Purpose

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Purpose

This WS is designed to create Request for Medication request

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Logic

Технічний опис бізнес-процесу виписування рецепту в ЕСОЗ (загальний процес для усіх рецептурних ЛЗ, в т.ч. і тих, які підлягають реімбурсації)

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Input parameters

ATTRIBUTES - see on Apiary

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No

Request structure

See on Apiary

Example:

{
  "medication_request_request": {
    "person_id": "585044f5-1272-4bca-8d41-8440eefe7d26",
    "employee_id": "d290f1ee-6c54-4b01-90e6-d701748f0851",
    "division_id": "881d6dee-dd3d-43f3-8983-922354c0e6ce",
    "created_at": "2017-08-17",
    "started_at": "2017-08-17",
    "ended_at": "2017-09-16",
    "medication_id": "1349a693-4db1-4a3f-9ac6-8c2f9e541982",
    "medication_qty": 10.34,
    "medical_program_id": "59781de0-2e64-4359-b716-bcc05a32c10f",
    "intent": "plan",
    "category": "community",
    "based_on": [
      {
        "identifier": {
          "type": {
            "coding": [
              {
                "system": "eHealth/resources",
                "code": "care_plan"
              }
            ]
          },
          "value": "9183a36b-4d45-4244-9339-63d81cd08d9c"
        }
      },
      {
        "identifier": {
          "type": {
            "coding": [
              {
                "system": "eHealth/resources",
                "code": "activity"
              }
            ]
          },
          "value": "9183a36b-4d45-4244-9339-63d81cd08d9c"
        }
      }
    ],
    "context": {
      "identifier": {
        "type": {
          "coding": [
            {
              "system": "eHealth/resources",
              "code": "encounter"
            }
          ]
        },
        "value": "9183a36b-4d45-4244-9339-63d81cd08d9c"
      }
    },
    "dosage_instruction": [
      {
        "sequence": 1,
        "text": "0.25mg PO every 6-12 hours as needed for menses from Jan 15-20, 2015.  Do not exceed more than 4mg per day",
        "additional_instruction": [
          {
            "coding": [
              {
                "system": "eHealth/SNOMED/additional_dosage_instructions",
                "code": "311504000"
              }
            ]
          }
        ],
        "patient_instruction": "0.25mg PO every 6-12 hours as needed for menses from Jan 15-20, 2015.  Do not exceed more than 4mg per day",
        "timing": {
          "event": [
            "2017-04-20T19:14:13Z"
          ],
          "repeat": {
            "bounds_duration": {
              "value": 10,
              "unit": "days",
              "system": "eHealth/ucum/units",
              "code": "d"
            },
            "count": 2,
            "count_max": 4,
            "duration": 4,
            "duration_max": 6,
            "duration_unit": "d",
            "frequency": 1,
            "frequency_max": 2,
            "period": 4,
            "period_max": 6,
            "period_unit": "d",
            "day_of_week": [
              "mon"
            ],
            "time_of_day": [
              "2017-04-20T19:14:13Z"
            ],
            "when": [
              "WAKE"
            ],
            "offset": 4
          },
          "code": {
            "coding": [
              {
                "system": "TIMING_ABBREVIATIONS",
                "code": "patient"
              }
            ]
          }
        },
        "as_needed_boolean": true,
        "site": {
          "coding": [
            {
              "system": "eHealth/SNOMED/anatomical_structure_administration_site_codes",
              "code": "344001"
            }
          ]
        },
        "route": {
          "coding": [
            {
              "system": "eHealth/SNOMED/route_codes",
              "code": "46713006"
            }
          ]
        },
        "method": {
          "coding": [
            {
              "system": "eHealth/SNOMED/administration_methods",
              "code": "419747000"
            }
          ]
        },
        "dose_and_rate": {
          "type": {
            "coding": [
              {
                "system": "eHealth/dose_and_rate",
                "code": "'ordered'"
              }
            ]
          },
          "dose_range": {
            "low": {
              "value": 0,
              "unit": "mg",
              "system": "eHealth/ucum/units",
              "code": "mg"
            },
            "high": {
              "value": 0,
              "unit": "mg",
              "system": "eHealth/ucum/units",
              "code": "mg"
            }
          },
          "rate_ratio": {
            "numerator": {
              "value": 0,
              "unit": "mg",
              "system": "eHealth/ucum/units",
              "code": "mg"
            },
            "denominator": {
              "value": 0,
              "unit": "mg",
              "system": "eHealth/ucum/units",
              "code": "mg"
            }
          }
        },
        "max_dose_per_period": {
          "numerator": {
            "value": 0,
            "unit": "mg",
            "system": "eHealth/ucum/units",
            "code": "mg"
          },
          "denominator": {
            "value": 0,
            "unit": "mg",
            "system": "eHealth/ucum/units",
            "code": "mg"
          }
        },
        "max_dose_per_administration": {
          "value": 0,
          "unit": "mg",
          "system": "eHealth/ucum/units",
          "code": "mg"
        },
        "max_dose_per_lifetime": {
          "value": 0,
          "unit": "mg",
          "system": "eHealth/ucum/units",
          "code": "mg"
        }
      }
    ],
    "priority": "routine",
    "prior_prescription": {
      "identifier": {
        "type": {
          "coding": [
            {
              "system": "eHealth/resources",
              "code": "medication_request"
            }
          ]
        },
        "value": "9183a36b-4d45-4244-9339-63d81cd08d9c"
      }
    },
    "container_dosage": {
      "system": "MEDICATION_UNIT",
      "code": "ML",
      "value": 4
    }
  }
}

