Purpose

This WS is designed to Pre-qualify data of Medication request Request (post) - check whether it's possible to use Medication request within the particular Medical program.

There are two types of medication requests:

• plan - The request represents an intention to ensure something occurs without providing authorization for others to act. Medication request with type plan can't be dispensed and only provide the instruction to administer the medicine. It also can't be qualified

• order - The request represents a request/demand and authorization for action. Medication request with type order can be dispensed.

Specification

Preconditions

1. Only authenticated and authorized users with appropriate scope can invoke Prequalify Medication Request Request (MRR)

2. This method simply returns the result of data validation within each submitted medical program, but not creates any entities in the system

3. 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

4. Any Medical program can have separate block of branching logic configured at medical program settings by NHS administrator

5. Сompatibility is checked only for programs which are available in payload (array)

6. Successful invocation of the method returns decision for each program if it is valid or not to create Medication Request with submitted combination of parameters in the payload. If program status is invalid, the reason must be saved and returned in response.

Logic

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

Input parameters

ATTRIBUTES - see on Apiary

Filters

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,
    "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
    }
  },
  "programs": [
    {
      "id": "59781de0-2e64-4359-b716-bcc05a32c10f"
    }
  ]
}

Authorize

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)

Headers

Content-Type:application/json

Authorization:Bearer c2778f3064753ea70de870a53795f5c9

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.

      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 medication request type

Only medication request with type (intent) order can be qualified.

1. Check medication request intent is order

   1. in case intent == plan - return 409, "Plan can't be qualified"

Validate division

Validate it is exists and active, relates to current legal entity (client_id from token)

• in case of error - return 422 error “Only employee of active divisions can create medication request!“

Validate dates:

1. Check ended_at >= started_at

   1. in case of error - return 422 error “Ended date must be >= Started date!“

2. Validate started_at >= created_at, but not greater than (created_at + MEDICATION_REQUEST_REQUEST_EXTENDED_LIMIT_STARTED_AT_DAYS)

   1. if invalid - return 422 error  (message: "The start 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).")

3. Validate started_at >= current_date()

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

4. Check created_at >= (current date - MEDICATION_REQUEST_REQUEST_DELAY_INPUT)

   1. in case of error - return 422 “Create date must be >= Current date - MRR delay input!”

Validate dosage instructions

Validate each item as described at Create Medication Request Request: Validate dosage instruction

Validate compliance for programs

Some checks (below in the text) must be passed for the programs

1. if passed - save the response by this program - status = VALID

2. if not passed - save response by this program - status = INVALID

Check each medical program in the array is:

1. is exists

   1. in case of error - return status = INVALID and reject reason = “Medical program not found”

2. is_active = true

   1. in case of error - return status = INVALID and reject reason = “Medical program is not active”

1. Check INNM complience for the programs

There is a list of medications (BRANDs, which links to Innms)  which can be used for the program. It must be check whether there is at least one available medication (with `medication_request_allowed` == TRUE)  for the Innm for the particular program 

1. Check compatibility of innm with medication list for the program

   1. if data is not found:

      1. add to response: status = INVALID

      2. add to response: rejection_reason = "Innm not on the list of approved innms for program {program_name}"

SELECT m0.id, m2.id, m2.package_qty, m2.package_min_qty, m3.id, m3.name
FROM medications AS m0
         INNER JOIN ingredients AS i1 ON i1.medication_child_id = {$.medication_id}
         INNER JOIN medications AS m2 ON i1.parent_id = m2.id
         INNER JOIN medical_programs AS m3 ON m3.id = {$.medical_program_id}
         INNER JOIN program_medications AS p4 ON (m3.id = p4.medical_program_id) AND (p4.medication_id = m2.id)
WHERE (i1.is_primary = TRUE)
  AND (m0.id = {$.medication_id})
  AND (m0.type = 'INNM_DOSAGE')
  AND (m0.is_active = TRUE)
  AND (m2.is_active = TRUE)
  AND (m3.medication_request_allowed = TRUE)
  AND (p4.is_active = TRUE)
  AND (p4.medication_request_allowed = TRUE)

