FHIR Implementation Guide Medication Process 9 version 2.0.0 bèta
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This publication has beta status and is being further developed for the Kickstart Medicatieoverdracht. Final publication expected in June 2022. For an overview of current documentation for Medication Process see here Landingspagina_Medicatieproces |
1 Introduction
This is the implementation guide (IG) for the information standard Medication Process 9 (MP9) version 2.0.0 using the HL7® FHIR® standard. The MP9 standard is described in this functional specification and further specified here using FHIR version R4. This implementation guide assumes that the reader is familiar with both the functional specification and this version of FHIR.
Apart from this document, the guidelines as specified in the general FHIR Implementation Guide apply. In particular, the reader should take note of the Overarching principles and the use of FHIR packages. Where the general IG uses the term ‘use case’, this IG follows the functional specification in using the term ‘transaction’ for the various processes that are described. The functional specification uses the term ‘use case’ for more practical examples.
This IG first describes the boundaries and relationships in place, after which the implementation is described per transaction.
2 Boundaries and relationships
2.1 Building blocks and profiles
The exchange of data within the MP9 standard version 2.0.0 is largely based on the 2020 publication of the Dutch Health and Care Information Models (Dutch: ‘zorginformatiebouwstenen’ or ‘zibs’). The objects that are present in the functional data set of the MP9 standard (and which are actually exchanged) are referred to as ‘building blocks’, and can thus be seen as ‘extended zibs’ suitable for implementation.
However, due to new insights, the medication related building blocks in the functional data set have deviated from the corresponding zibs they were originally based on, making them incompatible in varying degrees from a technical point of view. Therefore it was not possible to implement the FHIR profiles for these main building blocks by building on and extending the nl-core profiles based on zib-publication 2020. Hence the profiles for these building blocks have been created ‘independently’ from these profiles, meaning that the MP9 profiles have no dependency on the zib2020-package.
All (incompatible) changes made in the medication related building blocks have resulted in change requests for the zibs, which will be part of the 2022 pre-publication. Thus, strictly speaking the MP9 standard is based on the 2022 pre-publication of the zibs.
2.1.1 Medication building blocks
As described above, the main medication building blocks have no dependency on any zib2020 counterparts, resulting in so-called ‘mp’ profiles. Moreover, note that the building block VariableDosingRegimen does not have a zib counterpart, hence it makes sense to include it as an mp profile as well.
| Building block (EN) | Building block (NL) | FHIR resource | FHIR profile |
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| MedicationAgreement | Medicatieafspraak | MedicationRequest | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationAgreement |
| VariableDosingRegimen | WisselendDoseerschema | MedicationRequest | http://nictiz.nl/fhir/StructureDefinition/mp-VariableDosingRegimen |
| DispenseRequest | Verstrekkingsverzoek | MedicationRequest | http://nictiz.nl/fhir/StructureDefinition/mp-DispenseRequest |
| AdministrationAgreement | Toedieningsafspraak | MedicationDispense | http://nictiz.nl/fhir/StructureDefinition/mp-AdministrationAgreement |
| MedicationDispense | Medicatieverstrekking | MedicationDispense | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationDispense |
| MedicationUse2 | Medicatiegebruik2 | MedicationStatement | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationUse2 |
| MedicationAdministration2 | Medicatietoediening2 | MedicationAdministration | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationAdministration2 |
2.1.2 Supporting building blocks
Additionally, the standard uses several supporting building blocks referenced from the main medication building blocks. All supporting building blocks are part of the zib2020 package as ‘nl-core’ profiles.
Note the following:
- Each occurrence of the zib HealthProfessional is normally represented by two FHIR resources: an instance of nl-core-HealthProfessional-PractitionerRole and an instance of nl-core-HealthProfessional-Practitioner. Sending systems should only fill the reference to the PractitionerRole instance where relevant. Receiving systems can resolve the reference to the Practitioner resource from that PractitionerRole instance.
