Medication Scheme Implementation Guide
1.0.0 - draft Estonia flag

Medication Scheme Implementation Guide, published by TEHIK. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TEHIK-EE/ig-ee-medication-scheme/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Behavior: Operation Definitions

These are custom operations that can be supported by and/or invoked by systems conforming to this implementation guide.

Find confirmed medication scheme

The confirmed operation is used to get current confirmed medication scheme.

Find interactions for medications

The interactions operation is used to get interactions for given Medications or MedicationPlan.

Find renal failure warnings for medications

The renal failure warnings operation is used to get renal warnings for given Medications or Medication Scheme.

Get history of medication statements

Returns the history of the current MedicationPlan(confirmed MedicationStatements) for requested patient

Medication Statement Confirm

The $confirm operation manages a medication plan of a patient, i.e. creates a snapshot of effective medication statements as well as propagates medication requests.

Task reimbursements

The reimbursement operation is used to get possible reimbursement for given Medication.

Validate MedicationStatement business rules

Builds on the default validate, by running MedIN specific business rules and RK checks

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

EETISCommunication

Ravimiskeemi kommentaar. Comment about one treatment line in mediction list.

EETISComposition

Kokkuvõte. Hetkel ei kasuta (vajalik Document Bundle jaoks). This resource gathers together all resources needed to form a document for Medication Overview bundle. Currently replaced with List.

EETISMedicationDispensedToPatient

Väljamüüdud ravim. Medication resource as it is presented today in Estonian e-Prescription center (Retseptikeskus). Used on prescriptions and dispensations.

EETISMedicationEPC

Ravim. Medication resource as it is presented today in Estonian e-Prescription center (Retseptikeskus). Used on prescriptions NOT on dispensations.

EETISMedicationExtemporal

Ekstemporaalne ravim. Profile for representing medication that is prepared in pharmacy by pharmacist. E.g. sulfur ointment or solution of Protargoli.

EETISMedicationInteraction

Ravimite omavahelised koostoimed. This profile is for the representation of the interactions between medication A and medication B in order to display warnings related to medications.

EETISMedicationList

Ravimiskeem. This profile gathers patient's medications in one list for better overview of the whole medication scheme

EETISMedicationOverview

Ravimiskeem kui dokument. Hetkel ei kasuta! Not in use. Medication Overview gathers together all resources related to patient's prescribed and dispensed medication.

EETISMedicationStatement

Ravimiskeemi rida. One or more Medication Statements form patient's Medication Scheme.

EETISMedicationStatementFoodSupplement

Ravimiskeemi rida toidulisandile. Medication Statement for (patient reported) food supplements.

EETISMedicationStatementOTC

Ravimiskeemi rida käsimüügiravimi puhul. Medication Statement for over-the-counter medications.

EETISObservationEGFR

eGFR analüüsi tulemus. Observation about eGFR

EETISOrganization

Asutus. Organization resource is used to refer to a certain identifiable place which is related to persons prescribing or dispensing medication.

EETISPharmacyLocation

Apteegi asukoht. This resource is used when there is a need to specify a certain pharmacy for medication dispensation.

EETISPractitioner

Tervishoiutöötaja. Practitioner has qualification in healthcare. E.g. nurse, pharmacist, doctor of medicine.

EETISPractitionerRole

Tervishoiutöötaja roll. Certified/licenced practitioner in a certain role in specified organization. E.g doctors working in different places may have different obligations/rights depending on the role they have in that organization.

EETISPrescription

Retsept. This is a profile for medication prescription.

EETISPrescriptionDispense

Ravimi väljastamine. When the medication prescribed is dispensed in pharmacy.

EETISReimbursementTask

Soodusmäära küsimine. Task is for the practitioner to ask reimbursement rates for prescription medicine. The MedicationStatement with its medication is sent to the Estonian Prescription Center and in return the practitoner recieves reimbursement rate (with additional explanation) for the medication.

EETISReimbursementTaskResponseParameters

This resource passes information back to EETISReimbursementTask output about the e-Prescription Centre's answer of allowed reimbursement rates. Also, information about insurance, EU insurance, pension and pension for incapacity for work are passed back.