...

1. Verify the validity of access token

   • in case of error - return 401 (“Invalid access token”) in case of validation fails

2. Verify that token is not expired

   • in case of error - return 401 (“Invalid access token”)

3. Check user scopes in order to perform this action (scope = 'medication_request_request:write')

   return 403 (“Your scope does not allow to access this resource. Missing allowances: medication_request_request:write”) in case of invalid scope(s

   this action (scope = 'medication_request_request:write')

   • return 403 (“Your scope does not allow to access this resource. Missing allowances: medication_request_request:write”) in case of invalid scope(s)

4. If BLOCK_UNVERIFIED_PARTY_USERS is true, then check party's data match following condition: verification_status != NOT_VERIFIED or (verification_status = NOT_VERIFIED and updated_at <= current_date - UNVERIFIED_PARTY_PERIOD_DAYS_ALLOWED):

   • in case not match - return 403 ("Access denied. Party is not verified")

Headers

Content-Type:application/json

...

1. Validate request according to JSON Schema

   1. Return 422 with list of validation errors in case validation fails.

Request data validation

Validate container_dosage field

$.container_dosage - volume of a medication’s primary container, which is requested by a doctor or issuer of a medication request, to be dispensed to patient.

1. Validate $.container_dosage field by schemata

   1. $.container_dosage.code and $.container_dosage.value should be both filled

      1. in case of error return 422 error ("required property %{property} was not present")

   2. $.container_dosage.system should be “MEDICATION_UNIT”

      1. in case of error return 422 error ("value is not allowed in enum")

   3. if $.container_dosage is filled then $.container_dosage.unit should be checked with the MEDICATION_UNIT dictionary by $.container_dosage.code as a key.

      in case of error return 422 error ("value is not allowed in enum

      .container_dosage.code as a key.

      1. in case of error return 422 error ("value is not allowed in enum")

2. Check if there is at list one record of Brand with requested primary container volume
   a. if not exist - return 404 error (message: "Not found any appropriate medication with such container parameters")

Validate priority

1. Check by schemata if $.priority is filled with the value of MEDICATION_REQUEST_PRIORITY dictionary

   1. in case of error return 422 error ("value is not allowed in enum")

Validate prior_prescription

1. Check that $.prior_prescription is UUID, exists and belongs to this person:

   1. is_active = true, and the same person. 

