op te halen. Het ligt daarom voor de hand om in je systeem wél bij te houden of je het gegeven van de échte bron hebt ontvangen.
+
*The copy indicator with the medicatieafspraak (MA), toedieningsafspraak (TA) and  medicatiegebruik (MGB) when consulting the medication overview. Whether a building block is a copy is not that important to a user and can be deduced by other data from that building block (such as the author of the building block). So it is not so important that a user can see that this has been delivered 'as a copy' and is probably only confusing. However, this information is important for suppliers, for example because they sometimes want to perform calculations with the data and it is then safer to collect the data from the real source. It is therefore obvious to keep track of whether you have received data from the real source in your system.
*Een applicatie hoeft niet het stoptype (tijdelijk/definitief) van een stop-afspraak te tonen, maar wel de uitwerking daarvan: namelijk het verwerken van de betekenis, waardoor een gehele MBH als gestopte medicatie getoond wordt of als onderbroken medicatie (blijft inzichtelijk onder huidige medicatie) of als een wijziging in geval van een 'technische stop-afspraak'.
+
*An application does not have to show the stop type (temporary / definite) of a stop appointment, but the elaboration thereof: namely the processing of the meaning, so that an entire MBH is shown as stopped medication or as interrupted medication (remains clear under current medication) or as a change in the case of a 'technical stop appointment'.
  
=Systemen en transacties=
+
=Systems and transactions=
Dit hoofdstuk bevat een opsomming van alle systeemrollen en transacties. In de verschillende proceshoofdstukken wordt hiernaar verwezen.
+
This chapter contains a list of all system roles and transactions that are referred to in the various process chapters.
 +
 
 +
The figure below ([[#figuur 10|Figure 10]]) contains an overview of all systems with their corresponding system roles. The system roles have been described in [[#tabel 3|Table 3]]. The system roles associated with consulting/making available medication data and the medication overview are important for all systems depending on the process in which they are used. The electronic prescribing system (EPS) also includes the system roles for receiving a proposed verstrekkingsverzoek, sending a reply proposed verstrekkingsverzoek and receiving a proposed medicatieafspraak and, in an outpatient situation, for sending a prescription and receiving data on the processing of a prescription. In addition to the basic system roles, a XIS and PGD also include the system roles for sending a proposed medicatieafspraak and a proposed verstrekkingsverzoek, for sending data on gebruik and for receiving a reply proposed verstrekkingsverzoek. The pharmacist information system (PIS) also includes, in addition to the basic system roles, the roles for sending a proposed medicatieafspraak, sending a proposed verstrekkingsverzoek and data on processing of the prescription, and receiving a prescription and reply proposed verstrekkingsverzoek. [[#Medication process|Chapter 2]] lists the main system roles per process.
  
Onderstaande figuur ([[#figuur 10|Figuur 10]]) bevat een overzicht van alle systemen met hun bijbehorende systeemrollen. De systeemrollen zijn beschreven in de daaronder opgenomen [[#tabel 3|Tabel 3]]. De systeemrollen die betrekking hebben op raadplegen/beschikbaarstellen van medicatiegegevens en medicatieoverzicht zijn voor alle systemen van belang al naar gelang het proces waarin zij gebruikt worden. Het elektronisch voorschrijfsysteem (EVS) heeft daarnaast de systeemrollen voor het ontvangen van een voorstel verstrekkingsverzoek, het versturen van een antwoord voorstel verstrekkingsverzoek en het ontvangen van een voorstel medicatieafspraak en in de ambulante situatie voor het versturen van een voorschrift en het ontvangen van een vervulling van het voorschrift. Een XIS en PGO hebben naast de generieke systeemrollen ook de systeemrollen voor het versturen van een voorstel medicatieafspraak en voorstel verstrekkingsverzoek en het sturen van gebruik en ontvangen antwoord voorstel verstrekkingsverzoek. Een apotheekinformatiesysteem heeft naast de basis systeemrollen ook de rollen voor sturen van voorstel medicatieafspraak, voorstel verstrekkingsverzoek en afhandeling voorschrift en het ontvangen van een voorschrift en antwoord voorstel verstrekkingsverzoek. In [[#Medicatieproces|hoofdstuk 2]] zijn de belangrijkste systeemrollen per proces benoemd.
 
  
 
{{anchor|figuur 10}}
 
{{anchor|figuur 10}}
Regel 1.662: Regel 1.621:
 
{{anchor|tabel 3}}
 
{{anchor|tabel 3}}
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
!style="text-align:left;"|Naam systeemrol
+
!style="text-align:left;"|System role name
!style="text-align:left;"|Afk.
+
!style="text-align:left;"|Abbr.
!style="text-align:left;"|Omschrijving
+
!style="text-align:left;"|Description
 
|-
 
|-
 
| style="background-color: white;"| MedicatieGegevensBeschikbaarstellend
 
| style="background-color: white;"| MedicatieGegevensBeschikbaarstellend
 
| style="background-color: white;"| MP-MGB
 
| style="background-color: white;"| MP-MGB
| style="background-color: white;"| Beschikbaarstellen medicatiegegevens aan medebehandelaars/patiënt
+
| style="background-color: white;"| Making medication data available to fellow healthcare providers/patient
 
|-
 
|-
 
| style="background-color: white;"| MedicatieGegevensRaadplegend
 
| style="background-color: white;"| MedicatieGegevensRaadplegend
 
| style="background-color: white;"| MP-MGR
 
| style="background-color: white;"| MP-MGR
| style="background-color: white;"| Raadplegen medicatiegegevens bij medebehandelaars/patiënt
+
| style="background-color: white;"| Consulting medication data at fellow healthcare providers/patient
 
|-
 
|-
 
| style="background-color: white;"| MedicatieGegevensSturend
 
| style="background-color: white;"| MedicatieGegevensSturend
 
| style="background-color: white;"| MP-MGS
 
| style="background-color: white;"| MP-MGS
| style="background-color: white;"| Sturen medicatiegegevens aan medebehandelaar/patiënt
+
| style="background-color: white;"| Sending data to fellow healthcare provider/patient
 
|-
 
|-
 
| style="background-color: white;"| MedicatieGegevensOntvangend
 
| style="background-color: white;"| MedicatieGegevensOntvangend
 
| style="background-color: white;"| MP-MGO
 
| style="background-color: white;"| MP-MGO
| style="background-color: white;"| Ontvangen medicatiegegevens van medebehandelaar/patiënt
+
| style="background-color: white;"| Receiving medication data from fellow healthcare provider/patient
 
|-
 
|-
 
| style="background-color: white;"| MedicatieOverzichtBeschikbaarstellend
 
| style="background-color: white;"| MedicatieOverzichtBeschikbaarstellend
 
| style="background-color: white;"| MP-MOB
 
| style="background-color: white;"| MP-MOB
| style="background-color: white;"| Beschikbaarstellen medicatieoverzicht aan medebehandelaars/patiënt
+
| style="background-color: white;"| Making medication overview available to fellow healthcare providers/patient
 
|-
 
|-
 
| style="background-color: white;"| MedicatieOverzichtRaadplegend
 
| style="background-color: white;"| MedicatieOverzichtRaadplegend
 
| style="background-color: white;"| MP-MOR
 
| style="background-color: white;"| MP-MOR
| style="background-color: white;"| Raadplegen medicatieoverzicht bij medebehandelaars/patiënt
+
| style="background-color: white;"| Consulting medication overview at fellow healthcare providers/patient
 
|-
 
|-
 
| style="background-color: white;"| MedicatieOverzichtSturend
 
| style="background-color: white;"| MedicatieOverzichtSturend
Regel 1.696: Regel 1.655:
 
| style="background-color: white;"| MedicatieOverzichtOntvangend
 
| style="background-color: white;"| MedicatieOverzichtOntvangend
 
| style="background-color: white;"| MP-MOO
 
| style="background-color: white;"| MP-MOO
| style="background-color: white;"| Ontvangen medicatieoverzicht van medebehandelaar/patiënt
+
| style="background-color: white;"| Receiving medication overview from fellow healthcare provider/patient
 
|-
 
|-
 
| style="background-color: white;"| VoorschriftSturend
 
| style="background-color: white;"| VoorschriftSturend
 
| style="background-color: white;"| MP-VOS
 
| style="background-color: white;"| MP-VOS
| style="background-color: white;"| Sturen verzoek tot medicatieverstrekking van medicatie of verwerking van wijziging in medicatieafspraak
+
| style="background-color: white;"| Sending verstrekkingsverzoek or request for processing of modifications to medicatieafspraak.
 
|-
 
|-
 
| style="background-color: white;"| VoorschriftOntvangend
 
| style="background-color: white;"| VoorschriftOntvangend
 
| style="background-color: white;"| MP-VOO
 
| style="background-color: white;"| MP-VOO
| style="background-color: white;"| Ontvangen verzoek tot medicatieverstrekking van medicatie of verwerking wijziging in medicatieafspraak
+
| style="background-color: white;"| Receiving verstrekkingsverzoek or request for processing of modifications to medicatieafspraak.
 
|-
 
|-
 
| style="background-color: white;"| VoorschriftAfhandelingSturend
 
| style="background-color: white;"| VoorschriftAfhandelingSturend
 
| style="background-color: white;"| MP-VAS
 
| style="background-color: white;"| MP-VAS
| style="background-color: white;"| Sturen afhandeling van de medicatieafspraak en evt. verstrekkingverzoek in toedieningsafspraak en/of medicatieverstrekking
+
| style="background-color: white;"| Sending data on processing of medicatieafspraak and possibly verstrekkingsverzoek in toedieningsafspraak and/or medicatieverstrekking
 
|-
 
|-
 
| style="background-color: white;"| VoorschriftAfhandelingOntvangend
 
| style="background-color: white;"| VoorschriftAfhandelingOntvangend
 
| style="background-color: white;"| MP-VAO
 
| style="background-color: white;"| MP-VAO
| style="background-color: white;"| Ontvangen afhandeling van de medicatieafspraak en evt. verstrekkingverzoek in toedieningsafspraak en/of medicatieverstrekking
+
| style="background-color: white;"| Receiving data on processing of medicatieafspraak and possibly verstrekkingsverzoek in toedieningsafspraak and/or medicatieverstrekking
 
|-
 
|-
 
| style="background-color: white;"| ToedienGegevensSturend
 
| style="background-color: white;"| ToedienGegevensSturend
 
| style="background-color: white;"| MP-TGS
 
| style="background-color: white;"| MP-TGS
| style="background-color: white;"| Sturen gegevens ten behoeve van medicatietoediening  
+
| style="background-color: white;"| Sending data for medicatietoediening
 
|-
 
|-
 
| style="background-color: white;"| ToedienGegevensOntvangend
 
| style="background-color: white;"| ToedienGegevensOntvangend
 
| style="background-color: white;"| MP-TGO
 
| style="background-color: white;"| MP-TGO
| style="background-color: white;"| Ontvangen gegevens ten behoeve van medicatietoediening
+
| style="background-color: white;"| Receiving data for medicatietoediening
 
|-
 
|-
 
| style="background-color: white;"| GebruikSturend
 
| style="background-color: white;"| GebruikSturend
 
| style="background-color: white;"| MP-MGS
 
| style="background-color: white;"| MP-MGS
| style="background-color: white;"| Sturen medicatiegebruik
+
| style="background-color: white;"| Sending data on medicatiegebruik
 
|-
 
|-
 
| style="background-color: white;"| GebruikOntvangend
 
| style="background-color: white;"| GebruikOntvangend
 
| style="background-color: white;"| MP-MGO
 
| style="background-color: white;"| MP-MGO
| style="background-color: white;"| Ontvangen medicatiegebruik
+
| style="background-color: white;"| Receiving data on medicatiegebruik
 
|-
 
|-
 
| style="background-color: white;"| VoorstelVerstrekkingsverzoekSturend
 
| style="background-color: white;"| VoorstelVerstrekkingsverzoekSturend
 
| style="background-color: white;"| MP-VVS
 
| style="background-color: white;"| MP-VVS
| style="background-color: white;"| Informeren voorschrijver over voorstel tot nieuw verstrekkingsverzoek, ontvangen antwoord op voorstel verstrekkingsverzoek
+
| style="background-color: white;"| Informing prescriber about voorstel new verstrekkingsverzoek, receiving reply to proposed verstrekkingsverzoek
 
|-
 
|-
 
| style="background-color: white;"| VoorstelVerstrekkingsverzoekOntvangend
 
| style="background-color: white;"| VoorstelVerstrekkingsverzoekOntvangend
 
| style="background-color: white;"| MP-VVO
 
| style="background-color: white;"| MP-VVO
| style="background-color: white;"| Ontvangen voorstel tot nieuw verstrekkingsverzoek, sturen antwoord op voorstel verstrekkingsverzoek
+
| style="background-color: white;"| Receiving new  voorstel verstrekkingsverzoek, sending reply to voorstel verstrekkingsverzoek
 
|-
 
|-
 
| style="background-color: white;"| VoorstelMedicatieafspraakSturend
 
| style="background-color: white;"| VoorstelMedicatieafspraakSturend
 
| style="background-color: white;"| MP-VMS
 
| style="background-color: white;"| MP-VMS
| style="background-color: white;"| Informeren voorschrijver over voorstel tot nieuwe of gewijzigde medicatieafspraak
+
| style="background-color: white;"| Informing prescriber about new voorstelor modified medicatieafspraak
 
|-
 
|-
 
| style="background-color: white;"| VoorstelMedicatieafspraakOntvangend
 
| style="background-color: white;"| VoorstelMedicatieafspraakOntvangend
 
| style="background-color: white;"| MP-VMO
 
| style="background-color: white;"| MP-VMO
| style="background-color: white;"| Ontvangen voorstel tot nieuwe of gewijzigde medicatieafspraak
+
| style="background-color: white;"|Receiving voorstel for new or modified medicatieafspraak
|}<small>Tabel 3 Overzicht systeemrollen</small>
+
|}<small>Table 3 Overview system roles</small>
In Tabel 4 is een overzicht opgenomen van alle transactiegroepen, transacties, bijbehorende systeemrollen en de bouwstenen die met deze transactiegroep worden uitgewisseld. De namen van de transactiegroepen en transacties linken naar de Art-decor publicatie waarin per scenario is uitgewerkt welke gegevenselementen daarin voorkomen.  
+
 
 +
Table 4 gives an overview of all transaction groups, transactions, corresponding system roles and building blocks exchanged with this transaction group. The names of the transaction groups and transactions link to the ART-DECOR publication which details per scenario which data elements are used.
  
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
! style="text-align:left;"| '''Transactiegroep'''
+
! style="text-align:left;"| '''Transaction group'''
! style="text-align:left;"| '''Transactie'''
+
! style="text-align:left;"| '''Transaction'''
! style="text-align:left;"| '''Systeemrol'''
+
! style="text-align:left;"| '''System role'''
! style="text-align:left;"| '''Bouwstenen'''
+
! style="text-align:left;"| '''Building blocks'''
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.12-2016-03-23T163243.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.100_20160323163243 Medicatiegegevens (PULL)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.12-2016-03-23T163243.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.100_20160323163243 Medication data (PULL)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.102-2016-03-23T163243.html Beschikbaarstellen medicatiegegevens]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.102-2016-03-23T163243.html Making medication data available]
 
|style="background-color: white;vertical-align:top;"|MP-MGB
 
|style="background-color: white;vertical-align:top;"|MP-MGB
|style="background-color: white;vertical-align:top;" rowspan="2"|Eén of meer: ma, vv, ta, mve, mtd, mgb
+
|style="background-color: white;vertical-align:top;" rowspan="2"|One or more: ma, vv, ta, mve, mtd, mgb
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.136-2016-07-12T133747.html Raadplegen medicatiegegevens]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.136-2016-07-12T133747.html Consulting medication data]
 
|style="background-color: white;vertical-align:top;"|MP-MGR
 
|style="background-color: white;vertical-align:top;"|MP-MGR
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.12-2016-03-23T163243.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.133_20160712121605 Medicatiegegevens (PUSH)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.12-2016-03-23T163243.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.133_20160712121605 Medication data (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.134-2016-07-12T121605.html Sturen medicatiegegevens]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.134-2016-07-12T121605.html Sending medication data]
 
|style="background-color: white;vertical-align:top;"|MP-MGS
 
|style="background-color: white;vertical-align:top;"|MP-MGS
|style="background-color: white;vertical-align:top;" rowspan="2"|Eén of meer: ma, vv, ta, mve, mtd, mgb
+
|style="background-color: white;vertical-align:top;" rowspan="2"|One or more: ma, vv, ta, mve, mtd, mgb
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen medicatiegegevens
+
|style="background-color: white;vertical-align:top;"|Receiving medication data
 
|style="background-color: white;vertical-align:top;"|MP-MGO
 
|style="background-color: white;vertical-align:top;"|MP-MGO
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.21-2016-07-04T122422.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.146_20161108103441 Medicatieoverzicht (PULL)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.21-2016-07-04T122422.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.146_20161108103441 Medication overview (PULL)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.148-2016-11-08T103441.html Beschikbaarstellen medicatieoverzicht]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.148-2016-11-08T103441.html Making medication overview available]
 
|style="background-color: white;vertical-align:top;"|MP-MOB
 
|style="background-color: white;vertical-align:top;"|MP-MOB
 
|style="background-color: white;vertical-align:top;" rowspan="4"|ma, ta, mgb
 
|style="background-color: white;vertical-align:top;" rowspan="4"|ma, ta, mgb
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.147-2016-11-08T103441.html Raadplegen medicatieoverzicht]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.147-2016-11-08T103441.html Consulting medication overview]
 
|style="background-color: white;vertical-align:top;"|MP-MOR
 
|style="background-color: white;vertical-align:top;"|MP-MOR
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.21-2016-07-04T122422.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.149_20161108104329 Medicatieoverzicht (PUSH)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.21-2016-07-04T122422.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.149_20161108104329 Medication overview (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.150-2016-11-08T104329.html Sturen medicatieoverzicht]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.150-2016-11-08T104329.html Sending medication overview]
 
|style="background-color: white;vertical-align:top;"|MP-MOS
 
|style="background-color: white;vertical-align:top;"|MP-MOS
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen medicatieoverzicht
+
|style="background-color: white;vertical-align:top;"|Receiving medication overview
 
|style="background-color: white;vertical-align:top;"|MP-MOO
 
|style="background-color: white;vertical-align:top;"|MP-MOO
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.10-2015-12-01T103215.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.94_20151201103215 MedicatieVoorschrift (PUSH)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.10-2015-12-01T103215.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.94_20151201103215 Medication prescription (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.95-2015-12-01T103215.html Sturen medicatievoorschrift]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.95-2015-12-01T103215.html Sending medication prescription]
 
|style="background-color: white;vertical-align:top;"|MP-VOS
 
|style="background-color: white;vertical-align:top;"|MP-VOS
|style="background-color: white;vertical-align:top;" rowspan="2"|ma met of zonder vv, lengte, gewicht, nierfunctiewaarde
+
|style="background-color: white;vertical-align:top;" rowspan="2"|ma with or without vv, length, weight, renal function value
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen medicatievoorschrift
+
|style="background-color: white;vertical-align:top;"|Receiving medication prescription
 
|style="background-color: white;vertical-align:top;"|MP-VOO
 
|style="background-color: white;vertical-align:top;"|MP-VOO
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.22-2016-07-12T113914.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.130_20160712113914 MedicatieVoorschrift Afhandeling (PUSH)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.22-2016-07-12T113914.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.130_20160712113914 Medication prescription processing (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.131-2016-07-12T113914.html Sturen afhandeling medicatievoorschrift]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.131-2016-07-12T113914.html Sending data on processing of medication prescription]
 
|style="background-color: white;vertical-align:top;"|MP-VAS
 
|style="background-color: white;vertical-align:top;"|MP-VAS
|style="background-color: white;vertical-align:top;" rowspan="2"|ta met of zonder mve
+
|style="background-color: white;vertical-align:top;" rowspan="2"|ta with or without mve
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen afhandeling medicatievoorschrift
+
|style="background-color: white;vertical-align:top;"|Receiving data on processing of medication prescription
 
|style="background-color: white;vertical-align:top;"|MP-VAO
 
|style="background-color: white;vertical-align:top;"|MP-VAO
 
|-
 
|-
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.26-2016-11-10T135849.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.152_20161110135849 Toediengegevens (PUSH)]
+
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.26-2016-11-10T135849.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.152_20161110135849 Administration data (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.153-2016-11-10T135849.html Sturen toediengegevens]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.153-2016-11-10T135849.html Sending administration data]
 
|style="background-color: white;vertical-align:top;"|MP-TGS
 
|style="background-color: white;vertical-align:top;"|MP-TGS
|style="background-color: white;vertical-align:top;" rowspan="2"|ma en/of ta
+
|style="background-color: white;vertical-align:top;" rowspan="2"|ma and/or ta
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen toediengegevens
+
|style="background-color: white;vertical-align:top;"|Receiving administration data
 
|style="background-color: white;vertical-align:top;"|MP-TGO
 
|style="background-color: white;vertical-align:top;"|MP-TGO
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.23-2016-07-13T092958.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.137_20160713092958 Medicatiegebruik (PUSH)]
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.23-2016-07-13T092958.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.137_20160713092958 Medicatiegebruik (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.138-2016-07-13T092958.html Sturen medicatiegebruik]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.138-2016-07-13T092958.html Sending data on medicatiegebruik]
 
|style="background-color: white;vertical-align:top;"|MP-GBS
 
|style="background-color: white;vertical-align:top;"|MP-GBS
 
|style="background-color: white;vertical-align:top;" rowspan="2"|mgb
 
|style="background-color: white;vertical-align:top;" rowspan="2"|mgb
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen medicatiegebruik
+
|style="background-color: white;vertical-align:top;"|Receiving data on medicatiegebruik
 
|style="background-color: white;vertical-align:top;"|MP-GBO
 
|style="background-color: white;vertical-align:top;"|MP-GBO
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.14-2016-04-13T170607.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.103_20160323165450 Voorstel verstrekkingsverzoek (PUSH)]
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.14-2016-04-13T170607.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.103_20160323165450 Voorstel verstrekkingsverzoek (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.104-2016-03-23T165450.html Sturen voorstel verstrekkingsverzoek]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.104-2016-03-23T165450.html Sending proposed verstrekkingsverzoek]
 
|style="background-color: white;vertical-align:top;"|MP-VVS
 
|style="background-color: white;vertical-align:top;"|MP-VVS
 
|style="background-color: white;vertical-align:top;" rowspan="2"|vvv
 
|style="background-color: white;vertical-align:top;" rowspan="2"|vvv
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen voorstel verstrekkingsverzoek
+
|style="background-color: white;vertical-align:top;"|Receiving proposed verstrekkingsverzoek
 
|style="background-color: white;vertical-align:top;"|MP-VVO
 
|style="background-color: white;vertical-align:top;"|MP-VVO
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.14-2016-04-13T170607.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.157_20180417082037 Antwoord voorstel verstrekkingsverzoek (PUSH)]
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.14-2016-04-13T170607.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.157_20180417082037 Antwoord voorstel verstrekkingsverzoek (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.158-2018-04-17T082037.html Sturen antwoord voorstel verstrekkingsverzoek]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.158-2018-04-17T082037.html Sending reply voorstel verstrekkingsverzoek]
 
|style="background-color: white;vertical-align:top;"|MP-VVO
 
|style="background-color: white;vertical-align:top;"|MP-VVO
 
|style="background-color: white;vertical-align:top;" rowspan="2"|avvv
 
|style="background-color: white;vertical-align:top;" rowspan="2"|avvv
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen antwoord voorstel  
+
|style="background-color: white;vertical-align:top;"|Receiving reply voorstel verstrekkingsverzoek
 
|style="background-color: white;vertical-align:top;"|MP-VVS
 
|style="background-color: white;vertical-align:top;"|MP-VVS
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.14-2016-04-13T170607.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.106_20160413170607 Voorstel medicatieafspraak (PUSH)]
 
|style="background-color: white;vertical-align:top;" rowspan="2"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/sc-2.16.840.1.113883.2.4.3.11.60.20.77.3.14-2016-04-13T170607.html#_2.16.840.1.113883.2.4.3.11.60.20.77.4.106_20160413170607 Voorstel medicatieafspraak (PUSH)]
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.107-2016-04-13T170607.html Sturen voorstel medicatieafspraak]
+
|style="background-color: white;vertical-align:top;"|[http://decor.nictiz.nl/medicatieproces/mp-html-20200122T161947/tr-2.16.840.1.113883.2.4.3.11.60.20.77.4.107-2016-04-13T170607.html Sending voorstel medicatieafspraak]
 
|style="background-color: white;vertical-align:top;"|MP-VMS
 
|style="background-color: white;vertical-align:top;"|MP-VMS
 
|style="background-color: white;vertical-align:top;" rowspan="2"|vma
 
|style="background-color: white;vertical-align:top;" rowspan="2"|vma
 
|-
 
|-
|style="background-color: white;vertical-align:top;"|Ontvangen voorstel medicatieafspraak
+
|style="background-color: white;vertical-align:top;"|Receiving voorstel medicatieafspraak
 
|style="background-color: white;vertical-align:top;"|MP-VMO
 
|style="background-color: white;vertical-align:top;"|MP-VMO
|}<small>Tabel 4 Overzicht transactiegroepen</small>
+
|}<small>Table 4 Overview transaction groups</small>
  
In [[#Medicatieproces|hoofdstuk 2]] zijn per proces alleen de relevante transacties per processtap aangegeven. Daarin zijn de transactiegroepen niet opgenomen. Bovenstaande tabel bevat alle transactiegroepen en transacties.
+
[[#Medication process|Chapter 2]] lists for each process only the relevant transactions per process step. The transaction groups are not included in this. Table 4 includes all transaction groups and transactions.
  
=Functionaliteit=
+
=Functionality=
Dit hoofdstuk beschrijft aanwijzingen voor de functionaliteit van een informatiesysteem.
+
This chapter describes indications for the functionality of an information system.
  
==Filteren van medicatie uit 2e/3e lijn (alle systemen)==
+
==Filtering medication from 2nd/3rd line (all systems)==
Een instelling stelt <u>alle</u> eigen medicatiegegevens (alle bouwstenen) beschikbaar. Deze gegevens zijn voor de ontvangende zorgverleners mogelijk niet allemaal relevant. De ontvangende systemen kunnen een filter opnemen afhankelijk van de behoefte van de betreffende zorgverlener/patiënt. Onderstaande lijst (Tabel 5) bevat typen medicatie waarvan benoemd is dat medicatietoediening <u>tijdens</u> de opname relevant is voor zorgverleners buiten de instelling.
+
An institution makes <u>all</u> its medication data (all building blocks) available. Not all data may be relevant for the receiving healthcare providers. Receiving systems may therefore include a filter depending on the requirements of the specific healthcare provider/patient. The list below (Table 5) includes medication types of which it has been determined that medicatietoediening <u>during</u> admission is relevant for healthcare providers outside the institution.
  
 
{{anchor|tabel 5}}
 
{{anchor|tabel 5}}
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
! style="text-align:left;"| ATC-groepscode
+
! style="text-align:left;"| ATC-code
! style="text-align:left;"| Naam
+
! style="text-align:left;"| Name
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|L01
 
| style="background-color: white;vertical-align:top;"|L01
| style="background-color: white;vertical-align:top;"|Cytostatica
+
| style="background-color: white;vertical-align:top;"|Cytostatics
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| L03AX03  
 
| style="background-color: white;vertical-align:top;"| L03AX03  
| style="background-color: white;vertical-align:top;"|BCG-vaccin urologie
+
| style="background-color: white;vertical-align:top;"|BCG vaccine, urology
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|L04AA23; L04AA25; L04AA26; L04AA33; L04AA34; L04AB; L04AC  
 
| style="background-color: white;vertical-align:top;"|L04AA23; L04AA25; L04AA26; L04AA33; L04AA34; L04AB; L04AC  
| style="background-color: white;vertical-align:top;"|Immunosuppresiva
+
| style="background-color: white;vertical-align:top;"|Immunosuppressive agents
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|B03AC; B03XA; B06AC
 
| style="background-color: white;vertical-align:top;"|B03AC; B03XA; B06AC
| style="background-color: white;vertical-align:top;"| IJzer, epo, middelen tegen angioedeem
+
| style="background-color: white;vertical-align:top;"|Iron, erythropoietin, drugs used in angioedema
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|G03GA; G03GB02
 
| style="background-color: white;vertical-align:top;"|G03GA; G03GB02
| style="background-color: white;vertical-align:top;"|Gonadotropines (HCG etc), clomifeen
+
| style="background-color: white;vertical-align:top;"|Gonadotropins (HCG, etc.), clomiphene
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|H01CA; H01CC; L02AE04  
 
| style="background-color: white;vertical-align:top;"|H01CA; H01CC; L02AE04  
| style="background-color: white;vertical-align:top;"|Gonadoreline, hypothalamus hormonen, triptoreline
+
| style="background-color: white;vertical-align:top;"|Gonadorelin, hypothalamic hormones, triptorelin
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|J06; J07  
 
| style="background-color: white;vertical-align:top;"|J06; J07  
| style="background-color: white;vertical-align:top;"|Immunoglobulines, vaccins
+
| style="background-color: white;vertical-align:top;"|Immunoglobulins, vaccines
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|M03AX01
 
| style="background-color: white;vertical-align:top;"|M03AX01
| style="background-color: white;vertical-align:top;"|Botox
+
| style="background-color: white;vertical-align:top;"|Botulinum toxin
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|R03DX05
 
| style="background-color: white;vertical-align:top;"|R03DX05
Regel 1.883: Regel 1.843:
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"|S01LA04; S01LA05; S01LA  
 
| style="background-color: white;vertical-align:top;"|S01LA04; S01LA05; S01LA  
| style="background-color: white;vertical-align:top;"|Oogheelkundige anti neovasculaire stoffen
+
| style="background-color: white;vertical-align:top;"|OOphthalmological antineovascularisation agents
|}<small>Tabel 5 Typen klinische medicatie relevant voor extramurale zorgverleners</small>
+
|}<small>Table 5 Types of clinical medication relevant for external healthcare providers</small>
 +
 
 +
==Making medication data available (all systems)==
 +
All <u>proprietary</u> medication data may be made available when the patient has given his consent (in accordance with applicable laws and regulations). Data received from third parties copied (health care provider/patient) in one’s own system and marked as ‘copy’, are not made available. The only exception is the transaction Medicatiegegevens (Medication data)  PUSH and PULL and Medication overview PUSH and PULL, in which case third parties’ building blocks are made available on the condition that they include the original identification label (see also [[#Inference rules|paragraph 5.6]]).
  
==Beschikbaarstellen medicatiegegevens (alle systemen)==
+
==Notification date or dispense date (pharmacist information system)==
Alle <u>eigen</u> medicatiegegevens mogen beschikbaargesteld worden wanneer de patiënt daarvoor toestemming heeft gegeven (conform vigerende wet- en regelgeving). Gegevens ontvangen van anderen (zorgverleners/patiënt) die men in het eigen systeem heeft overgenomen en aangemerkt als kopie worden niet beschikbaargesteld. De enige uitzondering is de transactie Medicatieoverzicht PUSH en PULL, daar worden bouwstenen van anderen beschikbaar gesteld mits zij voorzien zijn van de originele identificatie (zie ook [[#paragraaf5.1|paragraaf 5.1]]).
+
The notification date and the actual dispense date may be recorded in the medicatieverstrekking. When a verstrekkingsverzoek is processed immediately and the patient picks up the medication that same day, both dates will be the same. When the patient picks up the medication one or several days later, different dates must be entered. The dispense date is the date on which the medicatieverstrekking has actually taken place. The request date is the time at which a pharmacy records an intended medicatieverstrekking. When medication is dispensed on several occasions as part of the same verstrekkingsverzoek (for example, when prescriptions are split), each medicatieverstrekking has its own request date. When an automated dispense system is being used, the dispense date is the time at which the patient picks up the medication from the system. Until this time is available in the PIS, the time at which the medication is deposited in the automated dispense system may be used. See also [[#Request and dispense|paragraph 4.2.5]].
  
==Aanschrijfdatum of verstrekkingsdatum (apotheekinformatiesysteem)==
+
==Updating after system malfunction==
In de medicatieverstrekking kan zowel de aanschrijfdatum als de daadwerkelijke datum van uitgifte worden vastgelegd. Wanneer een verstrekkingsverzoek direct verwerkt wordt en de patiënt komt het nog dezelfde dag ophalen zijn beide datums gelijk. Wanneer de patiënt de medicatie één of meerdere dagen later komt ophalen dan moeten deze datums verschillend worden ingevuld. De verstrekkingsdatum is de datum dat de daadwerkelijke medicatie-uitgifte heeft plaats gevonden. De aanschrijfdatum is het tijdstip waarop een apotheker een voorgenomen uitgifte vastlegt. Wanneer er meerdere verstrekkingen worden gedaan onder hetzelfde verstrekkingsverzoek (bijv. bij knippen recept) dan heeft elke verstrekking een eigen aanschrijfdatum.
+
After a system malfunction, the prescriber’s system needs to determine whether changes have been made to medicatieafspraken. For use cases and rationale, see [[#Discontinuation of medication by third parties|paragraph 4.1.26]] and [[#Two PRKs in a single medicamenteuze behandeling|paragraph 4.1.27]].
Wanneer er gewerkt wordt met een uitgifte-automaat is de verstrekkingsdatum het tijdstip waarop de patient de medicatie uit de automaat haalt. Wanneer dit tijdstip niet beschikbaar is in het AIS mag tot die tijd ook het tijdstip worden gebruikt waarop de medicatie in de uitgifte-automaat wordt gelegd. Zie ook [[#Aanschrijven, verstrekken en niet afhalen| paragraaf 4.2.5 Aanschrijven, verstrekken en niet afhalen]].
 
  
==Bijwerken na systeemstoring==
+
==Construction for ‘once every 36 hours’ interval==
Na systeemuitval moet het systeem van de voorschrijver controleren of er wijzigingen zijn doorgevoerd in medicatieafspraken. Zie voor use cases en onderbouwing [[#Staken van medicatie door derden|paragraaf 4.1.26]] en [[#Twee PRK's onder één medicamenteuze behandeling|paragraaf 4.1.27]].
+
When the dosing instruction reads ‘1 tablet every 36 hours’, this may normally be recorded in one medicatieafspraak (dose: 1 tablet, interval: 36 hours). However, when a system does not go beyond an interval of, for example, 24 hours, another solution needs to be found.
  
==Constructie voor interval eenmaal per 36 uur==
+
''Variation 1:''
Wanneer de doseerinstructie luidt 1 tablet per 36uur kan dit normaliter in één medicatieafspraak worden weergegeven (keerdosis: 1 tablet, interval: 36uur). Maar wanneer een systeem niet verder gaat dan een interval van bijvoorbeeld 24 uur dan is er een andere oplossing nodig. <br />
+
Making use of an ‘as needed’ instruction with the criterion: ‘36 hours have passed since the last medicatietoediening’. This does however come with a certain amount of freedom that may not be desirable.
  
