hl7ch / ch-emed Goto Github PK

ch.fhir.ig.ch-emed#0.3.0 /StructureDefinition-ch-emed-composition-medicationtreatmentplan.html

The sections in the documents should have fix order equivalent to CDA-CH-EMED:

1. Medication Treatment Plan Section Content Module (or other depending on document)
2. Remarks Section - coded (DYNAMIC)
3. Original Representation Section - coded (DYNAMIC)

oe, ahdis

ch.fhir.ig.ch-emed#0.2.0 /Bundle-2-7-MedicationCard.xml.html

The example does not define the unit/code of the doseQuantity (Tablets).

Input from Walter Wellauer during eMedication Projectathon

ch.fhir.ig.ch-emed#1.0.0 /Organization-Hausarzt.xml.html

Das Element Organization.telecom ist mit der Extension nullFlavor dargestellt. Das war ursprünglich mal wegen dem Mapping FHIR-CDA so vorgeschlagen worden. In den Bundle-Beispielen hat man es aber angepasst und wenn es keinen Wert hat, wird das Element auch nicht abgebildet. Vorschlag, das Element aus dem Organization-Beispiel ebenso entfernen.

Michaela Ziegler, ahdis ag

ch.fhir.ig.ch-emed#1.0.0 /StructureDefinition-ch-emed-ext-substitution.html

Substitution of the medication
Binding: ActSubstanceAdminSubstitutionCode (preferred)

Points to the HL7 V3 ValueSet: https://terminology.hl7.org/2.1.0/ValueSet-v3-ActSubstanceAdminSubstitutionCode.html which contains the code F (Formulary), the code F is not within https://art-decor.org/art-decor/decor-valuesets--ch-pharm-?id=2.16.756.5.30.1.1.11.81&effectiveDate=2020-07-10T00%3A52%3A42

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.1.2 /Binary-1-1-pdf.json.html

Test the feedback

Mutiline

oe - ahdis

ch.fhir.ig.ch-emed#0.3.0 /StructureDefinition-ch-emed-dosage-structured.html

We should make the dosage type required if no text is provided (business constraint), otherwise we don't know if it corresponds to a normal, split or tapered dose.

see also hl7ch/cda-fhir-maps#24

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medicationstatement-treatmentplan-definitions.html
ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medicationrequest-definitions.html
ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medicationdispense.html
ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-observation.html
ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medicationstatement-card-definitions.html

#%.subject should reference CH Core Composition Patient Profile EPR or CH Core Patient for all the above metioned profiles to be able to be referenced / integrated in other CH Profiles like CH AllergyIntolerance, CH VACD, CH eTransitionOfCare, CH t.b.d.
#MedicationStatement.subject
#MedicationRequest.subject
#MedicationDispense.subject
#Observation.subject
The constraint to CH Core Composition Patient Profile EPR should be achieved on the composition level with FHIR Path rules or similar
If not every clinical profile has to be duplicated for B2B and other Swiss use cases which makes it much harder for conistent maintenance and usablitly

Walter Wellauer, Cistec AG

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-composition-medicationcard.html

out of discussion from eMed-Projectathon:

• for a start, PDF representation should only be required on Medication Card document which is also the first document to enter the EPR legal framework
• what this PDF has to include (at minimum) should be defined, probably in discussion with interprofessional group IPAG

annatina foppa, eHealth Suisse

Incorrect, actual base profile:
<baseDefinition value="http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-document"/>

Correct base profile would be:
<baseDefinition value="http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-document-epr"/>

The composition referenced in the Bundle this derives from the correct profile.