      1. in case of error - return 422 (message: "Prior prescription is not found")

Validate employee

Validation of an employee for the possibility of creating a medication request.

1. Invoke employee_id from request

2. Validate employee

   1. Validate that exists

      1. in case invalid return 422 error with msg ("Employee not found")

   2. Validate that $.employees.status == APPROVED

      1. in case invalid return 409 error with msg ("Employee is not active")

   3. Validate that $.employees.legal_entity_id == client_id from token

      1. in case invalid return 422 error with msg ("Employee does not belong to legal entity from token")

   4. If medical program has medical_program_settings.skip_employee_validation == false (or absent), then validate <employee_type>:

      1. validate if employee_type is present in medical_program_settings . employee_types_for_create_medication_request employee_types_to_create_requestvariable

         1. in case invalid return 422 error with msg ("Employee type can't create medication request with medical program from request") 

         2. in case employee_type = DOCTOR

            1. if variable skip_medication_request_employee_declaration_verify skip_request_employee_declaration_verify = false or null/absent

               1. then: get $.declarations by employee_id, person_id, status=ACTIVE

                  1. if not found - return 422 error  "Only doctors with an active declaration with the patient can create medication request with medical program from request!"

               2. else skip declaration verification on employee level (if true)

            2. if variable skip_medication_request_legal_entity_declaration_verify skip_request_legal_entity_declaration_verify = false or null/absent

               1. then: get $.declarations by employee's legal_entity_id, person_id, status=ACTIVE

                  1. if not found - return 422 error "Only legal entity with an active declaration with the patient can create medication request with medical program from request!"

               2. else skip declaration verification on legal entity level (if true)

            3. else if both are true - skip declaration verification at all

         3. in case employee_type = SPECIALIST

            1. get $.employees.speciality.speciality(speciality_officio == true)

            2. validate that speciality present in $.medical_programs.medical_program_setting.speciality_types_allowed variable

               1. in case invalid return 422 error with msg ("Employee's specialty doesn't allow create medication request with medical program from request") 

         4. in case employee_type = MED_COORDINATOR

            1. skip validation that speciality present in $.medical_programs.medical_program_setting.speciality_types_allowed variable

   5. If medical program has medical_program_settings with medical_program_settings.skip_employee_validation == true any user who has a scope can create medication request

...

1. created_at - similar to assertion date in FHIR -> Actual date medication request being created

2. inserted_at - date when Medication request was registered in E-Health

3. started_at/ended_at - Treatment period. Cannot be less than MR expiration period. Defined by doctor.

4. dispence_valid_from - Used for dispense validation. As for now equals Created at.

5. dispense_valid_to -  Implements dispense expiration period. If MR has medical program setting with not empty parameter medication_empty parameter medication_dispense_period_day dispense_period_day, then dispence_valid_from + medication_ medication_dispense_period_day dispense_period_day, else Dispense valid from + medication_dispense_period global parameter value.

...

1. Validate that created_at, started_at, ended_at in date format

   1. in case invalid return 422 with msg ("expected \"%{actual}\" to be a valid ISO 8601 date")

2. Validate ended_at >= started_at

   1. if invalid - return 422 error  (message: "Ended date must be >= Started date!")

3. Validate started_at` at >= created_at, but not greater than (created_at + MEDICATION_REQUEST_REQUEST_EXTENDED_LIMIT_STARTED_AT_DAYS)

   1. if invalid - return 422 error  (message: "Started The start date must be >= Created date!should be equal to or greater than the creation date, but the difference between them should be not exceed {{MEDICATION_REQUEST_REQUEST_EXTENDED_LIMIT_STARTED_AT_DAYS}} day(s).")

4. Validate started_at >= current_date()

   1. if invalid - return 422 error  (message: "Started date must be >= current date!")

5. Validate created_at >= current_date() - MEDICATION_REQUEST_REQUEST_DELAY_INPUT chart param

   1. if invalid - return 422 error  (message: "Create date must be >= Current date - MRR delay input!")

