Purpose

This WS is designed to create Request for Medication request

There are two types of medication request:

plan - The request represents an intention to ensure something occurs without providing an authorization for others to act. Medication request with type plan can't be dispensed and only provide the instruction to administer the medicine.
order - The request represents a request/demand and authorization for action. Medication request with type order can be dispensed

Specification

Apiary

Key points

Only authenticated and authorized users with appropriate scope can Create Medication Request Request (MRR)
Patient should be stored in hashed form according to security requirements.

Authorize

Verify the validity of access token
1. in case of error - return 401 (“Invalid access token”) in case of validation fails
Verify that token is not expired
1. in case of error - return 401 (“Invalid access token”)
Check user scopes in order to perform this action (scope = 'medication_request_request:write')
1. return 403 (“Your scope does not allow to access this resource. Missing allowances: medication_request_request:write”) in case of invalid scope(s)

Validations

Validate schema

Validate request according to JSON Schema
1. Return 422 with list of validation errors in case validation fails

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.

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")

Validate priority

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

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.

Invoke employee_id from request
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 variable
    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 = false or null/absent
        then: get $.declarations by employee_id, person_id, status=ACTIVE
        if not found - return 422 error "Only doctors with an active declaration with the patient can create medication request with medical program from request!"
        else skip declaration verification on employee level (if true)
      2. if variable skip_medication_request_legal_entity_declaration_verify = false or null/absent
        then: get $.declarations by employee's legal_entity_id, person_id, status=ACTIVE
        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!"
        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
        in case invalid return 422 error with msg ("Employee's specialty doesn't allow create medication request with medical program from request")
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

Validate division

Validation of the division for the possibility of creating a medication request.

Invoke Get division details
Validate division_id - division_id exists
1. in case invalid return 422 error with msg ("Division not found")
Validate Response $.data.status==ACTIVE
1. if not found - return 422 error (message: "Only employee of active divisions can create medication request!")
Division should be active and refers to current legal_entity
1. is_active = true
2. status = 'ACTIVE'
3. division.legal_entity_id = client_id (context)

Validate legal entity

Validation of the legal entity for the possibility of creating a medication request.

Get client_id from token
Validate client_id=legal_entity_id
1. check that legal_entity exist
  1. in case invalid return 422 error with msg (422 Legal entity not found)
2. check that legal_entities.status == ACTIVE
  1. in case invalid return 422 error with msg ("Only active legal entity can provide medication request")
3. check legal entity type in chart parameter MEDICATION_REQUEST_REQUEST_LEGAL_ENTITY_TYPES
  1. in case invalid return 409 error with msg (“Invalid legal entity type“)

Validate person

Validation of person for the possibility of creating a medication request.

Invoke Get patient by ID
Validate person_id - mpi_id exists
1. in case invalid return 422 (422 Person not found)
Save temporary variables from: $.data.authentication_methods
Validate Response $.data.is_active==TRUE
1. if not found - return 422 error (message: "Only for active MPI record can be created medication request!")
Validate person's verification status:
1. If MRR has based_on with valid activity, then skip this validation.
2. Else check patient's verification_status is not equal to NOT_VERIFIED.
  1. in case NOT_VERIFIED - return error 409, "Patient is not verified"

Validate dates

created_at - similar to assertion date in FHIR -> Actual date medication request being created
inserted_at - date when Medication request was registered in E-Health
started_at/ended_at - Treatment period. Cannot be less than MR expiration period. Defined by doctor.
dispence_valid_from - Used for dispense validation. As for now equals Created at.
dispense_valid_to - Implements dispense expiration period. If MR has medical program setting with not empty parameter medication_dispense_period_day, then dispence_valid_from + medication_dispense_period_day, else Dispense valid from + medication_dispense_period global parameter value.

