FHIR Implementation Guide Medication Process Medication Process 9 version 2.0.0 bèta

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1 Introduction

This is the FHIR implementation guide for the information standard Medicatieproces 9 version 2.0.0 bèta. 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:

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 Verwijzing.png CapabilityStatement: Client Client requirements
Healthcare professional The user of a healthcare information system (XIS) Server XIS Verwijzing.png 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 [1] 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 [1],[2] 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[1] 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:

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 Release notes

Release notes can be found on the functional design page.

6 Footnotes

  1. 1,0 1,1 1,2 The search parameter consists of a custom FHIR search parameter not represented in the FHIR specification.
  2. The FHIR profiles that represent the medication building blocks contain fixed code values in the .category elements to allow searching on specific medication building blocks.