''Variant 1:''
+
''Variation 2:''
Gebruik maken van een Zo nodig instructie waarbij het criterium is: ‘er is 36 uur verstreken sinds de laatste medicatietoediening’. Maar dit levert een bepaalde mate van vrijblijvendheid die mogelijk niet gewenst is.
+
A repeating dosing schedule can be created, with alternation between administration in the morning, administration in the evening and a day without medicatietoediening:
 +
Repeat period: 3 days
 +
Dosage instruction
 +
  Sequence number: 1
 +
  Dosage duration: 1 day
 +
  Dosage
 +
    Dose per administration: 1 tablet
 +
    Administration time: 9 am (per example, this could also be a part of the day)
 +
  Sequence number: 2
 +
  Dosage duration: 1 day
 +
  Dosage
 +
  Dose per administration: 1 tablet
 +
  Administration time: 9 pm (per example, this could also be a part of the day)
  
''Variant 2:''
+
If it is not technically possible to choose a 36 hours interval, variation 2 applies.
Er kan ook een repeterend schema worden gemaakt waarbij gewisseld wordt tussen ochtend en avond en een dag niet:
 
Herhaalperiode: 3 dagen
 
Doseerinstructie
 
  Volgnummer: 1
 
  Doseerduur: 1 dag
 
  Dosering
 
    Keerdosis: 1 stuks
 
    Toedientijd: 9uur (bijvoorbeeld, kan ook een dagdeel zijn)
 
  Volgnummer: 2
 
  Doseerduur: 1 dag
 
  Dosering
 
  Keerdosis: 1 stuks
 
  Toedientijd: 21uur (bijvoorbeeld, kan ook een dagdeel zijn)
 
  
Wanneer het systeemtechnische niet mogelijk is om een interval van 36uur te kiezen wordt variant 2 toegepast.
+
==EVS / HIS processing Regulation processing==
 +
The prescribing system is informed by the pharmacist of all dispensings and changes in toedieningsafspraken through the transaction Afhandeling voorschrift (settlement prescription). This handling must be automatically processed in the prescribing system. The prescriber only assesses the toedieningsafspraken and does not have to assess all the dispensings (verstrekkingen).
  
==EVS/HIS verwerken Afhandeling voorschrift==
+
==Examples dosages==
Het voorschrijvende systeem wordt door de apotheker geïnformeerd over alle verstrekkingen en wijzigingen in toedieningsafspraken middels de transactie Afhandeling voorschrift. Deze afhandeling moet automatisch verwerkt worden in het voorschrijvende systeem. De voorschrijver beoordeelt alleen de toedieningsafspraken en hoeft niet alle verstrekkingen te beoordelen.
+
See [[mp:V9.1 Voorbeelden doseringen|examples dosages 9.1.0]] (both functional and technical effect in HL7v3 CDA and in FHIR)
==Voorbeelden doseringen==
 
Zie [[mp:V9.1 Voorbeelden doseringen|Voorbeelden doseringen 9.1.0 (zowel functioneel als technische uitwerking in HL7v3 CDA én in FHIR)]]
 
  
==Medicatiegebruik: gebruikindicator, volgens afspraak indicator, stoptype, gebruiksperiode en doseerinstructie==
+
==Medicatiegebruik: use indicator, according to agreement indicator, stop type, period of use and dosing instructions==
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
|style="text-align:center;" |Situatie || 1. Medicatie is/wordt in gebruiksperiode gebruikt volgens afspraak|| 2. Medicatie is/wordt in gebruiksperiode gebruikt maar niet volgens afspraak || 3. In tegenstelling tot de afspraak is/wordt in gebruiksperiode de medicatie niet gebruikt || 4. Medicatie is/wordt in de gebruiksperiode niet gebruikt en dat is ook volgens afspraak || 5. Medicatie is/wordt in de gebruiksperiode gebruikt maar onbekend of dit volgens afspraak is of er is geen afspraak (zelfzorgmedicatie)
+
|style="text-align:center;" |Situation || 1. Medication is/will be used during period of use according to agreement|| 2. Medication is/will be used during period of use, but not according to agreement || 3. Contrary to agreement, medication is/will not be used during period of use || 4. Medication is/will not be used during period of use, which is according to agreement || 5.Medication is used during period of use but it is unknown if this is according to agreement (selfmedication)
 
|-
 
|-
! Gebruikindicator<br> ''(wordt dit product gebruikt)'' !! Ja !! Ja !! Nee !! Nee !! Ja
+
! Use indicator (is this product being used) <br> !! Yes!! Yes !! No !! N/A (because this would lead to a double negative otherwise) !! Yes
 
|-
 
|-
! Volgens afspraak indicator!! Ja !! Nee !! Nee !! Ja !! -  
+
! According to agreement indicator !! No!! No !! No!! Yes!! -  
 
|-
 
|-
! Stoptype!! Nvt !! Nvt!! Definitief of Tijdelijk !! Definitief of Tijdelijk !! Nvt
+
! Stoptype!! N/A!! N/A!! Discontinuation or Stop  !! Definitve of Temporary !! N/A
 
|-
 
|-
| || || || Stoptype afhankelijk of er gestaakt of onderbroken wordt || Stoptype conform de stop-afspraak ||
+
| || || || Stoptype depends if agreement is being stoped or dicontinued || Stoptype in acoordance with stop-agreement ||
 
|-
 
|-
! Gebruiksperiode!! Conform ma of ta !!  Max. 2 van de 3 !! Max. 2 van de 3 !! Max. 2 van de 3 !! Max. 2 van de 3
+
! Period of use!! In accordance with ma or ta !!  Max. 2 out of 3 !! Max. 2 out of 3 !! Max. 2 out of 3 !! Max. 2 out of 3
 
|-
 
|-
|style="text-align:right;" | ingangsdatum || Het tijdstip waarop het gebruik is gestart. || Het tijdstip waarop het afwijkende gebruik is/wordt gestart. || Het tijdstip vanaf wanneer gestaakt of onderbroken wordt.|| Het tijdstip vanaf wanneer gestaakt of onderbroken wordt. || Het tijdstip waarop het gebruik is gestart.  
+
|style="text-align:right;" | start date || The time at which the use was started. ||The time at which the deviating use was/will be started. . || Contrary to agreement, medication is/will not be used during period of use || The time at which the use was/will be discontinued. || The time at which the use was started.  
 
|-
 
|-
|style="text-align:right;" | gebruiksduur || De beoogde gebruiksduur. || De beoogde duur van het afwijkende gebruik. || De (beoogde) duur van het onderbreken. (nvt. voor staken)|| De (beoogde) duur van het onderbreken. (nvt. voor staken)|| De beoogde gebruiksduur.
+
|style="text-align:right;" | duration of use|| The intended duration of use. || The intended duration of deviating use. || The (intended) duration of non-use||The (intended) duration of non-use. || The intended duration of use.
 
|-
 
|-
|style="text-align:right;" | einddatum || Het tijdstip waarop de gebruiksperiode eindigt (of geëindigd is of zal eindigen). || Het tijdstip waarop het afwijkende gebruik eindigt (of geëindigd is of zal eindigen). || Het tijdstip waarop het onderbreken eindigt en gebruik is/wordt herstart (of beoogd wordt te herstarten). (nvt. voor staken)|| Het tijdstip waarop het onderbreken eindigt en gebruik is/wordt herstart (of beoogd wordt te herstarten). (nvt. voor staken) || Het tijdstip waarop de gebruiksperiode eindigt (of geëindigd is of zal eindigen).
+
|style="text-align:right;" | end date  || The time at which the period of use ends (or has ended or will end). || The time at which the period of deviating use ends (or has ended or will end). || The time at which the use was/will be resumed (or is intended to resume).|| The time at which the use was/will be resumed (or is intended to resume). || The time at which the period of use ends (or has ended or will end).
 
|-
 
|-
! Doseerinstructie!! Conform ma of ta!! Verplicht!! Nvt !! Nvt !! Verplicht
+
! Dosing instructions!! In accordance with ma or ta!! Required!! N/A !! N/A!! Required
 
|-
 
|-
| || Medicatie is/wordt in gebruiksperiode gebruikt volgens afspraak  || Medicatie is/wordt in gebruiksperiode niet gebruikt volgens afspraak, daadwerkelijk gebruikte dosering moet doorgegeven worden. || De medicatie is/wordt niet gebruikt, er is geen dosering. || De medicatie is/wordt niet gebruikt, er is geen dosering.|| Dosering die patiënt met zichzelf heeft afgesproken.
+
| || Medication was/will be used during the period of use according to the agreement, therefore dosage is known.  || Medication was/will not be used according to the agreement, the actual dosage used must be communicated. || The medication was/will not be used, there is no dosage. || The medication was/will not be used, there is no dosage. || Dosage tha the patient has agreed upon himself
 
|}
 
|}
'''VOORBEELDEN:'''<br>
+
'''Examples:'''<br>
'''Situatie 1: Medicatie is/wordt in gebruiksperiode gebruikt volgens afspraak'''<br>
+
'''Situation 1a: Medication is / is used during the period of use according to agreement'''<br>
Patiënt heeft Ferrofumaraat voorgeschreven gekregen tegen bloedarmoede. Dosering is 3x daags 1 tablet een half uur voor het eten innemen, met als startdatum 4 juni 2018 en zonder einddatum.<br>
+
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half a hour before eating, with a start date of June 4, 2018 and no end date.<br>
Op 10 juni registreert de patiënt het medicatiegebruik over de afgelopen periode (van 4 t/m 10 juni).<br>
+
On 10 June, the patient registers the medication use for the past period (from 4 to 10 June).<br>
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Situatie 1 !!  
+
! Situation 1a !!  
 
|-
 
|-
| Geneesmiddel || FERROFUMARAAT 100MG TABLET
+
| Medication || FERROFUMARATE 100MG TABLET
 
|-
 
|-
| Gebruiksindicator || Ja
+
| Use indicator || Yes
 
|-
 
|-
| Volgens afspraak indicator || Ja
+
| According to indicator agreement || Yes
 
|-
 
|-
| Stoptype || nvt
+
| Stoptype || Not applicable
 
|-
 
|-
| Ingangsdatum || 4 juni 2018
+
| Start date|| 4 June 2018
 
|-
 
|-
| Einddatum || 10 juni 2018
+
| End date || 10 June 2018
 
|-
 
|-
| Doseerinstructie || ''Overeenkomstig de afspraak''
+
| Dosing instruction || ''According agreement''
 
|}
 
|}
  
'''Situatie 1: Medicatie is/wordt in gebruiksperiode gebruikt volgens afspraak'''<br>
+
'''Situation 1b: Medication is / is used during the period of use according to agreement'''<br>
Patiënt heeft Ferrofumaraat voorgeschreven gekregen tegen bloedarmoede. Dosering is 3x daags 1 tablet een half uur voor het eten innemen, met als startdatum 4 juni 2018 en zonder einddatum.<br>
+
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018 and no end date.<br>
Op 10 juni registreert de patiënt het medicatiegebruik en het voornemen om deze medicatie te blijven gebruiken volgens de afspraak.<br>
+
On 10 June, the patient registers the medication use for the past period (from 4 to 10 June).
 +
<br>
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Situatie 1 !!  
+
! Situation 1b !!  
 
|-
 
|-
| Geneesmiddel || FERROFUMARAAT 100MG TABLET
+
| Medication || FERROFUMARATE 100MG TABLET
 
|-
 
|-
| Gebruiksindicator || Ja
+
| Use indicator || Yes
 
|-
 
|-
| Volgens afspraak indicator || Ja
+
| According to indicator agreement || Yes
 
|-
 
|-
| Stoptype || nvt
+
| Stoptype || Not applicable
 
|-
 
|-
| Ingangsdatum || 4 juni 2018
+
| Start date|| 4 June 2018
 
|-
 
|-
| Einddatum || -
+
| End date || -
 
|-
 
|-
| Doseerinstructie || ''Overeenkomstig de afspraak''
+
| Dosing instruction || ''According agreement''
 
|}
 
|}
  
'''Situatie 2: Medicatie is/wordt in gebruiksperiode gebruikt maar niet volgens afspraak'''<br>
+
'''Situation 2: Medication is / is used during the period of use, but not by agreement'''<br>
Patiënt heeft Ferrofumaraat voorgeschreven gekregen tegen bloedarmoede. Dosering is 3x daags 1 tablet een half uur voor het eten innemen, met als startdatum 4 juni 2018 en zonder einddatum.<br>
+
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018 and no end date.<br>
De patiënt is overdag veel op pad en vergeet een werkweek lang om telkens de medicijnen voor de lunch in te nemen. Wel worden de tabletten 's ochtends en 's avonds voor het eten ingenomen<br>
+
The patient is on the road a lot during the day and forgets for a week to take the medicines for lunch. However, the tablets are taken in the morning and evening before eating.<br>
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Situatie 2 !!  
+
! Situation 2 !!  
 
|-
 
|-
| Geneesmiddel || FERROFUMARAAT 100MG TABLET
+
| Medication || FERROFUMARATE 100MG TABLET
 
|-
 
|-
| Gebruiksindicator || Ja
+
| Use indicator || Yes
 
|-
 
|-
| Volgens afspraak indicator || Nee
+
| According to indicator agreement || No
 
|-
 
|-
| Stoptype || nvt
+
| Stoptype || Not applicable
 
|-
 
|-
| Ingangsdatum || 11 juni
+
| Start date|| 11 June
 
|-
 
|-
| Einddatum || 15 juni
+
| End date || 15 June
 
|-
 
|-
| Doseerinstructie || 2x daags 1 tablet
+
| Dosing instruction || 1 tablet 2 times a day
 
|}
 
|}
'''Situatie 3: In tegenstelling tot de afspraak is/wordt in gebruiksperiode de medicatie niet gebruikt'''<br>
+
'''Situation 3: Contrary to the agreement, the medication is / is not used during the period of use'''<br>
Patiënt heeft Ferrofumaraat voorgeschreven gekregen tegen bloedarmoede. Dosering is 3x daags 1 tablet een half uur voor het eten innemen, met als startdatum 4 juni 2018 en zonder einddatum.<br>
+
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018 and no end date.<br>
De patiënt gaat een lang weekend op vakantie en komt er te laat achter dat de medicatie niet ingepakt is. De komende paar dagen zal de patiënt de tabletten niet nemen en ze  wil dit registreren.<br>
+
The patient goes on vacation for a long weekend and finds out too late that the medication is not packed. The patient will not take the tablets for the next few days and wants to record it.<br>
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Situatie 3 !!  
+
! Situation 3 !!  
 
|-
 
|-
| Geneesmiddel || FERROFUMARAAT 100MG TABLET
+
| Medication || FERROFUMARATE 100MG TABLET
 
|-
 
|-
| Gebruiksindicator || Nee
+
| Use indicator || No
 
|-
 
|-
| Volgens afspraak indicator || Nee
+
| According to indicator agreement || No
 
|-
 
|-
| Stoptype || Tijdelijk
+
| Stoptype || Temporary
 
|-
 
|-
| Ingangsdatum || 20 juli
+
| Start date|| 20 July
 
|-
 
|-
| Einddatum || 23 juli
+
| End date || 23 July
 
|-
 
|-
| Doseerinstructie || nvt
+
| Dosing instruction || Not applicable
 
|}
 
|}
'''Situatie 4: Medicatie is/wordt in de gebruiksperiode niet gebruikt en dat is ook volgens afspraak'''<br>
+
'''Situation 4: Medication is / is not used during the period of use and that is also by agreement'''<br>
Patiënt heeft Ferrofumaraat voorgeschreven gekregen tegen bloedarmoede. Dosering is 3x daags 1 tablet een half uur voor het eten innemen, met als startdatum 4 juni 2018.<br>
+
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018.<br>
Op 12 augustus blijkt na controle dat er geen sprake meer is van bloedarmoede en de arts stopt de medicatie. De patiënt wil registreren dat ze gestopt is met de medicatie en registreert dit zelf op 15 augustus.<br>
+
On August 12, it turns out after checking that there is no longer anemia and the doctor stops the medication. The patient wants to register that she has stopped taking the medication and registers this herself on August 15.<br>
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Situatie 4 !!  
+
! Situation 4 !!  
 
|-
 
|-
| Geneesmiddel || FERROFUMARAAT 100MG TABLET
+
| Medication || FERROFUMARATE 100MG TABLET
 
|-
 
|-
| Gebruiksindicator || Nee
+
| Use indicator || No
 
|-
 
|-
| Volgens afspraak indicator || Ja
+
| According to indicator agreement || Yes
 
|-
 
|-
| Stoptype || Definitief
+
| Stoptype || Definite
 
|-
 
|-
| Ingangsdatum || 12 augustus 2018
+
| Start date|| 12 August 2018
 
|-
 
|-
| Einddatum || -
+
| End date || -
 
|-
 
|-
| Doseerinstructie || nvt
+
| Dosing instruction || Not applicable
 
|}
 
|}
'''Situatie 5: Medicatie is/wordt in de gebruiksperiode gebruikt maar onbekend of dit volgens afspraak is of er is geen afspraak (zelfzorgmedicatie)'''<br>
+
'''Situation 5: Medication is used during the period of use, but it is unknown whether this is by appointment or there is no appointment (self-care medication)'''<br>
Patiënt heeft de griep en hij neemt tegen de koorts en pijn paracetamol 500 mg van de plaatselijke drogist. Hij neemt inmiddels al vier dagen 4 tot 6 tabletten per dag en denkt dit nog drie dagen te zullen doen. Hij registreert dit op 12 augustus als medicatiegebruik.<br>
+
Patient has the flu and he takes paracetamol 500 mg from the local drug store for fever and pain. He has been taking 4 to 6 tablets a day for four days and expects to do this for another three days. He registers this on August 12 as medication use.<br>
 
{| class="wikitable"
 
{| class="wikitable"
 
|-
 
|-
! Situatie 5 !!  
+
! Situation 5 !!  
 
|-
 
|-
| Geneesmiddel || Paracetamol 500mg
+
| Medication || Paracetemol 500mg
 
|-
 
|-
| Gebruiksindicator || Ja
+
| Use indicator || Yes
 
|-
 
|-
| Volgens afspraak indicator || -
+
| According to indicator agreement || -
 
|-
 
|-
| Stoptype || nvt
+
| Stoptype || Not applicable
 
|-
 
|-
| Ingangsdatum || 9 augustus 2018
+
| Start date|| 9 August 2018
 
|-
 
|-
| Duur || 7 dagen
+
| End date || 7 days
 
|-
 
|-
| Doseerinstructie || 4 tot 6 tabletten per dag
+
| Dosing instruction || 4 to 6 tablets a day
 
|}
 
|}
  
==Implementatie geïndividualiseerde distributievorm (GDV)-velden==
+
==Implementation of individualized distribution form (GDV) fields==
 +
 
 +
===Background===
 +
More and more patients are receiving their medication through Individualized Distribution Forms (In dutch geindividualiseerde distributie vorm), with the pharmacist providing patients overview and organization of their drugs by preparing them in separate compartment units. This form of delivery took off when the Medicines Act in 2007 stipulated that in healthcare institutions without a pharmacy, the medication should be individually registered for the patients.
 +
 
 +
It is important for healthcare providers to know whether a patient is using GDV. In 2018, an analysis was conducted (under the direction of Z-Index, with healthcare providers) of the bottlenecks and wishes regarding the recording of a patient using GDV. Overall, it has emerged that it is desirable to be able to see whether a patient is using GDV at both the medication level and the patient level. For details see next paragraph.
 +
 
 +
The directions below provide guidance on how the Medication Process can support these needs.
  
===Achtergrond===
+
===Wishes of care providers===
Steeds meer patiënten ontvangen hun medicatie via geïndividualiseerde distributievormen (GDV), waarbij de apotheker overzicht en ordening voor de patiënt aanbrengt in diens geneesmiddelen door deze gereed te maken in afzonderlijke compartimenteenheden. Deze aflevervorm heeft met name een vlucht genomen toen de Geneesmiddelenwet in 2007 bepaalde dat in zorginstellingen zonder apotheek de medicatie voor de patiënten op naam gesteld dient te zijn.
+
In 2018, an inventory was made with the user councils of Z-Index about the wishes regarding the recording and exchange of GDV. Below is an overview of these wishes.<br>
  
Voor zorgverleners is het van belang om te weten of een patiënt een gebruikmaakt van GDV. In 2018 is geanalyseerd (onder regie van Z-Index, met zorgverleners) wat de knelpunten en wensen zijn rondom het vastleggen dat een patiënt gebruikmaakt van GDV. Daaruit is globaal naar voren gekomen dat het wenselijk is om zowel op medicatieniveau als op patiëntniveau te kunnen zien of een patiënt gebruik maakt van GDV. Voor de details zie volgende paragraaf.
+
'''Who'''
 +
*All healthcare parties (from prescriber to operator)
 +
'''What'''
 +
*Determines which pharmacy delivers
 +
*Pharmacy must know whether the change applies to the current roll or not
 +
*Important for stopping previous medication at the start of GDV
 +
*Evaluation of GDV patients for health insurer
 +
*Other logistics processes towards home care / informal care
  
Onderstaande aanwijzingen geven een handreiking hoe het Medicatieproces deze wensen kan ondersteunen.
+
'''Why'''
 +
*Determines which pharmacy delivers
 +
*Pharmacy must know whether the change applies to the current roll or not
 +
*Important for stopping previous medication at the start of GDV
 +
*Evaluation of GDV patients for health insurer
 +
*Other logistics processes towards home care / informal care
  
===Wensen zorgverleners===
+
'''When'''
In 2018 is met de gebruikersraden van Z-Index geïnventariseerd wat de wensen rondom het vastleggen en uitwisselen van GDV is. Hieronder het overzicht van deze wensen.<br>
+
*When starting medication, in a pharmacy already before notification of prescription
 +
*When transferring 1st / 2nd line
 +
*When changing (incl. Stopping) medication
 +
*When changing ICA data
  
'''Wie'''
+
'''Where'''
*Alle zorgpartijen (van voorschrijver t/m toediener)
+
*When working in the patient's file, it should be clear that this characteristic applies to the patient concerned. This can be different for each type of care provider (patient file, medication file). The wish of public pharmacists is that they always have this characteristic available for a specific patient.
'''Wat'''
+
*On medication overview
*Vastleggen/uitwisselen dat iemand gebruik maakt van GDV
 
*Vastleggen waaróm iemand GDV patiënt is
 
*Vastleggen/uitwisselen bij medicatie dat dit in de GDV moet
 
*Vastleggen/uitwisselen wat de duur van een rol is
 
*Uitwisselen of wijziging per direct is of bij volgende rolwissel
 
'''Waarom'''
 
*Bepaalt welke apotheek aflevert
 
*Apotheek moet weten of wijziging voor lopende rol geldt of niet
 
*Van belang voor stoppen van eerdere medicatie bij starten van GDV
 
*Evaluatie van GDV-patiënten voor zorgverzekeraar
 
*Overige logistieke processen richting thuiszorg/mantelzorg
 
'''Wanneer'''
 
*Bij starten van medicatie, in apotheek al voor aanschrijven recept
 
*Bij overdracht 1e/2e lijn
 
*Bij wijzigen (incl. stoppen) van medicatie
 
*Bij wijzigen ICA-gegevens
 
'''Waar'''
 
*Bij het werken in het dossier van de patiënt dient inzichtelijk te zijn dat dit kenmerk bij betreffende patiënt van toepassing is. Per soort zorgverlener kan dit een verschillende plaats zijn (patiëntendossier, medicatiedossier). De wens van openbaar apothekers is dat ze dit kenmerk altijd bij de patiënt inzichtelijk hebben.
 
*Op medicatieoverzicht
 
  
===Data-elementen Medicatieproces===
+
===Data elements Medication process===
De bouwstenen voor het Medicatieproces kennen de volgende velden die een rol spelen bij het vastleggen van GDV.<br>
+
The building blocks for the Medication Process have the following fields that play a role in recording GDV.<br>
  
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
! style="text-align:left;"| '''Bouwsteen'''
+
! style="text-align:left;"| '''Buildingblock '''
 
! style="text-align:left;"| '''Data-element nr'''
 
! style="text-align:left;"| '''Data-element nr'''
! style="text-align:left;"| '''Omschrijving'''
+
! style="text-align:left;"| '''Description'''
! style="text-align:left;"| '''Soort inhoud'''
+
! style="text-align:left;"| '''Type of content '''
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"| Medicatieafspraak
 
|style="background-color: white;vertical-align:top;"| Medicatieafspraak
 
|style="background-color: white;vertical-align:top;"|23283
 
|style="background-color: white;vertical-align:top;"|23283
|style="background-color: white;vertical-align:top;"|Aanvullende informatie
+
|style="background-color: white;vertical-align:top;"|Additional information
|style="background-color: white;vertical-align:top;"|Aanvullende informatie bevat een lijst van bijzonderheden over de gemaakte afspraak die van belang zijn voor de medicatiebewaking en invulling door de apotheker.
+
|style="background-color: white;vertical-align:top;"|Additional information contains a list of details of the medicatieafsrpaak that are important for pharmacovigilance monitoring and completion by a pharmacist.
Bijvoorbeeld: ‘wijziging in GDS per direct’.
+
 
 +
For example: "change in GDS immediately"..
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"| Verstrekkingsverzoek
 
|style="background-color: white;vertical-align:top;"| Verstrekkingsverzoek
 
|style="background-color: white;vertical-align:top;"|22759
 
|style="background-color: white;vertical-align:top;"|22759
|style="background-color: white;vertical-align:top;"|Aanvullende wensen
+
|style="background-color: white;vertical-align:top;"|Supplementary wishes
|style="background-color: white;vertical-align:top;"|Logistieke aanwijzingen van belang voor de invulling van het verstrekkingsverzoek door de apotheker. Bijvoorbeeld: ‘niet opnemen in GDS’
+
|style="background-color: white;vertical-align:top;"|Logistical instructions important for the completion of the dispensing request by the pharmacist.
 +
 
 +
For example: "do not include in GDS"
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;" rowspan="4"| Verstrekking
 
|style="background-color: white;vertical-align:top;" rowspan="4"| Verstrekking
 
|style="background-color: white;vertical-align:top;"|20927
 
|style="background-color: white;vertical-align:top;"|20927
|style="background-color: white;vertical-align:top;"|Distributievorm
+
|style="background-color: white;vertical-align:top;"|Distribution form
|style="background-color: white;vertical-align:top;"|Distributievorm.
+
|style="background-color: white;vertical-align:top;"|Distribution form.
Bijvoorbeeld: GDS  
+
 
 +
For example: GDS
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|20924
 
|style="background-color: white;vertical-align:top;"|20924
|style="background-color: white;vertical-align:top;"|Verbruiksduur
+
|style="background-color: white;vertical-align:top;"|Consumption period
|style="background-color: white;vertical-align:top;"|Voorraad voor deze duur
+
|style="background-color: white;vertical-align:top;"|Stock for this duration
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|22500
 
|style="background-color: white;vertical-align:top;"|22500
|style="background-color: white;vertical-align:top;"|Aanschrijfdatum
+
|style="background-color: white;vertical-align:top;"|Registration date
|style="background-color: white;vertical-align:top;"|De aanschrijfdatum is het tijdstip waarop een apotheker een voorgenomen uitgifte vastlegt
+
|style="background-color: white;vertical-align:top;"|The registration date is the time when a pharmacist records an intended dispensing
 
|-
 
|-
 
|style="background-color: white;vertical-align:top;"|20272
 
|style="background-color: white;vertical-align:top;"|20272
|style="background-color: white;vertical-align:top;"|Datum
+
|style="background-color: white;vertical-align:top;"|Date
|style="background-color: white;vertical-align:top;"|Het tijdstip van uitgifte. De datumtijd waarop het geneesmiddel ter hand gesteld wordt
+
|style="background-color: white;vertical-align:top;"|The time of the dispensing. The date when the medicine is made available to the patient
 
|}
 
|}
  
===Toepassing data-elementen ter ondersteuning gewenste functionaliteit voor GDV-patiënten===
+
===Application of data elements to support desired functionality for GDV patients===
====Vastleggen dát iemand gebruik maakt van GDV====
+
====Recording that someone uses GDV====
Bij het werken in het dossier van de patiënt is het van belang om te zien dat iemand gebruik maakt van GDV. Dat geldt zowel voor de apotheek die de GDV levert, als andere zorgverleners van de patiënt. Daarom is het van belang dat dit gegeven kan worden gecommuniceerd naar en getoond aan andere zorgverleners.<br>
+
When working in the patient's file it is important to see that someone is using GDV. This applies to the pharmacy that supplies the GDV, as well as other care providers of the patient. It is therefore important that this information can be communicated with and shown to other healthcare providers.
Zolang er nog geen patiëntkenmerk is waarmee GDV vastgelegd kan worden, kan ervoor gekozen worden dit gegeven af te leiden uit de GDV-gegevens die bij de medicatie zijn vastgelegd.
 
Een mogelijk handvat hiervoor is het feit dat medicatie in de distributiemodule is opgenomen tezamen met het veld Distributievorm in de verstrekking.
 
*Stap 1: indien medicatie in de distributiemodule is opgenomen: vul het veld Distributievorm in de verstrekking met ‘GDS’.
 
*Stap 2: op basis van het veld Distributievorm afleiden dat een patiënt gebruikmaakt van GDV. Het feit dat een patiënt enige verstrekking heeft waarbij het veld Distributievorm met ‘GDS’ is gevuld, geeft aan dat de patiënt gebruik maakt van GDV. Deze verstrekking kan een eigen verstrekking zijn, of een verstrekking ontvangen van een andere apotheek (voor zover deze gegevens worden binnengehaald en zodanig worden vastgelegd dat de inhoud van het veld Distributievorm herbruikbaar is). Het gegeven dat een patiënt gebruikmaakt van GDV, kan vervolgens getoond worden bij het werken in het medicatiedossier c.q. het patiëntendossier. In overleg met eindgebruikers dient nader bepaald te worden waar en hoe dit getoond wordt.
 
 
 
====Vastleggen waaróm iemand gebruik maakt van GDV====
 
Gebruikers hebben aangegeven dat het wenselijk is om te kunnen vastleggen waarom iemand gebruik maakt van GDV. Op dit moment zijn hier geen structurele velden voor beschikbaar.
 
  
====Bij medicatie vastleggen dat dit in de GDV moet====
+
As long as there is no patient characteristic with which GDV can be registered, it can be decided to derive this information from the GDV data that have been recorded with the medication. A possible handle for this is the fact that medication is included in the distribution module together with the Distribution form field in the verstrekking (dispensing).
Voorschrijvers willen kunnen aangeven of een middel al dan niet via GDV verstrekt dient te worden. Dit kan als volgt:
+
*Step 1: if medication is included in the distribution module: fill in the Distribution form field in the verstrekking with 'GDS'.
*Verstrekkingsverzoek, veld Aanvullende wensen. De codelijst voor dit veld bevat het item ‘niet in GDS’. Deze codelijst is thesaurus 2051 van bestand 902 in de G-Standaard.
+
*Step 2: Based on the Distribution form field, deduce that a patient is using GDV. The fact that a patient has a dispensing (vertrekking) where the Distribution form field is filled with "GDS" indicates that the patient is using GDV. This dispensing can be a private dipsenisn, or it can be dispensed from another pharmacy (insofar as this data is collected and recorded in such a way that the contents of the Distribution form field are reusable). The fact that a patient uses GDV can then be shown when working in the medication file or the patient file. In consultation with end users, it should be further determined where and how this is shown.
  
====Vastleggen/uitwisselen wat de duur van een medicatierol is====
+
====Recording why someone uses GDV====
De duur van de medicatierol kan worden bepaald op basis van de ‘verbruiksduur’ van de verstrekking: de ‘verbruiksduur’ geeft aan wat de loopduur van een medicatierol is.
+
Users have indicated that it is desirable to be able to record why someone uses GDV. There are currently no structural fields available for this.
  
====Vastleggen/uitwisselen of een wijziging in de medicatie per direct moet of niet====
+
====Record for medication that this must be in the GDV====
Het is wenselijk dat een voorschrijver kan aangeven of wijzigingen in de medicatie per direct doorgevoerd moeten worden of dat deze kunnen wachten tot de volgende rolwissel. De handvatten hiervoor zijn als volgt:
+
Prescribers want to be able to indicate whether or not a medicine should be provided via GDV. This can be done as follows:
*Medicatieafspraak, veld Aanvullende informatie. De codelijst voor dit veld bevat twee items die betrekking hebben op wijzigingen in de GDV, namelijk ‘Wijziging in GDS per direct’ en ‘Wijziging in GDS per rolwissel’. Deze codelijst is thesaurus 2050 van bestand 902 in de G-Standaard.
+
*Verstrekkingsverzoek, Additional wishes (aanvullende wensen) field. The code list for this field contains the item "not in GDS". This code list is thesaurus 2051 from file 902 in the G-Standard.
*Daarbij is het van belang dat de voorschrijver inzicht heeft in de duur van de rol en hoe lang het nog duurt voordat de huidige medicatierol op is. Dit is te herleiden uit:
 
**De verstrekking, veld Verbruiksduur, zie hierboven. Hiervoor dient het voorschrijfsysteem wel de beschikking te hebben over de verstrekkingsgegevens van eerdere verstrekkingen.
 
**Verstrekking, veld Aanschrijfdatum of Datum (of als niet dit veld gevuld is maar het veld Aanschrijfdatum, dan het veld Aanschrijfdatum; als beide zijn gevuld heeft Datum de voorkeur). Op basis van deze datum en de verbruiksduur, kan berekend worden per welke datum de huidige medicatierol is verbruikt.
 
  
=Beschouwingen=
+
====Establishing / exchanging the duration of a medication roll====
==Ongeadresseerd voorschrijven (ambulant)==
+
The duration of the medication roll can be determined on the basis of the "duration of use" of the provision: the "duration of use" indicates the duration of a medication roll.
In deze paragraaf wordt de term “prescriptie” gebruikt om het bericht waarmee een patiënt een geneesmiddel bij een verstrekker mag afhalen aan te duiden. Een prescriptie bevat een medicatieafspraak en een verstrekkingsverzoek.
 