Purpose validation: Must be: ended_at >= started_at >= created_at

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")
Validate ended_at >= started_at
1. if invalid - return 422 error (message: "Ended date must be >= Started date!")
Validate started_at` >= created_at
1. if invalid - return 422 error (message: "Started date must be >= Created date!")
Validate started_at >= current_date()
1. if invalid - return 422 error (message: "Started date must be >= current date!")
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!")
Validate started_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
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
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 MEDICATION_REQUEST_MAX_PERIOD_DAY parameter from charts
    1. in case of error - return 409 “Period length exceeds default maximum value“

Validate medication

Check FK, status `is_active`=TRUE, type = INNM_DOSAGE

Invoke Get INNM Dosage by ID
Validate medication_id - medication_id exists
1. in case of error return 422 ("Medication not found")
Validate Response code == 200
1. if invalid - return 422 error (message: "Only medication with type `INNM_DOSAGE` can be use for created medication request!")\
Validate Response $.is_active==TRUE
1. if not found - return 422 error (message: "Only active innm_dosage can be use for created medication request!")

Validate context

Validate "context" is present in the request
1. in case of error return 422 ("required property context was not present")
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 == $.data.context.identifier.value that belongs to the current patient
  1. in case of error 409 "{$.data.context.identifier.type.coding[*].code} not found"
2. Validate that entity is not in status "entered-in-error"
  1. in case of error 409 "Entity in status "entered-in-error" can not be referenced"
3. Validate that related episode exist
  1. in case of error 409 "Entity without related episode can not be referenced"

Validate dosage instruction

Each non-empty attribute must be valid and reference to appropriate dictionary or object

Sequence must be unique within dosage instruction array
1. in case of error return (422, "Sequence must be unique")
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"
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"
Route must refer to a valid dictionary
1. $.dosage_instruction[*].route.coding[*].system == "eHealth/SNOMED/route_codes"
2. $.dosage_instruction[*].route.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/route_codes"
  1. in case of error return 409 "Incorrect route"
Method must refer to a valid dictionary
1. $.dosage_instruction[*].method.coding[*].system == "eHealth/SNOMED/administration_methods"
2. $.dosage_instruction[*].method.coding[*].code is a valid entry in dictionary "eHealth/SNOMED/administration_methods"
  1. in case of error return 409 "Incorrect method"
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.

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
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
4. If it has quantity then calculate remaining quantity:
  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
  5. 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"
5. 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")
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")

Validate medical program

Validate medical_program_id is present in the request
1. in case of error return 422 ("required property medical_program_id was not present")
Validate medical_program_id - medical_program_id exists
1. in case of error return 422 ("Medical program not found")
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“
If medical program has funding_source = LOCAL , then invoke validation described at RC_Rx_PreQualify Medication request request (modified_EN) | 11. Check provision for a programsarchived

Validate multiplicity & medication request allowed for participants

Perform validation as described at PreQualify Medication Request Request | 1. Check INNM complience for the programs.
Perform validation as described at

PreQalify Medication Request: Check absence the same medications for the programs.

Service Logic

Generate number & verification_code for Medication request

Generate human readable number for receipt (See specs)
Structure number XXXX-1234-5678-9012-345-C , where: - XXXX - series: numbers + only some letters (A, E, H, K, M, P, T, X) - 1234-5678-9012-345 - randomly generated numbers - C - checksum: Should be calculated using the Damn algorithm or Verhoeff algorithm After new Request number was generated we should check that it is unique in the DB (entity: medication_request + medication_request_request
Generate verification_code for MPI.person_authentication_methods == OTP or OFFLINE

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

Create Medication request Request

set:
1. dispense_valid_from = created_at
2. dispensed_valid_to = dispensed_valid_from + dispense_period
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
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

Generate content for response

Generate data structure with Responce WS structure
- Set IL.medication_request_requests this structure
in case if response is VALID enrich response with urgent_data:
- get authetification_method by person_id and return masked number (in case if any)

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

RC_Rx_Create Medication request Request (modified - )