- The zib HealthcareProvider is mapped to both a Location and Organization profile. Most often, the Location profile acts as the focal resource, because most references to this zib are concerned about the recording of the physical location where the care to patient/client takes place rather than the organizational information. For the latter, the profile on Organization is used which is referenced using the
Location.managingOrganizationelement. Sending systems should only fill the reference to the Location instance where relevant. Incidentally, concepts that are only concerned with organizational information can refer to the Organization instance.
2.1.3 Transaction specific profiles
For several transactions, additional profiles are provided. For each transaction the profile relevant is explicitly mentioned in the corresponding subsection.
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The Medication overview transaction profiles will be updated at a later point in time. |
2.2 Mappings between profiles and data set
Each transaction starts with links to the functional definition in an ART-DECOR publication and references one or several FHIR profiles. Where the functional definition contains all specific data elements for the transaction (prefixed with ‘dataelement-mp920’), the FHIR profiles only contain a mapping to these data elements that do not have a dependency on a zib counterpart. For example: ‘mp-dataelement920-83’ (MedicationAgreementDateTime) has a relation with the zib element with id ‘NL-CM-9.6.19757’, therefore no mapping with ‘mp-dataelement920-83’ can be found in the profiles. On the other hand, ‘mp-dataelement920-42’ (Identification) has no relation with a zib element, therefore a mapping can be found in the relevant FHIR profile.
Because of open world modelling, the cardinality of elements in the FHIR profiles can be less strict than the cardinalities in the ART-DECOR transactions. However, the latter cardinality is leading when it comes to exchanging building blocks in the context of a specific transaction. For example: in the mp-MedicationAgreement profile, .requester has a cardinality of 0..1, while in the ‘Serve Medication data’ ART-DECOR transaction, the Prescriber element has a cardinality of 1..1 R. Therefore, .requester is expected to be filled with either a Reference to an nl-core-HealthProfessional-PractitionerRole resource or a DataAbsentReason extension, see the general FHIR IG on ‘Missing information’.
Each transaction contains a Patient building block with cardinality 1..1 M. This patient is the subject of all other building blocks in the transaction, although no explicit relation exists in the data set. Therefore, a reference to a Patient resource conforming to the nl-core-Patient profile is expected in .subject of each FHIR instance of each building block.
Relations between different building blocks exist in transactions by means of concepts with a name starting with ‘Relation…’ (Dutch: ‘Relatie…’) and an underlying concept 'Identification' of data type Identification, for example RelationAdministrationAgreement (mp-dataelement920-1328) in building block MedicationAgreement. These relations are mapped to the FHIR data type ‘Reference’. Implementers SHOULD use literal references (using .reference) instead of logical references (using .identifier) where possible, see the general FHIR IG on the Reference data type.
2.3 Pharmaceutical treatment
The MP9 transaction data sets reference a container ‘Pharmaceutical treatment’ (Dutch: ‘Medicamenteuze behandeling’), which contains all medication building blocks relevant to the transaction. For the specification of the Pharmaceutical treatment, see the functional specification. In FHIR, the Pharmaceutical treatment does not have an explicit resource representation. Instead, each medication building block contains the PharmaceuticalTreatmentIdentifier extension which contains the ‘Pharmaceutical Treatment Identifier’. This Identifier shall be the same across different related medication resources that constitute one Pharmaceutical treatment. The custom search parameter pharmaceutical-treatment-identifier, see ‘Search parameters’, is used within the ‘Medication data’ transaction to query a server for all building blocks within a specific Pharmaceutical treatment.
2.4 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 patient, 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, which is a chained search parameter for all resource types except Patient, 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
All request examples in this document do not include patient identification mechanisms. Requesters are assumed to include these if necessary.
2.5 Resource identification
All profiles used within the MP9 information standard contain .identifier elements with a cardinality of 0..* because of open world modelling. However, all ART-DECOR transactions referenced within this IG assign a 1..1 R cardinality, meaning a stable identifier SHOULD be provided, or the DataAbsentReason extension if a value is missing. Identifiers SHALL contain both a .system and a .value.