Profiles that need to be adapted:

• input\resources\structuredefinition\ch-emed-document-medicationcard.xml
• input\resources\structuredefinition\ch-emed-document-medicationdispense.xml
• input\resources\structuredefinition\ch-emed-document-medicationlist.xml
• input\resources\structuredefinition\ch-emed-document-medicationprescription.xml
• input\resources\structuredefinition\ch-emed-document-medicationtreatmentplan.xml
• input\resources\structuredefinition\ch-emed-document-pharmaceuticaladvice.xml

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-composition-medicationprescription.html

composition.type.coding.display has Fixed Value: Medical Prescription record (record artifact) ->> change to MediCInal Prescr ... as in SNOMED CT https://browser.ihtsdotools.org/?perspective=full&conceptId1=761938008&edition=MAIN/2021-01-31&release=&languages=en
annex 3 was wrong, will be corrected, artdecor already updated with correct display name: http://ehealthsuisse.art-decor.org/ch-epr-html-20200622T124207/voc-2.16.756.5.30.1.127.3.10.1.27-2020-02-26T173448.html

Annatina Foppa, eHealth Suisse

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-composition-medicationcard.html

Why is the cardinality of the Annotation section.entry.reference 1..1? In the example no entry.reference is specified.

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-dosage-structured.html

TiminEvent: Our "Swiss" dose time regime, like 1 - 1 - 1 -1 as TimingEvent, How should it be coded? There is also the open issue mentioned here (https://art-decor.org/art-decor/decor-issues--ch-pharm-?id=2.16.756.5.30.1.127.77.4.6.20&language=en-US)

CDA-CH-EMED / CH EMED examples:
ACM - ACD- ACV - HS

Cistec:
CM", "CD", "CV", "HS"

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-observation.html

The CH EMED Observation Profile used in the Pharmaceutical Advice should be able to change the strucutred dosage for a referencing Medication Treament Plan. As a proposal we could create a "contained" MedicationStatement that is referenced inside the "partOf" Attribut of the CH EMED Observation Profile.

Cistec AG

if a GTIN is specified, ingredients are not required according to IPAG, this is
modeled in CDA and FHIR looks here too strong:

ingredient 1..* -> in CDA it is 0..*

does this affect all Medication Profiles?

https://art-decor.org/art-decor/decor-templates--cdachemed-?section=templates&id=2.16.756.5.30.1.1.10.4.34&effectiveDate=2019-12-11T11:31:52&language=en-US

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medication-medicationstatement.html

Medication.amount and Medication.ingredient.strenght are of Type Ratio where you have numerator and denominator as Quantity. These elements should also be constrained by http://fhir.ch/ig/ch-emed/StructureDefinition-ch-emed-quantity.html that the units are defined accordingly.

This would apply to all Medication Profiles.

This is related also to #22

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-range.html

low and high should be profiles on Quantity(CHEMEDQuantityWithEmedUnits) instead of
CHEMEDRangeWithEmedUnits

OE / AF / MZ

Profile Tab: show profile list (equivalent to ch-core)
Profile according to documents -> move to document tabs

ch.fhir.ig.ch-emed#0.2.0 /ValueSet-UnitsOfPresentation.html

Der Begriff "actuation" kann sowohl für einen Hub (Lösung) als auch für einen Sprühstoss (Aerosol) stehen. Die Übersetzungen "Betätigung (Sprühstoss)" sowie "bouffée" lassen jedoch nur die Verwendung als Einheit für ein Aerosol zu. Damit steht aber keine Einheit für z.B. eine orale Lösung (wie Tramal mit Dosierpumpe oder auch Flatulex) zur Verfügung. Wir bitten um Übersetzungen auf derselben "Ebene". Konkret sollte die Klammerbemerkung bei der Deutschübersetzung weggelassen werden, also lediglich "Betätigung" (allenfalls ginge auch Hub, weil Hub sowohl für eine Dosierpumpe als auch für ein Aerosol gebraucht wird). Im Französischen darf es ebenfalls nicht "bouffée" sein - da können wir aber keinen konkreten Vorschlag machen (dazu braucht es einen französischsprechenden Experten), Unklar ist für uns auch, ob die italienische Übersetzung sowohl für Aerosole als auch Lösungen gebraucht werden kann. Für allfällige weitere Erklärungen stehe ich gerne zur Verfügung.

Priska Vonbach, PEDeus AG

ch.fhir.ig.ch-emed#0.2.0 /Bundle-1-1-MedicationTreatmentPlan.html

For the provided examples the included "original representations" are just PDF's, and not in PDF 1/a format. The same PDF's are also used for the corresponding CDA-CH-EMED examples.