6. Validate started_at regarding frequency of receiving drugs

   1. get $.medical_programs.medical_program_setting by medical_program_id from request

      1. validate skipvalidate skip_mnn_in_treatment_period skip_treatment_period variable

         1. in case skipcase skip_mnn_in_treatment_period period skip_treatment_period== FALSE (or absent)

            1. validate request according to logic: PreQualify Medication request: 2. Check absence the same medications for the programs

         2. in case skipcase skip_mnn_in_treatment_period skip_treatment_period period == TRUE

            1. skip validating frequency of receiving drugs

7. Validate created_at regarding frequency of receiving drugs

   1. get $.medical_programs.medical_program_setting by medical_program_id from request

      1. validate skip_mnn_in_treatment_period variable

         1. in case skip_mnn_in_treatment_period == FALSE (or absent)

            1. validate request according to logic: PreQualify Medication request: 2. Check absence the same medications for the programs

         2. in case skip_mnn_in_treatment_period == TRUE

            1. skip validating frequency of receiving drugs

8. Validate period length (ended_at - started_at):

   1. If medical program has been submitted:

      1. validate request according to logic: PreQualify Medication request: 7. Validate period

   2. else:

      1. Check that medication request period less than or equal to MEDICATIONto MEDICATION_REQUEST_MAX_PERIOD_DAY request_max_period_dayparameter from charts

         1. in case of error - return 409 “Period length exceeds default maximum value“ 

...

1. Sequence must be unique within dosage instruction array

   1. in case of error  return (422, "Sequence must be unique")

2. Additional instruction must refer to a valid dictionary

   1. $.dosage_instruction[*].additional_instruction.coding[*].system == "eHealth/SNOMED/additional_dosage_instructions"

   2. $.dosage_instruction[*].additional_instruction.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/additional_dosage_instructions"

      1. in case of error return 409 "Incorrect additional instruction"

3. Site must refer to a valid dictionary

   1. $.dosage_instruction[*].site.coding[*].system == "eHealth/SNOMED/anatomical_structure_administration_site_codes"

   2. $.dosage_instruction[*].site.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/anatomical_structure_administration_site_codes"

      1. in case of error return 409 "Incorrect site"

4. Route must refer to a valid dictionary

   1. $.dosage_instruction[*].route.coding[*].system == "eHealth/SNOMED/route_codes"

   2. $.dosage_instruction[*].siteroute.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/anatomical_structure_administration_siteroute_codes"

      1. in case of error return 409 "Incorrect siteroute"

5. Route must Method must refer to a valid dictionary

   1. $.dosage_instruction[*].routemethod.coding[*].system == "eHealth/SNOMED/routeadministration_codesmethods"

   2. $.dosage_instruction[*].routemethod.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/routeadministration_codesmethods"

      1. in case of error return 409 "Incorrect routemethod"

6. Method must Dose and rate type must refer to a valid dictionary

   1. $.dosage_instruction[*].method.dose_and_rate.type.coding[*].system == "eHealth/SNOMED/administrationdose_and_methodsrate"

   2. $.dosage_instruction[*].methoddose_and_rate.type.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/administration_methods"code is a valid entry in dictionary "eHealth/SNOMED/dose_and_rate"

      1. in case of error return 409 "Incorrect dose and rate type"

Validate based_on

If submitted, check field has array with two values of Reference type: one is valid Care plan resource, another - Activity resource.

1. Verify Care plan:

   1. It should belong to the same person as set in MRR

      1. in case of error return 422 with msg ("Care plan not found")

   2. It should be in active status

2. Verify submitted Activity:

   1. It belongs to the Care plan.

      1. in case of error return 409 "Incorrect method"

3. Dose and rate type must refer to a valid dictionary

   1. $.dosage_instruction[*].dose_and_rate.type.coding[*].system == "eHealth/SNOMED/dose_and_rate"

   2. $.dosage_instruction[*].dose_and_rate.type.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/dose_and_rate"

      1. in case of error return 409 "Incorrect dose and rate type"

Validate based_on

If submitted, check field has array with two values of Reference type: one is valid Care plan resource, another - Activity resource.