  
In Nederland is het tot op heden gebruikelijk om prescripties digitaal te versturen naar een ontvangende apotheek in plaats van het ophalen van prescripties. Daarvoor is nodig, dat de apotheek al van te voren bekend is. <br>
+
====Establishing / exchanging whether a change in the medication should be effective immediately or not====
Dit heeft het risico, dat poliklinische recepten uit gemak altijd naar de poliklinische apotheek gaat en dat de patiënt niet meer bij de vertrouwde vaste apotheek kan halen.  
+
It is desirable that a prescriber can indicate whether changes in the medication should be implemented immediately or that they can wait until the next roll change. The handles for this are as follows:
 +
*Medicatieafspraak, Additional information (aanvullende informatie) field. The code list for this field contains two items that relate to changes in the GDV, namely "Change in GDS immediately" and "Change in GDS per roll change". This code list is thesaurus 2050 from file 902 in the G-Standard.
 +
*It is important that the prescriber has insight into the duration of the roll and how long it will take before the current medication roll is used up. This can be deduced from:
 +
**The verstrekking, period of use (verbruiksduur), see above. For this, the prescribing system must have access to the verstrekking data of previous verstrekkingen (dispensings).
 +
**Verstrekking (dispensing), Registration Date (aanschrijfdatum) or Date (datum) field (or if this field is not filled but the Registration date field is, then the registration date.; if both are filled, Date is preferred). Based on this date and the consumption period, it is possible to calculate the date on which the current medication roll is used.
  
Deze paragraaf is een beschouwing of er meer flexibiliteit in de logistieke afhandeling van prescripties te bereiken is, zonder de huidige voordelen teniet te doen. Deze paragraaf kan beschouwd worden als een lange termijn visie waar wij naar toe willen werken.
+
=Reflections=
 +
==Prescription without specified recipient (ambulatory)==
 +
In this paragraph, the term ‘prescription’ is used to indicate the message through which a patient may pick up a medicinal product from a supplier. A prescription contains a medicatieafspraak and a verstrekkingsverzoek.
  
===Uitgangspunten===
+
In the Netherlands it is customary to digitally send prescriptions to a receiving pharmacy instead of having to collect prescriptions. This requires that the pharmacy is already known.<br>
In de afweging hoe wij flexibiliteit in de afhandeling kunnen bewerkstelligen zijn uitgangspunten geformuleerd. Deze zijn:
+
This carries the risk that for the sake of convenience outpatient clinic prescriptions are always sent to the outpatient pharmacy, preventing the patient from picking up the medication at a regular, familiar pharmacy.
*De patiënt heeft de keuzevrijheid van afhandeling.
 
*De huidige verwerking van verzenden van prescripties blijft mogelijk.
 
*Het systeem moet zoveel mogelijk dezelfde functionaliteit hergebruiken.
 
*Een prescriptie mag maar éénmaal verstrekt worden.
 
  
Omdat de hieronder beschreven methodiek gebruik maakt van de bestaande methode van verzenden van prescripties, gelden dezelfde juridische regels over de geldigheid van de prescripties. Alle discussies over elektronische handtekeningen gelden evenzeer voor de huidige methode van communicatie van prescripties.
+
This paragraph considers whether more flexibility can be achieved in the logistical processing of prescriptions, without canceling out current advantages. This paragraph may be seen as a long-term vision that we aim towards.
  
===Uitwerking===
+
===Basic principles===
Een patiënt kan kiezen uit 3 keuzemogelijkheden:
+
When considering how to achieve flexibility in the processing of prescriptions, these basic principles have been formulated:
#Een prescriptie wordt altijd naar een vaste apotheker verzonden.
+
*The patient is free to choose where prescriptions are handled
#De patiënt geeft per keer op waar de prescriptie naar toe verzonden wordt.
+
*The current option for sending prescriptions remains possible.
#De patiënt geeft niets op en komt bij een apotheek die een prescriptie opvraagt en afhandelt.
+
*The system must reuse the same functionality as much as possible.
 +
*A prescription may only be dispensed once.
 +
Since the methodology described below uses the existing method of sending prescriptions, the same legal rules and regulations apply to prescription validity. All discussions about electronic signatures are equally applicable to the current method of communicating prescriptions.
  
Voor opties 1 en 2 is een patiënt portaal nodig, waarin de patiënt zijn voorkeur aangeeft. Bij optie 2 mag een patiënt een voorkeurapotheek definiëren, die boven aan in het selectiescherm zal staan als de patiënt gevraagd wordt, waarheen de prescriptie gestuurd moet worden. Als een patiënt niets opgeeft kan optie 3 de enige werkwijze zijn.  
+
===Details===
 +
A patient may choose from 3 options:
 +
#A prescription is always sent to the same regular pharmacist.
 +
#The patient indicates each time where the prescription has to be sent.
 +
#The patient does not give any indication, and goes to a pharmacy which subsequently requests and processes the prescription.
 +
Options 1 and 2 require a patient portal, in which the patient indicates his preference. For option 2, a patient may define a preferred pharmacy which would be at the top of the selection screen when the patient is asked where the prescription must be sent. If the patient does not give any indication, option 3 can be the only procedure.
  
De methodiek maakt deels gebruik van een concept dat “publish en subscribe” heet.
+
The method partly uses a concept called “publish and subscribe”.  
  
Het is van belang, dat de apotheker aan zijn vaste klanten uitlegt hoe het principe werkt.
+
It is important that the pharmacist explains this principle to his customers.
  
===Werkproces===
+
===Work process===
Een arts besluit een prescriptie te doen aan een patiënt. Dit kan bij een consult of zelfs bij aanvraag van herhaalreceptuur zijn. De arts registreert de prescriptie in zijn voorschrijfsysteem ( EVS). De arts hoeft zich niet te bekommeren om de apotheek, dat doet de patiënt immers via het portaal.
+
A physician decides to create a prescription for a patient. This may be during a consultation or even when repeat prescriptions are requested. The physician registers the prescription in his prescribing system (EPS). The physician does not need to consider the pharmacy as the patient handles this through the portal.
  
Na akkoord van de prescriptie wordt een centrale prescriptie-index bijgewerkt. Dit gebeurt automatisch door het EVS, die een aanmelding stuurt naar deze prescriptie register. In deze beschouwing wordt de prescriptie-index als een apart register beschouwd met de gegevenssoort “voorschriften”. Later kan altijd nog geëvalueerd worden of dit niet samengevoegd kan worden. In eerste instantie wordt ook gedacht aan een atomaire registratie in het register. Later kan overwogen worden of een categorale registratie niet toereikend is.
+
After approval of the prescription, a central prescription index is updated. The EVS automatically sends a notification to this prescription registry to facilitate this. Here, the prescription index is seen as a separate registry with the data type “prescriptions”. It is always possible to consider whether or not this can be merged at a later time. Initially, atomic registration in the registry is being considered. However, at a later date, consideration could be given as to whether categorical registration would be sufficient.
  
Het is belangrijk om te begrijpen, dat er op dit moment alleen nog maar gemeld wordt, dat een prescriptie klaar staat. De prescriptie is immers nog altijd bij het EVS in een database vorm met status “staat klaar”. Er is dus nog geen prescriptie bericht.
+
It is important to realise that currently only a notification is given when a prescription is ready. After all, the prescription is still in the EVS database with the status “is available”. There is no prescription message yet.
  
Het register systeem weet uit de voorkeurinstelling van de patiënt wat er met de aanmelding moet gebeuren:
+
The prescription registry knows from the patient’s preference settings what needs to be done with the notification:
#Bij de keuze vaste apotheker van de patient wordt een signaal naar de ingevulde abonneehouder van de patiënt gestuurd met de melding, dat een prescriptie opgehaald kan worden.
+
#With the option ‘send to regular pharmacy’, a notification is sent to the subscription holder of the patient with the message that a prescription can be retrieved.
#Bij deze keuze stuurt het register systeem een signaal (bijv. SMS) naar de patiënt. Vervolgens wacht het register systeem totdat de patiënt via een app op de smartphone of via het patiëntportaal ingeeft naar welke apotheek het signaal verzonden moet worden.  
+
#With the option ‘patient indicates pharmacy’, the prescription registry sends a notification (e.g., SMS) to the patient. The prescription registry then waits until the patient uses a smartphone app or the patient portal to indicate to which pharmacy the notification should be sent.
#Bij deze optie doet het register systeem niets. De patiënt heeft geen vaste abonneehouder.
+
#With the option ‘no indication’, the prescription registry does nothing. The patient does not have a regular subscription holder.
  
===Verwerking in de apotheek===
+
===Processing by pharmacy===
Een ontvangende apotheek herkent aan het doorgestuurde signaal (gegevenssoort), dat dit om een openstaande prescriptie gaat. In het signaal is ook bekend wie de patiënt is en wie de bron is van de prescriptie.  
+
A receiving pharmacy can deduce from the transmitted notification signal (data type) that it refers to an open prescription. The signal also identifies who the patient is as well as the source of the prescription.
  
Bij een patiënt die voor optie 3 gekozen heeft, begint het proces pas hierna. De patiënt identificeert zich en meldt aan de apotheker, dat een prescriptie bij een bepaalde instelling klaar staat. De apotheker zoekt eventueel in het prescriptieregister om welk EVS het gaat.
+
For patients who selected option 3 (no indication), the process starts now. The patient identifies himself and notifies the pharmacy that a prescription is ready at a certain institution. The pharmacist may look in the prescription registry to find out which EVS is involved.
  
Het apotheek systeem vraagt dan aan het EVS bronsysteem om de verzending van de prescriptie van de betreffende patiënt. Aangezien dit ook een verzoek is zonder medische inhoud, zou dit zelfs met een laag vertrouwensniveau verzocht kunnen worden.
+
The pharmacy system asks the EVS source system to send the prescription of the respective patient. Since this is a request without medical content, it may even be submitted at lower trust levels.
  
===Verzending door het EVS===
+
===Sending via EVS===
Als een EVS een verzoek ontvangt voor “verzending van openstaande prescriptie” dan controleert het EVS of de prescriptie inderdaad nog open staat. Hiermee wordt voorkomen, dat een prescriptie meerdere keren wordt opgevraagd. Het adres van de apotheek wordt ingevuld en het voorbereide prescriptie bericht wordt dan eindelijk aangemaakt. Het prescriptie bericht wordt verzonden naar de betreffende apotheek.  
+
If an EVS receives a request for “sending outstanding prescriptions”, the EVS will check whether prescriptions are indeed outstanding. This prevents a prescription from being retrieved several times. The address of the pharmacy is entered and the prepared prescription message is finally created. The prescription message is sent to the respective pharmacy.
  
Als de prescriptie al eerder opgevraagd is geweest, dan wordt een foutmelding naar de opvragende apotheek verzonden met de mededeling dat de prescriptie niet meer opvraagbaar is.
+
If the prescription has been retrieved before, an error message is sent to the retrieving pharmacy announcing that the prescription is no longer available.
  
'''Het verzenden van een prescriptie is feitelijk het standaard proces, dat nu al gebruikelijk is bij het pushen van prescripties.''' Dit heeft het voordeel dat de ontvangende apotheek alleen één manier hoeft te onderhouden voor het verwerken van ontvangende prescripties. Hier wordt nogmaals opgemerkt, dat dezelfde juridische regels van toepassing blijven.
+
'''Sending prescriptions is the standard process and already customary for pushing prescriptions.''' The advantage of this is that the receiving pharmacy only needs to maintain one method for processing received prescriptions. It is noted again that the same legal rules and regulations continue to apply.
  
Na de verzending wordt door het EVS tevens een bericht naar het prescriptie register verzonden om de registratie van de openstaande prescriptie te verwijderen. Hiermee wordt dan duidelijk gemaakt, dat de betreffende prescriptie niet meer op te vragen is.
+
After sending a prescription, the EVS also sends a notification to the prescription registry to remove the entry of the outstanding prescription. This indicates that the respective prescription can no longer be retrieved.
  
 
{{anchor|figuur 11}}
 
{{anchor|figuur 11}}
 
[[Bestand:Interactiediagramvoorschrijven.png|Figuur 11 Interactiediagram Ongeadresseerd voorschrijven]]
 
[[Bestand:Interactiediagramvoorschrijven.png|Figuur 11 Interactiediagram Ongeadresseerd voorschrijven]]
  
=Bijlage referenties=
+
=Appendix References=
  
==Algemene referenties==
+
==General references==
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
! style="text-align:left;"| Auteur(s)
+
! style="text-align:left;"| Author(s)
! style="text-align:left;"| Titel
+
! style="text-align:left;"| Title
! style="text-align:left;"| Versie
+
! style="text-align:left;"| Version
! style="text-align:left;"| Datum (raadplegen)
+
! style="text-align:left;"| Date (consultation)
! style="text-align:left;"| Bron
+
! style="text-align:left;"| Source
! style="text-align:left;"| Organisatie
+
! style="text-align:left;"| Organisation
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| NHG, KNMP, Z-index
 
| style="background-color: white;vertical-align:top;"| NHG, KNMP, Z-index
| style="background-color: white;vertical-align:top;"| Bouwstenen van het medicatieproces
+
| style="background-color: white;vertical-align:top;"| Building blocks of the medication process
 
| style="background-color: white;vertical-align:top;"| 2014
 
| style="background-color: white;vertical-align:top;"| 2014
 
| style="background-color: white;vertical-align:top;"| Augustus 2015
 
| style="background-color: white;vertical-align:top;"| Augustus 2015
Regel 2.256: Regel 2.222:
 
| style="background-color: white;vertical-align:top;"| NHG, KNMP, Z-index
 
| style="background-color: white;vertical-align:top;"| NHG, KNMP, Z-index
 
|-
 
|-
| style="background-color: white;vertical-align:top;"| ActiZ, KNMP, NVZA e.a.
+
| style="background-color: white;vertical-align:top;"| ActiZ, KNMP, NVZA a.o
| style="background-color: white;vertical-align:top;"| Veilige principes in de medicatieketen
+
| style="background-color: white;vertical-align:top;"| Safe principles in the medication chain
 
| style="background-color: white;vertical-align:top;"| 2014
 
| style="background-color: white;vertical-align:top;"| 2014
| style="background-color: white;vertical-align:top;"| Augustus 2015
+
| style="background-color: white;vertical-align:top;"| August 2015
 
| style="background-color: white;vertical-align:top;"| http://www.knmp.nl/patiëntenzorg/samenwerking/brochure-veilige-principes-in-de-medicatieketen
 
| style="background-color: white;vertical-align:top;"| http://www.knmp.nl/patiëntenzorg/samenwerking/brochure-veilige-principes-in-de-medicatieketen
| style="background-color: white;vertical-align:top;"| ActiZ, KNMP, NVZA e.a.
+
| style="background-color: white;vertical-align:top;"| ActiZ, KNMP, NVZA a.o.
 
|-
 
|-
| style="background-color: white;vertical-align:top;"| Diversen
+
| style="background-color: white;vertical-align:top;"| Miscellaneous
| style="background-color: white;vertical-align:top;"| Richtlijn Overdracht van medicatiegegevens in de keten
+
| style="background-color: white;vertical-align:top;"| Guideline on exchange of medication data in the medication chain
| style="background-color: white;vertical-align:top;"| 25-4-2008
+
| style="background-color: white;vertical-align:top;"| 25 April 2008
| style="background-color: white;vertical-align:top;"| Augustus 2015
+
| style="background-color: white;vertical-align:top;"| August 2015
 
| style="background-color: white;vertical-align:top;"| Website KNMP
 
| style="background-color: white;vertical-align:top;"| Website KNMP
| style="background-color: white;vertical-align:top;"| Diversen
+
| style="background-color: white;vertical-align:top;"| Miscellaneous
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| Paul Geels
 
| style="background-color: white;vertical-align:top;"| Paul Geels
| style="background-color: white;vertical-align:top;"| Beoordeling Eigen beheer van Medicatie (BEM) in verzorgingshuizen, Instituut voor Verantwoord Medicijngebruik
+
| style="background-color: white;vertical-align:top;"| Assessment of medication self-management (BEM) in care homes, Institute for Responsible Medication Use
| style="background-color: white;vertical-align:top;"| Februari 2009
+
| style="background-color: white;vertical-align:top;"| February 2009
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"| http://www.instellingsapotheek.nl/downloads/rapporten/beoordeling_eigen_beheer_van_medicatie_in_verzorgingshuizen.pdf
 
| style="background-color: white;vertical-align:top;"| http://www.instellingsapotheek.nl/downloads/rapporten/beoordeling_eigen_beheer_van_medicatie_in_verzorgingshuizen.pdf
| style="background-color: white;vertical-align:top;"| Instituut voor Verantwoord Medicijngebruik
+
| style="background-color: white;vertical-align:top;"| Institute for responsible medicatiegebruik
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| ActiZ
 
| style="background-color: white;vertical-align:top;"| ActiZ
| style="background-color: white;vertical-align:top;"| Veiligheid in de medicatieketen
+
| style="background-color: white;vertical-align:top;"| Safety in the medication chain
| style="background-color: white;vertical-align:top;"| Maart 2012
+
| style="background-color: white;vertical-align:top;"| March 2012
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"| https://www.knmp.nl/downloads/brochure-veiligheid-in-de-medicatieketen.pdf
 
| style="background-color: white;vertical-align:top;"| https://www.knmp.nl/downloads/brochure-veiligheid-in-de-medicatieketen.pdf
| style="background-color: white;vertical-align:top;"| ActiZ, Diversen
+
| style="background-color: white;vertical-align:top;"| ActiZ, Miscellaneous
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| KNMG
 
| style="background-color: white;vertical-align:top;"| KNMG
| style="background-color: white;vertical-align:top;"| Richtlijn electronisch voorschrijven
+
| style="background-color: white;vertical-align:top;"| Guideline on electronic prescription
 
| style="background-color: white;vertical-align:top;"| September 2013
 
| style="background-color: white;vertical-align:top;"| September 2013
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"|  
Regel 2.292: Regel 2.258:
 
|}
 
|}
  
==Kwalificatiescripts==
+
==Qualification scripts==
Kwalificatiescripts zijn gepubliceerd op [[mp:Vdraft Kwalificatie|de wiki pagina "Kwalificatie".]]
+
[[mp:Vdraft Kwalificatie|Qualification scripts]]
  
=Bijlage: Documenthistorie=
+
=Attachment: Document history=
  
 
{{anchor|tabel 6}}
 
{{anchor|tabel 6}}
 
{| class="wikitable" "cellpadding="10"
 
{| class="wikitable" "cellpadding="10"
!style="text-align:left;"|Versie
+
!style="text-align:left;"|Version
!style="text-align:left;"|Datum
+
!style="text-align:left;"|Date
!style="text-align:left;"|Omschrijving
+
!style="text-align:left;"|Description
 
|-
 
|-
 
| style="background-color: white;"| 0.95
 
| style="background-color: white;"| 0.95
| style="background-color: white;"| 15 juli 2016
+
| style="background-color: white;"| 15 July 2016
| style="background-color: white;"| Versie t.b.v. pilot
+
| style="background-color: white;"| Pilot version
 
|-
 
|-
 
| style="background-color: white;"| 0.96
 
| style="background-color: white;"| 0.96
| style="background-color: white;"| 1 december 2016
+
| style="background-color: white;"| 1 December 2016
| style="background-color: white;"| Paragraaf 2.4 Proces: toedienen aangepast en als gevolg daarvan ook H6: toegevoegd Sturen/ontvangen toediengegevens.
+
| style="background-color: white;"| Paragraph 2.4 Process: Administer was adapted and C6: Sending/receiving administration data was added as a result.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 0.97
 
| style="background-color: white;vertical-align:top;"| 0.97
| style="background-color: white;vertical-align:top;"| 22 december 2016
+
| style="background-color: white;vertical-align:top;"| 22 December 2016
| style="background-color: white;"| Paragraaf 2.4, 4.3.1 opmerkingen review verwerkt.<br>Paragraaf 4.2.11 aanscherping in tekst.
+
| style="background-color: white;"| Paragraph 2.4, 4.3.1 review remarks incorporated.<br>
 +
Paragraph 4.2.11 text made more precise.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.0.2
 
| style="background-color: white;vertical-align:top;"| 9.0.2
| style="background-color: white;vertical-align:top;"| 18 juni 2017
+
| style="background-color: white;vertical-align:top;"| 18 June 2017
| style="background-color: white;"| Omzetting document naar wiki.
+
| style="background-color: white;"| Conversion of the document to wiki.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.0.4
 
| style="background-color: white;vertical-align:top;"| 9.0.4
| style="background-color: white;vertical-align:top;"| september 2017
+
| style="background-color: white;vertical-align:top;"| September 2017
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"|  
*Verwerkt [[mp:V9.0_Ontwerpbeslissingen|Ontwerpbeslissingen]] in functioneel ontwerp. Daarmee zijn de ontwerpbeslissingen vervallen. Het huidige FO is vanaf nu leidend.<br>
+
*Processed [[mp:V9.0_Ontwerpbeslissingen|Design decisions]] in functional design. This means the design decisions have become obsolete. The current Functional Design is now leading.
*Par. 1.3.1. Definities bouwstenen aangepast en afkorting voor medicatieverstrekking gewijzigd van vs naar mve.<br>
+
*Par. 1.3.1. Definitions of building blocks have been adapted and the abbreviation for medicatieverstrekking has changed to MVE.
*Par. 1.3.3. Medicamenteuze behandeling nu op basis van PRK, stuk herschreven en ontstaan mbh en omgang met parallelle ma toegevoegd.<br>
+
*Par. 1.3.3. Medicamenteuze behandeling is now based on PRK, rewritten and introduced PT as well as added text on handling parallel MAs.
*Par. 1.3.4. Nieuw datamodelplaaje, diverse relatie toegevoegd en aangepast op basis van ontwerpbeslissingen.<br>
+
*Par. 1.3.4. New data model diagram, various relations added and adapted on the basis of design decisions.
*Par. 1.5 Begrippenlijst verwijderd.<br>
+
*Par. 1.5 Glossary removed.
*H.2 Plaatje medicatieproces aangepast: mo toegevoegd bij actief beschikbaarstellen door gebruiker; lijnen in swimlane van toediener/gebruiker aangepast.<br>
+
*C2 Medication process diagram changed: MO added to actively making available by the user; lines in swimlane of administrator/use adapted.
*H4.1 Nieuwe use cases toegevoegd: Niet verstrekken voor, Verschillende PRKs onder dezelfde medicamenteuze behandeling, Staken van medicatie door derden, Achteraf vastleggen medicatieafspraak, Parallelle medicatieafspraken.<br>
+
*C4.1 New use cases added: Do not dispense before, Two PRKs in a single medicamenteuze behandeling, Discontinuation of medication by third parties, Creating a medicatieafspraak after the fact, Parallel medicatieafspraken.
*H4.2 Nieuwe use case: Stop-toedieningsafspraak; gewijzigde use case: Aanschrijfdatum, verstrekken en niet afhalen.<br>
+
*C4.2 New use case: Discontinuing medication in a GDS; modified use case: Request, dispense and not picked up.
*H5: Onderscheiden van medicatieprofiel en medicatieoverzicht beschreven; afleidingsregels aangepast op basis van de nieuwe ontwerpbeslissingen.<br>
+
*C5: Differences between medication profile and medication overview were described; inference rules adapted on the basis of the new design decisions.
*Waar logisch verwijzingen vanuit Art-decor naar FO H7 aangebracht.<br>
+
*Where necessary, references from ART-DECOR to FD C7 were added.
*Diverse grammaticale en kleine tekstuele wijzigingen.<br>
+
*Various grammatical and minor textual changes.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.0.5
 
| style="background-color: white;vertical-align:top;"| 9.0.5
| style="background-color: white;vertical-align:top;"| januari 2018
+
| style="background-color: white;vertical-align:top;"| January 2018
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"|  
*Terminologie: Stop-ma gewijzigd naar staken-ma conform eerdere projectafspraken.<br>
+
*Terminology: Stop-MA was changed to stop-MA in accordance with earlier project agreements (in Dutch different terminology Stop changed to staken)
*Par. 1.3.4 Aanvulling dat ma ook mag verwijzen naar bouwsteen onder andere medicamenteuze behandeling.<br>
+
*Par. 1.3.4 Addition to indicate that MA may also refer to a building block under a different medicamenteuze behandeling.
*Par. 4.1.22 Ontslag aangepast omdat bij ontslag eerder gestaakte ambulante medicatie opnieuw gestart kan worden.<br>
+
*Par. 4.1.22 Discharge was adapted because outpatient medication that was discontinued earlier may be started again at discharge.
*Par. 4.1.26 Staken van medicatie door derden aangepast.<br>
+
*Par. 4.1.26 Discontinuation of medication by third parties was adapted.
*Par. 4.1.27 Twee PRK's onder één medicamenteuze behandeling.<br>
+
*Par. 4.1.27 Two PRKs under a single medicamenteuze behandeling.
*Par. 2.2.5.3 Staken medicatieafspraak aangepast ter verduidelijking van impact op reeds ingevoerde toekomstige medicatieafspraken.<br>
+
*Par. 2.2.5.3 Medication discontinuation agreement was adapted to clarify the impact on previously entered future medicatieafspraken.
*Voetnoot 3 Voorlopige en definitieve medicatieopdracht verduidelijkt en use case medicatieopdracht (par. 4.1.31) toegevoegd.<br>
+
*Footnote 3 Provisional and final medication order clarified and use case Provisional and final medication order (par. 4.1.31) added.
*Par. 4.1.30 Use case Eenmalig gebruik toegevoegd.<br>
+
*Par. 4.1.30 Use case Single use added.
*Paragraaf 2.2.4, 2.2.5.2, 2.2.5.4, 4.1.16, 4.1.22 aangepast voor substitutie.Bij substitutie wordt een medicamenteuze behandeling niet tijdelijk onderbroken maar daadwerkelijk gestaakt. Het substituut wordt onder een nieuwe medicamenteuze behandeling gestart.<br>
+
*Paragraphs 2.2.4, 2.2.5.2, 2.2.5.4, 4.1.16, 4.1.22 were adapted for substitution. In case of substitution, a medicamenteuze behandeling is not temporarily halted but effectively discontinued. The substitution is started under a new medicamenteuze behandeling.
*Paragraaf 4.1.33 Ontbreken digitale medicatieafspraak bij opname toegevoegd.<br>
+
*Paragraph 4.1.33 Missing digital medicatieafspraak at admission was added.
*H5 Medicatieoverzicht aangepast met verwijzing naar nieuwe inhoudelijke pagina met functionele uitwerking.<br>
+
*C5 Medication overview was adapted with a reference to a new content page with functional elaboration.
*Paragraaf 7.10 Medicatiegebruik: gebruikindicator, volgens afspraak indicator en stoptype toegevoegd.<br>
+
*Paragraph 7.10 Medicatiegebruik: use indicator, according to agreement indicator and stop type added as agreed.
*H6 Bouwstenen van medicatieoverzicht gewijzigd naar ma, ta en mgb.<br>
+
*C6 Building blocks of medication overview were changed to MA, TA and MGB.
*Figuur 2 Kleuren in datamodel conform figuur 1.<br>
+
*Figure 2 Colours in data model in accordance with Figure 1.
*Diverse afkortingen verklaard.<br>
+
*Various abbreviations explained.
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.0.6
 
| style="background-color: white;vertical-align:top;"| 9.0.6
| style="background-color: white;vertical-align:top;"| mei 2018
+
| style="background-color: white;vertical-align:top;"| May 2018
 
| style="background-color: white;vertical-align:top;"|  
 
| style="background-color: white;vertical-align:top;"|  
*Aanvulling op voorstel verstrekkingsverzoek en toevoeging van antwoord-voorstel verstrekkingsverzoek<br>
+
*Addition to proposed verstrekkingsverzoek and addition of reply proposed verstrekkingsverzoek
*Hoofdstuk 6 tabel 4 toevoeging van linkjes naar ART-DECOR transacties<br>
+
*Chapter 6 table 4 addition of links to ART-DECOR transactions
*Verwijderd: hoofdstuk over LSP<br>
+
*Removed: chapter about LSP  
*Par. 7.10 tabel uitgebreid met gebruiksperiode en doseerinstructie<br>
+
*Par. 7.10 table was extended with period of use and dosing instructions
*Aanscherpingen in diverse teksten<br>
+
*Various paragraphs were made more precise
*Toevoeging van kenmerk 'bouwsteen van iemand anders' voor MA, TA, MGB in medicatieoverzicht<br>
+
*Addition of the property ‘third parties’ building block’ for MA, TA and MGB in medication overview
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.0.7
 
| style="background-color: white;vertical-align:top;"| 9.0.7
| style="background-color: white;vertical-align:top;"| december 2018
+
| style="background-color: white;vertical-align:top;"| December 2018
 
| style="background-color: white;vertical-align:top;"|
 
| style="background-color: white;vertical-align:top;"|
*Par 1.3.3. MBH op HPK niveau in geval van 'niet geneesmiddelen' zonder een PRK niveau<br>
+
*Par 1.3.3. MBH at HPK level in case of 'non medicines' without a PRK level
*Par 1.3.3. MBH voor geneesmiddelen zonder PRK (magistralen, infusen etc)<br>
+
*Par 1.3.3. MBH for medicines without PRK (magistrals, infusions, etc.)
*Par 2.2.5.5. Wijzigen medicatie: Technisch stop-ma: afspraak datum voor stop-ma en nieuwe ma moeten hetzelfde zijn. Wijziging op MA die reeds gestopt is toegelicht (geen extra staken-ma nodig)<br>
+
*Par 2.2.5.5. Changing medication: Technical stop-ma: appointment date for stop-ma and new ma must be the same. Change on MA that has already been stopped explained (no extra Stop-ma needed)
*Par 2.2.6. Toegevoegd: VV onder MA van iemand anders<br>
+
*Par 2.2.6. Added: VV under MA of someone else
*Par 4.2.15. Uitleg GDS leverancier levert ander HPK<br>
+
*Par 4.2.15. Explanation GDS supplier supplies different HPK
*Par 7.10: Medicatiegebruik gebruikindicator, volgens afspraak indicator, stoptype, gebruiksperiode en doseerinstructie: tabel aangepast en voorbeelden toegevoegd<br>
+
*Par 7.10: Medication use indicator, according to appointment indicator, stop type, period of use and dosing instruction: table adapted and examples added
*Par 4.1.34: Eigen artikelen uitleg toegevoegd<br>
+
*Par 4.1.34: Own articles explanation added
*Hoofdstuk 5: voorbeeld medicatieoverzicht ingevoegd in deze wiki pagina ipv een losse wiki pagina (om zoeken binnen het FO te vereenvoudigen).
+
*Chapter 5: example medication overview inserted in this wiki page instead of a separate wiki page (to simplify searching within the FO).
*Diverse tekstuele aanscherpingen/verbeteringen
+
*Various textual tightening / improvements
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.0.7
 
| style="background-color: white;vertical-align:top;"| 9.0.7
| style="background-color: white;vertical-align:top;"| juli 2019
+
| style="background-color: white;vertical-align:top;"| July 2019
 +
| style="background-color: white;vertical-align:top;"|
 +
*Removed examples of specific infrastructures
 +
|-
 +
| style="background-color: white;vertical-align:top;"| 9.1.0
 +
| style="background-color: white;vertical-align:top;"| 29 January 2020
 
| style="background-color: white;vertical-align:top;"|
 
| style="background-color: white;vertical-align:top;"|
Voorbeelden voor specifieke infrastructuren verwijderd.
+
*Stop textual adjustments
 +
*Par 7.11 added: Implementation of individualized distribution form (GDV) fields
 +
*[https://bits.nictiz.nl/browse/MP-85 BITS MP-85], [https://bits.nictiz.nl/browse/MP-93 BITS MP-93], [https://bits.nictiz.nl/browse/MP-122 BITS MP-122] Use cases added (Register usage based on verstrekkingn, Verstrekkingsverzoek with number of repetitions, Prescribe non-drug)
 +
*Chapter 4: Added pictures of use cases
 +
*Renal function value in the prescription
 +
*[https://bits.nictiz.nl/browse/MP-48 BITS MP-48] Medication Overview: Par 5.7 added 'Fields not to be shown'
 +
*Various textual specifications/ improvements, including [https://bits.nictiz.nl/browse/MP-131 o.a. BITS MP-131]
 +
*Paragraph 'Unaddressed prescription' moved to chapter 'Considerations'
 +
*[https://bits.nictiz.nl/browse/MP-151 BITS MP-151] Removed draft TA creation process
 +
*[https://bits.nictiz.nl/browse/MP-128 BITS MP-128] Par 4.1.8: Explanation 'Medical necessity'
 +
*[https://bits.nictiz.nl/browse/MP-129 BITS MP-129] Par 4.1.35: Use case added
 
|-
 
|-
 
| style="background-color: white;vertical-align:top;"| 9.1.0
 
| style="background-color: white;vertical-align:top;"| 9.1.0
| style="background-color: white;vertical-align:top;"| 29 januari 2020  
+
| style="background-color: white;vertical-align:top;"| September 2020
 
| style="background-color: white;vertical-align:top;"|
 
| style="background-color: white;vertical-align:top;"|
*Tekstuele aanpassingen staken/stoppen<br>
+
*[https://bits.nictiz.nl/browse/MP-167 BITS MP-167] FO Translated in English
*Par 7.11 toegevoegd: Implementatie geïndividualiseerde distributievorm (GDV)-velden
 
*[https://bits.nictiz.nl/browse/MP-85 BITS MP-85], [https://bits.nictiz.nl/browse/MP-93 BITS MP-93], [https://bits.nictiz.nl/browse/MP-122 BITS MP-122] Use cases toegevoegd (Gebruik registreren op basis van verstrekking, Verstrekkingsverzoek met aantal herhalingen, Voorschrijven van niet geneesmiddelen)
 
*Hoofdstuk 4: plaatjes bij use cases toegevoegd
 
*Nierfunctiewaarde in het voorschrift
 
*[https://bits.nictiz.nl/browse/MP-48 BITS MP-48] Medicatieoverzicht: Par 5.7 toegevoegd 'Velden die niet getoond hoeven te worden'
 
*Diverse tekstuele aanscherpingen/verbeteringen [https://bits.nictiz.nl/browse/MP-131 o.a. BITS MP-131]
 
*Paragraaf 'Ongeadresseerd voorschrijven' verplaatst naar hoofdstuk 'Beschouwingen'
 
*[https://bits.nictiz.nl/browse/MP-151 BITS MP-151] Proces van aanmaken concept-TA verwijderd
 
*[https://bits.nictiz.nl/browse/MP-128 BITS MP-128] Par 4.1.8: Toelichting 'Medische noodzaak'
 
*[https://bits.nictiz.nl/browse/MP-129 BITS MP-129] Par 4.1.35: Use case toegevoegd
 
 
|}
 
|}
  
=Bijlage: Figuren en tabellen=
+
=Appendix: Figures and tables=
[[#figuur 1|Figuur 1 Bouwstenen - overzicht]]<br>
+
[[#figuur 1|Figure 1 Building blocks - overview]]<br>
[[#figuur 2|Figuur 2 Bouwstenen - samenhang]]<br>
+
[[#figuur 2|Figure 2 Building blocks - coherence]]<br>
[[#figuur 3|Figuur 3 Activiteitendiagram - Medicatieproces algemeen]]<br>
+
[[#figuur 3|Figure 3 Activity diagram - Medication process in general]]<br>
[[#figuur 4|Figuur 4 Processtappen en transacties - medicatieverificatie]]<br>
+
[[#figuur 4|Figure 4 Process steps and transactions - medication verification]]<br>
[[#figuur 5|Figuur 5 Processtappen en transacties - voorschrijven]]<br>
+
[[#figuur 5|Figure 5 Process steps and transactions - prescribing]]<br>
[[#figuur 6|Figuur 6 Processtappen en transacties - ter hand stellen]]<br>
+
[[#figuur 6|Figure 6 Process steps and transactions - make available]]<br>
[[#figuur 7|Figuur 7 Processtappen en transacties - toedienen]]<br>
+
[[#figuur 7|Figure 7 Process steps and transactions - administer]]<br>
[[#figuur 8|Figuur 8 Processtappen en transacties - gebruiken]]<br>
+
[[#figuur 8|Figure 8 Process steps and transactions - use]]<br>
[[#figuur 9|Figuur 9 Voorbeeld effectieve periode]]<br>
+
[[#figuur 9|Figure 9 Example effective period]]<br>
[[#figuur 10|Figuur 10 Overzicht systemen en systeemrollen]]<br>
+
[[#figuur 10|Figure 10 Overview of systems and system roles]]<br>
[[#figuur 11|Figuur 11 Interactiediagram Ongeadresseerd voorschrijven]]<br>
+
[[#figuur 11|Figure 11 Interaction diagram Prescribing without address]]<br>
  
  
[[#tabel 1|Tabel 1 Bouwstenen – beschrijving]]<br>
+
[[#tabel 1|Table 1 Building blocks - description]]<br>
[[#tabel 2|Tabel 2 Informeren versus (Actief) beschikbaarstellen]]<br>
+
[[#tabel 2|Table 2 Informing versus (Active) making available]]<br>
[[#tabel 3|Tabel 3 Overzicht systeemrollen]]<br>
+
[[#tabel 3|Table 3 Overview of system roles]]<br>
[[#tabel 4|Tabel 4 Overzicht transactiegroepen]]<br>
+
[[#tabel 4|Table 4 Overview of transaction groups]]<br>
[[#tabel 5|Tabel 5 Typen klinische medicatie relevant voor extramurale zorgverleners]]<br>
+
[[#tabel 5|Table 5 Types of clinical medication relevant for outpatient care providers]]<br>
  
=Bijlage: Diagram Medicatieproces algemeen=
+
=Appendix: General Diagram Medicatioprocess=
Terug naar hoofdstuk [[#Medicatieproces|Medicatieproces]]
+
Back to chapter [[#Medication process|Medication process]]
  
 
[[Bestand:Diagram.algemeen.png|Activiteitendiagram - Medicatieproces algemeen]]
 
[[Bestand:Diagram.algemeen.png|Activiteitendiagram - Medicatieproces algemeen]]
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{{EindUitgefaseerd}}

Huidige versie van 27 okt 2022 om 09:41

Icoon Nictiz Cirkel Informatie Grafiet.svg

Deze versie van de informatiestandaard is per 01-10-2021 uitgefaseerd. Zie de landingspagina Medicatieproces 9 voor de actuele versie van de informatiestandaard.