EETISRelatedPerson

Seotud isik. Related person can be involved in patient's care process without being a healthcare proffessional.

EETISRenalFailureDS

Neerufuntsiooni puudulikkuse otsustustoe vastus. This profile is for the representation of patient's renal function failure and alerts about it so the medication can be adjusted according to failure degree.

Structures: Data Type Profiles

These define constraints on FHIR data types for systems conforming to this implementation guide.

EETISAnnotation

Kommentaar/märkus. Note or comment with time and author.

EETISDosage

Annustamisjuhis. Dosage is for exact representation of what quantity in which units and how often should medication be taken by patient.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

ExtensionEETISAdditionalInformationLink

Link lisa-infole. Link which takes to another page including additional and more detailed information about the topic.

ExtensionEETISAffectedMedicationStatements

Koostoimest mõjutatud ravimiskeemi rida.This extension is used in EETISMedicationInteraction profile to identify all medication statements which are related to interaction.

ExtensionEETISBuyerEPC

Ostja. When someone other than the subject of prescription buys medication.

ExtensionEETISCancelledStatusReason

Annulleerimise põhjus. Extension for describing the reason of 'cancelled' status of prescription

ExtensionEETISConsentWithInteractions

Nõusolek koostoimetega ning neerufunktsiooni hiatustega. This extension is used in EETISMedicationList profile to express whether or not the practitioner adding medicines considered the interactions (or renal function failure warnings) and consented with them.

ExtensionEETISCourseOfTherapyType

Ravikuuri tüüp. Defines whether the medication course is fixed or continuous etc.

ExtensionEETISDispensationAuthorization

Volituse liik. Defines the authorization of the prescription.

ExtensionEETISDosageModification

Annustamise soovitused. Recommendation for dosaging

ExtensionEETISGroupedItems

Grupeerija. Used when there is a need to group several items that contain data about the same line of medication prescribed to the patient.

ExtensionEETISLockStatus

Broneering retseptil. When pharmacy locks the prescription for ordering unauthorized medication for patient.

ExtensionEETISMedicationRemainder

Jääk. Extension describing how many days worth medication is left on prescription.

ExtensionEETISMedicinalProductClassification

Klassifikatsioon. Classification of the product, e.g. ATC, narcotic/psychtropic or prescription/over-the-counter medication

ExtensionEETISMedicinalProductName

Ravimi nimi. Registered name for the medicinal product.

ExtensionEETISNephrotoxic

Asendamine lubatud. Reason for not allowing the substitution of medication.

ExtensionEETISPrescriptionChange

Retsepti muutmise aeg, muutja ja põhjus.

ExtensionEETISPrescriptionIntent

Kas retsept on "order" või "proposal". Viimane on müügiloata ravimite puhul. Intent of prescription.

ExtensionEETISPrescriptionValidityTime

Retsepti kehtivuse lõpu aeg ravimiskeemi rea kontekstis. Validity end date of a prescription in a MedicationStatement.

ExtensionEETISReimbursementRate

Soodustuse määr ja tingimused (soodusravimite nimekirja järgi). For representation of the reimbursement rate and reason of prescription medicine.

ExtensionEETISRelatedObservationOrCondition

Seotud analüüs/test/uuring, mis on võib mõjutada neerufunktsiooni.This extension is used in to express renal function related observation/condition.

ExtensionEETISSizeOfItem

Pakkeühiku suurus. Size of medicinal product item (3ml).

ExtensionEETISSubstitution

Asendamine lubatud. Reason for not allowing the substitution of medication.

ExtensionEETISTotalPrescribedAmount

Väljakirjutatud kogus. How much in total there is medication prescribed on one Medication Request.

ExtensionEETISUnauthorizedProductRequest

Müügiloata ravimi taotlus. Used for requesting marketing permit for unauthorized medication.

ExtensionEETISVerification

Kinnitamine. This extension is used for the verification of the MedicationStatement - when practitioner changes, adds or deletes anything in patient's medication scheme it must be verified with date and id of the practitioner.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Ravimvormid

Üldised ja detailsed ravimvormid, mida on lubatud kasutada digiretseptil ja ravimiskeemis.