Because in HL7v3 (CDA) an identifier can only be composed using OIDs, the .system SHALL be an OID to accommodate compatibility in transformations to and from FHIR. The Netherlands HL7v3 datatype II also defines additional restrictions on the maximum length of both @root and @extension (equivalent to respectively .system and .value in FHIR). For the same compatibility reasons, .system SHALL have a maximum of 128 characters and .value SHALL have a maximum of 64 characters.
Systems that encounter or resolve references, either logical or literal, in resources they receive, SHALL NOT rewrite these references to a copy of these resources (with http://nictiz.nl/fhir/StructureDefinition/ext-CopyIndicator present) they may store. This means that relative literal references may need to be rewritten to absolute ones. This also goes for included secondary resources in transactions.
2.6 Differentiating between transactions
All transactions described in this IG use the same medication building blocks in different combinations and settings, making it necessary to differentiate between them. Several mechanisms are used to achieve this. Aside from PUSH/PULL, the type of medication building blocks, supporting resources like List and Communication for specific transactions and fixing the value of specific FHIR elements in applicable profiles, the actionable tag is used. The latter is described more in depth in the following section. Next to that, a summarizing table is provided.
Note that Resource.meta.profile, although present in each building block (see the general FHIR IG on ‘Profile use and declaration’), SHOULD not be used for identification of the building block type and therefore for differentiating between transactions.
2.6.1 Actionable tag
To differentiate between sending or serving building blocks that are either of informative nature or of actionable nature, the actionable tag is used. Tags are Coding elements present in Resource.meta.tag used for workflow management.
If applicable, the profiles used by a transaction require the use of .meta.tag with .system = http://terminology.hl7.org/CodeSystem/common-tags and .value = actionable to indicate that the resource is part of a request intended to be acted upon. The absence of this tag indicates that the resource is merely of informative nature.
It is up to systems to determine how and when the transactions using the actionable tag are handled from a functional perspective. Systems may store the resource including the actionable tag or remove it either upon storing or when the request is acted upon. However, systems SHALL make sure the tag is removed when serving or sending the resource as part of an informative transaction.
2.6.2 Summarizing table
| Transaction | PUSH/PULL | Building blocks | actionable tag | FHIR element value | Other |
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| Medication data (Retrieve/Serve) | PULL | One or more of all building blocks | No | ||
| Medication data (Send/Receive) | PUSH | One or more of all building blocks | No | ||
| Medication overview (Retrieve/Serve) | PULL | MedicationAgreement, AdministrationAgreement, MedicationUse | No | Includes MedicationOverview List resource in Bundle | |
| Medication overview (Send/Receive) | PUSH | MedicationAgreement, AdministrationAgreement, MedicationUse | No | Includes MedicationOverview List resource in Bundle | |
| Medication prescription (Send/Receive) | PUSH | MedicationAgreement, DispenseRequest (optional) | Yes | MedicationRequest.intent = order (for both MedicationAgreement and DispenseRequest building blocks)
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| Medication prescription processing (Send/Receive) | PUSH | AdministrationAgreement, MedicationDispense (optional) | Yes | ||
| Proposal dispense request (Send/Receive) | PUSH | DispenseRequest | Yes | MedicationRequest.intent = plan
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| Reply proposal dispense request (Send/Receive) | PUSH | Yes | Communication resource with reference to DispenseRequest | ||
| Proposal medication agreement (Send/Receive) | PUSH | MedicationAgreement | Yes | MedicationRequest.intent = plan
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| Reply proposal medication agreement (Send/Receive) | PUSH | Yes | Communication resource with reference to MedicationAgreement |
3 Transactions
This section describes the FHIR implementation of all transactions listed in section 7 of the functional specification. Transactions are paired per transaction group. Each subsection below hyperlinks the names of the transaction groups and transactions to the functional definition in an ART-DECOR publication. The ART-DECOR publication details which data elements are expected to be supported (cardinality and conformance) for each transaction. Where the functional specification uses the terms ‘Consulting’ and ‘Making available’, this IG uses the terms ‘Retrieving’ and ‘Serving’.
3.1 Medication data (Retrieve/Serve)
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 for specific medication building blocks.