This version of this information standard has been deprecated as of 01-10-2021. Consult the overview page Medicatieproces 9 for the current versions of the information standard.



For an overview of relevant wiki pages for Medication Process see Landingspagina_Medicatieproces

1 Introduction

This document is the functional design for the Medication Process Information Standard (in Dutch: Informatiestandaard Medicatieproces). It provides a general description as well as a description of specific practical situations. The recording and exchange of information is described for specific situations using actors (people, systems) and transactions (which information is exchanged when).

Target groups for this document:

  • Healthcare providers
  • Information analysts and architects
  • Software suppliers

1.1 Scope and vision

This document has been produced within the Medication process program. The Medication process program aims first to take away existing obstacles in the medication process, while taking into account current legislation and the possibility of obtaining tangible results in the foreseeable future.

One of the main obstacle entails the lack of insight in the actual medication use of patients. This is partly due to the fact that therapeutic and logistical information are often mixed, which results in the medication history becoming unclear. The following distinction between therapy and logistics exist:

  • Therapy covers the medical side. This includes medication (and treatment) agreements, as well as the corresponding support and implementation. Therapeutic intention, (actual) medication use, self-medication and pharmacotherapy are also covered by the term ‘therapy’ as it is defined in this document.
  • Logistics covers the physical flow of medicinal products, including requests, planning and dispense. This also includes medication supply and consumption.

The program has taken into account current legislation and feasibility within the foreseeable future. The vision goes beyond the scope of the Medication process program and lays the foundations for a situation where a dispense request is no longer required. The ultimate objective is for prescribers to only have to concern themselves with the therapeutic side (which medicinal product, which strength, which dosage, when to start, etc.). It will no longer be necessary to create a verstrekkingsverzoek. Instead, the prescriber will make medicatieafspraken directly with the patient. Based on these medicatieafspraken, the pharmacist will take care of the logistical process, eliminating the need for a verstrekkingsverzoek altogether. Because of legislation this is not (yet) possible. The Medication process program does however take the first necessary step in the right direction.

1.2 Reading guide

The following paragraph introduces the main building blocks and the terminology used in this document. Detailed descriptions of the various processes (prescribe, dispense, administer, use) are given in Chapter 2. The purpose of the descriptions is to clarify how healthcare processes function in an ideal situation; which process steps are needed; which actors are participating; which information applies and which moments of exchange exist. The process descriptions follow a fixed format:

  • Current situation 
    This paragraph describes the relevant differences between the current situation and the desired situation (“soll”) in accordance with this information standard. Any obstacles will be described here.
  • Process description with the paragraphs:
    • Precondition
      The conditions that must be met before the process is started.
    • Trigger Event
      The event that starts the process.
    • One or more process steps
      Description of part of the process.
    • Post-condition
      The conditions that are met after the process steps have been carried out.
    • Use cases
      List of use cases associated with a specific subprocess. The use cases are detailed in Chapter 4.
    • Systems and transaction groups,
      This paragraph describes the systems, system roles, transactions and transaction groups related to the process steps. All information concerning systems and transaction groups is also included in Chapter 6.

Chapter 3 describes a number of domain-specific interpretations of the medication process, for instance those of the thrombosis service and those related to service observation services in an ambulatory situation. Chapter 4 describes several use cases in more detail. The practical situations are derived from general medical practice in a large number of cases but are illustrative of similar situations in a different setting. The use cases are classified according to subprocess, as indicated in Chapter 2.
Chapter 5 describes how a medication profile can be constructed from the different building blocks. Chapter 6 includes an overview of all systems, system roles, transactions and transaction groups. Guidelines for the functionality of the various systems have been detailed in Chapter 7.

1.3 Introduction of relevant terms

1.3.1 Therapeutic and logistical building blocks

The use cases include a description of the process and the data elements associated with it. Related data elements are grouped together in Clinical Information Models (CIM) (in Dutch: zorginformatiebouwstenen - ZIBs). The dataset details the data elements of which these ZIBs consist. The data set includes the complete set of definitions of the data elements of the building blocks. The building blocks together with their data elements can be used in various scenarios for arranging/modelling healthcare applications or for defining interfaces for data exchange. Clinical Information Models and building blocks are synonymous in this document.

The different building blocks are shown in the figure below. They have been ordered according to process and subprocesses, and according to therapy versus logistics.

Figuur 1 Buildingblocks- overview

The table below provides a description of the building blocks. The three additional concepts ‘voorstel medicatieafspraak’ (therapeutic) and ‘voorstel verstrekkingsverzoek’ (logistics) and ‘antwoord voorstel-verstrekkingsverzoek’ (logistics) are also described.

Bouwsteen Afk. Beschrijving
medicatieafspraak ma A medicatieafspraak is the prescriber’s proposal for use with which the patient agrees. An agreement to discontinue medication is also a medicatieafspraak[1].
verstrekkingsverzoek vv A verstrekkingsverzoek is a request from a prescriber to a pharmacist to supply the patient with one or more medicinal products in support of current medicatieafspraken[2].
toedieningsafspraak ta A toedieningsafspraak contains the instructions for use (or administration) of the pharmacist to the patient (or his representative or administrator), adding to the medicatieafspraak[3].
medicatieverstrekking mve A medicatieverstrekking is the provision of a supply of medicinal product to the patient or his administrator or representative.
medicatietoediening mtd Medicatietoediening is the registration of the individual administrations of the medicinal product to the patient by the person who administers them (such as a nurse or the patient himself) in relation to the agreements made
medicatiegebruik mgb Medicatiegebruik is a statement about historical, current or intended use of a medicinal product[4].
medicatieverbruik mvb Medicatieverbruik is the logistical perspective on medicatiegebruik. It describes how long a (partial) supply of medicinal products has lasted or will last for a patient[5].
voorstel-medicatieafspraak vma The voorstel medicatieafspraak is a recommendation or request from the pharmacist or the patient to the prescriber about the agreed medicinal product. The recommendation request may include evaluating, discontinuing, starting or modifying medication.
voorstel‐verstrekkingsverzoek vvv The proposed verstrekkingsverzoek is a proposal from the pharmacist to the prescriber to approve one or more verstrekkingsverzoeks in support of current medicatieafspraken. This is comparable with the current situation of submitting the authorization form or combined prescription or submitting a repeat prescription for signing. The patient may also submit a proposed verstrekkingsverzoek to the prescriber.
antwoord voorstel‐verstrekkingsverzoek avvv The antwoord voorstel- verstrekkingsverzoek is a reply from the prescriber to the proposed verstrekkingsverzoek.
Table 1 Building blocks – description

1.3.2 Medication overview

See Chapter 5 for more information about these overviews, the applicable building blocks and how a medication profile/current overview can be compiled.

1.3.3 Medicamenteuze behandeling

The different medication building blocks represent steps in the medication process, from prescribing a medicinal product (medicatieafspraak and/or verstrekkingsverzoek), followed by dispensing it (toedieningsafspraak and/or medicatieverstrekking) up to and including administering and using the medicinal product. The model is designed in such a way that therapeutic building blocks and logistical building blocks are separated from each other.
Scope
In order to be able to give a name to the interdependence of the medication building blocks, the concept of ‘pharmaceutical treatment’ (medicamenteuze behandeling in Dutch) is introduced.

Medicamenteuze behandeling is a technical concept in the information standard. Its purpose is:
  1. To unambiguously identify the set of interdependent medication building blocks, and
  2. To apply rules to it to unambiguously determine the present situation.

The functional application of the concept of medicamenteuze behandeling is as follows:

  • Medication (or medicamenteuze behandeling) is started by creating a first medicatieafspraak as part of a new medicamenteuze behandeling.
  • Medication (or medicamenteuze behandeling) is discontinued by creating a new medicatieafspraak within the same medicamenteuze behandeling.
  • Medication (or medicamenteuze behandeling) is modified by:
  1. Discontinuing the existing medicatieafspraak and
  2. Creating a new changed medicatieafspraak as part of the same medicamenteuze behandeling. The starting date of this new medicatieafspraak may also be in the future.

Prescribing a new medicinal product always results in a new medicatieafspraak. A medicatieafspraak is always related to a single medicamenteuze behandeling. For the time being, the PRK level (Prescription Code from the G-standard) of the medicinal product determines whether the medicatieafspraak belongs to a new or an existing medicamenteuze behandeling. This may be extended to the SNK level (Stam Naam Kode) in the future, which would mean that changes in strength or between medicinal products from the same group no longer lead to a new medicamenteuze behandeling. A detailed description can be found in paragraph 2.2.5 Process step: Creating a medicatieafspraak.

Exceptions:

  • Products without PRK (a non-medicine such as crutches or bandages). In this case the HPK level (Trade Product Code from the G-Standard) determines if the medicatieafspraak will lead to a new medicamenteuze behandeling
  • Medication without PRK (magistrals often consist of several substances that are not covered by the same PRK, these substances are included separately as ingredients in the medicatieafspraak). Every magisterial or adaptation to it falls under a medicamenteuze behandeling.
  • Own articles without PRK (articles listed in the internal system under 90 million numbers stored, such as half tablets, commonly used magistrals). Any item or adaptation to this falls under a medicamenteuze behandeling.
  • IVs (still be selected)

Examples
Five examples illustrate the scope of a medicamenteuze behandeling:

  • Diazepam, 5 mg, 1 tablet 4x daily is changed to diazepam, 5 mg, 1 tablet 3x daily. The PRK level of both products is the same, they are both part of the same medicamenteuze behandeling.
  • Paroxetin tablet, 10 mg, 1 tablet 1x daily, is changed to paroxetin tablet, 20 mg, 1 tablet 1x daily. This is a modification of a medicatieafspraak with two different medicinal products at the PRK level. This change requires that the first medicamenteuze behandeling is discontinued and a new medicamenteuze behandeling is started.
  • A gastroprotective drugs has been agreed upon in a treatment with prednisone: prednisone and gastroprotective drugs are two different medicinal products, which are used parallel to each other and their use can be modified and discontinued independently of each other. This means they are not part of the same medicamenteuze behandeling.
  • Switching from a beta blocker to an ACE inhibitor means a new PRK and this is achieved by discontinuing the medicamenteuze behandeling of the beta blocker and starting a new medicamenteuze behandeling for the ACE inhibitor.
  • When there is no PRK and the composition of the medicinal products in the medicatieafspraak changes (any change in the ingredients), the existing medicamenteuze behandeling is discontinued and a new medicamenteuze behandeling is started. This applies, for example, to extemporaneous preparations, drips and proprietary products.

Setting up a medicamenteuze behandeling A schematic overview of how a medicamenteuze behandeling (MBH) is set up can be seen in the figure below. When a new building block (MA, TA, VV, MVE, MTD or MGB) is created, a check is first performed to determine whether this is a new medication or if there already is a current building block with the same product. This applies to all building blocks, both proprietary or third parties’. In most systems, the user of the system will indicate that he wants to change one of the existing medication building blocks or wants to introduce new medication. In that case, it is easy to find out whether there already is a medicamenteuze behandeling that includes the building block.

  • If there is no existing building block for this medication, a new building block with a new medicamenteuze behandeling is created.
  • If there is an existing building block with a medicamenteuze behandeling, the user of the system is asked whether the new building block and the existing building block belong to the same treatment. When this is the case, the same medicamenteuze behandeling will be used. When the building blocks do not belong to the same treatment, a new medicamenteuze behandeling will be created.

Figuur 2 Ontstaan medicamenteuze behandeling


Parallel medicatieafspraken
Within a medicamenteuze behandeling, several medicatieafspraken may be active simultaneously. These are all medicatieafspraken that are valid (“current”) at this time or that will become valid in the future. In principle, only one medicatieafspraak is valid at any time in a medicamenteuze. However, there are a number of situations where parallel medicatieafspraken are conceivable:

  1. The same medicinal product, but a different strength, where the total strength should essentially be prescribed in one agreement.
  2. Related (different) medicinal products that are given together, but that should be considered as a whole when evaluating treatment.
  3. Technical omissions in systems. For example, in the case of complicated dosing schedules or combination drips.

Situation 1 can be resolved by prescribing at a higher level (SNK). G-standard/Z-Index is working on this, but it is not yet possible. Until that time, 1 or more products can be combined in the same medicatieafspraak by entering the products as ingredients. This is comparable to extemporaneous preparations. However, the instructions for use for all these products must be identical.[6]
Situation 2 is solved in different ways in different systems, each with their own grouping mechanisms. It concerns the correlation between different medicamenteuze behandelingmedicamenteuze behandelings. The information standard does not provide a universal grouping mechanism.
Situation 3 is the only situation in which parallel medicatieafspraken are permitted under one medicamenteuze behandelingmedicamenteuze behandeling. Complex phasing-in and phasing-out schedules and combination drips may be included in one medicatieafspraak, but not all systems support this. For those systems, it is permitted to create parallel medicatieafspraken within a single medicamenteuze behandelingmedicamenteuze behandeling.

1.3.4 Correlation between building blocks and medicamenteuze behandeling

The figure below shows the correlations between building blocks and the medicamenteuze behandeling. The relations between building blocks and the medicamenteuze behandeling as well as the relations between the building blocks themselves are described as follows:

  • Building blocks belong to a single medicamenteuze behandeling. A medicamenteuze behandeling includes at least one medicatieafspraak and may include 0 or more of the building blocks verstrekkingsverzoek, toedieningsafspraak, medicatieverstrekking, consumption and medicatietoediening.
  • Unless, for example, self-medication has been recorded with use or there

a paper prescription has been submitted, a drug treatment can exist without it medication appointment, but with medication use or an administration appointment. An MBH will never cease to exist, but it may no longer be effective when there are no current building blocks linked to it. A voorstel medicatieafspraak, voorstel verstrekkingsverzoek and antwoord voorstel-verstrekkingsverzoek are not yet part of an MBH as these are still a draft/proposal that may or may not lead to a final medicatieafspraak or verstrekkingsverzoek linked to a medicamenteuze behandeling. A voorstel medicatieafspraak may lead to zero (if the recommendation is not followed), one or more medicatieafspraken and a voostel verstrekkingsverzoek may lead to zero (if the proposal is not honoured), one or more verstrekkingsverzoeken.

  • An MBH may also only have a stop-MA in addition to, for example, a user building block. For example, in the event that a healthcare provider asks a patient to stop using free available medicine (self-care medication or Over the Counter (OTC) medication ). The healthcare provider records the use of the self-care medication in an MGB building block and discontinues use by creating a stop medicatieafspraak (stop-MA belonging to the same MBH).
  • An MA may refer to the previous MA or a TA or MGB on which it is based. This may also be an MA, TA or MGB that belongs to another medicamenteuze behandeling. It is possible that no digital MA is available (e.g. paper prescription paragraph 4.1.17). This MA must then be created. This MA may refer to the TA or MGB. A pharmacist is never the source of an MA but he may have a copy.
  • In principle, only one medicatieafspraak is valid at any one time in a medicamenteuze behandeling. Only when there are technical omissions in systems, for example in case of complicated dosing schedules or combination drips, are parallel medicatieafspraken allowed (see also the previous section).
  • A medicatieafspraak is supported by zero (if there is still enough supply or if no medicatieverstrekking is needed), one or more (when there is, for example, continuous medication) verstrekkingsverzoeks.
  • A verstrekkingsverzoek is based on current medicatieafspraken and any existing corresponding TA in a medicamenteuze behandeling. There may be several.
  • A verstrekkingsverzoek refers to one or more MAs (for example, in the case of an interim dosage increase, a verstrekkingsverzoek can be made that replenishes the supply for the existing MA and also starts the supply for the future MA).
  • A verstrekkingsverzoek may result in zero (for example when the patient does not pick up the medication) to several MVEs (medicatieverstrekkingen).
  • Multiple (possibly parallel) toedieningsafspraken may be based on the same medicatieafspraak (for example, when a pharmacist switches to a different commercial product or when the medicinal product is supplied as two or more medicinal products with different strengths, with the total strength remaining the same). When a paper prescription is submitted and the medicatieafspraak and the verstrekkingsverzoek are not available in digital form, there is a toedieningsafspraak without a medicatieafspraak.
  • A medicatieafspraak does not always have to lead to a toedieningsafspraak, for example when no verstrekkingsverzoek is required with a short use MA, where the

patient still has sufficient stock.

  • A toedieningsafspraak is supported by zero (when there is enough supply), one or more occasions when medication is dispensed.
  • A medicatieverstrekking is based on a toedieningsafspraak and, in an ambulatory situation, on a verstrekkingsverzoek. The exception are over-the-counter (OTC/self-medication) sales for the purpose of self-care medication: these have no medicatieafspraken and no verstrekkingsverzoeken. Self-care medication provided by the pharmacist may be recorded by that pharmacist as a toediendingsafspraak with medicatieverstrekking, or as consumption by a random healthcare provider or by the patient himself.
  • A medicatieverstrekking may support multiple toedieningsafspraken.
  • A medicatie or toedieningsafspraak may be followed by a new medicatie or toedieningsafspraak. This may be the case when existing medication is changed (modification of MA and/or TA) or when use is discontinued (stop-MA/TA).


Figuur 2 - Datamodel Medicatieproces

1.3.5 Informing and (actively) making available

Chapter 2 describes the medication process. This includes process steps labelled ‘Inform’ or ‘(actively) make available’. The table below includes a detailed description of the reason for this. Chapter 2 further elaborates on situations in which information is actively sent or made available.

Term Toelichting
Inform ‘Inform’ means sending an order or request addressed to another actor. This is a so-called ‘push’ of information: the actor sends the information specifically to recipient. This may be by means of
  • An electronic message via a digital network,
  • Paper (for example by giving a prescription intended for a pharmacist to the patient),
  • A fax message,
  • A combination of the above options.
(actively) make available The healthcare provider (actively) makes information available to another actor. This process step concerns:
  • Actively sending or informing (‘push’) as described above or
  • Automatically making information available to healthcare providers and/or the patient when they request it on the basis of prior permission or
  • A combination of both previous bullets.

Data are always made available. Additionally, the healthcare provider has the option to specifically inform fellow healthcare providers and/or the patient at any time during the process. In consultation with the patient, data can be sent to a healthcare provider of his choice (inform).

Table 2 Informing versus (actively) making available

The technical mechanism (‘pull’, ‘publish and subscribe’, ‘push’, etc.) used to (actively) make data available, is infrastructure-dependent and is therefore not detailed in this document.

The Royal Dutch Medical Association (KNMG) describes in its publication Van wet naar praktijk: implementatie van de WGBO Deel 4. Toegang tot patiëntengegevens [From law to practice: implementation of the Dutch Medical Treatment Contracts Act Part 4. Access to patient data] when there is implicit consent and explicit consent. The exchange described in this information standard is subject to current legal frameworks and guidelines concerning consent and opt-in and these are therefore not explicitly described.

1.4 Legend/Explanation

A manual for this Nictiz wiki documentation can be found at:
http://informatiestandaarden.nictiz.nl/wiki/Handleiding_Wiki_documentatie
It also includes a legend for the various figures that appear in this document.

2 Medication process

This chapter describes the medication process in relation to the building blocks for first-line, second-line and third-line health care. The process is fundamentally the same in each case. The main difference is which pharmacy supplies the medication: a community pharmacy (including an outpatient pharmacy) or a hospital pharmacy. Another difference is that in an ambulatory setting a verstrekkingsverzoek is required for the supply of medicinal products. This is not required in a hospital setting: the (hospital) pharmacist ensures that the medicinal products are available as long as the medicatieafspraak continues.

The medication process is a cyclical process consisting of prescribing, dispensing, administering and using medication. The process starts when the patient/client visits a healthcare provider (general practitioner, hospital or other institution) for a treatment with a medicinal product and ends when the medication is no longer needed. The process is depicted in Figure 4. The yellow bar indicates the medication verification process, green prescription, purple dispensing, and orange administration and use. The blue bar indicates receipt or retrieval of data made available. This may occur in any of the subprocesses and is described in more detail in the continuation of this chapter for the relevant subprocesses. A larger version of the diagram can be found at the end of this document in Chapter 12. The following paragraphs describe the medication verification, prescription, dispensing, administration and consumption processes.

Figuur 3 Activity diagram - medication process Figure 3 (MO = Medicatieoverzicht)

2.1 Process: medication verification

Prior to the prescription process, the patient’s actual consumption is determined. This is done[7]:

  • In the GP practice by the general practitioner during a consultation,
  • At the GP service, A&E department or mental health crisis service by the triage specialist or the treating healthcare provider, as soon as possible, upon arrival or admission,
  • In case of clinical or day admission at a hospital or other institutions by for example the nursing staff, pharmacy assistent or outpatient/hospital pharmacist.
  • In case of outpatient consultation by for example nursing staff, doctors’ assistant or the treating healthcare provider.

2.1.1 Current situation

  • In the current situation, patients or family/informal caregivers are asked which medication they are using. The patient is sometimes unable to answer this. Family/informal caregivers (if known) are also often unable to answer this. If this is the case, the physician will contact the general practitioner or the pharmacist to find out the medication. This is difficult outside office hours and during weekends.

2.1.2 Precondition

The patient comes in for a consultation/an outpatient consultation or is admitted (in the future).

2.1.3 Trigger event

  • Outpatient setting: consultation of and/or prescription to outpatients and patients residing in another healthcare institution[8]. In this case, medication verification often occurs during treatment assessment (see paragraph 2.2.4).
  • Clinical setting: preparation of patient admission.

2.1.4 Process

The healthcare provider collects the medication data from various sources, which may include:

  • Patient’s own story,
  • Dispense overviews from pharmacies,
  • Digitally available medication data from healthcare providers or personal health records (PGO),
  • Medication brought in by the patient,
  • If necessary, information by telephone from the patient’s own pharmacist or general practitioner.

The healthcare provider verifies the medication together with the patient and records the verified medication as consumption (MGB, incl. self medication). This results in an updated medication profile; see also paragraph 5.6.

In practice, medication verification will lead to recording of use, only when it proves clinically relevant followed by updating the medication profile, particularly upon admission and discharge. The medication overview and recorded data on consumption are made available to fellow healthcare providers and the patient, so that they can access the data. The medication overview may also be sent to a specific healthcare provider.

2.1.5 Post-condition

The patient’s use is recorded and the resulting medication overview is made available if created. Medication data (consumption) are made available.

2.1.6 Systems and transaction groups

Chapter 6 includes an overview of all systems, system roles, transactions, etc. Those most important for the medication verification process are included in the overview below.

Figuur 4 Processtappen en transacties - medicatieverificatie

2.2 Process: prescribe

This paragraph describes the prescription process. This includes all prescribers, such as general practitioners, specialists, other physicians and specialist nurse prescribers. The prescription process consists of an evaluation of existing medicamenteuze behandeling, if any. If necessary, a medicatieafspraak is created and, only in an ambulatory situation, possibly a verstrekkingsverzoek. Finally, the recorded data are (actively) made available. See chapter 12 for a diagram depicting this process.

2.2.1 Current situation

The following deviations from the desired situation that are currently observed are:

  • The logistical process often determines whether information is recorded (and certainly if it is communicated). Changes in medication or discontinuation are insufficiently recorded and/or communicated, resulting in, among other things, inaccurate monitoring, incorrect use and incorrect medication profiles.

The pharmacotherapeutic policy should be leading, not the logistical process as is currently the case.

  • Since the therapeutic intention is not communicated to the pharmacist, it is not possible to deduce from the available data whether a request for a repeat prescription falls within that therapeutic intention. Because of this, use may be erroneously resumed or continued.
  • If a change is not communicated, a request for a repeat prescription (through the pharmacist) may be based on outdated instructions for use. This can easily lead to errors.
  • In an outpatient setting, medicatieafspraken and/or verstrekkingsverzoeken are usually not (electronically) sent to the pharmacist.

2.2.2 Precondition

There is a certain reason why a prescriber wants to start or evaluate/review a medicamenteuze behandeling.

2.2.3 Trigger event

The trigger event for the process is the start of a new medicamenteuze behandeling, the evaluation of an ongoing treatment, receipt of a voorstel verstrekkingsverzoek or voorstel medicatieafspraak, receipt from a pharmacist of a prescription to be processed, or patient admission to or patient discharge from an institution.

2.2.4 Process step: Evaluating a (pharmaceutical) treatment

In order to evaluate treatment, an up-to-date overview of medication data is required. The medical file from the healthcare provider is, where possible and if necessary, updated with data from external sources. In addition, the patient may be asked which medicinal products he is currently using. This consumption can be recorded by the healthcare provider. If desired, a more extensive medication verification can be carried out (see paragraph 2.1).

The treating physician[9] evaluates the (pharmaceutical) treatment and decides to:

  • start a new medicamenteuze behandeling by creating an initial medicatieafspraak and/or
  • continue, discontinue, temporarily halt or modify an existing medicatieafspraak (1 or more)[10] and/or
  • correct/cancel an existing medicatieafspraak and/or
  • approve a voorstel medicatieafspraak or a voorstel verstrekkingsverzoek (including a reply via the reply voorstel verstrekkingsverzoek)

These situations are further explained in the following paragraph. See also paragraph 1.3.3 for more information on the concept of medicamenteuze behandeling. A new medication overview may be created to conclude the evaluation and the resulting new agreements and verstrekkingsverzoeks (see paragraph 5.6).

2.2.5 Process step: Creating a medicatieafspraak

When creating a medicatieafspraak, the following principle applies: each change is recorded in a new medicatieafspraak. Technically this means that the existing medicatieafspraken is terminated by entering an end date for the period of use and that a new medicatieafspraak is created with the desired changes [11]. Medicatieafspraak can also be created to begin at a point in the future. These medicatieafspraken will receive a period of use with future starting date which is later than the date of the agreement itself. Any prior medicatieafspraak will end just before the starting date/time of the future one. In the period of use, only one effective date can be indicated (without duration or end date), this is the case with continuous medication.

Before the medicatieafspraak is created, medication monitoring will occur in accordance with current guidelines. This is a part of this process step.

The next paragraphs describe the different situations in which a medicatieafspraak is created, i.e. initial medicatieafspraak, continuing medication, discontinuing medication, temporarily halting medication or correcting/canceling a medicatieafspraak. Information about medicamenteuze behandelingis assumed to be known (see paragraph 1.3.3).

2.2.5.1 New medicatieafspraak

A new medicatieafspraak is created at the start or modification of a medicamenteuze behandeling. When a new medicamenteuze behandeling is started, the prescriber should consider whether an existing medicamenteuze behandeling should be discontinued. The description in paragraph 1.3.3 is based on the most common process from prescription to administering or using. In a transitional situation or in the absence of digital data (e.g. when there is no opt-in or because of regional boundaries of the Dutch Landelijk Schakelpunt [LSP; national data exchange point]), it is also technically possible that a medicamenteuze behandeling could start with a toediendings afspraak, for example. This might occur for instance when a pharmacist has not received the medicatieafspraak with the corresponding medicamenteuze behandeling in digital form. The pharmacist will consequently start a new medicamenteuze behandeling when the toedieningsafspraak is created. This may also be the case for any other building block. A patient can, for example, start a medicamenteuze behandeling by recording consumption, without having the original medicamenteuze behandeling.

2.2.5.2 Continuing medication

In a number of cases the therapeutic intention of the prescriber remains the same and the medicatieafspraak does not have to be modified. For instance:

  • In an ambulatory situation when, for a repeat prescription, only a new verstrekkingsverzoek is needed, or
  • At admission to an institution where the home medication continues to be used, whether or not in combination with self-medication.

In both of these cases, the existing medicatieafspraak will not be adjusted. Should there be a change in PRK, e.g. at admission or discharge, the existing medicamenteuze behandeling will be discontinued by creating a stop-MA (see Discontinuing medication (paragraph 2.2.5.3)) and a new medicamenteuze behandeling is started (see New medicatieafspraak (paragraph 2.2.5.1.)).

2.2.5.3 Discontinuing medication

Medication is discontinued by creating a new medicatieafspraak (stop-MA) within the same medicamenteuze behandeling. The reason for discontinuation is recorded in this medicatieafspraak. The medication may be discontinued immediately or in the future. The new stop medicatieafspraak (stop-MA) is a copy of the existing medicatieafspraak with:

  • The period of use as end date on which the medicatieafspraak ends (may also be in the future),
  • Its own author,
  • Its own agreement date,
  • Stop type definitief,
  • Reference to the specific medicatieafspraak that will be changed (future medicatieafspraken will remain in place) OR no reference causing the entire medicamenteuze behandeling to be discontinued (including already made future medicatieafspraken),
  • Its own reason for the medicatieafspraak to be discontinued(this does not apply to a stop-MA made as part of a modification. In that case, no reason is given).

A medicatieafspraak in which an end date is immediately agreed upon, e.g. in the case of a course of treatment, is not an additionalystop-MA but a regular medicatieafspraak needed. When a medicatieafspraak with an end date in the future is extended, it will be considered as a normal change (see Changing medication (paragraph 2.2.5.5)). A stop-MA always has the ‘Discontinuation’ stop type, even if it is a stop-MA resulting from a change. In case of a change, the stop-MA is followed by a new medicatieafspraak. A stop-MA resulting from a change is not always relevant for end users. A stop-ma as a result of a change, it is also referred to as a technical stop-ma. The user interface must adequately support this. A prescriber will be less interested than a pharmacist who may need to adjust his logistical process because of the change.

2.2.5.4 Temporarily halting and resuming medication

Temporarily halting medication is the discontinuation of medication for a known or unknown period of time. Medication may be halted immediately or in the future. When use is temporarily halted, the medication still remains relevant for monitoring because the medication may be resumed in the future. Temporary substitution with another medicinal product is not considered an interruption but rather a discontinuation of the original medication and the start of a new medicamenteuze behandeling with the substitute. Temporary halting medication is covered by two medicatieafspraken[12]: a medicatieafspraak (stop-MA) is created to stop use in accordance with guidelines for a stop-MA (see previous paragraph) and a new medicatieafspraak is created for resuming the medication (including the reason for this, if any). All medicatieafspraken are part of the same medicamenteuze behandeling. The reason for the interruption is recorded in the stop-MA. A stop-MA either refers to an original medicatieafspraak or it does not refer to a medicatieafspraak in which case the entire medicamenteuze behandeling is discontinued. The stop type for the stop-MA is 'tijdelijk’.

2.2.5.5 Changing medication

Medication modifications may be related to:

a) Dosage,
b) Strength of the medicinal product,
c) Method of administration,
d) Duration of treatment (such as an extension of the therapy).

Switching to a completely different medicinal product is technically a switch to a different medicamenteuze behandeling (see also paragraph 1.3.3). In that case, the physician will discontinue the existing treatment (see paragraph 2.2.5.3) and start a new one (see paragraph 2.2.5.1). If the PRK stays the same, changes will be recorded under the same medicamenteuze behandeling. When a modification needs to be made, a technical stop-MA is created (see paragraph 2.2.5.3) and , a new medicatieafspraak is made with the desired change. The appointment date of the technical stop-ma and the new medication appointment must be always be the same. The reason for the modification is included in the new medicatieafspraak with a reference to the original medicatieafspraak, if possible. Modifications may take effect immediately or in the future. A technical stop-ma and the related new medicatieafspraak are made available simultaneously. In case of renewal of a medicatieafspraak of which the duration has already expired or the end date has already expired, then this is not seen as a change (a stop-ma on the already automatically stopped medicatieafspraak is unnecessary). In this case, a new MA under the same medicamenteuze behandeling can be made.

2.2.5.6 Correcting/canceling a medicatieafspraak[13]

This paragraph describes correcting or canceling a medicatieafspraak when the prescriber has made an error. The error may have been discovered by the prescriber himself or by a fellow healthcare provider. For example, a physician who makes a typing error in the dosage of a medicatieafspraak: 10 inhalations, 2x daily, instead of 1 inhalation, 2x daily. If the medicatieafspraak has not yet been shared with other healthcare providers, the prescriber can personally correct that medicatieafspraak or delete (cancel) it from his own system. If the medicatieafspraak has already been shared with other healthcare providers, the prescriber will mark the incorrect medicatieafspraak as ‘cancelled’ and he will then create a new medicatieafspraak under the same medicamenteuze behandeling with the correct information. The prescriber will actively inform the pharmacist and any fellow healthcare providers about both the cancelled and new medicatieafspraak and will make both available (see paragraph 2.2.8).