Siseriiklik ATC

WHO ATC klassifikatsioon koos Eesti laiendkoodidega

Toimeainete loend

Ravimiameti nimekiri ravimite toimeainetest

additional information TEST-VS

placeholder. USE text.

drug form groub TEST-VS

placeholder. USE text.

failure degree TEST-VS

placeholder. USE text.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Siseriiklik ATC

WHO ATC klassifikatsioon koos Eesti laiendkoodidega

Toimeained

Ravimiameti nimekiri ravimite toimeainetest

additional information TEST-CS

placeholder. USE text.

drug form groub TEST-CS

placeholder. USE text.

failure degree TEST-CS

placeholder. USE text.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Comment-changed

Comment about alprazolam where the comment has been changed

Comment1

Comment about alprazolam

D12345

Practitioner, Doctor Mart Murakas

D98765

Practitioner, Doctor Arst Ly

MedicationStatement-complex-dosaging

Ravimiskeemi rida muutuva annustamisega. Schema line for metformin with complex dosaging

MedicationStatement-metformin

Ravimiskeemi rida. Schema line for metformin

MedicationStatement-metformin-grouped-items

Ravimiskeemi rida kus identifikaatorid on grupeeritud. Schema line for metformin where several identifiers are grouped.

MedicationStatementAlprazolam

Ravimiskeemi rida. Schema line for alprazolam

MedicationStatementFoodSupplementRaud

Ravimiskeemi rida patsiendi sõnul ravimile. Treatment line for patient reported iron

MedicationStatementOTC-Aspirin

Ravimiskeemi rida käsimüügiravimile. Schema line for over-the-counter Aspirin

N98765

Practitioner, Nurse Õde Laura

PractRoleD12345

Practitioner D12345 in practitioner role doctor and with occupation pediaater

PractRoleD98765

Practitioner D98765 in practitioner role doctor and with occupation kardioloog

PractRoleN98765

Practitioner N98765 in practitioner role nurse and occupation õde

Ravimiskeem, kinnitatud D12345 poolt

List of patient's medications verified by D12345

TiamiinPyridoksiinTsyanokobalamiinLidokaiin

Description of medication Milgamma with four ingredient

adrenalin

Description of medication adrenaline

alprazolam

Description of medication alprazoleme

alprazolam-dispensed

Description of medication alprazoleme for dispensation to patient

aspirin

Description of medication Aspirin

comment-renal-failure

Comment about alprazolam when the patient has renal failure

dexamethason

Description of medication dexamethasone

dispensation-alprazolam

Alprasolaami väljamüük teise soodustusega kui mida arst on retseptile pannud. Dispensation of alprazolam prescription with 0 reinbursement rate in pharmacy

dispensation-metformin

Metformiini väljamüük patsiendi esindajale. Dispensation of metformin prescription for other buyer

extemporal

Extemporal medication example of sulfur ointment

fenoksymetyylpenitsilliin

Description of medication phenoxymethylpenicillin

metformin

Description of medication metformin

metformin-dispensed

Description of medication metformin dispensed to patient

novorapid

Description of medication aspart-insulin

observation-egfr1

Example of an eGFR observation

parameters-response

Soodustuse päringu vastus. Response for reimbursement parameters.

pat1MatiMeri

Patient Mati Meri

pharmacistKristiina

Practitioner with Medre code P00197 in practitioner role pharmacist

prescription-adrenalin-pos-dec

Unauthorized medication adrenaline with positive decision for marketing request and permission to form prescription

prescription-alprazolam

Prescription of alprazolam with reimbursement rate 50%

prescription-cancelled

Cancelled prescription of phenoxymethylpenicillin

prescription-metformin

Prescription of metformin with substitution NOT allowed and reason for that

renal-function-failure

Example of a alert when medication affects renal function and dosage must be corrected

rh

Organization Rakvere Haigla

tehiku-apteek

Location of pharmacy Tehiku apteek