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
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| Medication data (PULL) | Retrieving medication data | Client | MP-MGR | CapabilityStatement Retrieve/serve medication data |
| Serving medication data | Server | MP-MGB |
3.1.1 Retrieve (request message)
When a patient or healthcare professional wants to obtain all medication data or specific parts matching various parameters, they issue 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 search query. Multiple request messages may be needed to retrieve all desired information.
GET [base]/[type]{?[parameters]}
3.1.1.1 Search parameters
The client MAY supply, and the server SHALL be capable of processing, all search parameters listed in the table below.
| MP9 search parameter | Description | FHIR search parameter | FHIR resource | Example |
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| PatientIdentificationNumber | Search on patient. | patient.identifier [1]
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MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration | 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 |
| Identification | Search on identifier. | identifier
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MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration | Retrieves a MedicationRequest resource with a specific identifier.
GET [base]/MedicationRequest?identifier=http://example.nl/fhir/NamingSystem/MedicationRequest|999922448 |
| Identification | Search on the pharmaceutical treatment identifier.
Note: retrieval of all medication resources belonging to one pharmaceutical treatment requires to search on all medication resource types. |
pharmaceutical-treatment-identifier [2]
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MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration | Retrieves all MedicationRequest resources that are part of a pharmaceutical treatment with a specific identifier.
GET [base]/MedicationRequest?pharmaceutical-treatment-identifier=http://example.nl/fhir/NamingSystem/pharmaceuticaltreatment|1247848 |
| Type | Search on type of medication building block. | category [2]
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MedicationRequest | Retrieves all MedicationRequest resources that represent the building block MedicationAgreement.
GET [base]/MedicationRequest?category=http://snomed.info/sct|33633005 Retrieves all MedicationRequest resources that represent the building block DispenseRequest. GET [base]/MedicationRequest?category=http://snomed.info/sct|52711000146108 Retrieves all MedicationRequest resources that represent the building block VariableDosingRegimen. GET [base]/MedicationRequest?category=http://snomed.info/sct|395067002 |
| MedicationDispense | Retrieves all MedicationDispense resources that represent the building block MedicationDispense.
GET [base]/MedicationDispense?category=http://snomed.info/sct|373784005 Retrieves all MedicationRequest resources that represent the building block AdministrationAgreement. GET [base]/MedicationRequest?category=http://snomed.info/sct|422037009 | |||
| MedicationStatement | Retrieves all MedicationStatement resources that represent the building block MedicationUse2.
GET [base]/MedicationStatement?category=http://snomed.info/sct|422979000 | |||
| MedicationAdministration | Retrieves all MedicationAdministration resources that represent the building block MedicationAdministration2.
GET [base]/MedicationAdministration?category=http://snomed.info/sct|18629005 | |||
| MedicationCode | Search on medication code. | medication.code[3]
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MedicationRequest, MedicationDispense, MedicationStatement, MedicationAdministration | Retrieves all MedicationRequest resources that represent the building block MedicationAgreement and have Carbasalaatcalcium Sandoz 600 30 as medication.
GET [base]/MedicationRequest?category=http://snomed.info/sct|33633005&medication.code=urn:oid:2.16.840.1.113883.2.4.4.8|13610554 |
| PeriodOfUse | Search on medication use in the past, present or future within the specified time period. | period-of-use[2]
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MedicationRequest, MedicationDispense | Retrieves all MedicationRequest resources that represent the building block MedicationAgreement and were in effect from 01-01-2010.
GET [base]/MedicationRequest?category=http://snomed.info/sct|33633005&period-of-use=ge2010-01-01 |
| DispensePeriod | Returns all medication dispenses within the specified time period. | whenhandedover
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MedicationDispense | Retrieves all MedicationDispense resources that represent the building block MedicationDispense 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
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MedicationAdministration | Retrieves all MedicationAdministration resources that represent the building block MedicationAdministration2 and where administration happened on a specific day.
GET [base]/MedicationAdministration?category=http://snomed.info/sct|18629005&effective-time=eq2022-01-01 |
| - | 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.
