RC_Create Medication Dispense by Pharmacy User (RMDN-285)

Purpose

This method is designed to create Medication dispense. The medication dispense is the result of a pharmacy system responding to a medication order.

Key points

1. Only authenticated and authorized users of legal entity can create Medication dispense.

2. Can be used both for creating and processing Medication dispense (depending on the requirements of the program).

   1. In order to process dispense in case if Funding source of Medical program is “NHS” payment_id (optional) and payment_amount should be added.

3. Invoke https://e-health-ua.atlassian.net/wiki/spaces/RMDN/pages/17847517280 for receiving information about program participants.

4. Dispense of medication is possible only under Medication request and during the period specified in Medication request.

5. Several medications of different manufacturers with the same substance can be dispensed at a time.

   1. Total of medication_qty should be less or equal to medication quantity specified in Medication request

Specification

Apiary

Authorization

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_dispense:write')

   • return 403 (“Your scope does not allow to access this resource. Missing allowances: medication_dispense: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):

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

5. If BLOCK_DECEASED_PARTY_USERS is true, check that party is not deceased (party_verification record does not equal to: dracs_death_verification_status = VERIFIED and dracs_death_verification_reason = MANUAL_CONFIRMED):

   1. in case of error - return 403 ("Access denied. Party is deceased")

Validations

Validate schema

1. Validate request according to JSON Schema

   • Check presence of extra parameters

     • In case of error - return 422 ('schema does not allow additional properties')

   • Check presence of required parameters

     • In case of error - return 422 ('required property %{property} was not present')

Validate Legal entity

• Extract client_id from token

• Check legal entity status is ACTIVE

  • In case of error - return 422 ('Legal entity is not active')

• Check legal entity type in MEDICATION_DISPENSE_LEGAL_ENTITY_TYPES config parameter

  • in case of error - return 409 ('Invalid legal entity type')

Validate Division

Division must have active pharmacy license in order to dispense medications

1. Validate division is exist

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

2. Validate division is active

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

3. Validate division belongs to user's legal entity

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

4. 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 "Invalid division dls status"

5. Check division parameters

   1. division.dls_verified must be true

      1. otherwise - return 409 error ('Invalid division dls status')

6. 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_allowedparameter

         1. in case of error - return 409 ('Division must have active licenses to dispense medication request')

Validate Medication request

1. Check that medication_request_id is exist

   1. in case of error - return 422 ('Medication request not found')

2. Check intent specified in Medication request equal to order

   1. in case of error - return 409 error ('Medication request with intent PLAN cannot be dispensed')

3. Сheck that Medication request is_active = true and status == 'ACTIVE'

   1. in case of error - return 409 error ('Medication request is not active')

4. Check that Medication request not blocked (medication_requests.is_blocked = false or NULL)

   1. in case of error - return 409 error ('Medication request is blocked')

5. Check that dispense date is in period specified in Medication request (dispense_valid_from >= current_date() and dispense_valid_to <= current_date())

   1. in case of error - return 409 error ('Invalid dispense period')

6. Check if medication_request.based_on is present and not null AND medication_program is absent:

   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 activity status")

Qualify Medication request

This validation must be done only if medical_program exists in request

1. Check that medication request is valid and available for dispense

   1. Invoke Qualify method

   2. Get medical_program_id from request, check that medical_program_id from request equals to medication_requests.medical_program_id

      1. if true, use medication_requests.medical_program_id as program for qualify

      2. if false, use medical_program_id from request as program for qualify

   3. Check that program_medication_id is in Qualify response

      1. Medication request is prohibited for dispense in case $.data[?(@.program_id=medication_requests.medical_program_id)].status = 'INVALID' or program_medication_id is absent in qualify response

         1. In case of error - return 409 error ('Medication request can not be dispensed. Invoke qualify medication request API to get detailed info')

      2. Medication request is allowed for dispense in case $.data[?(@.program_id=medication_requests.medical_program_id)].status = 'VALID' and program_medication_id is present in qualify response

Validate Medical program

1. Check that medical_program_id is exist

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

2. Сheck that medical_program_id is_active = true and status == 'ACTIVE'

   1. in case of error - return 422 error ('Medication request is not active')

3. Check if medical program has setting medical_program_change_on_dispense_allowed parameter from settings of medical program from medication request:

   1. if it is false (absent), medical program in dispense must be the same as medical program in medication request (request.medical_program_id = medication_requests.medical_program_id)

      1. in case of error - return 409 ('Medical program in dispense doesn't match the one in medication request')

4. Check if medical program has setting skip_contract_provision_verify = true, than skip contract validation

   1. Else validate there is a contract in PRM.contracts that meets following requirements:

      1. contracts.type==reimbursement

      2. contracts.status==VERIFIED

      3. Contract dates: start_date <= current_date & end_date >= current_date

      4. contracts.contractor_legal_entity_id=token.client_id

      5. contracts.medical_program_id==$.medical_program_id

      6. сontracts.is_suspended == false

   2. in case of error - return 409 ('Program cannot be used - no active contract exists')

5. If the medical program has no setting skip_dispense_division_dls_verify or it is set in false/null validate:

   • Check $.division.dls_verify == true:

     • In case of error - return 409 "Invalid division dls status"

   else if skip_dispense_division_dls_verify = true, then skip license verification for the division

Validate Code

1. Check that code in request is equal to code in medication_request

   1. In case code exists in request - it should match with code in medication_request

      1. in case of error - return 403 (message: “Incorrect code“)

Validate Medication dispenses

1. Check all connected medication dispenses:

   1. there isn't medictaion dispenses with the 'NEW' status

      1. in case of error - return 422 "Medication dispense in status NEW already exist."

