mp:V9 2.0.0-draft FHIR MedicationProcess

1 Introduction

This is the FHIR implementation guide for the information standard Medicatieproces 9, version 2.0. This standard is described in this functional specification and implemented here using HL7 FHIR, R4. This implementation guide assumes that the reader is familiar with this FHIR version.

Apart from this document, the guidelines as specified in general FHIR Implementation Guide apply. In particular, the reader should take note of the Use case overarching principles and the use of FHIR packages.

Use cases:

• Retrieve medication data
• Retrieve medication overview

2 Actors involved

Persons		Systems		FHIR Capability Statements
Name	Description	Name	Description	Name	Description
Patient or Healthcare professional	The user of a personal healthcare environment (PHR) or a healthcare information system (XIS).	Client	PHR or XIS	CapabilityStatement: Client	Client requirements
Healthcare professional	The user of a healthcare information system (XIS)	Server	XIS	CapabilityStatement: Server	Server requirements

3 Use case: retrieve medication data

3.1 Introduction

The retrieve medication data transaction is used by the client to retrieve medication data from a server. The client can retrieve its desired information by searching on specific medication building blocks.

3.2 Actors

Transaction group	Transaction	Actor	Role
Retrieve Medication Data (PULL)	Consulting medication data	Client	Request medication data
	Making medication data available	Server	Serve medication data

The names of the transaction groups and transactions link to the functional definition in an ART-DECOR publication which details per scenario which data elements are used.

3.3 Invocations

3.3.1 Request message

When a patient or healthcare professional wants to obtain all medication data or specific parts matching various parameters, it issues a retrieve medication data request message. This message uses the HTTP GET method parameterized query against the server's medication FHIR endpoints. These endpoints can be one of the following:

• MedicationRequest
• MedicationDispense
• MedicationStatement
• MedicationAdministration

The search interaction is performed by an HTTP GET conform the FHIR search specification, as shown below. This URL is configurable by the client by configuring the query search parameters and search control parameters to modify the behaviour of the server such as response format and pagination. Multiple request messages may be needed to retrieve all desired information.

GET [base]/[type]{?[parameters]}

3.3.1.1 Patient identification

This implementation guide assumes that the client system is able to make a connection to the right server that contains the patient's information. It does not provide information on finding the right server nor does it provide information about security. Moreover, each transaction is performed in the context of a specific (authenticated) patient, for whose context might have been established using the authentication mechanisms described in external specifications such as the MedMij 'Afsprakenstelsel' or through the usage of search parameters for patient identification. Each server is required to perform filtering based on the patient associated with the context for the request or based on the patient identification search parameters, so only the records associated with the authenticated patient are returned.

When patient identification requires the use of search parameters, the following search parameters SHALL be supported:

• Patient: identifier
• MedicationRequest: patient
• MedicationDispense: patient
• MedicationStatement: patient
• MedicationAdministration: patient

An example of a request that retrieves all MedicationRequest resources of a patient with a fake BSN of 11122233:

GET [base]/MedicationRequest?patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333

3.3.1.2 Search Parameters

The client MAY supply, and the server SHALL be capable of processing, all query parameters listed in the table below.