2.2.6 Process step: Creating a verstrekkingsverzoek

A verstrekkingsverzoek (besides a medicatieafspraak) only applies in an ambulatory situation. A verstrekkingsverzoek may be made when the medication supply of the patient needs to be replenished. This does not have to coincide with a medicatieafspraak. At the start of a medicamenteuze behandeling for which the patient still has a sufficient supply at home from a previous agreement, a verstrekkingsverzoek is not needed. When the dosage is reduced, the patient may also have a sufficient supply. In the case of a medicinal product that is used for a prolonged period of time (e.g. an antihypertensive drug), with a continuous medicatieafspraak (meaning a period of use with only a start date), several verstrekkingsverzoeken may be made over time within the scope of this existing agreement. Logistical and emergency instructions may be included in the verstrekkingsverzoek, such as dispense location, request to not include in the GDS (individualised distribution system, in Dutch Geindividiualiseerd Distributie Systeem), etc.

In the case of a verstrekkingsverzoek, the quantity to be supplied can be stated or the consumption period. With a consumption period, the quantity must be clearly deducible from the dosing instruction of the medicatieafspraak. Note: a consumption period end date has a meaning other than the period of use end date from the medictieafspraak and may be unequal.Period of use end date: date until which the pharmacist is allowed to to provide medication (and thereby provide sufficient supplies to the patient for use until that date).

period of use end date: date on which the patient must stop the medication (this can be equal to the consumption period end date or further in the future).

2.2.7 Process step: Sending renal function value with prescription

Renalfunction is important for certain medicines. The renal function value determines the choice of drug and / or drug dosage. It is legally stipulated that if a healthcare professional has performed further research on a patient renal function, he should share abnormal renal function values with the appropriate pharmacist, appointed by the patient (Article 6.10, regeling geneesmiddelenwet).

The renal function value is always sent with the prescription (using the building block laboratory results) for medicines for which this is important (characteristic in the G standard), so that the pharmacist can perform proper medication monitoring. The renal function value should not be older than 13 months, because with stable chronic renal impairment the renal function should be checked at least once a year. 1 month has been added to allow some backlog in practice.

If at the time of sending a medicatieafspraak and / or verstrekkingsverzoek no renal function is known, then the prescription policy remains unchanged. Sending the laboratory result renal function value without a medicatieafspraak and / or verstrekkkingsverzoek is beyond the scope of this information standard.

2.2.8 Process step: (Actively) making available

This step involves information exchange. Information can be sent or made available with different intentions:

A. As an order for the pharmacist to dispense medication. The prescriber sends the medicatieafspraak to the pharmacist. In an ambulatory situation, the verstrekkingsverzoek is also sent to the patient’s pharmacist. If the pharmacist is not known, this process step may also entail giving out a paper prescription and/or (reactively) making the data available (see C). When the pharmacist has filled the order, the prescriber will receive a notification (see paragraph 2.2.7).

B. As an order for the pharmacist to implement a medication change (including stop-MA and staken-MA) that impacts or may impact current medicatieverstrekking by this pharmacist. A current medicatieverstrekking indicates an order (as in A) that has been accepted, but has not yet been completely filled. For example, when medication is still being dispensed or when a verstrekkingsverzoek dictates that medication should be dispensed multiple times, but not all have taken place yet, e.g. with the GDS.

C. Making medication data (MA, VV, MGB) and possibly the medication overview available to allow fellow healthcare providers and/or patients to access these later, possibly in combination with prescription without a specified recipient (see paragraph 8.1).

D. Actively sending (informing) medication data (one or more building blocks) to a specific healthcare provider at the request of the patient when in the presence of this healthcare provider or at discharge.

In case of corrected data, the prescriber assesses who should be actively informed of this correction. This can be done, for example, by sending the new medicatieafspraak (option A or B above) or by means of a telephone consultation. In an ambulatory setting (general practitioner/outpatient clinic) medication data are usually sent or made available directly; in a clinical setting, medication data is usually made available at discharge or interim leave from the institution. This chapter deals with prescription with a specified recipient; paragraph 7.5 details prescription without a specified recipient. See also paragraph 1.3.5 for a further explanation on informing (situation A, B, D) and making available (situation C).

2.2.9 Post-condition

  • A new medicatieafspraak may have been created (starting, changing or discontinuing medication)
  • A verstrekkingsverzoek may have been made (only outpatient)
  • An order may have been sent to the pharmacist to carry out medicatieverstrekking
  • An order may have been sent to the pharmacist to modify medicatieverstrekking
  • Fellow healthcare providers and the patient have been informed or may inform themselves about the new medication data: medicatieafspraak, verstrekkingsverzoek, consumption.
  • Fellow healthcare providers and the patient have been informed or may inform themselves about a medication overview.

2.2.10 Systems and transaction groups

The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO[14]. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process. Chapter 6 includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.

Figuur 5 Processtappen en transacties - voorschrijven

2.2.11 Use cases

The following specific use cases have been elobarated:

2.3 Process: dispense

This paragraph describes the process of dispensing medication, including repeat prescriptions and GDS. This process encompasses all actions a pharmacist must take for the patient to not only receive a medicinal product, but to also receive the associated pharmaceutical care ensuring a safe and effective use of the medicinal product by the pa tient. The dispense process starts with providing pharmaceutical care. If necessary, a toedienafspraakwill made and medication is dispensed. Medicatieverstrekking (i.e. handing out a medicinal product) does not always take place. This may be the case when the medicatieafspraak is changed (e.g., in case of dose reduction where the patient still has enough supply), when the medication is discontinued or, in an ambulatory situation, the medication is not picked up. When the medicatieafspraak and/or the verstrekkingsverzoek are not in order (see paragraph 2.3.5), the prescriber will be informed. Finally, the recorded data are (actively) made available. See Chapter 12 for a diagram of the dispense process.

Medication assessment is the process in which the physician and pharmacist consider all medication of the patient against the background of his condition, applicable treatment guidelines, the well-being of the patient, etc. Medication assessment is defined in this document as a combination of treatment evaluation (as described in the previous paragraphs) and pharmaceutical care. Depending on the findings, the previously described medication verification and prescription processes are followed, after which medicatieverstrekking takes place.

For the GDS, many pharmacists collaborate with another organisation that handles part of the pharmacists’ logistics. This then also requires data exchange with that party. Besides, not all medication can be included in the GDS packaging, which adds to the logistical complexity for the pharmacist. The internal logistics and communication between the pharmacist and his ‘subcontractor(s) are outside the scope of this information standard. It has been established however that with the provision of the current building blocks and the underlying data elements, this logistical process can be adequately supported.

2.3.1 Current situation

The following deviations (from the desired situation that) are currently observed:

  • In the current situation, in the case of individualized distribution systems, the prescribing physician and other healthcare providers receive a large quantity of dispense messages. This becomes difficult to manage for these healthcare providers.
  • In the current situation, in the case of GDS (individualised distribution systems), pharmacists and general practitioners communicate via so-called authorisation lists. The pharmacist sends an overview of all the patient’s medication to the general practitioner for authorisation. This complicates matters for a general practitioner because he will need to verify all medicatieafspraken. This should not be necessary, as most medicatieafspraken/verstrekkingsverzoeks have already been authorised. It would be much more efficient if the general practitioner only needs to authorise those medicatieafspraken/verstrekkingsverzoeken that have not been authorised yet, e.g. a new verstrekkingsverzoek on the basis of an existing medicatieafspraak.
  • In the current situation, a locum pharmacy often does not inform the regular general practitioner and regular pharmacy when medication is dispensed.
  • In the current situation, a voorstel medicatieafspraak may have been aligned with the prescriber over the phone and/or the pharmacist and prescriber have made an agreement about handling a warning from the medication monitoring system.
  • The intention of the return message is not always clear: no distinction can be made in the return/delivery message between displaying a physical delivery and a transmission of information about a medication change.
  • In the current situation, pharmacists sometimes register (and communicate) medicatieverstrekking when they are preparing the medication for the patient instead of at the time when the medication is actually dispensed to the patient. This means that medication that hasn’t been picked up, is sometimes erroneously registered as dispensed.

2.3.2 Precondition

A medicatieafspraak exists. In an ambulatory situation there may also be a corresponding verstrekkingsverzoek.

2.3.3 Trigger event

The pharmacist starts the medication dispense process on the basis of one of the following events:

  • Receipt of an order to make a medicatieverstrekking on the basis of a new medicatieafspraak. In an ambulatory situation, this order is always accompanied by a verstrekkingsverzoek.
  • Receipt of an order to process a new medicatieafspraak in an ongoing medicatieverstrekking.
  • Receipt of a trigger (for example, via a patient or a repeat module of the pharmacist information system) for a repeat medicatieverstrekking under an existing or voorstel verstrekkingsverzoek.

2.3.4 Process step: Providing pharmaceutical care

Pharmaceutical care is provided by a community, outpatient (i.e. at the hospital) institutional pharmacy, depending on the healthcare provider who has created the medicatieafspraak:

  • Medicatieafspraak, possibly with a verstrekkingsverzoek from the general practitioner or specialist: care provided by an institutional or outpatient pharmacy,
  • Medicatieafspraak from specialists and other prescribers in hospitals/institutions: care provided by an institutional pharmacy or a community pharmacy that supplies the respective institution.

Medication monitoring is also part of pharmaceutical care.

Based on the received medicatieafspraak or a change in the situation of the patient, the pharmacist decides how to apply this by:

  • Making one or more new toedieningsafspraken,
  • Continuing, permanently discontinuing, temporarily halting or modifying an existing medicatieafspraak.
  • Rejecting the medicatieafspraak.
  • Proposing a new medicatieafspraak,
  • Proposing a new verstrekkingsverzoek.

The last three situations are explained in the following paragraph. The first two situations are explained in paragraph 2.3.6. A new up-to-date medication overview may be compiled and made available in conclusion of provided pharmaceutical care with possible new agreements and medicatieverstrekking.

2.3.5 Process step: Informing the prescriber

There is a number of situations in which the pharmacist informs the prescriber, including:

  • When a new or modified medicatieafspraak is needed
  • When a new verstrekkingsverzoek is needed

For more information about informing, see paragraph 1.3.5.

A new or modified medicatieafspraak is needed:

  • When a new toedieningsafspraak cannot be created based on the received medicatieafspraak because the pharmacist suspects an error in the medicatieafspraak, or
  • After a signal from the medication monitoring system as part of pharmaceutical care. The signal may indicate, for example, that the dosage should be lowered or increased, that it is advisable to select another medicinal product, that a product should be temporarily discontinued, that another additional product should be added, etc., or
  • Based on consumption as reported by the patient during pharmaceutical care, or
  • When the temporarily halted medicamenteuze behandeling may be resumed.
  • A toedieningsafspraak is not yet created or modified in these situations.

Instead, the pharmacist starts by contacting the prescriber by phone, informing him of the suspected error and proposing an alternative. The pharmacist may also send a digital proposition called voorstel medicatieafspraak to the prescriber. He recommends a specific medicatieafspraak in this proposal, together with the reason and arguments for that recommendation. The prescriber may approve the voorstel medicatieafspraak and make it into a final medicatieafspraak (see also paragraph 2.2.4).

A new verstrekkingsverzoek is needed when the patient’s medication stock is depleted or nearly used and the treatment may need to be continued (request repeat prescription). The patient either requests a repeat medicatieverstrekking from the pharmacist or has signed up in the past for proactive repeat medicatieverstrekking and a notification signal is generated by the repeat module of the AIS when the patient requires new medication[15]. When the existing verstrekkingsverzoek is not adequate, the pharmacist may communicate this request over the phone or send a digital voorstel verstrekkingsverzoek to the prescriber. The voorstel verstrekkingsverzoek may contain indications for the prescriber, such as urgency. The prescriber may approve the received proposal and alter it into a final verstrekkingsverzoek. The prescriber informs the requestor via a antwoord voorstel verstrekkingsverzoek (see also paragraph 2.2.4 and subsequent paragraphs).

2.3.6 Process step: Creating a toedieningsafspraak

If the medicatieafspraak and, if applicable, the corresponding verstrekkingsverzoek can be processed, a toedieningsafspraak will be created. By creating a toedieningsafspraak, the pharmacist fulfills the medicatieafspraak. The toedieningsafspraak is communicated to the patient or the person administrating the medication. The toedieningsafspraakbelongs to the same medicamenteuze behandeling as the medicatieafspraak it fulfills. As is the case with the corresponding medicatieafspraak, a toedieningsafspraakmay start in the future. The dosage in the toedieningsafspraak may deviate from that in the medicatieafspraak, for example because a certain strength is not in stock. This means that another ‘PRK’ can become part of the medicamenteuze behandeling when, for example, 1 tablet of 20 mg is changed into 2 tablets of 10 mg. Before the toedieningsafspraak is created, medication monitoring will occur in accordance with applicable guidelines, as part of this process step.

On the basis of the toedieningsafspraak, an administration list[16] can be compiled for home care or nursing staff, among others.

When creating a toedieningsafspraak, the same principle applies as for the medicatieafspraak: each change is recorded in a new toedieningsafspraak.

The following paragraphs describe the different situations in which a toedieningsafspraak is created: new toedieningsafspraak or continuing, permanently discontinuing, temporarily halting or modifying an existing toedieningsafspraak.

2.3.6.1 New toedieningsafspraak

In case of a new medicatieafspraak, a new toedieningsafspraak is always created. A new toedieningsafspraak is also created in case of a new preference policy or a change in stock which results in the selection of a different medicinal product. When creating a new toedieningsafspraak, the pharmacist takes into account, among other things:

  • Preference policy,
  • Inclusion in GDS-packaging,
  • Available stock of the institution (‘hospital formulary’) or the pharmacy itself.

If, in an ambulatory situation, the first provision/medicatieverstrekking to the patient occurs later than agreed, the start date of the toedieningsafspraak will be different from the start date of the medicatieafspraak.

2.3.6.2 Continuing a toedieningsafspraak

When the existing medicatieafspraak and toedieningsafspraak are sufficient to carry out a medicatieverstrekking, the toedieningsafspraak will not be adjusted.

2.3.6.3 Discontinuing a toedieningsafspraak

A medicatieafspraak in which it has been agreed to discontinue permanently, medication leads to a stop toedieningsafspraak under the same medicamenteuze behandeling (this also applies in case of a stop-MA as a result of a change) with stoptype ‘definitief’. The stop TA prevents a new medicatieverstrekking of the discontinued medication. In an ambulatory situation, the prescriber can indicate in the medicatieafspraak that the medication will be discontinued with the next roll (with GDS). In this case, the start date of the stop toedieningsafspraak may be later than indicated in the original stop medicatieafspraak.

2.3.6.4 Temporarily interrupting a toedieningsafspraak

Temporarily interrupting a medicatieafspraak results in a stop toedieningsafspraak (stop type: tijdelijk). Upon resuming, a new toedieningsafspraak is created. Both toedieningsafspraken belong to the same medicamenteuze behandeling as the medicatieafspraak.

2.3.6.5 Modifying a toedieningsafspraak

A modified medicatieafspraak (leading to a new medicatieafspraak) leads to a new toedieningsafspraak under the same medicamenteuze behandeling. As with the medicatieafspraak, a change to a toedieningsafspraak means the termination of the existing toedieningsafspraak (a technical stop-TA) and the creation of a new toedieningsafspraak.

2.3.7 Process step: Dispense

After creating the toedieningsafspraak, the pharmacist prepares the product and dispenses it to:

  • The patient in a community setting,
  • The patient admitted to a hospital, nursing home or other institution.

The pharmacist records medicatieverstrekking[17].

Medicatieverstrekking to patients:

  • In an ambulatory situation only occurs on the basis of a verstrekkingsverzoek or a repeat verstrekkingsverzoek,
  • In a clinical situation occurs on the basis of the medicatieafspraak without the need for a verstrekkingsverzoek.

2.3.8 Process step: (Actively) making available

This step involves information exchange. Information can be sent or made available with different intentions:

As a request to the prescriber to create a new medicatieafspraak (vma) or a new verstrekkingsverzoek (vvv).

Informing the prescriber about the processing of the prescription (toedieningsafspraak and/or medicatieverstrekking).

Making medication data available (verstrekkingsverzoek and medicatieverstrekking) to allow fellow healthcare providers and/or patients to access these later.

Making a medication overview available to allow fellow healthcare providers and/or patients to access these later.

2.3.9 Post-condition

  • A toedieningsafspraak could have been created.
  • A medicatieverstrekking could have taken place and, if necessary, the patient has received instructions on how to use the medicinal product.
  • Fellow healthcare providers have been informed or may inform themselves. The prescriber has been informed.
  • If necessary, the prescribing physician has been requested to provide a new/modified medicatieafspraak or voorstel verstrekkingsverzoek.

2.3.10 Systems and transaction groups

The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO[18]. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process. Chapter 6 includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.

Figuur 6 Processeps and transactions - dispense

2.3.11 Use cases

De volgende specifieke use cases van ter hand stellen zijn uitgewerkt:

2.4 Process: Administer

This paragraph describes the administration process. Medicatietoediening is carried out by the patient himself or by a healthcare provider, which in this case means a professional authorised to administer medication such as physicians/nurses/caregivers (home care/institution) as well as general practitioners/GP assistants, anaesthesiologists, midwives and dentists. Administration by, for example, an informal caregiver, is recorded as usage (see paragraph 2.5). See Chapter 12 for a diagram of this process.

2.4.1 Current situation

  • It often happens that the administration list in home care only lists the scheduled administration time for medicatieverstrekking in GDS packaging (‘baxter’ medication). In that case, the nurse infers the administration times of the other medication from the information on the label. In addition, medication as needed, injection schedules (for example, for insulin) and anticoagulant dosages are often missing on the administration list.
  • While providing home care, the nurse verifies with the client whether the medication on the administration list is still correct. Medication changes (including stop-orders) often do not appear on the administration list, or not in time. The nurse will the phone the pharmacist, general practitioner or medical specialists to find out what has to be administered.

2.4.2 Precondition

The patient must either be administered medication by a healthcare provider or the patient administers medication to himself.

2.4.3 Trigger event

The moment the medicinal products are administered.

2.4.4 Process step: Administering

The administrator receives the data he needs for administering the medication or he accesses the data (for example, toedieningsafspraak with corresponding medicatieafspraken and other relevant patient characteristics, conditions, laboratory values, previous administration data). The administrator verifies the medication to be administered on the basis of the medication present and the administration data. If agreed and if necessary, the healthcare provider prepares the medication for administration, based on the instructions provided by the pharmacist. The medication is administered. The person who administered the medication registers in his system or on the administration list how the medicatietoediening was carried out. Any abnormalities (no administration, modified dosage, patient refusal, swallowing problems, side effects, etc.) are also recorded and communicated to the prescriber and/or the pharmacist.

2.4.5 Process step: (Actively) making available

The recorded medication data (medicatietoediening) may be sent for information to a fellow healthcare provider or be made available so that the data can be accessed later. For example, the administration data can be retrieved upon transfer of the patient to another department or institution.

2.4.6 Post-condition

The client has been administered medicinal products and this has been registered. If necessary, findings have been communicated to the responsible physician and/or pharmacist.

2.4.7 Systems and transaction groups

The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO[19]. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.
Chapter 6 includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.

Figuur 7 Processtappen en transacties - toedienen

2.4.8 Use cases

The following use cases for medicatietoediening have been worked out:

2.5 Process: Use

This paragraph describes the process of use including registration of consumption by the patient or a healthcare provider. The information recorded by the patient or healthcare provider may be used, among other things, for medication verification by the healthcare provider. During medication verification, use is established by the healthcare provider. See Chapter 12 for a diagram of this process.

2.5.1 Current situation

  • There is currently a limited number of systems available in which the patient can record his own consumption. Exchange to healthcare providers is also highly dependent on the system used and is often limited to one specific healthcare provider via, for example, one specific platform/app.
  • De huidige medicatieprofielen zijn vaak onvolledig en niet actueel.

2.5.2 Precondition

The patient has been prescribed medication.

2.5.3 Trigger event

The patient has used the medication or does not use it (anymore).

2.5.4 Process step: Medicatiegebruik

The patient uses the prescribed medication, selfcare medication . consumption may be recorded by

  • The patient himself or his informal caregiver,
  • A home care or institution nurse and/or
  • Another healthcare provider.

This third option often applies in the event of medication verification (see paragraph 2.1). A variety of systems is available to record use: PHR, XIS, EPF [electronic patient file] / ECF [electronic client file], app, etc.

The following can be recorded as use:

  • Self-care and other proprietary medication,
  • Discrepancies compared to agreements made,
  • Confirmation of use (promoting compliance),
  • Verified medication (see medication verification),
  • Changes as a result of, for example, side effects (by the patient himself; a healthcare provider will record this in a different way).

Patients who are being administered medication by a nurse sometimes take the medication by themselves at a later time, depending on the BEM score (assessment of medication self-management, in Dutch: Beoordeling Eigen Beheer Medicatie); in that case, medicatietoediening data may deviate from medicatiegebruik.
While medication is being used, pharmaceutical care is provided by the pharmacist (see paragraph 2.3.4, e.g. in case of new laboratory values). There may also be follow-up contact during which the medicamenteuze behandeling is evaluated (see paragraph 2.2.4).

2.5.4.1 Recording medicatiegebruik by the patient

The patients makes use of a medication profile and indicates actual use for each medicinal product for which this is relevant. The patient can indicate whether or not he is using the product and/or whether this is ‘use according to agreement’ (whereby the medicatieafspraak and/or toedieningsafspraak is displayed) or if there were deviations. In case of deviations, it is possible to enter specific deviations (i.e. with regard to the schedule actually followed by the patient), but deviations can also be entered in more general terms (for example, I take the medication: ‘from time to time’, [x] times per [days/week] on average’, ‘1x daily instead of 2x’, ‘not anymore since 22 January 2015’ or ‘not anymore since about a month’). In case of deviation from the agreements, the patient also indicates the reason for changing or discontinuing.
The patient may also add his own medication to the overview and indicate any side effects as the reason for the changes.

Information about use will not always be present. There is also no certainty about the reliability of the information. Sometimes there are agreements between the healthcare provider and the patient about keeping track of consumption, and sometimes the initiative is the patient’s entirely.

2.5.4.2 Recording consumption by healthcare providers

During the process of medication verification (paragraph 2.1) or evaluating a medicamenteuze behandeling (2.2.4) the patient (or his informal caregiver) indicates, for example, that he does not use medication or uses it differently than was agreed. He may also indicate that he uses other medication as well (self-care products or foreign medication). The healthcare provider can record these data as consumption. The data about use are recorded in addition to the primary medication data with the patient being recorded as the source of the information and the healthcare provider as the author.
Instead of or in addition to recording the consumption, a prescriber may also choose to make a new or modified medicatieafspraak with the patient (in accordance with the process described in paragraph 2.2.5). This may occur when the prescriber sees reasons to adjust the agreement in response to the patient’s actual consumption. When the prescriber sees no reasons to adjust the agreement, he may choose to only record the consumption, perhaps with the remark that he has requested the patient to comply with the existing agreements.

In case of deviations in consumption, a pharmacist may create a voorstel medicatieafspraak for the prescriber (see paragraph 2.3.5) and/or advise the patient to inform the prescriber about the deviations.

The assessment of useconsumption (effect and side effect) will be recorded by the physician in the medical history or used as a reason to modify or discontinue a medicatieafspraak.

2.5.5 Process step: (Actively) making available

The recorded medication data (consumption) and possibly the medication overview may be sent for information to a fellow healthcare provider or be made available so that the data can be accessed later.

2.5.6 Process step: Informing the prescriber

The patient may also directly inform the prescriber when a new or modified medicatieafspraak or new verstrekkingsverzoek is needed. The process is similar to the process of the pharmacist informing the prescriber (paragraph 2.3.5).

2.5.7 Post-condition

The medication list has been updated by the patient and actual use has been added. If necessary, the patient has asked the prescriber for a new or modified medicatieafspraak or verstrekkingsverzoek.

2.5.8 Systems and transaction groups

The prescriber and the pharmacist as well as other healthcare providers and users all make use of an information system, respectively, an electronic prescribing system (EVS), a pharmacist information system (AIS, incl. ZAIS), a XIS and a PGO[20]. These systems each have different system roles which enable the exchange of data between these systems as part of the prescription process.
Chapter 6 includes an overview of all systems, system roles, transactions, etc. The most important elements for the prescription process are included in the overview below.

Figuur 8 Processtappen en transacties - gebruiken

2.5.9 Use cases

The use cases for consumption are described on the basis of registration by the patient. The prescriber may record consumption in the same way but will rather record the assessment of consumption (effect and side effect) in the medical history or use it as a reason to modify or discontinue a medicatieafspraak.

The following specific use cases for consumption have been worked out:

3 Domain-specific handling of the medication process

3.1 Locum GP ervice (HAP)

The locum GP service (LGP) works on behalf of the regular general practitioner. The GP service may (among other things) start, modify and discontinue medicatieafspraken in accordance with the process described in paragraph 2.1. If necessary, the LGP will also create the corresponding verstrekkingsverzoeken.
The LGP will inform the regular general practitioner about the observation. Currently, it has been agreed that the LGP does not act as a source of information for other healthcare providers of this patient. This means that the LGP will not carry out the process step ‘(actively) making available’. Instead, the regular general practitioner will make the relevant information available to the fellow healthcare providers. An exception may be made for a prescription created by the LGP without a specified recipient, see paragraph 8.1.
In principle, the locum GP service service will follow the generic prescription process, except that a locum GP physician will carry out certain steps on behalf of the regular GP (‘delegated’).

3.2 Thrombosis service

3.2.1 Current situation

  • Communication between thrombosis service and pharmacy is carried out by fax and/or secure e-mail.
  • Communication between prescriber and thrombosis service is carried out by telephone and initially using the registration form.
  • In order to get a complete picture of the medication the patient uses, the thrombosis service may sometimes ask for an AMO (Actueel Medicatie Overzicht) overviews from different pharmacies.

3.2.2 Process

When a patient has to start using anticoagulant medication, the prescribing physician (general practitioner or specialist) creates a medicatieafspraak with the patient stating which anticoagulant medication will be used, in accordance with the prescription process as described in paragraph 2.1. Fellow healthcare providers may inform themselves about anticoagulant use ‘in accordance with the thrombosis service schedule’.
The prescriber determines the therapeutic INR range (International Normalised Ratio, a measure for blood clotting time) and refers the patient to the thrombosis service. The prescribing physician remains responsible for verstrekkingsverzoeken. The thrombosis service however determines the specific dosing schedule on the basis of the therapeutic INR range and the measured INR (. The thrombosis service uses this to further complete the medicatieafspraak (‘dosage in accordance with the thrombosis service schedule’) documented in the toedieningsafspraak. The thrombosis service also creates medicatieafspraken, including verstrekkingsverzoeken themselves, about the use of vitamin K and heparin, in accordance with the prescription process as described in paragraph 2.1.
At the start of treatment and after each admission, the thrombosis service asks for current medication data (including allergies), receives notification signals from pharmacists about newly provided interacting medication and asks the patient at each visit for particulars, such as hospital admissions, illnesses and use of selfcare medication. Based on this information and possibly after consultation with the prescriber, interim dosage changes may be made.

The patient is informed via mail and/or a patient portal about the dosing schedule and possible use of vitamin K and heparin. In case of self-measurement, the patient enters their INR and consumption through a patient portal and makes it available.

All medication is dispensed by the pharmacist; the pharmacist is responsible for medicatieverstrekkingen. There are pilots ongoing to dispense anticoagulant medication in GDS. To facilitate this, the pharmacist receives the dosing schedule from the thrombosis service. Repeat prescriptions are handled by the general practitioner, possibly under the medicatieafspraak of the specialist.

When anticoagulant medication may be discontinued, the physician creates a stop-mediatieafspraak with stoptype ‘definitief’. Anticoagulant medication may also be temporarily halted, for example in case of surgery.

3.3 Mental health care

There are only few planned admissions in mental health care (almost only in departments for eating disorders, clinical rehabilitation, etc.). Most admissions are admissions as a result of acute crisis situations and are therefore comparable to admissions via the emergency departments in hospitals (see also paragraph 4.1.20).

3.3.1 Current situation

In the current situation, patient or family/informal caregivers are asked which medication the patient is using. In most cases, the patient is unable to give an answer (often the reason for admission). Family/informal caregivers (if known) are also not always able to answer this. If this is the case, the admitting physician/psychiatrists will contact the general practitioner or the pharmacist to find out the medication. This is difficult outside office hours and during weekends. When data do come in, only part of them is retyped in the system of the healthcare providers.

3.3.2 Process

In the new situation, it will be possible to retrieve the available medication data and medication overviews. On this basis, medication verification, assessment of the medicamenteuze behandeling (as soon as possible) and medication administration (in accordance with Chapter 2) can be started. Medication dispense is carried out by public pharmacists on an outpatient basis and, in clinical practice, often by a contracted hospital pharmacy.
As is the case with hospital discharge, medicamenteuze behandeling will be assessed at discharge from a mental health institution (paragraph 2.2.4 and subsequent). Clinical medication is discontinued and, if necessary, new medication is prescribed or temporarily halted outpatient medication is resumed or permanently discontinued. The physician/psychiatrist focuses mainly on psychiatric medication; somatic medication usually remains unaffected.
Letting the psychiatric patient record his own medication usage may be experienced as undesirable control instead of it stimulating proper use.
The medication data will be made available.

3.4 Nursing, care and home care (VVT)

The medication process in a VVT institution (nursing home, care home and home care) is similar to that of the clinical situation. However, in a VVT institution, a geriatrics specialist is responsible for prescribing medication to admitted clients and medication is being dispensed by one or more community pharmacists, possibly as part of GDS if needed. VVT institutions and home care make use of administration lists, which are drawn up based on the toedieningafspraken. The administration list is used to check medication before administering it and to sign off actual consumption. Communication of the administration list between pharmacist, prescriber and nursing staff will be explained in more details further on in this information standard.

4 Description of use cases

This chapter contains a description of various use cases. Specific practical situations have been described for the various subprocesses. A large number of the practical situations are based on general medical practice, but are illustrative of similar situations in a different setting. This chapter assumes the knowledge as previously described in Chapter 2.

4.1 Use cases, Prescribe

4.1.1 Short-term medication

A 35 year old female patient with a history of urinary tract infection brings her urine to the doctor’s assistant and tells her she has the same symptoms as the previous times. The assistant enquires about other symptoms such as fever and pain in the flank and checks the urine. There are no other symptoms and the urine reveals a urinary tract infection. She tells the patient that the general practitioner will prescribe a course of treatment and that she can pick it up from the pharmacist later. The General practitioner checks the previous courses of treatment and any cultures and records a medicatieafspraak. On 27 January it was agreed:

Nitrofurantoin CR capsule, 100 mg, 2x daily, 1 capsule, from now on[21] for 5 days.

He records this medicatieafspraak in his system. The general practitioner then immediately also makes a verstrekkingsverzoek for the pharmacist chosen by the patient:

Nitrofurantoin CR capsule, 100 mg; 10 capsules.

The general practitioner also records this verstrekkingsverzoek in his system.
The general practitioner consults with the patient to find out from which pharmacist she wants to pick up the medication. The general practitioner can then inform this pharmacist about the verstrekkingsverzoek and the medicatieafspraak.
The system of the general practitioner makes this information (verstrekkingsverzoek and medicatieafspraak) available to the other healthcare providers of this patient.

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4.1.2 Continuing medication

The process for continuing medication is practically the same as for short-term medication (see paragraph 4.1.1), except that in the case of continuing medication the medicatieafspraak is made for an indefinite period of time.

For example: the prescriber agrees with a patient who has hypertension that he should use a diuretic on a continuous basis. On 30 March 2013 it was agreed:

Hydrochlorothiazide tablet, 12.5 mg; 1x daily, 1 tablet; from now on for an indefinite period.

For example, the prescriber chooses in the verstrekkingsverzoek for an initial dispensing quantity of 100 pieces.

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4.1.3 Hard end date for period of use

A start date, end date and/or duration can be included in the period of use of a medicatieafspraak. If a hard end date is desired, this must also be explicitly stated in the explanation. Including an end date alone is not sufficient because this does not provide enough clarity about the intention of the prescriber.

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4.1.4 Medication as needed

A 31-year-old female patient has had headaches a few times in a year, with migraine now being diagnosed. The general practitioner prescribes:

Rizatriptan tablets, 10 mg, as needed 1c1t under the tongue. First tablet at the next clear migraine attack.

De huisarts legt de medicatieafspraak vast en doet een verstrekkingsverzoek:

6 sublingual rizatriptan tablets, 10 mg.

4.1.5 Course of treatment as needed starting in future

A 60-year-old patient with post-thrombotic syndrome experiences erysipelas (severe infection of the leg which can require admission if medication is not started quickly) sometimes every other year, sometimes three times a year. At the request of the patient, the general practitioner prescribes an antibiotic treatment the patient can start immediately in case of a recurrence of erysipelas. The following medicatieafspraak is created:

Flucloxacillin capsules, 500 mg, 1 capsule 4x daily, for 10 days. In the medicatieafspraak is indicated (if necessary): start in case of recurrence, as needed.

The general practitioner immediately creates a verstrekkingsverzoek:

Flucloxacilline 500mg capsules 40stuks.


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4.1.6 Two dosages of the same medication at the same time

A 79-year-old man with metastatic prostate cancer is increasingly suffering from pain and his medication is being changed. The specialist prescribes oxycodone tablets, 10 mg, 1 tablet 4x daily and as needed for pain during the night, 1 tablet 1x daily, on October 9. The specialist records this in one single medicatieafspraak with two dosing instructions and creates a verstrekkingsverzoek for 60 tablets of oxycodone of 10 mg.

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4.1.7 The same medicinal product with different strengths at the same time

The same 79-year-old patient (see paragraph 4.1.6) is experiencing even more pain. The specialist discontinues the 10 mg tablets of oxycodone on October 16 and prescribes 20 mg retard tablets of oxycodone, 2 tablets 3x daily, and 20 mg normal release tablets of oxycodone as needed in case of nocturnal pain, 1 tablet 1x daily. The specialist records this in two medicatieafspraken (with, for the time being, two separate medicamenteuze behandelings) and creates a verstrekkingsverzoek for both medicatieafspraken, respectively 45 retard tablets of 20 mg oxycodone and 30 tablets of 20 mg oxycodone (normal release).