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")

3. Check if there is at list one record medication_qty <= max_request_dosage or (max_request_dosage is null)

a. if not exist - return 404 error (message: "Not found any appropriate medication complying with max_request_dosage limit")

4. Check compliance of medication quantity: remainder of the division (medication_qty/package_min_qty) is equal to 0

a. in case it is not equal to zero - return 422 “The amount of medications in medication request must be divisible to package minimum quantity“

2. Check absence the same medications for the programs

It can be only 1 Medication request (ACTIVE, COMPLETED)  per one innm for the one patient at defined period of time.

Example validation: without crossing time

1. For info - status charts: Medication_request

2. Get `check_innm_id`

SELECT m0.id
FROM medications AS m0
         INNER JOIN ingredients AS i1 ON m0.id = i1.parent_id
         INNER JOIN (SELECT si2.id AS id
                     FROM medications AS sm0
                              INNER JOIN ingredients AS si1 ON si1.parent_id = sm0.id
                              INNER JOIN innms AS si2 ON si1.innm_child_id = si2.id
                     WHERE (sm0.is_active = TRUE)
                       AND (sm0.id = {$.medication_id})
                       AND (si1.is_primary = TRUE)
                       AND (si2.is_active = TRUE)) AS s2 ON i1.innm_child_id = s2.id
WHERE (m0.is_active = TRUE)

1. Get Medication requests with their completed Medication dispense by person_id & check_innm_id

SELECT m0.started_at, m0.ended_at
FROM medication_requests AS m0
WHERE (m0.medical_program_id = {$.medical_program_id})
  AND (m0.medication_id = ANY ({$.medication_id}))
  AND (m0.status = ANY (ACTIVE,COMPLETED))
  AND (m0.started_at <= {$.ended_at})
  AND (m0.patient_id = {$.patient_id} OR m0.person_id = {$.person_id})
ORDER BY m0.ended_at DESC
LIMIT 1

1. Validate exist (IF EXIST ()  - that is

any crossing  calculating term (started_at + ended_at) for payload with terms selecting Medication requests (started_at + ended_at).

1. if found and medical program setting skip_mnn_in_treatment_period = false (absent):

   1. add to response: status = INVALID

   2. add to response: rejection_reason = "It can be only 1 active / completed medication request request or medication request per one innm for the same patient at the same period of time!"

2. Fetch Medication Request by $

innm_dosge, $medical_program_id, $person_id and max(end_date). In case there is found Medication Request with ended_at>=current_date then next one  can be done in:

1. if (ended_at - started_at) >= MEDICATION_REQUEST_REQUEST_STANDARD_DURATION chart param then
   created_at from prequalify request should be greater then (ended at - MEDICATION_REQUEST_MAX_RENEW_DAY) of the found MR

   1. in case of error return 422 error ('It's to early to create new medication request for such innm_dosage and medical_program_id')

2. if (ended_at - started_at) < MEDICATION_REQUEST_REQUEST_STANDARD_DURATION chart param then
   created_at from prequalify request should be greater then (ended at - MEDICATION_REQUEST_MIN_RENEW_DAY) of the found MR

   1. in case of error return 422 error ('It's to early to create new medication request for such innm_dosage and medical_program_id')

3. Check that care plan is mandatory for programs

It is need to check if the medication request with a program need a care plan (with setting `care_plan_required` == TRUE) for a this program.

1. Check if there is a based_on in the request

   1. Check care_plan_required in medical program setting

SELECT medical_program_setting->>'care_plan_required'
FROM medical_programs
WHERE id = 'medical_program_id';

b. if care_plan_required true:

i. check based_on (reference on care_plan and it activity) in request comply with program

1. in case based_on not found:

a. add to response: status = INVALID

b. add to response: rejection_reason = "Medical program from activity should be equal to medical program from request"

4. Check diagnosis comply with programs

It is needed to check if medication request with a program needed a context (encounter) with a specified diagnosis. 