Supporting the include of the Patient and Medication resources referenced by building blocks is required. Others (Organization, Location, PractitionerRole, Practitioner, RelatedPerson, Observation) are optional. However: all resources referenced per literal reference SHALL be resolvable per the Nictiz IG. |
_include=[type]:patient
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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 |
The following custom search parameters are defined for this transaction:
- http://nictiz.nl/fhir/SearchParameter/pharmaceutical-treatment-identifier
- http://nictiz.nl/fhir/SearchParameter/category
- http://nictiz.nl/fhir/SearchParameter/period-of-use
3.1.1.2 Retrieve all medication data
To retrieve all known medication data, a client has to execute the following requests to retrieve all known medication data per building block, including referenced Medication resources:
GET [base]/MedicationRequest?category=http://snomed.info/sct|33633005&_include=MedicationRequest:medication GET [base]/MedicationRequest?category=http://snomed.info/sct|52711000146108&_include=MedicationRequest:medication GET [base]/MedicationRequest?category=http://snomed.info/sct|395067002&_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
3.1.2 Serve (response message)
The server returns an HTTP Status code appropriate to the processing outcome and returns a Bundle, with Bundle.type = searchset, including the resources matching the search query medication data. The resources included in the Bundle SHALL conform to the profiles listed in section 2.1.
3.1.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.2 Medication data (Send/Receive)
The send medication data transaction is used by the client to send medication data to a server.
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
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| Medication data (PUSH) | Sending medication data | Client | MP-MGS | CapabilityStatement Send/receive medication data |
| Receiving medication data | Server | MP-MGO |
3.2.1 Send (request message)
Because medication data consists of several building blocks along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The resources included in the Bundle SHALL conform to the profiles listed in section 2.1. Because of the informative nature of the transaction, no actionable tags shall be present.
3.2.2 Receive (response message)
The server checks each resource present within the Bundle it receives for the absence of actionable tags.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
3.2.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.3 Medication overview (Retrieve/Serve)
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The Medication overview transaction groups will be updated at a later point in time. |
The retrieve medication overview transaction is used by the client to retrieve a medication overview from the server.
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
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| Medication overview (PULL) | Retrieving medication overview | Client | MP-MOR | CapabilityStatement Retrieve/serve medication overview |
| Serving medication overview | Server | MP-MOB |
3.3.1 Retrieve (request message)
When a patient or healthcare professional wants to obtain a patient's medication overview, they issue a retrieve 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 an HTTP GET command conform the FHIR search specification, as shown below. This URL is configurable by the client by configuring the search query.
GET [base]/$medication-overview
3.3.2 Serve (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 resource with Bundle.type = searchset that conforms to the mp-MedicationOverview-Bundle profile. Thus this Bundle contains at least one List resource (that represents the medication overview and conforms to the mp-MedicationOverview profile) and (optionally) one Patient resource as entries, along with all the resources that represent the current medication overview. These latter resources SHALL be referenced from the List resource. The clinical content of the medication overview is defined in the Medication Process specification.
The Bundle.total value contains the number of matching building blocks (i.e. MedicationAgreement, AdministrationAgreement and MedicationUse2). Other included resources, such as Medication resources, are not included in the total. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
3.3.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.4 Medication overview (Send/Receive)
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The Medication overview transaction groups will be updated at a later point in time. |
The send medication overview transaction is used by the client to send a medication overview to a server.
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
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| Medication overview (PUSH) | Sending medication overview | Client | MP-MOS | CapabilityStatement Send/receive medication overview |
| Receiving medication overview | Server | MP-MOO |
3.4.1 Send (request message)
3.4.2 Receive (response message)
3.4.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.5 Medication prescription (Send/Receive)
The send medication prescription transaction is used by the client to send a request to dispense medication (Dutch: verstrekkingsverzoek) or process modifications to a medication agreement (Dutch: medicatieafspraak) to a server.