1. Verify Care plan:

   1. It should belong to the same person as set in MRR

      1. in case of error return 422 with msg ("Care plan not found")

   2. It should be in active status

2. Verify submitted Activity:

   1. It belongs to the Care plan.

      1. in case of error return 422 with msg ("Activity not found")

   2. It has activity.detail.kind=medication_request; activity.detail.product_reference=medication_id.

      1. in case of error return 422 with msg ("Invalid activity kind")

   3. It has scheduled, in_progress status.

      1. in case of error return 422 with msg ("Invalid activity status")

   4. If it has quantity then calculate remaining quantity

      1. 422 with msg ("Activity not found")

   5. It has activity.detail.kind=medication_request; activity.detail.product_reference=medication_id.

      1. in case of error return 422 with msg ("Invalid activity kind")

   6. It has scheduled, in_progress status.

      1. in case of error return 422 with msg ("Invalid activity status")

   7. if it has quantity then calculate remaining quantity:

      1. validate $.activity.details.remaining_quantity_type:

         1. if $.activity.details.remaining_quantity_type =for_request than:

            1. select all MRR in status NEW which based on current activity

            2. select all MR in statuses ACTIVE based on current activity

            3. select all MD (medication dispenses) in status PROCESSED related to the Medication requests which are in status COMPLETE, REJECTED, EXPIRED

            4. calculate:

               1. reserved_qty as sum of medication_qty in the filtered MRR  and MR list

               2. dispensed_qty as sum of medication_qty in the filtered MD list

               3. current_qty as medication_qty from current MRR

            5. calculate remaining quantity by subtracting reserved_quantity, dispensed_qty, current_qty from activity quantity

         2. if $.activity.details.remaining_quantity_type = for_use than:

            1. select all MRR in status NEW which based on current activity

            2. select all MR in statuses ACTIVE, COMPLETED based on current activity

            3. calculate reserved at the moment medication quantity as sum of medication_qty in the filtered MRR  and MR list, including medication_qty from current MRR

            4. calculate remaining quantity by subtracting reserved quantity from activity quantity

      2. Check remaining quantity is greater then or equal to zero

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

   8. check that medical_program_id equal to $.activity[].program

      1. in case of error return 422 with msg ("Medical program from activity should be equal to medical program from request")

3. Validate started_at/ended_at of Medication request Request: 

   1. if care plan activity has detail.scheduled_timing.repeat.bounds_period - validate started_at/ended_at within bounds_period

   2. if care plan activity has detail.scheduled_period - validate started_at/ended_at within scheduled_period

   3. else - validate started_at/ended_at crossing within care_plan.period

      1. in the case of started_at/ended_at is not within care_plan.period return 422 with msg  ("Invalid care plan period")

...

1. Validate medical_program_id is present in the request

   1. in case of error return 422 ("required property medical_program_id was not present")

2. Validate medical_program_id - medical_program_id

   was not present

   exists

   1. in case of error return 422 ("Medical program not found")

3. Validate medical_program_id - medical_program_id existsValidate medical_programs.medication_request_allowed parameter

   1. check if medication_request_allowed == true

      1. in case of error return

      422 

      1. 422 with msg ("

      Medical program not found

      1. Forbidden to create medication request for this medical program!")

4. Validate medical_programs.medical_program_setting parameters

   1. check if care_plan_required == true then the request should contain a based_on with care plan and activity that contains the same medical program

      1. in case of error return 422 with msg ("Care plan and activity with the same medical program should be present in request")

   2. If there is conditions_icd10_am_allowed parameter, then:

      1. Check if primary diagnosis from the encounter in context has code from eHealth/ICD10_AM/condition_codes dictionary

         1. Check diagnosis code in conditions_icd10_am_allowed

            1. in case of error - return 422 “Encounter in context has no primary diagnosis allowed for the medical program“

   3. If there is conditions_icpc2_allowed parameter, then:

      1. Check if primary diagnosis from the encounter in context has code from eHealth/ICPC2/condition_codes dictionary

         1. Check diagnosis code in conditions_icpc2_allowed

            1. in case of error - return 422 “Encounter in context has no primary diagnosis allowed for the medical program“.