Quentin brought this up in the google group, see https://groups.google.com/d/msgid/epd_projectathon/835d55cd-097b-4dbb-b321-2a60f7937b72n%40googlegroups.com.

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medicationstatement-card.html

The nonstructured Dosage is required in CH-EMD is required ( dosage:nonstructured, 1..1 CHEMEDDosageNonStructured), however the CDA-CH EMED spec has a 0..1 cardinality for the non structured dosage part.

https://art-decor.org/art-decor/decor-templates--cdachemed-?section=templates&id=2.16.756.5.30.1.1.10.4.34&effectiveDate=2019-12-11T11:31:52&language=en-US

IPAG provided the following definition: Dosierung o M
Entweder strukturiert oder im Freitext möglich

Should the nonstructured be also 0..1?

Point came up with Robert from Cerner during Projectathon preparation

Oliver Egger

ch.fhir.ig.ch-emed#0.2.0 /ValueSet-edqm-pharmaceuticaldoseform.html

Bemerkung Daniel Ratschiller, CISTEC: die Codes vom (für die Praxis schon fast unbrauchbar feingranularen) Valueset EDQM-Pharmaceutical Dose Form ... zu feingranular?
Ausserdem Bemerkung, dass zu viel Überschneidung mit UnitsOfPresentation Value Set

Annatina Foppa, eHealth Suisse

see hl7ch/hl7ch-cda#8

ch.fhir.ig.ch-emed#0.2.0 /

originalRespresentation/entry 1..1 Reference(Binary)PDF only for Mediaction Card Compostition and Medication Prescription prescrition, in all others only 0..1 Reference(Binary)PDF as they are only transactional documents. Following IHE PHARM, the Consumer only reads a consolidated view (medication card) or a prescription

Walter Wellauer, Cistec AG

ch.fhir.ig.ch-emed#0.2.0 /

error Encountered 1 definition(s) with the same resourceType and id as a previous definition. FHIR definitions should have unique resourceType and id. The following duplicate definitions will not be processed by GoFSH:

• C:\Daten\FHIR\IG\ch-emed.orig\package\ImplementationGuide-ch.fhir.ig.ch-emed.json (ImplementationGuide/ch.fhir.ig.ch-emed) matches C:\Daten\FHIR\IG\ch-emed.orig\package\ig-r4.json

=> to be able to process with GoFSH you have to remove ig-r4.json from the package

Walter Wellauer, Cistec AG

Create a basic profile for the MedicationStatement with the elements that are generally relevant, independent of the type of document.
The MedicationStatement of the Medication Card document and the Medication Treatment document are then derived from this and only the elements that are specific to it are defined there.

Proposal:
Later, transfer the basic MedicationStatement to CH Core.

ch.fhir.ig.ch-emed#1.0.0 /StructureDefinition-ch-emed-composition-medicationprescription.html

Typo in Constraint:
ch-emed-sect-annoot: -> annot (only 1 "o")

also in the other StructureDefinitions for Composition

Michaela Ziegler (ahdis ag)

https://gazelle.ihe.net/jira/servicedesk/customer/portal/8/EHS-445:

In different codings are the system as "fixed Value" defined. This way multiple codings with different systems are not allowed. This should be changed, so that it is possible.

e.g.: Medication.code.coding
http://fhir.ch/ig/ch-emed/StructureDefinition-ch-emed-medication-medicationstatement.html

Where this issue is present everywhere, needs to be reviewed.

ch.fhir.ig.ch-emed#0.2.0 /ValueSet-UnitsOfPresentation.html

see discussions during eMed Projectathon, Pero Grgic knows the current state

Annatina Foppa, eHealth Suisse

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medicationstatement-card.html

Currently the MedicationStatement.identifier is 0..*, however we need to have a unique uuid to identify this MedicationStatement in the exchange format (see CDA-CH-EMED: https://art-decor.org/art-decor/decor-templates--cdachemed-?section=templates&id=2.16.756.5.30.1.1.10.4.34&effectiveDate=2019-12-11T11:31:52&language=en-US). Propose to require one identifier with a uuid (system fixed).