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
|---|---|---|---|---|
| Medication prescription (PUSH) | Sending medication prescription | Client | MP-VOS | CapabilityStatement Send/receive medication prescription |
| Receiving medication prescription | Server | MP-VOO |
3.5.1 Send (request message)
Because a medication prescription consists of several building blocks along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The Bundle SHALL conform to the mp-MedicationPrescription-Bundle profile, which contains at least a MedicationAgreement building block (with MedicationRequest.intent = order) and optionally a DispenseRequest building block (with MedicationRequest.intent = order). Additionally, one instance of nl-core-Patient, nl-core-BodyHeight and nl-core-BodyWeight, and multiple instances of nl-core-PharmaceuticalProduct might be included, as well as other supporting resources. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
The mp-MedicationPrescription-Bundle profile prescribes the use of actionable tags to indicate that the resources sent are part of a prescription and of actionable nature.
3.5.2 Receive (response message)
The server checks the MedicationAgreement and DispenseRequest building blocks present within the Bundle it receives for the presence of actionable tags and the value of MedicationRequest.intent = order to determine the transaction type.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
Aside from the technical processing outcome described above, after functional processing an invocation of the ‘Send medication prescription processing’ transaction is expected.
3.5.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.6 Medication prescription processing (Send/Receive)
The send medication prescription processing transaction is used by the client to send data on the processing of a medication agreement (Dutch: medicatieafspraak) and possibly a dispense request (Dutch: verstrekkingsverzoek), in the form of an administration agreement (Dutch: toedieningsafspraak) and optionally a medication dispense (Dutch: medicatieverstrekking).
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
|---|---|---|---|---|
| Medication prescription processing (PUSH) | Sending data on processing of medication prescription | Client | MP-VAS | CapabilityStatement Send/receive medication prescription processing |
| Receiving data on processing of medication prescription | Server | MP-VAO |
3.6.1 Send (request message)
Because data on processing a medication prescription consists of several building blocks along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The Bundle SHALL conform to the mp-MedicationPrescriptionProcessing-Bundle profile, which contains at least an AdministrationAgreement building block and optionally a MedicationDispense building block. Additionally, one instance of nl-core-Patient and multiple instances of nl-core-PharmaceuticalProduct might be included, as well as other supporting resources. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
The mp-MedicationPrescriptionProcessing-Bundle profile prescribes the use of actionable tags to indicate that the resources sent are part of a prescription and of actionable nature.
3.6.2 Receive (response message)
The server checks the AdministrationAgreement and MedicationDispense building blocks present within the Bundle it receives for the presence of actionable tags.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
3.6.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
| Building block/transaction profile (EN) | Building block/transaction profile (NL) | FHIR resource | FHIR profile |
|---|---|---|---|
| MedicationPrescriptionProcessing | VoorschriftAfhandeling | Bundle | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationPrescriptionProcessing-Bundle |
| AdministrationAgreement | Toedieningsafspraak | MedicationDispense | http://nictiz.nl/fhir/StructureDefinition/mp-AdministrationAgreement |
| MedicationDispense | Medicatieverstrekking | MedicationDispense | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationDispense |
| Patient | Patient | Patient | http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient |
| PharmaceuticalProduct | FarmaceutischProduct | Medication | http://nictiz.nl/fhir/StructureDefinition/nl-core-PharmaceuticalProduct |
| HealthcareProvider | Zorgaanbieder | Location | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider |
| Organization | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization |
3.7 Proposal dispense request (Send/Receive)
The send proposal dispense request transaction is used by the client to inform the server about a new or modified proposal dispense request (Dutch: verstrekkingsverzoek).
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
|---|---|---|---|---|
| Proposal dispense request (PUSH) | Sending proposal dispense request | Client | MP-VVS | CapabilityStatement Send/receive proposal dispense request |
| Receiving proposal dispense request | Server | MP-VVO |
3.7.1 Send (request message)
Because a proposal dispense request consists of a DispenseRequest building block along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The Bundle SHALL conform to the mp-ProposalDispenseRequest-Bundle profile, which contains one DispenseRequest building block (with MedicationRequest.intent = plan). Additionally, one instance of nl-core-Patient and multiple instances of nl-core-PharmaceuticalProduct might be included, as well as other supporting resources. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
The mp-ProposalDispenseRequest-Bundle profile prescribes the use of actionable tags to indicate that the resources sent are part of a proposal and of actionable nature.