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4.1.8 Explanation in medicatieafspraak with deliberately chosen special characteristic

This use case is described in the ZIB medicatieafspraak/additional information. Here it is described for information purposes only. When selecting a medicinal product, it is possible to deviate from what is expected or standard. For example, when a hospital uses a different formulary than a community pharmacy. For reasons of efficiency the hospital has opted for a single gastric acid inhibitor: pantoprazole.
At admission, a patient with omeprazole is switched to pantoprazole for the duration of the hospitalization. At discharge, the patient returns to omeprazole.
It is clear that this may sometimes go wrong and that the patient might end up taking both omeprazole and pantoprazole if nothing is done. In the medicatieafspraak of the hospital for pantoprazole, a remark can be made about this deviation in order to make it clear that pantoprazole is the replacement of omeprazole or that it has to be used in addition to omeprazole.

Half-strengths are another example. The hospital sometimes as tablets available with half the strength of the normal commercial preparation (proprietary production). When a patient enters the hospital with a prescription of 25 mg of chlorthalidone, half a tablet 1x daily, he will receive 12.5 mg of chlorthalidone, 1 tablet 1x daily. In this specific case, this means that nursing staff does not have to break tablets in half. There is a risk that the patient will use the 25 mg again at home, but now a whole tablet at the time. An explanation in the medicatieafspraak (additional information) regarding the last 25 mg of chlorthalidone, makes it possible to indicate whether this was a deliberate increase.

If a prescribed product has to be a very specific commercial product, this can be indicated with ‘medical necessity’.

4.1.9 New medicatieafspraak, no verstrekkingsverzoek

A 50-year-old man comes to the general practitioner with back problems. The symptoms have been present for three weeks and he is already using paracetamol. The general practitioner agrees with the patient that he can additionally use diclofenac:

On 30 January it was agreed:

Diclofenac tablet, 50 mg, 1 tablet 3x daily, from now on for 3 weeks.

He records this medicatieafspraak in his system. The patient indicates there is sufficient supply at home: his wife still has an ample supply of diclofenac left because of a different problem a year ago.

A verstrekkingsverzoek is therefore not needed and the pharmacist also does not dispense any medication.
The general practitioner makes the new medicatieafspraak available to any fellow healthcare providers of this patient. This allows the regular pharmacist to inform himself about this new medicatieafspraak.

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Another example: Mr Simons receives medication from the pharmacy weekly. In the past there were many requests for extra medication, which led to clear agreements about the dispense policy.

This is about:

Medicatieafspraak: Diazepam, 5 mg, 1 tablet 4x daily, from 1 January 2012 for an indefinite period
Verstrekkingsverzoek: 28 tablets with 10 repeats; remark: weekly medicatieverstrekking

The verstrekkingsverzoek is repeated approximately every 11 weeks. The last verstrekkingsverzoek was on 3 March 2016:

one week (28 tablets) with 10 repeats

This way, the pharmacy can go on for 11 weeks.

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The last few years have been quiet. Mr. Simons is no longer asking for extra medication. At the last consultation he indicated that diazepam, 3x daily, is sufficient. This has been recorded in a medicatieafspraak:

1 April 2016 Diazepam, 5 mg, 1 tablet 3x daily, from 1 April 2016 for an indefinite period.

The previous medicatieafspraak will be terminated as of 31 March 2016 (see discontinuation of medication in paragraph 2.2.5).

In the current situation, the general practitioner would have called the pharmacy to make sure that 21 tablets of diazepam would be given with the following medicatieverstrekking, instead of 28. No new verstrekkingsverzoek would have been needed at the time.

In the new situation, the general practitioner sends the new medicatieafspraak to the pharmacy. Based on the new medicatieafspraak, the pharmacy provides 21 tablets per week, the previous verstrekkingsverzoek is still sufficient.

4.1.10 New verstrekkingsverzoek under existing medicatieafspraak

A prescriber may also create a new verstrekkingsverzoek as part of an existing medicatieafspraak. This medicatieafspraak may have been created by a different prescriber, for example a psychiatrist. This concerns repeat medication. This use case is described in paragraph 4.2.6.

4.1.11 Dosage change (sufficient supply)

Patient (37 years old, asthma) visited the pulmonologist on 13 August 2013 for a check-up of his asthma. The pulmonologist has established that patient’s asthma is not adequately controlled.
The patient is currently using beclomethasone in accordance with a previously made and registered medicatieafspraak: on 10 June 2010 it was agreed:

Beclomethasone aerosol, 100 microgram/dose, inhaler; 1 inhalation 2x daily; from 10 June 2010 for an indefinite period.

On 13 August 2013, the pulmonologist agrees with the patient on a dosage increase:

Beclomethasone aerosol, 100 microgram/dose, inhaler; 2 inhalations 2x daily; from 13 August 2013 for an indefinite period; reason for adjustment: insufficient effect.

The previous medicatieafspraak of 10 June 2010 it is no longer valid: it is terminated (see Changing medication in paragraph 2.2.5). The patient still has a sufficient supply, a verstrekkingsverzoek is therefore not needed.

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In case the patient has no more supply, a new verstrekkingsverzoek will be created.
The system of the pulmonologist makes the new medicatieafspraak available to the other healthcare providers of this patient. This modification is received by the pharmacist (fellow healthcare provider). The pharmacist processes the modification. The pharmacist may also choose to accept the modifications automatically.

4.1.12 Prescription no longer needed after first verstrekkingsverzoek

A 16-year-old woman has a boyfriend and does not want to become pregnant. After explanation she opts for the pill. The general practitioner prescribes ethinylestradiol/levonorgestrel tablets of 20/100 µg, 1 tablet 1x daily for 21 days, then no tablet for 7 days, then another 21 days of taking a tablet once a day. Start on the first day of the next menstruation. The general practitioner records the medicatieafspraak and creates a verstrekkingsverzoek for 63 coated microgynon 20 tablets. He explains to her that if she does not experience any problems, she can continue to get the pill via the pharmacy.
Three months later, the woman sends a request for repeat supply to the pharmacy. The pharmacy provides the product and communicates the medicatieverstrekking to the general practitioner.

4.1.13 Discontinuing medication

Patient (37 years old, asthma) visits the pulmonologist on 13 August 2013 for a check-up of his asthma. The patient is suffering from a side effect. The patient is currently using Beclomethasone in accordance with a previously made and registered medicatieafspraak. On 10 June 2010 it was agreed:

Beclometasone aerosol, 100 microgram/dose, inhaler; 1 inhalation 2x daily; from 10 June 2010 for an indefinite period.

On 13 August 2013, the pulmonologist agrees with the patient to discontinue the medication (medicamenteuze behandeling is discontinued). Medication verification is also applicable here. In addition, medication monitoring may also be relevant here, for example if gastroprotrective drugs are being used because of the use of the medication to be discontinued (the system will not always signal this automatically).
The pulmonologist records:

Beclometasone aerosol, 100 microgram/dose, inhaler; stoptype ‘definite’; from 13 August 2013. Because of a side effect.

This modification is received by the pharmacist (fellow healthcare provider). The pharmacist processes the modification. The pharmacist may also choose to accept the modifications automatically. The pulmonologist decides to also actively inform a fellow healthcare provider (such as a specialist) about this (part of the process step (actively) making available).
The system of the pulmonologist makes this information (agreement to discontinue) available to the other healthcare providers of this patient.

4.1.14 Temporarily halting/resuming medication

A patient is being treated with simvastatin (cholesterol-lowering agent): 40 mg, 1 tablet 1x daily, for an indefinite period. Because of a throat infection in combination with an allergy for the first antibiotic of choice, Clarithromycin, 250 mg, 1 tablet 2x daily (antibiotic) is prescribed for 1 week. During that week, simvastatin is temporarily halted because of an interaction.
The general practitioner records:

Simvastatin 40 mg; halt temporarily; for 1 week; reason: interaction
Clarithromycin, 250 mg; 1 tablet 2x daily; for 1 week (and a corresponding verstrekkingsverzoek)

The pharmacist is actively informed by the general practitioner about the temporary halt of simvastatin. A new medicatieafspraak is also created with which simvastatin is resumed after one week. The pharmacist will also receive the medicatieafspraak and the corresponding verstrekkingsverzoek for clarithromycin. See also Temporarily halting and resuming medication in paragraph 2.2.5.

4.1.15 Temporarily halting for an intervention

A 62-year-old man uses acetylsalicylic acid, 100 mg, 1 tablet 1x daily because of coronary disease. He has an intestinal polyp that must be removed. The general practitioner informs him that he should stop using acetylsalicylic acid three days before the intervention and resume the day after the intervention. The general practitioner records the temporary halt in a medicatieafspraak with an enddate 3 days before the intervention; stoptype ‘temporary’; reason for halting: ‘intervention’. In the (second) medicatieafspraak for presuming, 1 day after the intervention is used as the start date. The general practitioner actively informs the pharmacist and the gastroenterologist about the medicatieafspraken.
When the date of the intervention is unknown or uncertain, the explanation will indicate that the medication should be halted three days before the intervention and resumed one day later. The duration of the temporary halt is then 4 days. See also Temporarily halting and resuming medication in paragraph 2.2.5.

4.1.16 Substitution

Upon admission, home medication may be switched to medication from the hospital formulary. The existing (home medication) medicatieafspraak will then be discontinued and a new medicatieafspraak will be created under a new (institution medication) medicamenteuze behandeling (see also paragraph 1.3.3). This (institution medication) medicatieafspraak refers to the medicatieafspraak for the home medication. At discharge, the institutional medication is discontinued and, if necessary, the home medication under the previous or a new medicamenteuze behandeling will be restarted by creating a new medicatieafspraak that refers to the original medicatieafspraak for the home medication.

4.1.17 Paper prescription

The physician gives the patient a paper prescription[22]. A paper prescription contains a medicatieafspraak and a verstrekkingsverzoek. The patient can use this prescription to pick up the medication from any pharmacist. The general practitioner does not inform the issuing pharmacist in this case. However, the process is actually the same: the activity ‘(actively) making available’ is now only ‘handled’ by the paper prescription in the hands of the patient. The supplying pharmacist will copy this paper medicatieafspraak and verstrekkingsverzoek in his own system and complete it with a toedieningsafspraak. The pharmacist may also retrieve the medicatieafspraak and verstrekkingsverzoek that were made available digitally and process them in his own system this way.
The system of the general practitioner makes the new medicatieafspraak and verstrekkingsverzoek available for fellow healthcare providers. When the system of the general practitioner has not made these available this may be because it concerns a toedieningsafpsraak without digitally available medicatieafspraak and verstrekkingsverzoek. The pharmacist will not make the medicatieafspraak and verstrekkingsverzoek obtained ‘from paper’ available because he is not the owner. Next to that, this could lead to, possibly only in the future, wrongful duplication of medicatieafspraken and verstrekkingsverzoeken.

4.1.18 Carrying out medication verification and evaluation of foreign or self-care medication

When medication cannot be found in the system (such as foreign medication and self-care medication), this medication will be recorded as consumption (see paragraph 2.2.5).

4.1.19 Day treatment

An admission for day treatment is comparable with an outpatient consultation or an emergency admission during which the medication is supplied by the hospital pharmacist. In the case of admission for a day, extensive medication verification does not usually occur. In the case of admission for a day, the medication prescribed is recorded (often on the basis of protocols according to which verification is carried out afterwards) and administered.
For treatments with cytostatics, for example, there is a medicatieafspraak, but it is not always clear in advance when the medicatieverstrekking/administration takes place. Reason: treatments are often postponed and then supplied and administered later.

4.1.20 Starting with medication before admission

Prior to cataract surgery, Nevanac is started three days before the surgery. The eye drops are used until three weeks after surgery (a total duration of use of 24 days). The specialist creates a medicatieafspraak for Nevanac, 1 drop in the morning, for 24 days. When the date of the surgery is unknown or uncertain, the explanation may indicate that Nevanac should be started 3 days before surgery takes place.

4.1.21 Emergency admission

In the event of an emergency admission, extensive medication verification is not carried out beforehand as would normally be the case with clinical admissions. Agreeing on medication with the patient is also often not possible in the event of an emergency admission. Often, the patient is administered medication as soon as possible and verification only takes place afterward

4.1.22 Discharge

When a patient is discharged from the hospital, all clinical medication is discontinued. The medicamenteuze behandeling is evaluated during which it is decided which medication the patient will use after discharge:

  • Previous outpatient medication that was discontinued at admission is started again (new medicatieafspraak under previous or new medicamenteuze behandeling) with possible reference to medication from before admission.
  • Previous outpatient medication that was temporarily halted at admission (without substitution) is resumed using a new medicatieafspraak under the same medicamenteuze behandeling
  • New outpatient medication is agreed upon: as an outpatient replacement of clinical medication or as a new therapy (new medicamenteuze behandeling with possible reference to institutional medication)

See Chapter 2.2.4 for this. The medication overview and the medication data are (actively) made available.

4.1.23 Interim discharge

When a patient temporarily leaves the hospital/institution to go home, for example, for weekend leave, the clinical medication continues. In order to keep the patient’s own general practitioner informed, the medication overview is provided to the patient and the medication data are made available.

4.1.24 Transfe rto another institution

In case of a transfer to another institution, the medicamenteuze behandeling is evaluated (see Chapter 2.2.4 and paragraph 2.2.5). Medication overview and medication data are (actively) made available. The new attending physician evaluates the medicamenteuze behandeling and determines the institutional medication.

4.1.25 Do not dispense before

The prescribing physician creates a verstrekkingsverzoek on 14 April 2017, but wants to indicate in that same verstrekkingsverzoek the medicatieverstrekking may only take place on or from a later date, for example, 23 April 2017. This cannot be recorded in a structured manner in the verstrekkingsverzoek, but is included in the explanation (as free text).

4.1.26 Discontinuation of medication by third parties

Medication can be discontinued by the prescriber himself (see paragraph 4.1.13) but also by another prescriber. For example, the specialist can end medicatieafspraken made by a general practitioner that are up to date according to the system, but that turn out not to be, for example after medication verification. When a healthcare provider discontinues medication, he creates a new stop-MA. The healthcare provider cannot modify someone else’s medicatieafspraak, only create a stop-MA. He therefore actively informs the healthcare provider of the original medicatieafspraak about this change. The healthcare provider of the original medicatieafspraak modifies the end date in the existing medicatieafspraak. If required, this may also be automated by the system. This prevents the second healthcare provider from not having to produce data after a period of time because the production period has expired (also no stop-MA), while the healthcare provider of the original medicatieafspraak continues to produce it for no reason (without an end date).

4.1.27 Two PRKs in a single medicamenteuze behandeling

In certain circumstances, the pharmacy is allowed to select a different PRK for the toedieningsafspraak than is indicated in the medicatieafspraak made by a prescriber. If for instance a failure of the prescriber’s system would result in only the communication of the toedieningsafspraak, a subsequent prescriber will only have this toedieningsafspraak with the new PRK. The next prescriber will then probably assume that this PRK is also the PRK of the medicatieafspraak. A modification of the medicatieafspraak will then also result in a stop-MA (without referring to the original MA) and a new medicatieafspraak on the basis of this PRK. This means that there are now two medicatieafspraken with different PRKs under the same medicamenteuze behandeling. These two medicatieafspraken continue to exist. After any system failure, (the system of) the prescriber must check whether there have been changes and implement them, if necessary (see also paragraph 4.1.26).

4.1.28 Creating a medicatieafspraak after the fact

In emergency situations, for example, it may happen that the medicatieafspraak is only created after the medication has been dispensed or administered. This may lead to conflicting medicatieafspraken. This means that one or more medicatieafspraken must be discontinued in order to prevent the occurrence of parallel medicatieafspraken. The only exception for parallel medicatieafspraken is described in paragraph 1.3.3.

4.1.29 Parallel medicatieafspraken

See paragraph 1.3.3.

4.1.30 Single use

For medication meant for single use, only an end date is included in the period of use. An example would be a vaccination (for example, a tetanus shot) or a situation in which a patient should take a medication just once, for example 3 weeks before he leaves on holiday.

4.1.31 Provisional and final medication order

The prescriber at the clinic prescribes medication. This is recorded in a provisional medication order (the medicatieafspraak). The hospital pharmacist verifies this order and records it as a final medication order (the toedieningsafspraak). See also [3].

4.1.32 Inadvertently ‘outstanding’ medication or 'orphans'

In a transitional situation and in a situation where not every XIS is connected, medicatieafspraken for the same treatment may exist that have been created by different systems under different medicamenteuze behandelings. These medicatieafspraken should ideally be combined in a single medicamenteuze behandeling. This particularly applies to medication with an open end date, as this medication may have been discontinued under a different medicamenteuze behandeling. The medicatieafspraak therefore remains open, resulting in continued medicatieverstrekking. This is a so-called ‘orphan’ (a building block that has been registered, but in which, at a certain point, the healthcare provider no longer has an active role. However, his system continues to provide the building block, even if it has already been discontinued elsewhere). For medication with an end date, this problem will solve itself. Therefore, it is not necessary to take any action. When medication verification or medication assessment reveals that the medication is inappropriately still ‘open’, a stop-MA is created under the same medicamenteuze behandeling. The original prescriber is actively informed about this stop-MA and enters an end date for the medicatieafspraak in his own system. Depending on the supplier and the client’s wishes, setting this end date can be done automatically or through an intervention of the prescriber. See also paragraph 4.1.26.

4.1.33 Missing digital medicatieafspraak at admission

If no digital medicatieafspraak is available when medication verification is carried out, a new medicamenteuze behandeling is started by recording consumption. When this use has to be discontinued, a stop-medicatieafspraak is created under the same medicamenteuze behandeling that refers to the recorded consumption. If possible, the original prescriber (for example, general practitioner) and the pharmacy are actively informed about the discontinuation of this medication.

4.1.34 Own articles (90 million numbers)

It is possible to exchange a 90 million number. The condition is that within an organization a 90 million number once created may never be modified. During the exchange, the root OID (unique technical identification of the organization) in combination with the 90 million number ensures that it is unique compared to all 90 million numbers form other organizations. The substances that make up this article are included as ingredients in the medicatieafspraak (at least one ingredient), as is the case with magistrals.

4.1.35 Dosing with minimum interval

Medication can be prescribed at a fixed interval (for example: 2 tables every 6 hours). Prescribing medication with a minimum interval should be partly in free text. For example, if needed, a maximum of 3 times a day, a minimum of 6 hours between the intake moments: if needed, a maximum of 3 times a day is recorded in the standard way. The section “at least 6 hours between intake times” is recorded in free text as an Additional Instruction.

4.1.36 Verstrekkingsverzoek with number of repetitions

The prescriber makes a verstrekkingsverzoek with a medicatieafspraak in which she enters the number of repetitions. The prescriber hereby indicates to the provider that it may make additional provisions. The number of repetitions in combination with the quantity to be dispensed results in: (Number of repetitions + 1) X quantity to be dispensed. In case of “number of repetitions =3” and “quantity to be supplied = 30 pieces” the provider may provide 4 times 30 pieces (total 120 pieces). The number of repetitions in combination with the duration of use period results in: (number of repetitions + 1) x duration of use. The amount to be dispensed depends on the dosage. In case of “dosage = 3 x per day 2 pieces”, and “Duration of use period = 30 days” the provider may provide 180 pieces 4 times (6 pieces per day X 30 days = 180, 4 times = a total of 720 pieces).

4.1.37 Prescribing non-medicines

Non medicines can be prescribed from the G-standard at HPK level. For example, this could be an inhaler (Aerochamber, HPK 1915185) as an aid to prescribed aerosols. Non-medicinal products are not applicable for the medication overview or medication monitoring.

4.1.38 Send renal function value in the prescription

A) Renal function value with a new prescription:
For the prevention of stroke, a patient (male, 65 years old) is prescribed Dabigatran for the first time. The patient has renal impairment and the prescriber has a recent renal function value available. Based on this renal function value, the prescriber deviates from the standard dose and makes a medicatieafspraak with a lower dosage of Dabigatran twice a day 1 capsule of 110 mg, starting from January 15, 2020. The prescriber also makes a verstrekkingsverzoek and sends the prescription (medicatieafspraak, verstrekkingsverzoek and the laboratory result of the renal function value) to the pharmacist.
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B) Renal function value reason for a change:
A 70-year-old man was prescribed 1 tablet of metformin 500 mg 3 times a day a few days ago (medicatie afspraak and verstrekkingsverzoek). At the same time, the doctor initiated a blood test to determine the renal function value of the patient. The value was not yet known at the time of prescription.

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The blood test shows that renal function is impaired and gives reason to adjust the medicatieafspraak. The prescriber adjusts the dose on January 17, 2020 to 2 tablets metformin 500mg twice a day and discuss this with the patient. The new prescription (the 'technical' stop medicatieafspraak, new medicatieafsrpaak and the laboratory result of the renal function value) is sent to the pharmacy by the prescriber. Because the patient had already collected the medication and therefore has enough stock, no new verstrekkingsverzoek is sent along.

C) Renal function value due to drug:
The patient is prescribed Nitrofurantoin 100 mg, 1 capsule twice daily as a 5-day course due to a bladder infection and must start immediately on January 6, 2020. With this drug, the renal function value (if known and not older than 13 months) needs to be sent along. The prescriber has a renal function value available for this patient, but this does not lead to an adjusted dosage. The prescriber sends the prescription (medicatieafspraak, verstrekkingsverzoek and the laboratory result of the renal function value) to the pharmacist.
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4.2 Use case, Dispense

4.2.1 New medicatieafspraak, medicatieverstrekking of the same product

The patient is at the pharmacist on 27 January 2013 to collect his medication. The pharmacist opens the file of the patient and verifies the medication file. It is a new medicatieafspraak for this patient. The relevant information of the prescribing physician is displayed on the screen of the pharmacist.
Medicatieafspraak: Nitrofurantoin CR capsule, 100 mg, 1 capsule 2x daily, from now on for 5 days.
Verstrekkingsverzoek: Nitrofurantoin CR capsule, 100 mg; 10 capsules.
The pharmacist selects a product on the basis of the medicatieafspraak and other factors (such as the pharmacist’s stock and the preference policy of the healthcare insurer):
FURABID CR CAPSULE, 100 MG. The pharmacist carries out medication monitoring using the system, no (warning) signals are given.
The pharmacist carries out pharmaceutical care (compliance, education, et cetera) and agrees with the patient on how she will use the medication. This toedieningsafspraak on 27 January 2013 reads:
FURABID CR CAPSULE, 100MG; 1 capsule 2x daily; from now on for 5 days. The pharmacist provides the medication to the patient:
on 27 January 2013, FURABID CR CAPSULE, 100 MG; 10 capsules. The pharmacist actively informs the prescribing physician about the medicatieafspraak and the medicatieverstrekking.
The system of the pharmacist makes the new toedieningsafspraak and medicatieverstrekking available to the other healthcare providers of this patient.

Uc4.2.1.PNG

4.2.2 New medicatieafspraak, more precise product specification

Here, the difference when specifying the product is that the toedieningsafpsraak and also the medicatieverstrekking deviates from the medicatieafspraak the patient has made with the prescribing physician. The process is otherwise the same as described in the previous paragraph.

Example
Medicatieafspraak: Nitrofurantoin capsule mga 100 mg, 1 capsule 2 times a day from today for 5 days.

The pharmacist specifies a different product:
Nitrofurantoine MC Actavis capsule 50 mg. The pharmacist agrees with the patient on how she will use the medication. This toedieningsafspraak on 27 January 2013 reads:
Nitrofurantoin MC CR capsule 50 mg, 1 capsule 2x daily, from now on for 5 days.
The pharmacist provides the medication to the patient:
on 27 January 2013, Nitrofurantoin MC Actavis capsule 50 mg; 20 pieces.

Uc4.2.2.PNG

4.2.3 Existing toedieningsafpsraak is adequate

The process of repeat medicatieverstrekking on the basis of an existing medicatieafspraak and possibly existing verstrekkingsverzoek and toedieningsafsrpaak occurs in case of repeat prescriptions and is described in paragraph 4.2.10, situation 2.

4.2.4 Medicatieafspraak wanted (informing the prescriber)

Example 1 - adjusting dosage:
For a 70-year-old patient with a creatinine clearance of 45 mL/min, the pharmacist enters a toedieningsafspraak for gabapentin tablets of 600 mg, 1 tablet 3x daily. Renal function has been recorded in the patient’s file at the pharmacy, and based on this a signal appears that the maximum dosage is 900 mg daily. The pharmacist sends the prescriber a proposed medicatieafspraak with an adjusted dosage of 300 mg, 3x daily, and the reason for this proposal (maximum dosage exceeded). The prescriber receives the proposed medicatieafspraak in his EVS and sends an adjusted medicatieafspraak back to the pharmacist.

Example 2 – temporarily halting a medicinal product:
For a 50-year-old patient with on oral fluconazole as part of his current medication, the pharmacist enters a toedieningsafspraak for simvastatin. A message appears with the advice to consider temporarily halting simvastatin. The pharmacist can make a proposed medicatieafspraak for halting the simvastatin (stoptype ‘temporary’). See example 1 for further steps.

Example 3 – adding a medicinal product:
For a 55-year-old woman, the pharmacist enters a toedieningsafspraak for prednisone, 10 mg daily for three months. The patient is not using osteoporosis prophylaxis. A message appears with the advice to add a biphosphonate drug and to check whether the patient is taking calcium and vitamin D. If the patient is not, the pharmacist can make a proposed medicatieafspraak for these products. See example 1 for further steps.

PLEASE NOTE: it will depend on the situation whether it is useful to create an automated proposal for adjustment/addition of a MA. If the advice is complex, it may still be useful to phone and to consult instead of sending a digital proposal.
The proposed medicatieafspraak may help the prescriber to enter this change in the system. The latter is important when medicatieafspraken are consulted, for example, by service observation general practitioners.

4.2.5 Request and dispense

When a medicatieafspraak and verstrekkingsverzoek arrives at the pharmacy, it is processed by the pharmacy system as an intended medicatieverstrekking. This is called the request date, which is captured as the request date of the medication dispensing The date of dispensing is only registered at the moment of pick up or hand over of the medication. The pharmacist informs the prescriber about the handling of the prescription (toedieningsafspraak and/or medicatieverstrekking).

It is possible to create multiple dispensings under the same toedieningsafpsraak:

  • A verstrekkingsverzoek comes in with a medicatieafspraak with a one-year use period
  • There will be a first provision with a new toedieningsafspraak and a medication supply that is sufficient for, for example, a period of 4 months.


Uc4.2.5a.PNG

  • The second dispensing is performed based on the existing medicatieafpsraak, verstrekkingsverzoek and toedieningsafspraak (no new prescription or new administration appointment is needed). The new second medication dispensing (with new write-up date and the pre-existing associated toedieningsafspraak) is sent to the prescriber when the dispensing date is registered.


Uc4.2.5b.PNG

4.2.6 Patient requests repeat prescription via physician (reactive repeat)

A physician has previously diagnosed hypertension in a patient (57 years old) and has prescribed the patient medication for this. The patient uses this medication and the medication is running out. The patient makes a request to repeat the medication, for example through the repeat line, by phone, by email to the practice, counter/boxes, website, app or portal of the physician. The physician approves the repeat. This leads to a new verstrekkingsverzoek.
For example: The general practitioner makes, in the context of the medicatieafspraak of 30 March 2010:

Nifedipine CR 30 mg; 1 tablet 1x daily, from 30 March 2010 for an indefinite period

on 13 April 2013 a verstrekkingsverzoek to a pharmacist chosen by the patient:

Nifedipine, CR tablet, 30 mg; ‘for three months’.

In consultation with the patient, the prescriber can send the verstrekkingsverzoek with the corresponding medicatieafspraken and toedieningsafspraken as an order to a pharmacy of the patient’s choice. The prescriber also makes the new verstrekkingsverzoek available to fellow healthcare providers and the patient. The existing medicatieafspraken had already been made available.
The pharmacist receives the verstrekkingsverzoek together with the medicatieafspraak and processes it in accordance with the dispense process and starts with the pharmaceutical care process step.

When the patient, on the basis of a toedieningsafspraak or on the basis of his use asks for a repeat prescription, and the medicatieafspraak is not digitally available, the physician creates a new medicatieafspraak based on this toedieningsafspraakor the patient’s use of the medication. No reference is made to the existing medicatieafspraak in that case.

4.2.7 Patient requests repeat prescription via pharmacist (informing prescriber)

The patient requests a repeat medication from the pharmacist, for example through repeat line, by phone, email, counter/boxes, website, app or portal of the pharmacist.
The pharmacist sends a proposed verstrekkingsverzoek including a copy of the existing medicatieafspraak for authorisation to the prescriber. The physician evaluates the proposed verstrekkingsverzoek and approves it. He informs the pharmacist via the reply proposed verstrekkingsverzoek and sends a new verstrekkingsverzoek together with the current agreements to the pharmacist. The pharmacist continues the dispense process and starts with the pharmaceutical care process step.
If the prescriber does not provide a verstrekkingsverzoek, he informs the pharmacist via the answer proposed verstrekkingsverzoek.

4.2.8 Proactive repeat prescription by pharmacist (informing prescriber)

The patient has signed up in the past for proactive repeats and the pharmacist has registered this in his proprietary pharmacist information system (PIS). The repeat module of this system will generate a signal when a patient needs new medication. When a new verstrekkingsverzoek is needed, this is similar to the process described in the previous paragraph, only the trigger is not the patient but the pharmacist (or his system). Proactive repeats are also used for GDS, see paragraph 4.2.11.

4.2.9 Dispense based on an existing verstrekkingsverzoek

The patient submits a repeat prescription to the pharmacist. In this case, it is a request for medicatieverstrekking on the basis of an existing, still valid, verstrekkingsverzoek. See paragraph 4.2.10 situation (3).

4.2.10 Splitting a prescription

The patient has been using the same medication for a number of years, which means that the medicatieafspraak can be created for an indefinite period. The toedieningsafspraak is also valid for an indefinite period. In such a case, the patient can be given a prescription for a year. This single year prescription will be split into several prescriptions by the pharmacist. These split prescriptions are commonly called ‘repeat prescriptions’, even though strictly speaking this is not true.

There are three possible situations:
1) The patient returns to his attending physician still suffering from the same symptoms. The prescriber prescribes the same medication (in the case of an expired medicatieafspraak, a new medicatieafspraak is created with a new verstrekkingsverzoek and in the case of a medicatieafspraak that is still valid, only a new verstrekkingsverzoek is created).
2) Prescriber and patient initially agree on 90 tablets with 3 repeat prescriptions. The patient receives the first 90 tablets. The next time the patient visits the pharmacist, a medicatieverstrekking is made under the existing agreements.
3) Prescriber and patient initially agree on 360 tablets for one year. The pharmacist splits this into 4 separate occasions of medicatieverstrekking. The patient is initially dispensed 90 tablets and without a new verstrekkingsverzoek, can go to the pharmacist 3 more times to pick up another 90 tablets each time.
Situation 3 best describes the way in which a pharmacist splits a year prescription.

4.2.11 Starting and continuing a GDS

The following example shows the process for one medicinal product used by the patient for an indefinite period of time. The system of the general practitioner and the pharmacist contains (among other things) the following data on a patient:

  • The medicatieafspraak of 2 January 2013 reads: Metoprolol, CR tablet, 100 mg (succinate); 1x tablet daily; from 2 January 2013 for an indefinite period.
  • The toedieningsafspraak of 2 January 2013 reads: Metoprolol PCH retard, 100 CR tablets of 95 mg; 1x tablet 1x daily; from 2 January 2013 for an indefinite period.

This elderly patient is taking so much medication that he has problems overseeing it all: a potentially dangerous situation. On 6 February, the pharmacist and the general practitioner agree that the medicatieverstrekking of medicinal products to this patient will take place via GDS.

The GDS is started: the pharmacist sends a proposed verstrekkingsverzoek (a similar event to the current combined prescription or authorisation form).

The proposed verstrekkingsverzoek of 6 February reads:

  • Verstrekkingsverzoek for the medicatieafspraak of 2 January 2013: Metoprolol, CR tablet, 100 mg (succinate), and a period of use to ensure enough stock up to and including 1 May 2013.

The pharmacist sends the proposal to the general practitioner. The general practitioner approves the proposal on February 6 and sends it unchanged to the pharmacist as a verstrekkingsverzoek. The GDS indicator is switched on in the system of the general practitioner as well as in the pharmacist’s system.

The pharmacist and the patient select a partial duration for the product. This toedieningsafspraak reads as follows:

  • On 7 February it was agreed: Metoprolol PCH retard, 100 CR tablets of 95 mg, 1 tablet in the morning, from 11 February (week 6), for an indefinite period.

Every second week, the pharmacist dispenses a Baxter medication roll containing (among other things) the metoprolol:

  • Medicatieverstrekking 1: The pharmacist dispenses, on Friday, 8 February 2013: 14 tablets, scheduled for weeks 6 and 7 (a period of use of 2 weeks).
  • Medicatieverstrekking 2: The pharmacist dispenses, on Friday, 22 February: 14 tablets, scheduled for weeks 8 and 9.
  • Medicatieverstrekking 3, 4, 5, etc.

With each medicatieverstrekking, it is indicated that medicatieverstrekking was carried out via GDS. After three months, there is a new proposed verstrekkingsverzoek from the pharmacy to the general practitioner, etc.

Consideration

  • The application of a proposed verstrekkingsverzoek instead of an authorisation form makes its meaning unambiguous.
  • In the current situation, toedieningsafspraken and medicatieverstrekkingen are registered as a single dispense. This makes it difficult to find useful information in the large number of messages. By dividing the dispense order into two building blocks, the overview is easier to understand: there are no new medicatieafspraken and only one new toedieningsafpsraak is created. There are no hidden surprises in the remaining logistical data and the general practitioner does not have to monitor the multiple medicatieverstrekkingen.
  • This way of registering and exchanging prevents double registration, and errors caused by this.
  • The toedieningsafspraken are the basis for the administration list and checklists of nursing homes and care homes. Signing them corresponds to the administration(s).

4.2.12 The pharmacist changes commercial product

This scenario builds on the previous scenario: after half a year a different commercial product is agreed with the patient (toedieningsafspraak), because the original product is not available. No new medicatieafspraak is made, as there is no change needed on that level. The toedieningsafspraak is changed:

  • On 1 July it was agreed: Metoprolol Sandoz ret, 100 CR tablets, 95 mg, 1 tablet in the morning; from 3 July, for an indefinite period. Reason: not available.

The toedieningsafspraak is a modification of the toedieningsafspraak of 7 February, which stops on 2 July (11:59 p.m.) and is an actual handling of the medicatieafspraak of 2 January. The pharmacist informs the general practitioner about this.


Consideration
This change in the actual handling of the medicatieafspraak using a toedieningsafspraak, changes nothing to the validity of the medicatieafspraak itself, improving the overall view for all parties. In addition, since the pharmacist records and communicates the reason for the adjustment, the prescriber is better able to assess whether the information is relevant.