   4. if skip_medication_request_employee_declaration_verify = false or null/absent

      1. then: get $.declarations by employee_id, person_id, status=ACTIVE

         1. if not found - return 422 error  "Only doctors with an active declaration with the patient can create medication request!"

      2. else skip declaration verification on employee level (if true).

   5. if skip_medication_request_legal_entity_declaration_verify = false or null/absent

      1. then: get $.declarations by employee's legal_entity_id, person_id, status=ACTIVE

         1. if not found - return 422 error "Only legal entity with an active declaration with the patient can create medication request!"

      2. else skip declaration verification on legal entity level (if true).

5. If medical program has funding_source = LOCAL , then invoke validation described at PreQualify Medication request request | 11.-Check-provision-for-a-programs

...

Access to the method is defined by the scope medication_request_request:write. Permission for this scope is determined by the System administrator by configuring scopes in the context of clients and roles.

Dictionaries

Dictionary MEDICATION_REQUEST_INTENT

Dictionary MEDICATION_REQUEST_CATEGORY

...

• MEDICATION_REQUEST_INTENT

• MEDICATION_REQUEST_CATEGORY

• MEDICATION_REQUEST_PRIORITY

• eHealth/SNOMED/additional_dosage_instructions

• eHealth/SNOMED/anatomical_structure_administration_site_codes

• eHealth/SNOMED/route_codes

• eHealth/SNOMED/administration_methods

• eHealth/SNOMED/dose_and_rate

• eHealth/ICD10_AM/condition_codes

• eHealth/ICPC2/condition_codes

Processing

Generate number & verification_code for Medication request

1. Generate human readable number for receipt (See specs)

   Code Block

   Structure number XXXX-1234XXXX-5678-9012-345-C XXXX-XXXX, where: - XXXX - series: numbers + only some letters (A, E, H, K, M, P, T, X) - first 1234-5678-9012-345 - randomly generated numbers - C - checksum: Should be calculated using the Damn algorithm or Verhoeff algorithm block - always "0000" for medication requests - pattern: ^[0]{4}-[#{symbols}]{4}-[#{symbols}]{4}-[#{symbols}]{4} - example: 0000-TP42-M36M-H6TH After new Request number was generated we should check that it is unique in the DB (entity: medication_request + medication_request_request), if Request number is already reserved - generate new

2. Generate verification_code for MPI.person_authentication_methods == OTP or OFFLINE

   Code Block
   Structure code 1234, where: - 1234 - randomly generated numbers

...

1. set:

   1. dispense_valid_from = created_at

   2. dispensed_valid_to = dispensed_valid_from + dispense_period

2. Fill 'data' structure for Response & save in IL.medication_request_requests

   1. If encounter is present in the request context then based on it - fill the IL.medication_request_requests.context_episode_id

3. Fill separately

   1. data_employee_id,
      data_intent,
      data_based_on_care_plan_id,
      data_based_on_activity_id,
      data_context_id,
      data_patient_id,
      data_legal_entity_id

Update based_on

1. If the medication request request is based on activity with quantity - set remaining_quantity for the activity which was calculated at validation Create Medication Request: Validate based_on (p. 2.d.1 )

Generate content for response

...

"urgent": {
    "authentication_method_current": {
      "type": "OTP",
      "number": "+38093*****85"
    }
  }

Response structure

See on Apiary

Example:

{
  "meta": {
    "code": "422",
    "url": "https://example.com/resource",
    "type": "object",
    "request_id": "req-adasdoijasdojsda"
  },
  "error": {
    "type": "unverified",
    "message": "Only active employee with type DOCTOR can create medication request!"
  }
}

Post-processing processes

API paragraph not found

HTTP status codes

Backward compatibility

...