3.7.2 Receive (response message)
The client checks the DispenseRequest building block present within the Bundle it receives for the presence of actionable tags and the value of MedicationRequest.intent = plan to determine the transaction type.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
Aside from the technical processing outcome described above, after functional processing an invocation of the ‘Send reply proposal dispense request’ transaction is expected.
3.7.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.8 Reply proposal dispense request (Send/Receive)
The send reply proposal dispense request transaction is used by the client to inform the server about a reply on a proposed dispense request (Dutch: verstrekkingsverzoek).
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
|---|---|---|---|---|
| Reply proposal dispense request (PUSH) | Sending reply proposal dispense request | Client | MP-VVO | CapabilityStatement Send/receive reply proposal dispense request |
| Receiving reply proposal dispense request | Server | MP-VVS |
3.8.1 Send (request message)
Because a reply proposal dispense request consists of a Communication resource (which contains the reply itself) along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The Bundle SHALL conform to the mp-ReplyProposalDispenseRequest-Bundle profile, which contains at least one Communication resource that conforms to the mp-ReplyProposalDispenseRequest profile. Additionally, one instance of nl-core-Patient and other supporting resources might be included. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
Note that the proposed dispense request that is replied to is internally resolvable by the server, hence it does not need to be included in the Bundle (and is thus not explicitly modelled in the mp-ReplyProposalDispenseRequest-Bundle profile).
The mp-ReplyProposalDispenseRequest profile prescribes the use of actionable tags to indicate that the resource sent is of actionable nature.
3.8.2 Receive (response message)
The client checks the Communication resource present within the Bundle it receives for the presence of actionable tags and the type of building block referenced to determine the transaction type.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
Aside from the technical processing outcome described above, after functional processing this transaction might lead to an invocation of the ‘Send medication prescription’ transaction.
3.8.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
| Building block/transaction profile (EN) | Building block/transaction profile (NL) | FHIR resource | FHIR profile |
|---|---|---|---|
| ReplyProposalDispenseRequest | AntwoordVoorstelVerstrekkingsverzoek | Bundle | http://nictiz.nl/fhir/StructureDefinition/mp-ReplyProposalDispenseRequest-Bundle |
| Communication | http://nictiz.nl/fhir/StructureDefinition/mp-ReplyProposalDispenseRequest | ||
| DispenseRequest | Verstrekkingsverzoek | MedicationRequest | http://nictiz.nl/fhir/StructureDefinition/mp-DispenseRequest |
| Patient | Patient | Patient | http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient |
| HealthProfessional | Zorgverlener | PractitionerRole | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole |
| Practitioner | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner | ||
| HealthcareProvider | Zorgaanbieder | Location | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider |
| Organization | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization |
3.9 Proposal medication agreement (Send/Receive)
The send proposal medication agreement transaction is used by the client to inform the server about a new or modified proposal medication agreement (Dutch: medicatieafspraak).
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
|---|---|---|---|---|
| Proposal medication agreement (PUSH) | Sending proposal medication agreement | Client | MP-VMS | CapabilityStatement Send/receive proposal medication agreement |
| Receiving proposal medication agreement | Server | MP-VMO |
3.9.1 Send (request message)
Because a proposal medication agreement consists of a MedicationAgreement building block along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The Bundle SHALL conform to the mp-ProposalMedicationAgreement-Bundle profile, which contains at least a MedicationAgreement building block (with MedicationRequest.intent = plan). Additionally, one instance of nl-core-Patient, nl-core-BodyHeight and nl-core-BodyWeight, and multiple instances of nl-core-PharmaceuticalProduct might be included, as well as other supporting resources. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
The mp-ProposalMedicationAgreement-Bundle profile prescribes the use of actionable tags to indicate that the resources sent are part of a proposal and of actionable nature.
3.9.2 Receive (response message)
The client checks the MedicationAgreement building block present within the Bundle it receives for the presence of actionable tags and the value of MedicationRequest.intent = plan to determine the transaction type.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
Aside from the technical processing outcome described above, after functional processing an invocation of the ‘Send reply proposal medication agreement’ transaction is expected.