MP9 search parameters	Description	FHIR search parameter	FHIR resource	Example
Identification	Search on identifier.	identifier	MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration	Retrieves a MedicationRequest resource with the identifier 999922448. GET [base]/MedicationRequest?identifier=http://example.nl/fhir/NamingSystem/MedicationRequest|999922448
Identification	Search on the pharmaceutical treatment identifier. Note: retrieval of all medication resoures belonging to one pharmaceutical treatment requires to search on all medication resource types.	pharmaceutical-treatment-identifier	MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration	Retrieves all MedicationRequest resources that are part of the pharmaceutical treatment with identifier value of 1247848. GET [base]/MedicationRequest?pharmaceuticaltreatment=http://example.nl/fhir/NamingSystem/medicationtreatment|1247848
Type	Search on type of medication building block.	category ,	MedicationRequest	Retrieves all MedicationRequest resources that represent a zib MedicationAgreement. GET [base]/MedicationRequest?category=http://snomed.info/sct|16076005 Retrieves all MedicationRequest resources that represent a zib DispenseRequest. GET [base]/MedicationRequest?category=http://snomed.info/sct|52711000146108
			MedicationDispense	Retrieves all MedicationDispense resources that represent a zib Dispense. GET [base]/MedicationDispense?category=http://snomed.info/sct|373784005 Retrieves all MedicationRequest resources that represent the zib AdministrationAgreement. GET [base]/MedicationRequest?category=http://snomed.info/sct|422037009
			MedicationStatement	Retrieves all MedicationStatement resources that represent a zib MedicationUse2. GET [base]/MedicationStatement?category=http://snomed.info/sct|422979000
			MedicationAdministration	Retrieves all MedicationAdministration resoures that represent a zib MedicationAdministration2. GET [base]/MedicationAdministration?category=http://snomed.info/sct|18629005&_include=MedicationStatement:medication
ProductCode	Search on medication code.	code	MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration	Retrieves all MedicationRequest resources that represent a zib MedicationAgreement and have Carbasalaatcalcium Sandoz 600 30 as medication. GET [base]/MedicationRequest?category=http://snomed.info/sct|16076005&medication.code=urn:oid:2.16.840.1.113883.2.4.4.8|13610554
UsePeriod	Search on medication use in the past, present or future within the specified time period.	period-of-use	MedicationDispense, MedicationRequest	Retrieves all MedicationRequest resources that represent a zib MedicationAgreement and were in effect from 01-01-2010. GET [base]/MedicationRequest?category=http://snomed.info/sct|16076005&period-of-use=ge2010-01-01
DispensePeriod	Returns all medication dispenses within the specified time period.	whenhandedover	MedicationDispense	Retrieves all MedicationDispense resources that represent a zib Dispense and were handed over within a 2 year period. GET [base]/MedicationDispense?category=http://snomed.info/sct|373784005&whenhandedover=ge2010-01-01&whenhandedover=le2011-12-31
AdministrationPeriod	Returns all medication administrations within the specified time period.	effective-time	MedicationAdministration	Retrieves all MedicationAdministration resources that represent a zib MedicationAdministration2 and were administration happened within a 2 year period. GET [base]/MedicationAdministration?category=http://snomed.info/sct|18629005&effective-time=ge2010-01-01&effective-time=le2011-12-31
-	The client may request that the server returns resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources.	_include	MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration	Retrieves all MedicationRequest resources that have Carbasalaatcalcium Sandoz 600 30 as medication and includes the Medication resource in the search results. GET [base]/MedicationRequest?medication.code=urn:oid:2.16.840.1.113883.2.4.4.8|13610554&_include=MedicationRequest:medication

3.3.1.3 Custom Search Parameters

The following custom search parameters are defined for this use case:

• http://nictiz.nl/fhir/SearchParameter/category
• http://nictiz.nl/fhir/SearchParameter/period-of-use
• http://nictiz.nl/fhir/SearchParameter/pharmaceutical-treatment-identifier

3.3.1.4 Retrieve all medication data

A common scenario for a client is to request all known medication data. The following requests retrieve all known medication data per building block and will include the Medication resource:

GET [base]/MedicationRequest?category=http://snomed.info/sct|16076005&_include=MedicationRequest:medication
GET [base]/MedicationRequest?category=http://snomed.info/sct|52711000146108&_include=MedicationRequest:medication
GET [base]/MedicationRequest?category=http://snomed.info/sct|274512008&_include=MedicationRequest:medication
GET [base]/MedicationDispense?category=http://snomed.info/sct|373784005&_include=MedicationDispense:medication
GET [base]/MedicationDispense?category=http://snomed.info/sct|422037009&_include=MedicationDispense:medication
GET [base]/MedicationStatement?category=http://snomed.info/sct|422979000&_include=MedicationStatement:medication
GET [base]/MedicationAdministration?category=http://snomed.info/sct|18629005&_include=MedicationStatement:medication

3.3.2 Response message

The server returns a HTTP Status code appropriate to the processing as well as a FHIR Bundle of type 'searchset' including the matching medication data. The returned data to the client SHALL be a valid instance of the applicable profile in the List of Profiles.

Note that the medication resources are grouped per 'pharmaceutical treatment' conform to the Medication Process specification. Grouping SHALL be done by use of a 'Pharmaceutical Treatment Identifier'. This identifier shall be the same across different related medication resources that constitute one medication treatment. The PharmaceuticalTreatmentIdentifier extension is to be used for this grouping purpose.

3.4 List of Profiles

zib/MP building block name NL	zib/MP building block name EN	FHIR Resource	FHIR Profile
Medicatieafspraak	MedicationAgreement	MedicationRequest	http://nictiz.nl/fhir/StructureDefinition/nl-core-MedicationAgreement
WisselendDoseerschema	VariableDosingRegimen	MedicationRequest	http://nictiz.nl/fhir/StructureDefinition/nl-core-VariableDosingRegimen
Verstrekkingsverzoek	DispenseRequest	MedicationRequest	http://nictiz.nl/fhir/StructureDefinition/nl-core-DispenseRequest
Toedieningsafspraak	AdministrationAgreement	MedicationDispense	http://nictiz.nl/fhir/StructureDefinition/nl-core-AdministrationAgreement
Verstrekking	Dispense	MedicationDispense	http://nictiz.nl/fhir/StructureDefinition/nl-core-MedicationDispense
Medicatiegebruik2	MedicationUse2	MedicationStatement	http://nictiz.nl/fhir/StructureDefinition/nl-core-MedicationUse2
MedicatieToediening2	MedicationAdministration2	MedicationAdministration	http://nictiz.nl/fhir/StructureDefinition/nl-core-MedicationAdministration2

Note that besides profiles listed in the above table, also profiles referred from/used by these profiles are applicable. These are profiles for zibs Patient, HealthProfessional, HealthcareProvider.