Validate Dispense details

1. Check that medical_program_id is exist and active

   1. medications.is_active = true

   2. medications.type = 'BRAND'

   3. ingredients.medication_child_id = medication_request.medication_id and ingredients.is_primary = true

   4. medication_id exists in program_medications (is_active = true)

      1. in case of error - return 422 ('Medication not found')

   5. in case if medical_program has funding_source = "NHS" check if sell_amount, sell_price, discount_amount are presented in the request.

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

   6. check dispensed_at

      1. if funding_source = "NHS" then dispensed_at = date.now()

         • in case of error - return 422 ('For Medical program with funding_source = "%{funding_source}" medication dispense dispensed_at must be equal to current date')

      2. else if funding_source != "NHS" then dispensed_at <= date.now()

         • in case of error - return 422 ('For Medical program with funding_source = "%{funding_source}" medication dispense dispensed_at must be equal to or less than current date')

Validate Medication quantity

1. Get multi_medication_dispense_allowed parameter from medical program settings:

   1. if it is true - check that requested medication quantity less or equal to available medication quantity in Medication Request
      (the way how to calculate available medication quantity is following:
      available_qty = medication_request.medication_qty - used_qty,
      where used_qty is the sum of medication_qty from medication_dispenses with medication_request_id = $.medication_request_id)

      1. medication_qty <= available_qty

         1. in case of error - return 422 ('Dispensed medication quantity must be lower or equal to medication quantity in Medication Request. Available quantity is #{available_qty}')

   2. if it is false (absent) - check that requested medication quantity equal to medication quantity in Medication Request

      1. medication_qty = medication_request.medication_qty

         1. in case of error - return 422 ('Dispensed medication quantity must be equal to medication quantity in Medication Request')

Validate Program medication

In case medications are dispensed to patient under specific medical program, program medication id must be provided provided by client or calculated by the system

In case program medication id exists in request:

1. Check that this program medication id relates to provided medical program and relates to provided medication

   1. in case of error - return 422 ('Invalid program medication id')

Calculate program medication id if it is absent in request:

1. Get last program_medication_id related to medical program and medication

   1. in case of error - return 422 ('There are no active program medications for this program and medication')

Validate Medication discount amount

The System must validate discount_amount in case if it exists in the request.

1. Define reimbursement_type according to Reimbursement Data model .

2. Validate percentage discount price.
   If sell_price is not submitted in the request, then skip discount_amount (steps 2, 3, 4) validation.
   Check if reimbursement_type == percentage and percentage_reimbursement_amount = 0
   (the way how to calculate percentage_reimbursement_amount is following:
   percentage_reimbursement_amount = sell_price (from request) * percentage_discount (from program_medications) /100)

   • In case if discount_amount != 0 - return 422 ('Requested discount price must be equal to 0')

   • Else (if discount_amount = 0)  - finish validation (do not validate 3, 4)

3. Validate allowed reimbursement amount.
   Check that requested discount price is less or equal to allowed reimbursement amount for the requested medication quantity
   (the way how to calculate allowed reimbursement amount is below.
   for type == percentage use percentage_reimbursement_amount, for fixed = use reimbursement_amount from program_medications):
          discount_amount <= reimbursement_amount * (medication_qty/package_qty)

   • In case of error - return 422 ('Requested discount price must be less or equal to allowed reimbursement amount')

4. Validate the ratio of discount price to reimbursement amount.
   Check that the ratio of requested discount price to allowed reimbursement amount is more or equal to allowed rule (including deviation) for the requested medication quantity
   (the way how to calculate allowed reimbursement amount is below.
   for type = percentage use percentage_reimbursement_amount, for fixed - use reimbursement_amount from program_medications):
          discount_amount/ (reimbursement_amount * (medication_qty/package_qty)) >= 1 - deviation

   • In case of error - return 422 ('The ratio of requested discount price to allowed reimbursement amount must be greater or equal to <1 - deviation>')

Service logic

1. Get skip_medication_dispense_sign from medical program settings.

2. If skip_medication_dispense_sign = false or absent:

          2.1. Check payment_id, payment_amount is absent in the request.

          2.2. Add record to medication_dispenses table:

          2.3. Add records to medication_dispense_details table:

          2.4. Add records to medication_2d_codes table (for each 2d code object in array):

1. If skip_medication_dispense_sign =

true:

             3.1. Check if medical_program has funding_source = "NHS" and payment_amount is submitted in the request.

• in case is absent - return 422 with path: $.payment_amount and message "required property payment_amount was not present"

             3.2. Call Process Medication Dispense by Pharmacy User process, but without validation of the previously created (NEW) medication dispense, digital sign and storage signed content to the bucket.

             3.3. Add records as described on steps 2.2-2.4, but with following differences: 

             medication_dispenses table