This would also apply to MedicationRequest, MedicationDispense and Observation (for Pharmaceutical Advice).

In addition the document itself needs also uuid as an identifier, since this is related to all EPR exchange format this has been added as a CH-Core issue, see hl7ch/ch-core#95

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#1.0.0 /StructureDefinition-ch-emed-composition-medicationcard.html

Oliver Egger, ahdis ag, original feedback by Rob

Following constraint for Bundle.entry.fullUrl is defined:
ch-core-doc-1: The fullUrl must be an absolute URL server address or an URI for UUID/OID: startsWith('http') or startsWith('urn:uuid:') = true

In the IG are just examples with absolute URLs.
TBD: Add an example with UUID.

altbekanntes Ticket: https://art-decor.org/art-decor/decor-issues--ch-pharm-?id=2.16.756.5.30.1.127.77.4.6.6&language=en-US
mir RepeatNumber required. NullFlavor hat dabei die Bedeutung "unlimited repeat/refill". Ist das im Mapping bzw. in der FHIR Specs schon berücksichtigt?

ch.fhir.ig.ch-emed#0.2.0 /Bundle-2-7-MedicationCard.html

The PDF representation for the FHIR (and also CDA) example contains a dosis per unit of 2.5mg but this is in the source 50 mg / unit for Beloc Zok Metoprolol.

See https://ehealthsuisse.ihe-europe.net/gazelle/testing/test/test/TestInstance.seam?id=39290&cid=354975

PDF can be extracted with https://base64.guru/converter/decode/pdf

Oliver Egger, ahdis

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medication-medicationstatement.html

In different codings are the system as "fixed Value" defined. This way multiple codings with different systems are not allowed. This should be changed, so that it is possible.

e.g.: Medication.code.coding
http://fhir.ch/ig/ch-emed/StructureDefinition-ch-emed-medication-medicationstatement.html

Where this issue is present everywhere, needs to be reviewed.

annatina (based on Ticket by Michaela from Projectathon 2020)

http://hl7.org/fhir/R4/valueset-event-timing.html
Teilweise bereits übersetzt in CDA.
Mit CodeSystem Supplement https://www.hl7.org/fhir/codesystem.html#supplements lösen.

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medication-medicationstatement.html

it should be possible to only indicate the ingredient without a code for a medication which is now required (1...1)

annatina foppa, eHealth Suisse

According to the CDA Spec (based on IPAG) the formCode for medication has a cardinality of 0..1.
FHIR is to strong with a minimum cardinality of 1

Change Medication.form to minimum cardinality of 0 in:

• MedicationDispense
• MedicationStatement
• MedicationRequest

ch.fhir.ig.ch-emed#1.0.0 /StructureDefinition-ch-emed-dosage-structured.html

timinig.repeat.bounds should be restricted to Period to be equivalent to CDA.

Die Anwendungsdauer wird in FHIR mit der Dosage angegeben, siehe http://fhir.ch/ig/ch-emed/StructureDefinition-ch-emed-dosage-structured.html, da können sowohl Duration, Range und Period angegeben
werden. Für CDA-CH-EMED (IHE Pharmacy PRE https://www.ihe.net/uploadedFiles/Documents/Pharmacy/IHE_Pharmacy_Suppl_PRE.pdf) ist nur low, high erlaubt (6.3.4.6.3.4 Effective Time (Duration of Treatment)), das könnte bei FHIR auch noch expliziter gemacht werden (https://docs.google.com/spreadsheets/d/1Ui3NGFE2I8yiOlHELk-B0Pke2l9-Jbe5BTeYOnS8-uE/edit#gid=1859696266).

Oliver Egger, ahdis

http://build.fhir.org/ig/ehealthsuisse/ch-emed/ValueSet-UnitsOfPresentation.html
To substantiate my comments in #24, I share here another Excel file with the analyses made.

• It contains some potential missing galenic forms.
• It shows a shortlist of units from our HIS that has emerged in Switzerland over 20 years.
• With the value sets of units and galenic forms as used in the Hospindex.
• With an analysis of how often these units and galenic forms are used in the Hospindex products.