Uc4.2.12.PNG

4.2.13 Adding medication to a GDS

When new medication is added to an existing GDS, the prescriber may opt for immediate addition to the current medicatieverstrekking roll (Change in GDS immediately) or for addition starting from the next roll (Change in GDS per change of roll). The prescriber indicates this in the medicatieafspraak (additional information). If ‘Modification in GDS when rolls are changed’ is chosen, the pharmacist will first dispense the medication separately, in addition to the existing GDS. This means that a toedieningsafspraak is created by the pharmacist for the bridging period. Starting with the new roll, the new medication is added to the roll. Starting with the start date of the new roll, a toedieningsafspraak can be made by the pharmacists with specific administration times. If the ‘bridging-toedieningsafspraak’ already includes the correct administration times, no new toedieningsafspraak is created at the date of inclusion in the roll.

4.2.14 Discontinuing medication in a GDS

When medication is discontinued, the prescriber creates a discontinuation-medicatieafspraak. In accordance with the process, the pharmacist is informed about this stop-MA and can adjust the medicatieverstrekking accordingly. The pharmacist will create a staken toedieningsafspraak . See paragraphs 2.2.5.3 and 2.3.6.3.

4.2.15 GDS supplier supplies other commercial product

It is possible that a GDS supplier delivers a different commercial product than that which is included in the toedieningsafspraak by the pharmacy. This is therefore a change in the HPK which results in a changed toedieningsafpsraak. This may only be afterwards, after feedback from the GDS supplier of the filling details.

4.2.16 Handling a stop medicatieafspraak

When the prescriber agrees to discontinue medication, a stop medicatieafspraak is created. This stop-MA this processed by the pharmacist by discontinuing the corresponding toedieningsafspraak.

4.3 Use cases, Administer

4.3.1 Double check

For a number of high-risk medicinal products (for example, insulin, anticoagulants, oral cytostatics, all parenterals) the medicatietoediening and/or any preparations are checked by another person (from a legal point of view this should be a random passer-by, but in practice this is often a nurse) than the person who has prepared the medication. This is also entered in the administration list. The pharmacist ensures that medications that have to be double-checked are marked in the administration list. When the medicatietoediening is made available, the information of the double check on the medicatietoediening is also provided.

4.3.2 Administering without medicatieafspraak or toedieningsafspraak

Sometimes, medicatietoediening is carried out on the basis of an oral medicatieafspraak. In such cases, the prescriber/pharmacist records the medicatieafspraak toedieningsafspraak, only after the medicatietoediening. In other cases a medicatieafspraak has been made, but no toedieningsafspraak exists yet. In such a case, the pharmacist only records the toedieningsafspraak after the medicatietoediening.
In the case of a single medicatietoediening without toedieningsafspraak, the administrator must carry out an allergy check as well as a dosage check.

4.4 Use cases, Use

4.4.1 Self-care product

A patient has acquired Ibuprofen from the drugstore and takes 1200 mg every day. The patient enters this product as gebruik, with such data as starting dates and dosage, and possibly the reason for use.

4.4.2 Medication from abroad

A patient has been prescribed medication on holiday and is taking this. The patient enters the medication as gebruik, with data such as start date and dosage, and possibly the reason for use. If known, the name of the prescriber and the pharmacist are also recorded.

4.4.3 Modification on the patient’s initiative

The patient has been prescribed propranolol. The patient is having severe problems sleeping because of this and has reduced the medication herself. The patient records gebruik with the modified dosage and the start date for this lower dose. The patient also indicates that she initiated this change herself.
In the case where a patient initiates a dose reduction, the patient can keep on using the medication for a longer period than initially agreed because she still has a supply. The patient can indicate this as additional gebruik.
In the case where a patients initiates a dosage increase, the patient’s supply may run out sooner. The patient may then have to return to the physician earlier than expected.

4.4.4 Discontinuation of medication on the patient’s initiative

Since he started using propranolol, the patient suffers from insomnia. He decides to stop without immediately informing the prescribing physician. The patient himself records that he has discontinued medication, indicating the date and giving insomnia as the reason for discontinuing.

4.4.5 No more supply

A patient has received medication ‘as needed’ for his skin problems. The medication is still active in the medication profile, but is no longer available at the pharmacist. The patient indicates that the medication has been discontinued because it is no longer available, possibly with the addition that the symptoms have disappeared. The patient may also make a proposed verstrekkingsverzoek to replenish his supply In this case, the reply proposed verstrekkingsverzoek comes back to the patient (and if approved, a verstrekkingsverzoek is also sent from the prescriber to the pharmacist).

4.4.6 Feedback to patient through a medication adherence app

In this example the patient uses an app on his mobile phone to help manage his medication. The patient or the pharmacist has created an administration schedule with reminder times (where possible using the app to obtain the toedieningsafspraken from the medicatietoediening). When it is time to take his medication, the patient receives a reminder signal from the app. The patient then records in the app whether or not he has taken his medication (for instance because he forgot to bring it along with him). If the app is linked, for example, to the patient’s PGO [personal health file, medication adherence is tracked automatically.

4.4.7 Registration of side effects by the patient

Since he started taking propranolol, a patient has been suffering from insomnia. The patient records this side effect in the explanatory notes to the consumption. When the patient changes the use of this medication from what was previously agreed, for example when he takes less tablets, he can give the side effect as a reason for this change. When his symptoms diminish or cease, the patient records this in the explanation for consumption.
It is possible that the patient is suffering from side effects without exactly knowing which medicinal products cause them. There is no provision within medication process to record this (yet).

4.4.8 Register usage based on provision

This applies in the transition period from the old medication process standard 6.12 to this medication process information standard.

Only verstrekking (dispensing) is available digitally (according to medication process version 6.12). However, the user's system offers the possibility to record all medication use. In that case, the medication use can be recorded with reference to the ID of the version 6.12 verstrekking.

5 Medication overview and inference rules

This chapter shows a sample medication overview and also specifies inference rules for 'The most current relevant building block', Verification for each medicamenteuze behandeling, etc.

5.1 Introduction

The term 'current medication overview' has been replaced by the term 'basisset medicatiegegevens’ (basic set of medication data): the medication overview in combination with additional information that is required (at least) to be able to prescribe, change, stop or safely provide medication in a safe and responsible manner in the Transfer of Medication Data in the Chain (Leidraad Overdracht van Medicatiegegevens in de keten, final draft 2017).

This page contains an example of a medication overview. This example was developed in the Medication Process Information Standard program and serves as an example of how data can be displayed in an application. The data numbered in the pictures below are normative, they are mandatory to show. The other (unnumbered) data in the example is optional and may be added as normative in the future. The layout of the overview in a system can differ per target group and per device. For pharmacists, for example, only toedieningsafspraken are initially visible, after which it is possible to click further to get to the corresponding medicatieafspraak and the medicatiegebruik. If only consumption or a medicatieafspraak is known, this will of course be shown immediately. The basic principle is that the overview shows all medication of the patient, not just the medication that is registered in the patient's own system.

The overview is described generically and therefore the same for all suppliers. The requirements of the end users are included on this page and no statements are made about the technical realization or implementation. The existing KNMP specification “User requirements specification Medication overview 2.0”, final concept “Guidance Transfer of Medication data in the chain (Leidraad OVerdracht van Medicatiegegevens in de keten)” and the new insights from the Medication process program have been incorporated in this.

Principles for the overview are:

  • Healthcare providers want to see a distinction between the therapeutic building blocks on a medication overview:
    • Medicatieafspraak
    • Toedieningsafpsraak
    • Medicatiegebruik
  • Logistical building blocks (verstrekkingsverzoek, dispensing) and the medicatietoedieningbuilding block are not relevant for the medication overview.


Medicatieoverzicht v0.5 Medicatieoverzicht v0.5

5.2 Functional specification

In the figures below the parts with normative data are included. The other parts are not yet normative. The numbered elements in the table are normative, other elements are optional for the time being.

5.2.1 Heading and General

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Filter: N/A

Sort: N/A

Medication Overview Date: This is the date that the last change to a medicatieafspraak, toedieningsafspraak or consumption was recorded within the system providing the medication overview.

NOTE: In the viewer, all dates are shown with the month in characters, so that there is no confusion between day-month and month-day (American format).

No Header Dataset Explanation
1 Name Patient – Name data (Initials, Surname, PartnerSurname), Date of Birth, Gender
2 Telephone Patient – Contact data – Telephone numbers Primary telephone number of patient
3 BSN Patient – Patient identification number Always BSN
4 Adress Patient – Address data
5 Healthcare Provider Name Healthcare Provider – Organization name Healthcare provider who has compiled the medication overview
6 Healthcare Provider Adress Healthcare Provider – Address – Address data Healthcare provider who has compiled the medication overview
7 Healthcare Provider Telephone Healthcare Provider – TelephoneMail – Contact data – Telephone numbers Healthcare provider who has compiled the medication overview
8 Healthcare Provider Email Healthcare Provider – TelephoneMail – Contact data – Email addresses Healthcare provider who has compiled the medication overview
9 Date of Medication Overview Document data – Document date
Height Body height – HeightValue, HeightDateTime
Weight Bodyweight – WeightValue, WeightDateTime
Checked by Healthcare Provider Document data – Verification by healthcare provider
Verified with Patient/Informal Caregiver Document data – Verification by patient

Elements 5 through 8 are not shown if the patient is the creator of the medication summary.

5.2.2 Intolerances, contraindications, allergies (ICA)

Medicatieoverzicht ICA v0.5.PNG

Active intolerances, contraindications and allergies.

Filter: end date is not filled, is in the future or was less than a year ago when compiling the overview.

Sort: most recent effective date at the top.

This part will be elaborated at a later time and is not yet normative.

5.2.3 Current medication

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Filter: all current medication, i.e. all medicatieafspraken and toedieningsafspraken that apply at the time the overview is compiled and the associated medicatiegebruik per source. The temporarily interrupted medication is also shown in this category. When only consumption is known, it is shown if it is not older than three months. When consumption is recorded by both a healthcare provider and a patient, the last registered medication use is shown for both.

Sorting: by medicamenteuze behandeling (MBH): medicatieafpsraak, toedieningsafsrpaak, medicatiegebruik (recorded by patient, care provider). Medicamenteuze behandelingen are sorted in descending order by startdate medicatieafspraak, toedieningsafspraak, medicatiegebruik.

No Header Dataset
1 Type Medicatieafspraak Toedieningsafspraak Medicatiegebruik
2 Medicinal product Agreed medicinal product- Medicinal product belonging to Toedieningsafspraak- Device-
Product – ProductCode (if absent: ProductSpecification, ProductName)
3 Start date Start date
4 End date/duration End date (if not available: Duration)
5 Dosage Instructions for use – Description
6 Route of toediening Instructions for use – Route of toediening
7 Reason Reason for prescribing &

if applicable reason for discontinuing/suspending medication

Reason for discontinuing/suspending medication Reason for discontinuing/suspending medication
8 Explanation Explanation & additional information Explanation
9 Source Prescriber- Provider- Author-
Healthcare provider – Name healthcare provider, specialty
n/a n/a or “Patient”

5.2.4 Future medication

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Filter: all medication that will become actual in the next 3 months. This includes intended medication use. For a description of the mapping, the same applies as with the current medication, see Current medication.

5.2.5 Recently discontinued medication

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Filter: any medication that has ended or stopped in the past 2 months.

For a description of the mapping, the same applies as with the current medication, see Current medication.

5.2.6 Additional lab values

Medicatieoverzicht Labwaarden v0.5.PNG

Most recent lab values and abnormal renal function values.

This part will be elaborated at a later time and is not yet normative.

5.2.7 Remarks

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For example, relevant (limited) health skills (competences: literacy, calculation and digital skills) that can have an impact on medication use / treatment.

This part will be elaborated at a later time and is not yet normative.

5.3 Building block instantiations

This section describes which instantiations of the building blocks belong to the medication overview. This concerns 'own' and 'other people's' building blocks (section 3.1) and then only the latest, relevant instantiations of this (section 3.2).

5.3.1 Own and other people

Both the own and a copy of (known to the sender) building blocks from other sources are included in the medication overview. This so that the medication overview is as complete as possible for the recipient. This ensures that recipients can start using it immediately and that they are not dependent on other sources. The technical representation of someone else's building block may differ from that of the real source. It is important that the recipient is aware of this. The original OID of someone else's building block should simply be given. The recipient can then choose to also collect the building block from its source in its original form.

The medicatieafspraak, toedieningsafspraak and consumption building blocks have been extended with a feature that indicates whether:

  • there is an 'own' building block or
  • that of "someone else" (an accent building block: MA’, TA’, MGB’)

This attribute only applies in the medication overview transaction, because that is the only transaction where other people's building blocks may be delivered.

The 'building block of someone else' attribute is on two levels:

  • The template ID of an MA’, TA’, MGB’ differs from an MA, TA and MGB.
  • In addition, the element copy indicator is always sent with value true in MA’, TA’, MGB’.

For the medication overview, it is permitted to offer the medicatieafspraken, toedieningsafspraken and consumption via a system-generated MGB or MGB '(Healthcare provider is author MGB). This must have a reference to an MA, TA or MGB.

5.3.1.1 Medication overview and derivation rules

An overview of medication that the patient is using (or should be using) can be put together in a system in two ways:
1) displaying a current medication overview (or overviews) obtained from another source (or sources)
2) showing coherent medication building blocks obtained from one's own system and from other sources.
In both cases, this overview of medication consists of the information as included in the building blocks medicatieafspraak, toedieningsafspraak and medicatiegebruik.

Re 1) When this document refers to a current medication overview, this means a coherent overview in which current medicatieafspraken, toedieningsafspraken and medicatiegebruik are included. This current medication overview is built up by the source on the basis of the data known at that time at the source. This overview can be exchanged with the transaction group Medicatieoverzicht (Medication overview) (PULL or PUSH).

The data and building blocks that are known at the source, but originating from another source, are supplied in the transaction with the 'accent' indicator so that they are recognizable as building blocks from someone else (MA accent, TA accent, MGB accent).

Re 2) It is also possible for a system to compile an overview by combining own and other people's separate individual medication building blocks. The transaction group Medicatiegegevens (medication data) (PULL) is used to request individual building blocks.

With the transaction group Medicatiegegevens (medication data) (PUSH), separate building blocks can also be sent directly to another healthcare provider or the patient (so without requests). This happens, for example, at discharge or at the request of a co-practitioner who has the patient in front of him (e.g. patient appears to a GP or pharmacist outside the region, where this GP or pharmacist requests the data by telephone from the patient's own GP and receives it digitally).

Both Medicatiegegevens (medication data) PUSH and PULL should not provide data obtained from other sources.

5.3.2 Last relevant

Only the last relevant building blocks (per medicamenteuze behandeling) are part of the medication overview. This section describes what exactly those last relevant building blocks are for a medication overview. Firstly for prescription medication (section 3.2.1), then for "over the counter" medication (section 3.2.2). The following section 3.2.3 further discusses the special situation that, in addition to a current, a future medicatieafspraak within the same medicamenteuze behandeling is valid. Finally, the last paragraph summarizes the rules to be applied.
Note: The (technical) stop-medicatieafspraken are not shown in the examples, but are implicitly assumed.

5.3.2.1 Prescription medication

5.3.2.1.1 Most simple "happy flow"

In a medicamenteuze behandeling, the simplest "happy flow" results in a sequence of:

  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik.

Usually, medicamenteuze behandeling (drug treatment) starts with a medicatieafspraak. A toedieningsafspraak concretely completes the medicatieafspraak. medicatiegebruik says something about the actual use of the patient in this medicamenteuze behandeling. All three building blocks are relevant in such a case and are part of the delivery of a medication overview, as indicated in green below.

  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik.

A toedieningsafspraak refers to the medicatieafspraak he enters. If no referral is available in the toedieningsafspraak, the appointment date (administration appointment) must be later than that of the medicatieafspraak to be relevant to delivery.
use medicatiegebruik can refer to a medicatieafspraak or toedieningsafspraak. If no referral is available in the medicatiegebruik, the registration date (medicatiegebruik) must be later than that of the medicatieafspraak to be relevant for delivery.

5.3.2.1.2 New medicatieafspraak in medicamenteuze behandeling

If you create a new medicatieafspraak in an existing medicamenteuze behandeling (drug treatment), the currently existing medicatieafspraken, toedieningsafspraken and records of medicatiegebruik are no longer relevant for the medication overview. The idea is that all older building blocks than the current medicatieafspraak are by definition "overruled" by this new medicatieafspraak and consequently no longer relevant for the medication overview.

  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik - Medicatieafspraak

If a toedieningsafspraak and possibly also medicatiegebruik are created and available following such a medicatieafspraak medication appointment, these will be included in the medication overview.

  • Medicatieafspraak – Toedieningsafspraak – MedicatiegebruikMedicatieafspraak – Toedieningsafspraak
  • Medicatieafspraak – Toedieningsafspraak – MedicatiegebruikMedicatieafspraak – Toedieningsafspraak – Medicatiegebruik
5.3.2.1.3 Medicatiegebruik earlier than toedieningsafspraak

It is possible that you have registered medicatiegebruik before the toedieningsafspraak has been made. Here too, the idea is that the newer toedieningsafspraak "overrules" the older registration of toedieningsafspraak and medicatiegebruik. The older medicatiegebruik is therefore no longer relevant for the medication overview.

  • Medicatieafspraak – Medicatiegebruik
  • MedicatieafspraakMedicatiegebruikToedieningsafspraak

Of course, a new record of medicatiegebruik can then be made, which is also relevant for the medication overview.

  • MedicatieafspraakMedicatiegebruikToedieningsafspraak - Medicatiegebruik
5.3.2.1.4 New toedieningsafspraak

Sometimes you make a new toedieningsafspraak under an existing medicatieafspraak. For example, because another product must be provided (as a result of preference policy or stock). In that case, too, such a new toedieningsafspraak may overrule older medicatieafspraken and medicatiegebruik.

  • MedicatieafspraakToedieningsafspraak – Medicatiegebruik - Toedieningsafspraak

Of course you can then record medicatiegebruik, which is also relevant for the medication overview.

  • MedicatieafspraakToedieningsafspraak – MedicatiegebruikToedieningsafspraak - Medicatiegebruik

5.3.2.2 Over the counter

Sometimes a patient uses medication for which there is no prescription. This applies, for example, to painkillers such as paracetamol or ibuprofen, which are available without a prescription. We call this “over the counter” medication. Such use of "over the counter" medication can be recorded with the medicatiegebruik building block. This is also relevant for the medication overview.

  • Medicatiegebruik

A new record of medicatiegebruik by the same type of author (type of author is patient or healthcare provider) "overrules" any older records of medicatiegebruik. Elaborated below, in order of registration date:

  • Medicatiegebruik - Medicatiegebruik

When a prescriber decides to formalize this medicamenteuze behandeling with a medicatieafspraak the rules as described above apply. Elaborated below, in order of appointment date (medicatieafspraak or toedieningsafspraak) / registration date (medicatiegebruik):

  • Medicatiegebruik – MedicatiegebruikMedicatieafspraak
  • Medicatiegebruik – MedicatiegebruikMedicatieafspraak - Medicatiegebruik
  • Medicatiegebruik – MedicatiegebruikMedicatieafspraak – Toedieningsafspraak - Medicatiegebruik
  • Medicatiegebruik – MedicatiegebruikMedicatieafspraakMedicatiegebruik - Toedieningsafspraak - Medicatiegebruik
  • Medicatiegebruik – MedicatiegebruikMedicatieafspraak - Medicatiegebruik - Medicatiegebruik

5.3.2.3 Future medicatieafspraken and toedieningsafspraken

A medicamenteuze behandeling may include more than one topical medicatieafspraak and toedieningsafspraak. Namely one for the current situation and one or more for the future situation. This section describes an example with one current and one future. For clarity, the future building blocks have a “T-” in the examples. Both current and future building blocks are relevant for the medication overview. The building blocks for toedieningsafspraak and medicatiegebruik must have adequate references to either the current or future appointments. Below are three examples, in order of appointment date / registration date (if these are equal, then sorted by period of use):

  • Medicatieafspraak – T Medicatieafspraak
  • Medicatieafspraak – Toedieningsafspraak – T Medicatieafspraak – T Toedieningsafspraak
  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik

Suppose that the toedieningsafspraak changes because the provider provides a different strength (2x 500mg tablets instead of 1x 1000mg tablets) and the patient still has enough stock for two weeks based on the first toedieningsafspraak:

  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T Toedieningsafspraak – T Medicatiegebruik
5.3.2.3.1 New medicatieafspraak

If you make a new medicatieafspraak in this situation, you always make a (technical) stop-medicatieafspraak. This stop-medicatieafspraak has two manifestations:
1) with reference to a specific medicatieafspraak that you stop
2) without a referral, and with that you stop the entire medicamenteuze behandeling (drug treatment)

Ad 1) Stop medicatieafspraak for one current medicatieafspraak. With this stop medicatieafspraak you stop one specific medicatieafspraak. You also make a new one for that medicatieafspraak. Suppose you only want to change the current medicatieafspraak, then this applies to the examples above, in order of appointment date:

  • MedicatieafspraakT Medicatieafspraak – Medicatieafspraak
  • Medicatieafspraak – ToedieningsafspraakT Medicatieafspraak – T Toedieningsafspraak – Medicatieafspraak
  • Medicatieafspraak – Toedieningsafspraak – MedicatiegebruikT Medicatieafspraak – T Toedieningsafspraak – T Medicatiegebruik – Medicatieafspraak

Suppose you only want to change the future medicatieafspraak, then this applies to the examples above, in order of appointment date:

  • MedicatieafspraakT MedicatieafspraakT Medicatieafspraak
  • Medicatieafspraak – ToedieningsafspraakT Medicatieafspraak – T ToedieningsafspraakT Medicatieafspraak
  • Medicatieafspraak – Toedieningsafspraak – MedicatiegebruikT Medicatieafspraak – T Toedieningsafspraak – T MedicatiegebruikT Medicatieafspraak

Ad 2) Stop medicatieafspraak for the entire medicamenteuze behandeling. With this stop medicatieafspraak you stop all existing (current and future) medicatieafspraken in the medicamenteuze behandeling. If you now want to make a medicatieafspraak for the future in addition to a current one, you must also make it again. Elaborated below for the same three examples as above, in order of appointment date.

  • Medicatieafspraak – T-MedicatieafspraakMedicatieafspraak – T Medicatieafspraak
  • Medicatieafspraak – Toedieningsafspraak – T-Medicatieafspraak – T-ToedieningsafspraakMedicatieafspraak – T Medicatieafspraak
  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik – T-Medicatieafspraak – T-Toedieningsafspraak – T MedicatiegebruikMedicatieafspraak – T Medicatieafspraak
5.3.2.3.2 New toedieningsafspraak

However, you can also make a new toedieningsafspraak for the current medicatieafspraak only. This new toedieningsafspraak must then have a reference to that current medicatieafspraak. Elaborated below for three examples, in order of appointment date.

  • Medicatieafspraak – T Medicatieafspraak – Toedieningsafspraak
  • MedicatieafspraakToedieningsafspraakT-Medicatieafspraak – T Toedieningsafspraak – Toedieningsafspraak
  • MedicatieafspraakToedieningsafspraak – MedicatiegebruikT Medicatieafspraak – T-Toedieningsafspraak – T Medicatiegebruik – Toedieningsafspraak

A new toedieningsafspraak with a reference to the future medicatieafspraak looks like this.

  • Medicatieafspraak – T Medicatieafspraak – Toedieningsafspraak – T-Toedieningsafspraak
  • Medicatieafspraak –Toedieningsafspraak – T-MedicatieafspraakT ToedieningsafspraakT Toedieningsafspraak
  • Medicatieafspraak –Toedieningsafspraak – Medicatiegebruik – T MedicatieafspraakT Toedieningsafspraak – T MedicatiegebruikT-Toedieningsafspraak

5.3.2.4 Rules of overruling listed

Based on the above description / examples, the following general rules for overruling can be derived. This concerns the rules for determining whether a building block is relevant for delivery in the medication overview. Within a medicamenteuze behandeling:

  • A new medicatieafspraak overrules all older building blocks (medicatieafspraak, toedieningsafspraak, medicatiegebruik) belonging to the medicatieafspraak /medicatieafspraken that this medicatieafspraak has stopped.
  • A new toedieningsafspraak overrules all older building blocks of the type of toedieningsafspraak or medicatiegebruik that belong to the same medicatieafspraak as the new toedieningsafspraak.
  • In principle, a new record of medicatiegebruik overrules (see exception below) older records of medicatiegebruik that belong to the same medicatieafspraak as the new medicatiegebruik.
    • Exception to this rule: medicatiegebruik with the author as a patient DOES NOT overrule an older record of medicatiegebruik with the care provider as author and vice versa. Both are therefore relevant to the medication overview.

The latter exception applied to a number of situations:

Deze laatste uitzondering toegepast op een aantal situaties:

  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik-ZVL – Medicatiegebruik-PAT
  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik-PAT – Medicatiegebruik-ZVL
  • Medicatieafspraak – ToedieningsafspraakMedicatiegebruik-PATMedicatiegebruik-PAT
  • Medicatieafspraak – Toedieningsafspraak – Medicatiegebruik-ZVLMedicatiegebruik-PATMedicatiegebruik-PAT
  • Medicatieafspraak – ToedieningsafspraakMedicatiegebruik-ZVL – Medicatiegebruik-PATMedicatiegebruik PAT – Medicatiegebruik-ZVL

5.4 Verification by medicamenteuze behandeling

A healthcare provider records verification per medicamenteuze behandeling with the medicatiegebruik building block:

  • Author = Healthcare provider
  • Possible informant: the patient, a care provider or another person
  • Possible characteristic "according to agreement": according to the author, is the medicatiegebruik in accordance with the medicatieafspraak or toedieningsafspraak?
  • Possible link to medicatieafspraak or toedieningsafspraak:
    • Medicatieafspraak or toedieningsafspraak that has been the reference for recording this use.
    • When it is indicated "by appointment", this is the medicatieafspraak or toedieningsafspraak according to which the patient uses.

Such a record of medicatiegebruik means: "I think the patient uses this drug as follows: ... ..".

Known: it is not currently provided in the information standard to indicate that a medicatieafspraak or toedieningsafspraak is correct, regardless of whether the patient uses it as such.

5.5 Process of the medication overview exchange

In addition to the content and verification, the process surrounding the medication overview is also important.

5.5.1 Who, when, with what information

The reliability and completeness of a medication overview depends on:

  • who composed it,
  • at what time and
  • with what basic information.

We can make agreements about this, for example:

  • only exchange/make available a medication overview once it has some form of reliability
    • after an explicit action by a healthcare provider or
    • automatically if certain conditions are met.
  • fully automatically exchange/make available medication overview without conditions
  • make medication overview fully automatically available without the need for a new data type (so when registering one of the other medication data types you are automatically also the source of a medication overview).

5.5.1.1 Decision

The above questions have not yet been answered. It has been decided that during the Proof-Of-Concept all parties that can provide a medication overview will do the same.

5.5.2 Responsibilities applicant and source

The applicant receives medication overviews from multiple sources. Processing this is the responsibility of the recipient. The topicality of a medication overview is important here.

Action: the transaction Medicatieoverzicht (medication record) must contain the most recent date of the collection of available appointment dates / registration dates of the delivered building block instantiations. The compiler (source) of the medication overview must therefore provide this date. This helps the recipient to better estimate the topicality of the medication overview.

5.5.3 Agreements continued

We continue the analysis with the results of the Proof-Of-Concept to arrive at a good process for the medication overview.

5.6 Inference rules

It is important that all parties, physician, pharmacist, nurse as well as patient can infer from the medication building blocks what is intended (i.e. what the current agreements are) and that this should be the same for all systems. For that reason, systems must be able to calculate the current situation using the same inference rules.

The current therapeutic situation is calculated on the basis of medicatieafspraken and toedieningsafspraken. Toedieningsafspraken have a relationship with the medicatieafspraak that they were added to. For this reason, toedieningsafspraken can be linked to the medicatieafspraak that they belong to.
Of course it is also useful to have information about medicatiegebruik. However, this does not indicate the aim of the healthcare provider, only what medication the patient has used. For that reason, the rules below do not take ‘Use/gebruik’ in consideration. However, ‘gebruik’ is part of a medication profile but is shown separately under the medicamenteuze behandeling concerned.

5.6.1 Effective period

The effective period lies between an effective start date and an effective end date.

The effective period describes the period to which a medicatieafspraak or toedieningsafspraak (ultimately) applies.

The effective period depends on adjustments (modifying/discontinuing/halting/resuming) of medication and by the ‘actual handling of a medicatieafspraak by a toedieningsafspraak. The effective period is not described in the dataset, because it is inferred which is only used to determine the current situation. The effective start date, effective end date and effective period are not data to be shown to the end user. Medication for an indefinite period has an effective end date that is in the future, but at a time that cannot be distracted (yet). It is only known that it is 'somewhere' in the future.

5.6.2 Actual and current medication

  • Actual (medicatieafspraken en toedieningsafspraken): the agreements of which the effective end date lies in the future.
  • Current (medicatieafspraken en toedieningsafspraken) agreements: the agreements for which the present date lies between their effective start date and the effective end date.
  • Actual medication: the collection of actual (current and future) medication and toedieningsafspraaks as well as current medicatiegebruik. It should be taken into account that it is never possible to say with certainty to what extent the patient complies with the agreements and/or reports actual gebruik.

5.6.3 Details

Approach
Using a number of different situations the inference rules are described for arriving at the effective therapeutic period in a medication profile:

1) Starting medication
2) Creating a toedieningsafspraak
3) Changing medication
4) Discontinuing medication
5) Temporarily halting and resuming medication

The inference rules are described below. The number for each inference rule indicates the order in which the rules must be executed.

1) Starting medication
Medication is started by creating a new medicatieafspraak. The medicatieafspraak has:

  • An agreement date - the date on which the agreement was made with the patient.
  • A period of use - this period is consists of:
    • A start date - the start date of the medicatieafspraak may be in the future;
    • The duration of use;
    • The end date – the date until which the medicatieafspraak is valid.
1a: The effective period of a new medicatieafspraak is equal to its period of use.

2) Creating a toedieningsafspraak
A toedieningsafspraak specifically fulfils a medicatieafspraak. From a patient perspective, the toedieningsafspraak, in a way, replaces a medicatieafspraak, as the toedieningsafspraak is a more specific indication of what the patient should be using.

Inference rule 1 is extended:

1b: The effective period of a new toedieningsafspraak is equal to its period of use 

Inference rule 2 is applicable when a medicatieafspraak has underlying toedieningsafspraken (see inference rule 2b for further explanation):

2a: The effective period of a medicatieafspraak is equal to the effective period of the toedieningsafspraak.

3) Changing medication

a) By means of a medicatieafspraak

The prescriber changes the medication (or the medicamenteuze behandeling) by creating a new medicatieafspraak (and discontinuing the existing one) within an existing medicamenteuze behandeling. Because the start date of a medicatieafspraak may lie in the future, several medicatieafspraken may be actual at the same time. For example, when a medicatieafspraak applies ‘for an indefinite period’ (ma1) and it is agreed to change the dosage in two weeks (ma2), the first medicatieafspraak (ma1) remains valid for two weeks, after which the second medicatieafspraak (ma2) becomes effective. The previous inference rules do not change because of this.

b) By means of a toedieningsafspraak

An toedieningsafspraak specifically fulfils a medicatieafspraak. This toedieningsafspraak may be modified. For example, when administration schedules are changed (when GDS is initiated), or when a commercial product is changed (for example, as a result of a preference policy). Several successive toedieningsafspraken can therefore be created under a single medicatieafspraak. Hence, rule 2 is expanded so that the effective period of the medicatieafspraak is determined by the entire series of underlying toedieningsafspraken.

2b: When several toedieningsafspraken are made under a single medicatieafspraak, the effective start date of the medicatieafspraak is then equal to the earliest start date of the underlying toedieningsafspraak and the end date of the last toedieningsafspraak.

Parallel toedieningsafspraken may exist under a single medicatieafspraak of which the agreement date and the start date are the same. Both are then valid at the same time and this does not change rule 2b.

The diagram below includes a simplified example of an actual profile composed of different building blocks. The patient, verification, ICA (intolerances, contraindications, allergies) and lab data have been excluded from this overview. Only limited data has been included, mainly to demonstrate the way in which the effective period works. Lines starting with ‘-’ are detail lines which can be hidden in the medication profile, if required. The first line shows the effective period for the underlying MAs and TAs. The ‘gebruik/Use” is also displayed, but this does not influence the calculation of the effective therapeutic period on the first line.

Figuur 9 Voorbeeld effectieve periode

4) Discontinuing medication
Discontinuing medication (i.e medicamenteuze behandeling) is done by creating a new medicatieafspraak in which stoptype ‘definite’ is indicated. The start date of this medicatieafspraak is the date on which the original medicatieafspraak started. The end date is the date on which the medication is discontinued. The effective period of the original medicatieafspraak is so replaced by the effective period of this new stop-MA.

1c: When a medicatieafspraak is discontinued, the effective period of the medicatieafspraak is then the effective period of the stop-MA.

An stop-toedieningsafspraak fulfils the stop-medicatieafspraak. In this way, for example, it is possible to indicate that the discontinuation starts when the next GDS roll is dispensed.

5) Temporarily halting and resuming medication
Temporarily halting medication is carried out in the same way as discontinuing medication. A stop-MA is created (stoptype ‘temporary’) with the same start date as that of the original medicatieafspraak. The end date of the stop-MA is the timing of the temporary halt, the stop type is ‘temporary’. Resuming medication is done by creating a new medicatieafspraak with the old (or adjusted) dosage with the date of resuming as the start date. A meaningful reason (example: resume previous policy) may serve to clarify matters. If the medication is not resumed, ‘discontinue medication’ (stoptype ‘definite’) can be executed in order to permanently end the medicamenteuze behandeling, which means the medication is no longer valid. Medication that is halted remains valid, and so remains visible in the medication profile.

1d: When medication is temporarily halted, the effective period is not affected. The effective period is determined by the effective period of the original medicatieafspraak. 

These inference rules are the basis for determining the current agreements. It is possible to conceive exceptional situations relating to a partial availability of medication data. These situations have not been elaborated. All inference rules are included and implemented in the open source medication viewer.

5.7 Data that need not be shown

Various data are important for the correct processing of information, but are not relevant to the end user:

  • An application does not have to show the (technical) identification of a medicamenteuze behandeling (MBH) (nor that of the building blocks themselves), but the elaboration thereof: namely, building blocks shown in coherence.
  • The copy indicator with the medicatieafspraak (MA), toedieningsafspraak (TA) and medicatiegebruik (MGB) when consulting the medication overview. Whether a building block is a copy is not that important to a user and can be deduced by other data from that building block (such as the author of the building block). So it is not so important that a user can see that this has been delivered 'as a copy' and is probably only confusing. However, this information is important for suppliers, for example because they sometimes want to perform calculations with the data and it is then safer to collect the data from the real source. It is therefore obvious to keep track of whether you have received data from the real source in your system.
  • An application does not have to show the stop type (temporary / definite) of a stop appointment, but the elaboration thereof: namely the processing of the meaning, so that an entire MBH is shown as stopped medication or as interrupted medication (remains clear under current medication) or as a change in the case of a 'technical stop appointment'.