4 Use case: retrieve medication overview

4.1 Introduction

The retrieve medication overview transaction is used by the client to retrieve a medication overview from the server.

4.2 Actors

Transaction group	Transaction	Actor	Role
Retrieve Medication overview (PULL)	Consulting medication overview	Client	Request Medication overview
	Making medication overview available	Server	Serve Medication overview

The names of the transaction groups and transactions link to the functional definition in an ART-DECOR publication which details per scenario which data elements are used.

4.3 Invocations

4.3.1 Request message

When the patient or healthcare professional wants to obtain a patient's medication overview, it issues a Consulting medication overview request message. This message uses an extended operation on the RESTful API to obtain a medication overview from a server. An operation is needed because the server will formulate the content of the response based on its internal business logic. The medication overview can not easily be described by standardized restful requests.

The client executes a medication-overview operation with HTTP POST against the server base endpoint as shown below.

POST [base]/$medication-overview

4.3.2 Response message

The server returns a HTTP Status code appropriate to the processing of the operation. The successful outcome of the $medication-overview operation is the body of the medication overview response message. Successful processing of this operation should result in a Bundle recourse of type 'searchset', containing one List and one Patient resource as entries along with all the resources that represent the current medication overview. These resources SHALL be referenced from the List resource. The clinical content of the medication overview is defined in the Medication Process specification.

The Bundle profile represents the structure of the retrieve medication overview response message. The List profile represents the medication overview. The List contains the medication overview metadata and references to all resources that constitute the medication overview. These resources are included in the Bundle as entries. The Bundle.total value contains the number of matching zib: MedicationUse, AdministrationAgreement and MedicationAgreement. Other included resources, such as Medication resources, are not included in the total. The returned Bundle has at least one List and one Patient resource. The returned data to the client SHALL be a valid instance of its applicable profile as shown in the List of Profiles.

Note that the medication resources blocks are grouped per 'pharmaceutical treatment' conform to the Medication Process specification. Grouping SHALL be done by use of a 'Pharmaceutical Treatment Identifier'. This identifier shall be the same across different related medication resources that constitute one medication treatment. The PharmaceuticalTreatmentIdentifier extension is to be used for this grouping purpose.

4.4 List of Profiles

zib name NL	zib name EN	FHIR Resource	FHIR Profile
-	-	Bundle	http://nictiz.nl/fhir/StructureDefinition/Bundle-MedicationOverview
-	-	List	http://nictiz.nl/fhir/StructureDefinition/MedicationOverview
Medicatieafspraak	MedicationAgreement	MedicationRequest	http://nictiz.nl/fhir/StructureDefinition/nl-core-MedicationAgreement
Toedieningsafspraak	AdministrationAgreement	MedicationDispense	http://nictiz.nl/fhir/StructureDefinition/nl-core-AdministrationAgreement
Medicatiegebruik	MedicationUse	MedicationStatement	http://nictiz.nl/fhir/StructureDefinition/nl-core-MedicationUse2

Note that besides profiles listed in the above table, also profiles referred from/used by these profiles are applicable. These are profiles for zibs Patient, HealthProfessional, HealthcareProvider, BodyWeight and BodyHeight.

5 Examples

1. Medicatieproces has a wiki page that contains examples in FHIR and CDA for dosage instructions.
2. Every profile or resource on Simplifier has a reference tab. The reference tab shows all references from and to the selected resource. So the listed profiles in these use cases have a reference tab on Simplifier where examples are listed that declare conformance to the specific profile.
3. Examples are accessible through the Simplifier project by going to the resources tab of the project. It is possible to filter on examples and underlying FHIR resource. This is clarified with the following URL, which lists all medication examples available in the NictizSTU3-MedicationProcess project: https://simplifier.net/nictizstu3-medicationprocess/~resources?category=Example&exampletype=MedicationDispense%7CMedicationStatement%7CMedicationRequest%7CMedication&fhirVersion=STU3&sortBy=DisplayName

6 Release notes

Release notes can be found on the functional design page.