3.9.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
3.10 Reply proposal medication agreement (Send/Receive)
The send reply proposal medication agreement transaction is used by the client to inform the server about a reply on a proposed medication agreement (Dutch: medicatieafspraak).
| Transaction group | Transaction | Actor | System role | FHIR CapabilityStatement |
|---|---|---|---|---|
| Reply proposal medication agreement (PUSH) | Sending reply proposal medication agreement | Client | MP-VMO | CapabilityStatement Send/receive reply proposal medication agreement |
| Receiving reply proposal medication agreement | Server | MP-VMS |
3.10.1 Send (request message)
Because a reply proposal medication agreement consists of a Communication resource (which contains the reply itself) along with supporting resources, a transaction interaction is used.
A transaction interaction allows for sending a Bundle with a set of resources in a single interaction and makes it possible to include referenced secondary resources. The interaction is performed by an HTTP POST command as shown:
POST [base]
The body of the POST submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP method of the action to be executed. Usually, this will be POST, even for informative 'secondary' resources.
The Bundle SHALL conform to the mp-ReplyProposalMedicationAgreement-Bundle profile, which contains at least one Communication resource that conforms to the mp-ReplyProposalMedicationAgreement profile. Additionally, one instance of nl-core-Patient and other supporting resources might be included. All resources included in the Bundle SHALL conform to their respective profiles listed in section 2.1.
Note that the proposed medication agreement that is replied to is internally resolvable by the server, hence it does not need to be included in the Bundle (and is thus not explicitly modelled in the mp-ReplyProposalMedicationAgreement-Bundle profile).
The mp-ReplyProposalMedicationAgreement profile prescribes the use of actionable tags to indicate that the resource sent is of actionable nature.
3.10.2 Receive (response message)
The client checks the Communication resource present within the Bundle it receives for the presence of actionable tags and the type of building block referenced to determine the transaction type.
The server returns an HTTP Status code appropriate to the processing outcome. If the transaction is successful, the server returns a Bundle with Bundle.type = transaction-response, that contains one entry for each entry in the request, in the same order, with the outcome of processing the entry. Included ‘secondary resources’ are handled following the Nictiz IG.
If the transaction fails, the server returns an OperationOutcome with one or multiple .issue elements filled with information, as detailed as possible, that describes why the transaction failed and which resource and/or request caused this.
Aside from the technical processing outcome described above, after functional processing this transaction might lead to an invocation of the ‘Send medication prescription’ transaction.
3.10.3 List of profiles
The table below includes all profiles that are explicitly mentioned in the data set of this transaction, and thus need to be supported.
| Building block/transaction profile (EN) | Building block/transaction profile (NL) | FHIR resource | FHIR profile |
|---|---|---|---|
| ReplyProposalMedicationAgreement | AntwoordVoorstelMedicatieafspraak | Bundle | http://nictiz.nl/fhir/StructureDefinition/mp-ReplyProposalMedicationAgreement-Bundle |
| Communication | http://nictiz.nl/fhir/StructureDefinition/mp-ReplyProposalMedicationAgreement | ||
| MedicationAgreement | Medicatieafspraak | MedicationRequest | http://nictiz.nl/fhir/StructureDefinition/mp-MedicationAgreement |
| Patient | Patient | Patient | http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient |
| HealthProfessional | Zorgverlener | PractitionerRole | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole |
| Practitioner | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner | ||
| HealthcareProvider | Zorgaanbieder | Location | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider |
| Organization | http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization |
4 Release notes
Release notes can be found here.
5 Footnotes
- ↑ This search parameter only needs to be supported when patient identification requires the use of search parameters, see section 2.4.
- ↑ 2,0 2,1 2,2 The search parameter consists of a custom FHIR search parameter not represented in the FHIR specification. Note that for
MedicationRequest.categoryandMedicationStatement.categorya core search parameter is available, hence no custom one is needed in those cases. - ↑ Chained search parameter: searches the medicationReference required in each building block for its
.code.