6 Systems and transactions

This chapter contains a list of all system roles and transactions that are referred to in the various process chapters.

The figure below (Figure 10) contains an overview of all systems with their corresponding system roles. The system roles have been described in Table 3. The system roles associated with consulting/making available medication data and the medication overview are important for all systems depending on the process in which they are used. The electronic prescribing system (EPS) also includes the system roles for receiving a proposed verstrekkingsverzoek, sending a reply proposed verstrekkingsverzoek and receiving a proposed medicatieafspraak and, in an outpatient situation, for sending a prescription and receiving data on the processing of a prescription. In addition to the basic system roles, a XIS and PGD also include the system roles for sending a proposed medicatieafspraak and a proposed verstrekkingsverzoek, for sending data on gebruik and for receiving a reply proposed verstrekkingsverzoek. The pharmacist information system (PIS) also includes, in addition to the basic system roles, the roles for sending a proposed medicatieafspraak, sending a proposed verstrekkingsverzoek and data on processing of the prescription, and receiving a prescription and reply proposed verstrekkingsverzoek. Chapter 2 lists the main system roles per process.


Figuur 10 Overzicht systemen en systeemrollen

System role name Abbr. Description
MedicatieGegevensBeschikbaarstellend MP-MGB Making medication data available to fellow healthcare providers/patient
MedicatieGegevensRaadplegend MP-MGR Consulting medication data at fellow healthcare providers/patient
MedicatieGegevensSturend MP-MGS Sending data to fellow healthcare provider/patient
MedicatieGegevensOntvangend MP-MGO Receiving medication data from fellow healthcare provider/patient
MedicatieOverzichtBeschikbaarstellend MP-MOB Making medication overview available to fellow healthcare providers/patient
MedicatieOverzichtRaadplegend MP-MOR Consulting medication overview at fellow healthcare providers/patient
MedicatieOverzichtSturend MP-MOS Sturen medicatieoverzicht aan medebehandelaar/patiënt
MedicatieOverzichtOntvangend MP-MOO Receiving medication overview from fellow healthcare provider/patient
VoorschriftSturend MP-VOS Sending verstrekkingsverzoek or request for processing of modifications to medicatieafspraak.
VoorschriftOntvangend MP-VOO Receiving verstrekkingsverzoek or request for processing of modifications to medicatieafspraak.
VoorschriftAfhandelingSturend MP-VAS Sending data on processing of medicatieafspraak and possibly verstrekkingsverzoek in toedieningsafspraak and/or medicatieverstrekking
VoorschriftAfhandelingOntvangend MP-VAO Receiving data on processing of medicatieafspraak and possibly verstrekkingsverzoek in toedieningsafspraak and/or medicatieverstrekking
ToedienGegevensSturend MP-TGS Sending data for medicatietoediening
ToedienGegevensOntvangend MP-TGO Receiving data for medicatietoediening
GebruikSturend MP-MGS Sending data on medicatiegebruik
GebruikOntvangend MP-MGO Receiving data on medicatiegebruik
VoorstelVerstrekkingsverzoekSturend MP-VVS Informing prescriber about voorstel new verstrekkingsverzoek, receiving reply to proposed verstrekkingsverzoek
VoorstelVerstrekkingsverzoekOntvangend MP-VVO Receiving new voorstel verstrekkingsverzoek, sending reply to voorstel verstrekkingsverzoek
VoorstelMedicatieafspraakSturend MP-VMS Informing prescriber about new voorstelor modified medicatieafspraak
VoorstelMedicatieafspraakOntvangend MP-VMO Receiving voorstel for new or modified medicatieafspraak
Table 3 Overview system roles

Table 4 gives an overview of all transaction groups, transactions, corresponding system roles and building blocks exchanged with this transaction group. The names of the transaction groups and transactions link to the ART-DECOR publication which details per scenario which data elements are used.

Transaction group Transaction System role Building blocks
Medication data (PULL) Making medication data available MP-MGB One or more: ma, vv, ta, mve, mtd, mgb
Consulting medication data MP-MGR
Medication data (PUSH) Sending medication data MP-MGS One or more: ma, vv, ta, mve, mtd, mgb
Receiving medication data MP-MGO
Medication overview (PULL) Making medication overview available MP-MOB ma, ta, mgb
Consulting medication overview MP-MOR
Medication overview (PUSH) Sending medication overview MP-MOS
Receiving medication overview MP-MOO
Medication prescription (PUSH) Sending medication prescription MP-VOS ma with or without vv, length, weight, renal function value
Receiving medication prescription MP-VOO
Medication prescription processing (PUSH) Sending data on processing of medication prescription MP-VAS ta with or without mve
Receiving data on processing of medication prescription MP-VAO
Administration data (PUSH) Sending administration data MP-TGS ma and/or ta
Receiving administration data MP-TGO
Medicatiegebruik (PUSH) Sending data on medicatiegebruik MP-GBS mgb
Receiving data on medicatiegebruik MP-GBO
Voorstel verstrekkingsverzoek (PUSH) Sending proposed verstrekkingsverzoek MP-VVS vvv
Receiving proposed verstrekkingsverzoek MP-VVO
Antwoord voorstel verstrekkingsverzoek (PUSH) Sending reply voorstel verstrekkingsverzoek MP-VVO avvv
Receiving reply voorstel verstrekkingsverzoek MP-VVS
Voorstel medicatieafspraak (PUSH) Sending voorstel medicatieafspraak MP-VMS vma
Receiving voorstel medicatieafspraak MP-VMO
Table 4 Overview transaction groups

Chapter 2 lists for each process only the relevant transactions per process step. The transaction groups are not included in this. Table 4 includes all transaction groups and transactions.

7 Functionality

This chapter describes indications for the functionality of an information system.

7.1 Filtering medication from 2nd/3rd line (all systems)

An institution makes all its medication data (all building blocks) available. Not all data may be relevant for the receiving healthcare providers. Receiving systems may therefore include a filter depending on the requirements of the specific healthcare provider/patient. The list below (Table 5) includes medication types of which it has been determined that medicatietoediening during admission is relevant for healthcare providers outside the institution.

ATC-code Name
L01 Cytostatics
L03AX03 BCG vaccine, urology
L04AA23; L04AA25; L04AA26; L04AA33; L04AA34; L04AB; L04AC Immunosuppressive agents
B03AC; B03XA; B06AC Iron, erythropoietin, drugs used in angioedema
G03GA; G03GB02 Gonadotropins (HCG, etc.), clomiphene
H01CA; H01CC; L02AE04 Gonadorelin, hypothalamic hormones, triptorelin
J06; J07 Immunoglobulins, vaccines
M03AX01 Botulinum toxin
R03DX05 Omalizumab
S01LA04; S01LA05; S01LA OOphthalmological antineovascularisation agents
Table 5 Types of clinical medication relevant for external healthcare providers

7.2 Making medication data available (all systems)

All proprietary medication data may be made available when the patient has given his consent (in accordance with applicable laws and regulations). Data received from third parties copied (health care provider/patient) in one’s own system and marked as ‘copy’, are not made available. The only exception is the transaction Medicatiegegevens (Medication data) PUSH and PULL and Medication overview PUSH and PULL, in which case third parties’ building blocks are made available on the condition that they include the original identification label (see also paragraph 5.6).

7.3 Notification date or dispense date (pharmacist information system)

The notification date and the actual dispense date may be recorded in the medicatieverstrekking. When a verstrekkingsverzoek is processed immediately and the patient picks up the medication that same day, both dates will be the same. When the patient picks up the medication one or several days later, different dates must be entered. The dispense date is the date on which the medicatieverstrekking has actually taken place. The request date is the time at which a pharmacy records an intended medicatieverstrekking. When medication is dispensed on several occasions as part of the same verstrekkingsverzoek (for example, when prescriptions are split), each medicatieverstrekking has its own request date. When an automated dispense system is being used, the dispense date is the time at which the patient picks up the medication from the system. Until this time is available in the PIS, the time at which the medication is deposited in the automated dispense system may be used. See also paragraph 4.2.5.

7.4 Updating after system malfunction

After a system malfunction, the prescriber’s system needs to determine whether changes have been made to medicatieafspraken. For use cases and rationale, see paragraph 4.1.26 and paragraph 4.1.27.

7.5 Construction for ‘once every 36 hours’ interval

When the dosing instruction reads ‘1 tablet every 36 hours’, this may normally be recorded in one medicatieafspraak (dose: 1 tablet, interval: 36 hours). However, when a system does not go beyond an interval of, for example, 24 hours, another solution needs to be found.

Variation 1: Making use of an ‘as needed’ instruction with the criterion: ‘36 hours have passed since the last medicatietoediening’. This does however come with a certain amount of freedom that may not be desirable.

Variation 2: A repeating dosing schedule can be created, with alternation between administration in the morning, administration in the evening and a day without medicatietoediening:

Repeat period: 3 days 
Dosage instruction
 Sequence number: 1
 Dosage duration: 1 day
  Dosage
   Dose per administration: 1 tablet
   Administration time: 9 am (per example, this could also be a part of the day)
 Sequence number: 2
 Dosage duration: 1 day
  Dosage
  Dose per administration: 1 tablet
  Administration time: 9 pm (per example, this could also be a part of the day)

If it is not technically possible to choose a 36 hours interval, variation 2 applies.

7.6 EVS / HIS processing Regulation processing

The prescribing system is informed by the pharmacist of all dispensings and changes in toedieningsafspraken through the transaction Afhandeling voorschrift (settlement prescription). This handling must be automatically processed in the prescribing system. The prescriber only assesses the toedieningsafspraken and does not have to assess all the dispensings (verstrekkingen).

7.7 Examples dosages

See examples dosages 9.1.0 (both functional and technical effect in HL7v3 CDA and in FHIR)

7.8 Medicatiegebruik: use indicator, according to agreement indicator, stop type, period of use and dosing instructions

Situation 1. Medication is/will be used during period of use according to agreement 2. Medication is/will be used during period of use, but not according to agreement 3. Contrary to agreement, medication is/will not be used during period of use 4. Medication is/will not be used during period of use, which is according to agreement 5.Medication is used during period of use but it is unknown if this is according to agreement (selfmedication)
Use indicator (is this product being used)
Yes Yes No N/A (because this would lead to a double negative otherwise) Yes
According to agreement indicator No No No Yes -
Stoptype N/A N/A Discontinuation or Stop Definitve of Temporary N/A
Stoptype depends if agreement is being stoped or dicontinued Stoptype in acoordance with stop-agreement
Period of use In accordance with ma or ta Max. 2 out of 3 Max. 2 out of 3 Max. 2 out of 3 Max. 2 out of 3
start date The time at which the use was started. The time at which the deviating use was/will be started. . Contrary to agreement, medication is/will not be used during period of use The time at which the use was/will be discontinued. The time at which the use was started.
duration of use The intended duration of use. The intended duration of deviating use. The (intended) duration of non-use The (intended) duration of non-use. The intended duration of use.
end date The time at which the period of use ends (or has ended or will end). The time at which the period of deviating use ends (or has ended or will end). The time at which the use was/will be resumed (or is intended to resume). The time at which the use was/will be resumed (or is intended to resume). The time at which the period of use ends (or has ended or will end).
Dosing instructions In accordance with ma or ta Required N/A N/A Required
Medication was/will be used during the period of use according to the agreement, therefore dosage is known. Medication was/will not be used according to the agreement, the actual dosage used must be communicated. The medication was/will not be used, there is no dosage. The medication was/will not be used, there is no dosage. Dosage tha the patient has agreed upon himself

Examples:
Situation 1a: Medication is / is used during the period of use according to agreement
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half a hour before eating, with a start date of June 4, 2018 and no end date.
On 10 June, the patient registers the medication use for the past period (from 4 to 10 June).

Situation 1a
Medication FERROFUMARATE 100MG TABLET
Use indicator Yes
According to indicator agreement Yes
Stoptype Not applicable
Start date 4 June 2018
End date 10 June 2018
Dosing instruction According agreement

Situation 1b: Medication is / is used during the period of use according to agreement
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018 and no end date.
On 10 June, the patient registers the medication use for the past period (from 4 to 10 June).

Situation 1b
Medication FERROFUMARATE 100MG TABLET
Use indicator Yes
According to indicator agreement Yes
Stoptype Not applicable
Start date 4 June 2018
End date -
Dosing instruction According agreement

Situation 2: Medication is / is used during the period of use, but not by agreement
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018 and no end date.
The patient is on the road a lot during the day and forgets for a week to take the medicines for lunch. However, the tablets are taken in the morning and evening before eating.

Situation 2
Medication FERROFUMARATE 100MG TABLET
Use indicator Yes
According to indicator agreement No
Stoptype Not applicable
Start date 11 June
End date 15 June
Dosing instruction 1 tablet 2 times a day

Situation 3: Contrary to the agreement, the medication is / is not used during the period of use
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018 and no end date.
The patient goes on vacation for a long weekend and finds out too late that the medication is not packed. The patient will not take the tablets for the next few days and wants to record it.

Situation 3
Medication FERROFUMARATE 100MG TABLET
Use indicator No
According to indicator agreement No
Stoptype Temporary
Start date 20 July
End date 23 July
Dosing instruction Not applicable

Situation 4: Medication is / is not used during the period of use and that is also by agreement
Patient has been prescribed Ferrofumarate for anemia. Dosage is 1 tablet 3 times a day half an hour before eating, with a start date of June 4, 2018.
On August 12, it turns out after checking that there is no longer anemia and the doctor stops the medication. The patient wants to register that she has stopped taking the medication and registers this herself on August 15.

Situation 4
Medication FERROFUMARATE 100MG TABLET
Use indicator No
According to indicator agreement Yes
Stoptype Definite
Start date 12 August 2018
End date -
Dosing instruction Not applicable

Situation 5: Medication is used during the period of use, but it is unknown whether this is by appointment or there is no appointment (self-care medication)
Patient has the flu and he takes paracetamol 500 mg from the local drug store for fever and pain. He has been taking 4 to 6 tablets a day for four days and expects to do this for another three days. He registers this on August 12 as medication use.

Situation 5
Medication Paracetemol 500mg
Use indicator Yes
According to indicator agreement -
Stoptype Not applicable
Start date 9 August 2018
End date 7 days
Dosing instruction 4 to 6 tablets a day

7.9 Implementation of individualized distribution form (GDV) fields

7.9.1 Background

More and more patients are receiving their medication through Individualized Distribution Forms (In dutch geindividualiseerde distributie vorm), with the pharmacist providing patients overview and organization of their drugs by preparing them in separate compartment units. This form of delivery took off when the Medicines Act in 2007 stipulated that in healthcare institutions without a pharmacy, the medication should be individually registered for the patients.

It is important for healthcare providers to know whether a patient is using GDV. In 2018, an analysis was conducted (under the direction of Z-Index, with healthcare providers) of the bottlenecks and wishes regarding the recording of a patient using GDV. Overall, it has emerged that it is desirable to be able to see whether a patient is using GDV at both the medication level and the patient level. For details see next paragraph.

The directions below provide guidance on how the Medication Process can support these needs.

7.9.2 Wishes of care providers

In 2018, an inventory was made with the user councils of Z-Index about the wishes regarding the recording and exchange of GDV. Below is an overview of these wishes.

Who

  • All healthcare parties (from prescriber to operator)

What

  • Determines which pharmacy delivers
  • Pharmacy must know whether the change applies to the current roll or not
  • Important for stopping previous medication at the start of GDV
  • Evaluation of GDV patients for health insurer
  • Other logistics processes towards home care / informal care

Why

  • Determines which pharmacy delivers
  • Pharmacy must know whether the change applies to the current roll or not
  • Important for stopping previous medication at the start of GDV
  • Evaluation of GDV patients for health insurer
  • Other logistics processes towards home care / informal care

When

  • When starting medication, in a pharmacy already before notification of prescription
  • When transferring 1st / 2nd line
  • When changing (incl. Stopping) medication
  • When changing ICA data

Where

  • When working in the patient's file, it should be clear that this characteristic applies to the patient concerned. This can be different for each type of care provider (patient file, medication file). The wish of public pharmacists is that they always have this characteristic available for a specific patient.
  • On medication overview

7.9.3 Data elements Medication process

The building blocks for the Medication Process have the following fields that play a role in recording GDV.

Buildingblock Data-element nr Description Type of content
Medicatieafspraak 23283 Additional information Additional information contains a list of details of the medicatieafsrpaak that are important for pharmacovigilance monitoring and completion by a pharmacist.

For example: "change in GDS immediately"..

Verstrekkingsverzoek 22759 Supplementary wishes Logistical instructions important for the completion of the dispensing request by the pharmacist.

For example: "do not include in GDS"

Verstrekking 20927 Distribution form Distribution form.

For example: GDS

20924 Consumption period Stock for this duration
22500 Registration date The registration date is the time when a pharmacist records an intended dispensing
20272 Date The time of the dispensing. The date when the medicine is made available to the patient

7.9.4 Application of data elements to support desired functionality for GDV patients

7.9.4.1 Recording that someone uses GDV

When working in the patient's file it is important to see that someone is using GDV. This applies to the pharmacy that supplies the GDV, as well as other care providers of the patient. It is therefore important that this information can be communicated with and shown to other healthcare providers.

As long as there is no patient characteristic with which GDV can be registered, it can be decided to derive this information from the GDV data that have been recorded with the medication. A possible handle for this is the fact that medication is included in the distribution module together with the Distribution form field in the verstrekking (dispensing).

  • Step 1: if medication is included in the distribution module: fill in the Distribution form field in the verstrekking with 'GDS'.
  • Step 2: Based on the Distribution form field, deduce that a patient is using GDV. The fact that a patient has a dispensing (vertrekking) where the Distribution form field is filled with "GDS" indicates that the patient is using GDV. This dispensing can be a private dipsenisn, or it can be dispensed from another pharmacy (insofar as this data is collected and recorded in such a way that the contents of the Distribution form field are reusable). The fact that a patient uses GDV can then be shown when working in the medication file or the patient file. In consultation with end users, it should be further determined where and how this is shown.

7.9.4.2 Recording why someone uses GDV

Users have indicated that it is desirable to be able to record why someone uses GDV. There are currently no structural fields available for this.

7.9.4.3 Record for medication that this must be in the GDV

Prescribers want to be able to indicate whether or not a medicine should be provided via GDV. This can be done as follows:

  • Verstrekkingsverzoek, Additional wishes (aanvullende wensen) field. The code list for this field contains the item "not in GDS". This code list is thesaurus 2051 from file 902 in the G-Standard.

7.9.4.4 Establishing / exchanging the duration of a medication roll

The duration of the medication roll can be determined on the basis of the "duration of use" of the provision: the "duration of use" indicates the duration of a medication roll.

7.9.4.5 Establishing / exchanging whether a change in the medication should be effective immediately or not

It is desirable that a prescriber can indicate whether changes in the medication should be implemented immediately or that they can wait until the next roll change. The handles for this are as follows:

  • Medicatieafspraak, Additional information (aanvullende informatie) field. The code list for this field contains two items that relate to changes in the GDV, namely "Change in GDS immediately" and "Change in GDS per roll change". This code list is thesaurus 2050 from file 902 in the G-Standard.
  • It is important that the prescriber has insight into the duration of the roll and how long it will take before the current medication roll is used up. This can be deduced from:
    • The verstrekking, period of use (verbruiksduur), see above. For this, the prescribing system must have access to the verstrekking data of previous verstrekkingen (dispensings).
    • Verstrekking (dispensing), Registration Date (aanschrijfdatum) or Date (datum) field (or if this field is not filled but the Registration date field is, then the registration date.; if both are filled, Date is preferred). Based on this date and the consumption period, it is possible to calculate the date on which the current medication roll is used.

8 Reflections

8.1 Prescription without specified recipient (ambulatory)

In this paragraph, the term ‘prescription’ is used to indicate the message through which a patient may pick up a medicinal product from a supplier. A prescription contains a medicatieafspraak and a verstrekkingsverzoek.

In the Netherlands it is customary to digitally send prescriptions to a receiving pharmacy instead of having to collect prescriptions. This requires that the pharmacy is already known.
This carries the risk that for the sake of convenience outpatient clinic prescriptions are always sent to the outpatient pharmacy, preventing the patient from picking up the medication at a regular, familiar pharmacy.

This paragraph considers whether more flexibility can be achieved in the logistical processing of prescriptions, without canceling out current advantages. This paragraph may be seen as a long-term vision that we aim towards.

8.1.1 Basic principles

When considering how to achieve flexibility in the processing of prescriptions, these basic principles have been formulated:

  • The patient is free to choose where prescriptions are handled
  • The current option for sending prescriptions remains possible.
  • The system must reuse the same functionality as much as possible.
  • A prescription may only be dispensed once.

Since the methodology described below uses the existing method of sending prescriptions, the same legal rules and regulations apply to prescription validity. All discussions about electronic signatures are equally applicable to the current method of communicating prescriptions.

8.1.2 Details

A patient may choose from 3 options:

  1. A prescription is always sent to the same regular pharmacist.
  2. The patient indicates each time where the prescription has to be sent.
  3. The patient does not give any indication, and goes to a pharmacy which subsequently requests and processes the prescription.

Options 1 and 2 require a patient portal, in which the patient indicates his preference. For option 2, a patient may define a preferred pharmacy which would be at the top of the selection screen when the patient is asked where the prescription must be sent. If the patient does not give any indication, option 3 can be the only procedure.

The method partly uses a concept called “publish and subscribe”.

It is important that the pharmacist explains this principle to his customers.

8.1.3 Work process

A physician decides to create a prescription for a patient. This may be during a consultation or even when repeat prescriptions are requested. The physician registers the prescription in his prescribing system (EPS). The physician does not need to consider the pharmacy as the patient handles this through the portal.

After approval of the prescription, a central prescription index is updated. The EVS automatically sends a notification to this prescription registry to facilitate this. Here, the prescription index is seen as a separate registry with the data type “prescriptions”. It is always possible to consider whether or not this can be merged at a later time. Initially, atomic registration in the registry is being considered. However, at a later date, consideration could be given as to whether categorical registration would be sufficient.

It is important to realise that currently only a notification is given when a prescription is ready. After all, the prescription is still in the EVS database with the status “is available”. There is no prescription message yet.

The prescription registry knows from the patient’s preference settings what needs to be done with the notification:

  1. With the option ‘send to regular pharmacy’, a notification is sent to the subscription holder of the patient with the message that a prescription can be retrieved.
  2. With the option ‘patient indicates pharmacy’, the prescription registry sends a notification (e.g., SMS) to the patient. The prescription registry then waits until the patient uses a smartphone app or the patient portal to indicate to which pharmacy the notification should be sent.
  3. With the option ‘no indication’, the prescription registry does nothing. The patient does not have a regular subscription holder.

8.1.4 Processing by pharmacy

A receiving pharmacy can deduce from the transmitted notification signal (data type) that it refers to an open prescription. The signal also identifies who the patient is as well as the source of the prescription.

For patients who selected option 3 (no indication), the process starts now. The patient identifies himself and notifies the pharmacy that a prescription is ready at a certain institution. The pharmacist may look in the prescription registry to find out which EVS is involved.

The pharmacy system asks the EVS source system to send the prescription of the respective patient. Since this is a request without medical content, it may even be submitted at lower trust levels.

8.1.5 Sending via EVS

If an EVS receives a request for “sending outstanding prescriptions”, the EVS will check whether prescriptions are indeed outstanding. This prevents a prescription from being retrieved several times. The address of the pharmacy is entered and the prepared prescription message is finally created. The prescription message is sent to the respective pharmacy.

If the prescription has been retrieved before, an error message is sent to the retrieving pharmacy announcing that the prescription is no longer available.

Sending prescriptions is the standard process and already customary for pushing prescriptions. The advantage of this is that the receiving pharmacy only needs to maintain one method for processing received prescriptions. It is noted again that the same legal rules and regulations continue to apply.

After sending a prescription, the EVS also sends a notification to the prescription registry to remove the entry of the outstanding prescription. This indicates that the respective prescription can no longer be retrieved.

Figuur 11 Interactiediagram Ongeadresseerd voorschrijven

9 Appendix References

9.1 General references

Author(s) Title Version Date (consultation) Source Organisation
NHG, KNMP, Z-index Building blocks of the medication process 2014 Augustus 2015 https://www.nhg.org/bouwstenen NHG, KNMP, Z-index
ActiZ, KNMP, NVZA a.o Safe principles in the medication chain 2014 August 2015 http://www.knmp.nl/patiëntenzorg/samenwerking/brochure-veilige-principes-in-de-medicatieketen ActiZ, KNMP, NVZA a.o.
Miscellaneous Guideline on exchange of medication data in the medication chain 25 April 2008 August 2015 Website KNMP Miscellaneous
Paul Geels Assessment of medication self-management (BEM) in care homes, Institute for Responsible Medication Use February 2009 http://www.instellingsapotheek.nl/downloads/rapporten/beoordeling_eigen_beheer_van_medicatie_in_verzorgingshuizen.pdf Institute for responsible medicatiegebruik
ActiZ Safety in the medication chain March 2012 https://www.knmp.nl/downloads/brochure-veiligheid-in-de-medicatieketen.pdf ActiZ, Miscellaneous
KNMG Guideline on electronic prescription September 2013 Website KNMG KNMG

9.2 Qualification scripts

Qualification scripts

10 Attachment: Document history

Version Date Description
0.95 15 July 2016 Pilot version
0.96 1 December 2016 Paragraph 2.4 Process: Administer was adapted and C6: Sending/receiving administration data was added as a result.
0.97 22 December 2016 Paragraph 2.4, 4.3.1 review remarks incorporated.

Paragraph 4.2.11 text made more precise.

9.0.2 18 June 2017 Conversion of the document to wiki.
9.0.4 September 2017
  • Processed Design decisions in functional design. This means the design decisions have become obsolete. The current Functional Design is now leading.
  • Par. 1.3.1. Definitions of building blocks have been adapted and the abbreviation for medicatieverstrekking has changed to MVE.
  • Par. 1.3.3. Medicamenteuze behandeling is now based on PRK, rewritten and introduced PT as well as added text on handling parallel MAs.
  • Par. 1.3.4. New data model diagram, various relations added and adapted on the basis of design decisions.
  • Par. 1.5 Glossary removed.
  • C2 Medication process diagram changed: MO added to actively making available by the user; lines in swimlane of administrator/use adapted.
  • C4.1 New use cases added: Do not dispense before, Two PRKs in a single medicamenteuze behandeling, Discontinuation of medication by third parties, Creating a medicatieafspraak after the fact, Parallel medicatieafspraken.
  • C4.2 New use case: Discontinuing medication in a GDS; modified use case: Request, dispense and not picked up.
  • C5: Differences between medication profile and medication overview were described; inference rules adapted on the basis of the new design decisions.
  • Where necessary, references from ART-DECOR to FD C7 were added.
  • Various grammatical and minor textual changes.
9.0.5 January 2018
  • Terminology: Stop-MA was changed to stop-MA in accordance with earlier project agreements (in Dutch different terminology Stop changed to staken)
  • Par. 1.3.4 Addition to indicate that MA may also refer to a building block under a different medicamenteuze behandeling.
  • Par. 4.1.22 Discharge was adapted because outpatient medication that was discontinued earlier may be started again at discharge.
  • Par. 4.1.26 Discontinuation of medication by third parties was adapted.
  • Par. 4.1.27 Two PRKs under a single medicamenteuze behandeling.
  • Par. 2.2.5.3 Medication discontinuation agreement was adapted to clarify the impact on previously entered future medicatieafspraken.
  • Footnote 3 Provisional and final medication order clarified and use case Provisional and final medication order (par. 4.1.31) added.
  • Par. 4.1.30 Use case Single use added.
  • Paragraphs 2.2.4, 2.2.5.2, 2.2.5.4, 4.1.16, 4.1.22 were adapted for substitution. In case of substitution, a medicamenteuze behandeling is not temporarily halted but effectively discontinued. The substitution is started under a new medicamenteuze behandeling.
  • Paragraph 4.1.33 Missing digital medicatieafspraak at admission was added.
  • C5 Medication overview was adapted with a reference to a new content page with functional elaboration.
  • Paragraph 7.10 Medicatiegebruik: use indicator, according to agreement indicator and stop type added as agreed.
  • C6 Building blocks of medication overview were changed to MA, TA and MGB.
  • Figure 2 Colours in data model in accordance with Figure 1.
  • Various abbreviations explained.
9.0.6 May 2018
  • Addition to proposed verstrekkingsverzoek and addition of reply proposed verstrekkingsverzoek
  • Chapter 6 table 4 addition of links to ART-DECOR transactions
  • Removed: chapter about LSP
  • Par. 7.10 table was extended with period of use and dosing instructions
  • Various paragraphs were made more precise
  • Addition of the property ‘third parties’ building block’ for MA, TA and MGB in medication overview
9.0.7 December 2018
  • Par 1.3.3. MBH at HPK level in case of 'non medicines' without a PRK level
  • Par 1.3.3. MBH for medicines without PRK (magistrals, infusions, etc.)
  • Par 2.2.5.5. Changing medication: Technical stop-ma: appointment date for stop-ma and new ma must be the same. Change on MA that has already been stopped explained (no extra Stop-ma needed)
  • Par 2.2.6. Added: VV under MA of someone else
  • Par 4.2.15. Explanation GDS supplier supplies different HPK
  • Par 7.10: Medication use indicator, according to appointment indicator, stop type, period of use and dosing instruction: table adapted and examples added
  • Par 4.1.34: Own articles explanation added
  • Chapter 5: example medication overview inserted in this wiki page instead of a separate wiki page (to simplify searching within the FO).
  • Various textual tightening / improvements
9.0.7 July 2019
  • Removed examples of specific infrastructures
9.1.0 29 January 2020
  • Stop textual adjustments
  • Par 7.11 added: Implementation of individualized distribution form (GDV) fields
  • BITS MP-85, BITS MP-93, BITS MP-122 Use cases added (Register usage based on verstrekkingn, Verstrekkingsverzoek with number of repetitions, Prescribe non-drug)
  • Chapter 4: Added pictures of use cases
  • Renal function value in the prescription
  • BITS MP-48 Medication Overview: Par 5.7 added 'Fields not to be shown'
  • Various textual specifications/ improvements, including o.a. BITS MP-131
  • Paragraph 'Unaddressed prescription' moved to chapter 'Considerations'
  • BITS MP-151 Removed draft TA creation process
  • BITS MP-128 Par 4.1.8: Explanation 'Medical necessity'
  • BITS MP-129 Par 4.1.35: Use case added
9.1.0 September 2020

11 Appendix: Figures and tables

Figure 1 Building blocks - overview
Figure 2 Building blocks - coherence
Figure 3 Activity diagram - Medication process in general
Figure 4 Process steps and transactions - medication verification
Figure 5 Process steps and transactions - prescribing
Figure 6 Process steps and transactions - make available
Figure 7 Process steps and transactions - administer
Figure 8 Process steps and transactions - use
Figure 9 Example effective period
Figure 10 Overview of systems and system roles
Figure 11 Interaction diagram Prescribing without address


Table 1 Building blocks - description
Table 2 Informing versus (Active) making available
Table 3 Overview of system roles
Table 4 Overview of transaction groups
Table 5 Types of clinical medication relevant for outpatient care providers

12 Appendix: General Diagram Medicatioprocess

Back to chapter Medication process

Activiteitendiagram - Medicatieproces algemeen

  1. This document only uses the term medicatieafspraak, which therefore also indicates the clinical equivalent provisional medication order
  2. The verstrekkingsverzoek building block is not applicable in the clinical setting. Dispensing medication is handled in different ways in the clinical setting. Replenishment of, for example, a department’s supply is not considered medicatieverstrekking, but rather an extension of the pharmacist’s stock. Medicatieverstrekking only takes place when the link between the medication and patient has been made. In clinical situations, administration often takes place immediately afterwards.
  3. 3,0 3,1 A provisional medication order, as it is used in hospitals, is both the request from the physician to the administrator to administer medication to the patient as a verstrekkingsverzoek to the pharmacist to ensure that the medication is available for the administrator. This last part corresponds to the medicatieafspraak and the verstrekkingsverzoek from the first line. In addition, the hospital pharmacist usually carries out a validation of the administration request (this creates the final medication order which is called a toedieningsafspraak here). The provisional medication order is therefore not the same as a proposal from, for example, from a nurse on the basis of a protocol that has not yet been approved by a physician.
  4. Use may have been preceded by medicatietoediening. Registration of use, for example after medicatietoediening of rabies vaccinations or infusion is not obvious.
  5. From one-time to a certain period. The building block ‘Medicatieverbruik’ has not been detailed any further in this information standard.
  6. In practice several medicatieafspraken (with different PRKs) are often combined into a single product instead of a single medicatieafspraak with underlying the composition.
  7. The patient may also verify his own medication. He then records ‘gebruik/use’, see paragraph 2.5.4.1.
  8. This is about patients from a nursing home or a mental health institution who are going to the outpatient clinic of a hospital.
  9.  This includes all healthcare providers who are authorised to prescribe: not only physicians, but also nurse practitioners and physician assistants, for example
  10. In the case of substitution, the existing medicatieafspraak is discontinued and a new medicatieafspraak is created under a new medicamenteuze behandeling.
  11.  Information systems keep an audit trail. In case of a change, the existing MA is discontinued (new record) and a new MA with the change is then created (new record). By using the records of the audit trail, no major adaptations are needed for discontinuing a MA in most systems.
  12. This does not mean that end users actually have to create two agreements. A user friendly presentation by the system is desired.
  13.  Correcting/canceling administration agreementtoedieningsafspraaks happens in the same way. XIS is a generic term for a random (health care) information system. PHR=personal health records.
  14.  XIS is a generic term for a random (health care) information system. PHR=personal health records.
  15.  The patient may also request a repeat directly from the prescriber: see paragraph 2.5.6.
  16.  In this document, the administration list means both the digital and the paper version, unless otherwise indicated. Sublist and checklist are synonyms.
  17. In a clinical situation, product may be taken from the department’s own supply, after which administration takes place immediately and the administration is recorded.
  18.  XIS is a generic term for a random (health care) information system. PHR=personal health records.
  19. XIS is a generic term for a random (health care) information system. PHR=personal health records.
  20. XIS is a generic term for a random (health care) information system. PHR=personal health records.
  21. See also paragraph 4.1.3.
  22. A similar situation occurs when the pharmacist receives a fax.