UnitsOfPresentation_HCI_Einheiten_Galenische_Form_Ballot.xlsx

ch.fhir.ig.ch-emed#0.2.0 /

to define which elements have to be "understood" by implementing systems

Annatina Foppa, eHealth Suisse

In CHCoreCompositionEPR, the version number is optional. It's required in CDA-CH-EMED.

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medication-medicationstatement.html

the description says: " If no code ist available, the text should indicate the ingredient name" ... but the cardinality 1...1 implies that text is always required, regardless of if there is a code or not

annatina foppa, eHealth Suisse

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-medication-medicationstatement.html

Is the package size defined as optional or required? There are currently different requirements.

• CH EMED: Medication.amount 0..1
• CDA CH EMED: pharm:capacityQuantity 1..1
• IPAG: Does not say anything about the package size for the Medication Card document.

Michaela Ziegler, ahdis ag

ch.fhir.ig.ch-emed#0.2.0 /StructureDefinition-ch-emed-quantity.html

Coded quantity should be mandatory to minimize possible mismatch with patient risk

Walter Wellauer, Cistec AG

We would like to put forward the following proposal for discussion: In order to do something against a free-text medication registration, which is rather undesirable in the structured medication transmission, the coding of medications could be required as follows:

If no GTIN or pharmaceutical code is available for an article, then at least the active ingredients should have to be indicated in coded form (by means of SCT substance codes).

Such a constraint could be modelled as follows:
: code.coding.where(system = urn:oid:2.51.1.1).exists() or ingredient.exists()

Can you please check this out?

ch.fhir.ig.ch-emed#0.3.0 /StructureDefinition-ch-emed-dosage-structured.html

Structured Dosage can be of different types.

For normal dosing one Structured Dosage is required, for split dosing (any probably also tapered) multiple dosages with a sequence number can be provided.

Proposition to create two profiles, one for NormalStructuredDosage (max 1 and no sequence number set) and one for SplitStructure Dosage (multiple and sequenceNumber set).

oe, ahdis

Aktuell und vollständig?
Betrifft: http://build.fhir.org/ig/ehealthsuisse/ch-emed/branches/issue46/terminology.html

description is mandatory according to https://confluence.hl7.org/display/FHIR/NPM+Package+Specification

Proposal for the profiles

• CH EMED MedicationRequest
  • MedicationRequest.dispenseRequest.quantity
• CH EMED MedicationDispense
  • MedicationDispense.quantity

-> change the data type from 'SimpleQuantity' to 'CHEMEDQuantityWithEmedUnits'

Adaption of the example from actual version:

  <dispenseRequest>
    <numberOfRepeatsAllowed value="2"/>
    <quantity>
      <value value="1"/>
    </quantity>
  </dispenseRequest>

to new version:

   <dispenseRequest>
      <numberOfRepeatsAllowed value="2"/>
      <quantity>
         <value value="1"/>
         <unit value="Package"/>
         <system value="http://unitsofmeasure.org"/>
         <code value="{Package}"/>
      </quantity>
   </dispenseRequest>

and as well for MedicationDispense examples

ch.fhir.ig.ch-emed#0.3.0 /StructureDefinition-ch-emed-composition-medicationlist.html

Composition.title und Composition.section:list.title heissen auf Englisch beide "Medication List", auf Deutsch/Französisch/Italienisch sind aber unterschiedliche Übersetzungen angegeben. Ist das Absicht und relevant?

Composition.title : 'Medikationsliste' in german or 'Liste de médication' in french or 'Elenco delle terapie farmacologiche' in italian or 'Medication List' in english or titles in other languages are also allowed

Composition.section:list.title : 'Medikamentenliste' in german or 'Liste de médicaments' in french or 'Lista farmaci' in italian or 'Medication List' in english or titles in other languages are also allowed

Bei anderen Doks teilweise auch so, habe aber nicht systematisch überprüft.
http://build.fhir.org/ig/ehealthsuisse/ch-emed/StructureDefinition-ch-emed-composition-medicationlist.html

Annatina Foppa, eHealth Suisse