CH EMED (R4)
1.1.0 - CI Build

CH EMED (R4), published by eHealth Suisse. This is not an authorized publication; it is the continuous build for version 1.1.0). This version is based on the current content of https://github.com/ehealthsuisse/ch-emed/ and changes regularly. See the Directory of published versions

Dosage

Overview

This implementation guide currently describes the unstructured and the structured dosage. For the unstructured form, the dosage is given as free text. With structured dosing, the format 1-1-1-1, meaning the administration time in the morning, at noon, in the evening, at night, is supported. In this case, an additional differentiation is made whether it is a normal or split dosing. For normal dosing, the dose quantity is the same at the defined administration times (e.g. 1-0-0-0, 1-0-1-0). For split dosing, the dose quantity varies depending on the administration time (e.g. 1-0-2-0, 2-1-2-0).

The dosage instruction is based on the 6.3.4.6 Dosage Instructions Content Module (1.3.6.1.4.1.19376.1.9.1.3.6) in the IHE Pharmacy Technical Framework Supplement: Community Prescription (PRE).

Timing Event

For the representation of the time of administration according to the 1-1-1-1 scheme, the values MORN-NOON-EVE-NIGHT from the ValueSet EventTiming are highly recommended for the Swiss use.

Route of Administration

A code for specifying the route of administration into or onto a patient’s body comes from the ValueSet EDQM - RouteOfAdministration.

Dose and Rate

The amount of medication administered is represented with SNOMED CT or UCUM codes, which are defined in the ValueSet UnitCode.

The current FHIR representation of the dosage within the defined documents for the exchange of medication information is shown here. The use case and the corresponding examples contain the so-called normal and split dosing.

The implementers are asked here to communicate other dosage forms that are relevant in their environment, so that any expansions can be made in a next step. Or feedback on whether these dosage forms are sufficient would be helpful.

Please add your feedback via the 'Propose a change'-link in the footer of the page.

 

Normal Dosing (incl. Dosage Non-Structured)

The normal dosing is represented using one structured dosage element.
One non-structured dosage element may be additionally be present.

Dosage example according the use case step 2-5

Dosage non-structured Dosage morning Dosage noon Dosage evening Dosage night Route of administration
Morgens und abends je 1 Tablette einnehmen 1 0 1 0 oral
    "dosage" : [
      {
        "text" : "Morgens und abends je 1 Tablette einnehmen"
      },
      {
        "timing" : {
            "repeat" : {
            "boundsPeriod" : {
                "start" : "2012-02-04"
            },
            "when" : [
                "MORN",
                "EVE"
            ]
          }
        },
        "route" : {
            "coding" : [
            {
                "system" : "urn:oid:0.4.0.127.0.16.1.1.2.1",
                "code" : "20053000",
                "display" : "Oral use"
            }
          ]
        },
        "doseAndRate" : [
            {
            "doseQuantity" : {
                "value" : 1,
                "unit" : "Tablet (unit of presentation)",
                "system" : "http://snomed.info/sct",
                "code" : "732936001"
            }
          }
        ]
      }
    ]

See the full example: 2-5 Medication Treatment Plan document

Split Dosing (incl. Dosage Non-Structured)

The split dosing differs from the normal dosing in that the dosage element can be repeated. In contrast to normal dosing, where the dosage element can occur once, the dosage element can be repeated n times in split dosing. The order of the dosage instructions is defined by the required element sequence.
One non-structured dosage element may be additionally be present.

Dosage example according the use case step 2-3

Dosage non-structured Dosage morning Dosage noon Dosage evening Dosage night Route of administration
Morgens 1 und abends 1/2 Tablette einnehmen 1 0 0.5 0 oral
    "dosage" : [
      {
        "text" : "Morgens 1 und abends 1/2 Tablette nehmen"
      },
      {
        "sequence" : 1,
        "timing" : {
            "repeat" : {
            "boundsPeriod" : {
                "start" : "2012-02-04"
            },
            "when" : [
                "MORN"
            ]
          }
        },
        "route" : {
            "coding" : [
            {
                "system" : "urn:oid:0.4.0.127.0.16.1.1.2.1",
                "code" : "20053000",
                "display" : "Oral use"
            }
          ]
        },
        "doseAndRate" : [
          {
            "doseQuantity" : {
                "value" : 1,
                "unit" : "Tablet (unit of presentation)",
                "system" : "http://snomed.info/sct",
                "code" : "732936001"
            }
          }
        ]
      },
      {
        "sequence" : 2,
        "timing" : {
            "repeat" : {
            "boundsPeriod" : {
                "start" : "2012-02-04"
            },
            "when" : [
                "EVE"
            ]
          }
        },
        "route" : {
            "coding" : [
            {
                "system" : "urn:oid:0.4.0.127.0.16.1.1.2.1",
                "code" : "20053000",
                "display" : "Oral use"
            }
          ]
        },
        "doseAndRate" : [
            {
            "doseQuantity" : {
                "value" : 0.5,
                "unit" : "Tablet (unit of presentation)",
                "system" : "http://snomed.info/sct",
                "code" : "732936001"
            }
          }
        ]
      }
    ]

See the full example: 2-3 Medication Treatment Plan document

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