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Purpose

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Purpose

This WS is designed to qualify Medication request (post) - check the ability to use Medication request within the Medication program and receive program participants

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Page Properties

Link

https://ehealthmisapi1.docs.apiary.io/#reference/public.-reimbursement/medication-request/qualify-medication-request-by-id

Посилання на Apiary або Swagger

Resource

/api/medication_requests/{{id}}/actions/qualify

Посилання на ресурс, наприклад: /api/persons/create

Scope

medication_request:details_pharm

Scope для доступу

Components

ePrescription

Зазначається перелік бізнес компонентів, які використовують цей метод, наприклад: ePrescription

Microservices

API paragraph not found

Перелік мікросервісів, які використовує метод API, наприклад: Auth, ABAC

Protocol type

REST

Тип протоколу, який використовується запитом, наприклад: SOAP | REST

Request type

POST

Тип запиту API, наприклад: GET, POST, PATCH…

Sync/Async

Sync

Метод є синхронним чи асинхронним?

Public/Private/Internal

Public

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  1. For info - status charts: Medication_request.

  2. Check Medication Request `status` = ACTIVE

    1. if invalid - return 409 error (message: "Invalid status Medication request for qualify action!")'.

Validate related Care plan

If medication_request.based_on is present and not null:

Verify Care plan:

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related Care plan

If medication_request.based_on is present and not null:

  1. Verify Care plan:

    1. It should be in active status

      1. in case of error - return 409 (message: "Invalid care plan status").

    2. Care plan's period end (if exist) should be greater than current date or equal

      1. in case of error - return 409 (message: “Care plan expired“).

  2. Verify care plan Activity:

    1. It has scheduled, in_progress status

      1. in case of error - return 409 (message: "Invalid care plan activity status").

    2. Care plan's period end (if exist) should be greater than current date or equal

      1. in case of error - return 409 (message: “Care plan expired“).

    Verify care plan Activity:

    1. It has scheduled, in_progress status

      1. in case of error - return 409 (message: "Invalid activity status").

    2. Validate quantity is not exceeded

      1. Select all MD (medication dispenses) in status PROCESSED related to the Medication requests which based_on one activity 

        1. Sum medication_qty in the filtered Medication dispenses as dispensed_qty

        2. medication_qty from current MR as current_qty

        3. Calculate remaining_qty = activity.quantity - (dispensed_qty+current_qty)

      2. Check remaining_qty is greater then zero

        1. error return 409 "The total amount of the dispensed medication quantity exceeds quantity in care plan activity"

Validate division

  1. Validate division is active

    1. in case of error - return 409 ("Division is not active")

  2. Validate division belongs to user's legal entity

    1. in case of error - return 409 ("Division does not belong to user's legal entity")

  3. If chart parameter DISPENSE_DIVISION_DLS_VERIFY is on, then validate division is DLS verified (dls_verified=true)

    1. in case of error - return 409 "Division is not verified in DLS"

  4. Check division participates in submitted programs. Validate Provision for each Medical Program:

    1. If the medical program has no setting skip_contract_provision_verify or it is equal to false/null:

      1. if medical program in the request has funding_source one of NHS, LOCAL

        1. In case of error - return status=INVALID for a program, rejection_reason="Program was configured incorrectly. Either incorrect source of funding or option skip_contract_provision_verify"

      2. provision exist and active for the division:

        1. in case of error - return status=INVALID for a program, rejection_reason= "Division does not provide the medical program"

      3. if medical program in the request has funding_source = NHS:

        1. provision relates to the actual reimbursement contract: contract.start_date <= current_date <= contract.end_date, is_active = true, status = VERIFIED, contracts.type==reimbursement, contracts.contractor_legal_entity_id=token.client_id, contracts.medical_program_id==$.medical_program_id

          1. in case of error - return status=INVALID for a program, rejection_reason="Medical program provision is not related to any actual contract for the current date"

        2. contract is_suspended = false

          1. in case of error - return status=INVALID for a program, rejection_reason="Contract with number <contract_number> is suspended"

      4. if medical program in the request has funding_source = LOCAL, then check medical_program_provision.msp_legal_entity_id = medication_request.legal_entity_id

        1. in case of error - return status=INVALID for a program, rejection_reson = "Medical program can not be provided for the legal entity specified in the medication request"

    2. else if skip_contract_provision_verify = true, then skip provision verification for the medical program

  5. Get license_types_allowed parameter from settings of medical program from request $.medical_program_id:

    1. if it is exists and not empty, get list of all license types from parameter.
      Check that division has active healthcare services with following parameters:

      1. legal_entity_id = client_id from access token

      2. division_id = division_id from request

      3. status = 'ACTIVE'

      4. licensed_healthcare_service.status = 'ACTIVE'

      5. healthcare_service.license_id is not null and licenses.type = value from license_types_allowed parameter

        1. in case of error - return status=INVALID for a program, rejection_reason = 'Division does not have active licenses to provide the medical program'

Logic for qualify (analyze compliance with programs)

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  • Each Medical program may have its unique conditions for the medication dispense. It can be based on analysis of personal info, medications list, terms, locations and combinations of them.

  • For now there are only conditions for the following programs "Dostupni liky", "Netsukrovyy diabet", "Insuliny z doplatoyu", "Insuliny bezoplatno" and we check them.

  • Also, it is possible to have the medication dispense without any Medical program.

  • However for any Medical program we need a separate block of branching logic.

  • Check compatibility only for programs which are available in payload (array)

  • If program status is invalid, the reason must be saved and returned in response

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Check INNM_dosage compliance for the programs

Applies to the following programs:

  1. Dostupni liky

  2. Netsukrovyy diabet

  3. Insuliny z doplatoyu

  4. Insuliny bezoplatno

Validation purpose:  There is a list of medications (which links to innm_dosage) which can be used for the program. It must be check whether there is at least one available medication for the innm_dosage for the particular program.

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Check absence a same medication for the programs

Applies to the following programs:

  1. Dostupni liky

  2. Netsukrovyy diabet

  3. Insuliny z doplatoyu

  4. Insuliny bezoplatno

Validation purpose: It could be done several dispenses for one medication request per one innm for one patient until sum(medication_dispenses.medication_qty) < medication_request.medication_qty

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  • Collect response array for all programs in payload with status for each (VALID or INVALID) and rejection_reason

  • For all VALID programs - Get linked medications (type = BRAND) with reimbursement info 

  • Show only active program medications based on start_date and end (start_date must be earlier or equal to current date or empty, end_date must be greater or equal to current date or empty)

    • Filter participants simultaneously by container_dosage and max_request_dosage

Code Block
SELECT *
FROM program_medications pm
    INNER JOIN ingredients i ON (i.parent_id = pm.medication_id
                                 AND i.medication_child_id = :medication_request_medication_id
                                 AND i.is_primary = TRUE)
    INNER JOIN medications m ON (m.id = pm.medication_id)
WHERE pm.medical_program_id = $.id
      AND pm.is_active = TRUE
      AND m.is_active = TRUE
      AND (pm.start_date <= now() OR pm.start_date IS NULL)
      AND (pm.end_date >= now() OR pm.end_date IS NULL)
 
-- added 2022-05-20:
      AND (
      ((M.container ->> 'numerator_unit' = $mr.container_dosage.code) AND
      (M.container ->> 'numerator_value' <>  $mr.container_dosage.value)) OR
           ( ($mr.dosage_container.code is NULL) AND ($mr.container_dosage.value is NULL) )
        )
      AND (M.max_request_dosage >= $.medication_qty or M.max_request_dosage is null)

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