1. If program has CONDITIONS_ICD10_AM_ALLOWED parameter in medical_program_settings:

   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 200 with status = INVALID and rejection_reason = “Encounter in context has no primary diagnosis allowed for the medical program“ 

2. If program has CONDITIONS_ICPC2_ALLOWED parameter in medical_program_settings:

   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 200 with status = INVALID and rejection_reason = “Encounter in context has no primary diagnosis allowed for the medical program“

5. Check employee

It is needed to check if medication request with a program allowed to create for specified employee.

Validate employee_id as described on Create Medication request Request. Except on Prequalify method a declaration has not checked for the employee.

6. Check Care plan and Activity

It is needed to check if medication request with a program allowed to be created for specified care plan and activity.

Validare based_on as described on Create Medication request Request.

7. Check period

It is needed to check if medication request period does not exceed allowed maximum of days.

1. If medication request has program with MEDICATION_REQUEST_MAX_PERIOD_DAY in medical program setting:

   1. Check that medication request period (ended_at - started_at) less than or equal to medical program setting MEDICATION_REQUEST_MAX_PERIOD_DAY parameter

      1. in case of error - return 200 with status = INVALID and rejection_reason = “Period length exceeds allowed value for the medical program“ 

2. If medication request has program without MEDICATION_REQUEST_MAX_PERIOD_DAY in medical program setting:

   1. Check that medication request period (ended_at - started_at) less than or equal to MEDICATION_REQUEST_MAX_PERIOD_DAY parameter from charts

      1. in case of error - return 200 with status = INVALID and rejection_reason = “Period length exceeds default maximum value“

8. Check context

1. Validate "context" is an active (not entered-in-error) entity from corresponding dictionary, that belongs to the current patient

   1. Validate there is an entity in collection $.data.context.identifier.type.coding[0].code with id == $.data.context.identifier.value that belongs to the current patient

      1.  in case of error - return 200 with status = INVALID and rejection_reason = “Entity not found“

   2. encounter diagnosis is not empty in $.encounter.diagnosis

      1. in case of error return 422 ("Encounter without diagnosis can not be referenced")

   3. Validate context.identifier.type.coding[0].code = encounter

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

   4. encounter diagnosis is not empty in $.encounter.diagnosis

      1. in case of error return 422 ("Encounter without diagnosis can not be referenced")

9. Check person

It is needed to check if person has allowed verification status to get medication.

Validate person's verification status as described on Create Medication request Request

10. Check declaration for a program

It is needed to check specified params for each medical program.

Declaration should always be validated for each program. Validate skip_medication_request_employee_declaration_verifyand skip_medication_request_legal_entity_declaration_verify  parameters at medical program settings as described at Create Medication request Request if there are some exclusions.

11. Check provision for a programs

It is needed to check if medical program can be provided by pharmacies.

1. If medical program has funding_source = LOCAL:

   1. Check there is exists any active medical program provision with msp_legal_entity_id equal to employee's legal entity

      1. in case of error - return 200 with status = INVALID and rejection_reason = "Medical program is not provided for legal entity specified in the medication request"

Response structure

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

See on Apiary

Example:

{
  "meta": {
    "code": 200,
    "url": "https://example.com/resource",
    "type": "object",
    "request_id": "req-adasdoijasdojsda"
  },
  "data": [
    {
      "program_id": "59781de0-2e64-4359-b716-bcc05a32c10f",
      "program_name": "Програма \"Доступні ліки\"",
      "status": "INVALID",
      "rejection_reason": "Innm not on the list of approved innms for program 'DOSTUPNI LIKI' !"
    }
  ]
}

HTTP status codes