Anfrage zum Ausstellen einer Verordnung (ServiceRequest)

Motivation

Als zentrales Element in einer Anfrage gelten in dieser Spezifikation ServiceRequests. Diese Bündeln die Informationen für eine konkrete Anfrage an einen anderen Leistungserbringer. Folgende Begriffe werden in diesem IG für diesen ServiceRequests genutzt:

  • ServiceRequest meint den Request als Basisprofil von HL7
  • ERPServiceRequestPrescriptionRequest meint konkret dieses Profil in diesem Projekt
  • Verordnungsanfrage ist der fachliche Begriff für dieses Profil

Der ERPServiceRequestPrescriptionRequest ist eine Anfrage zum Ausstellen einer Verordnung an einen Arzt. Alle für den Arzt relevanten Informationen zum Ausstellen einer entsprechenden Verordnung sind hier aufgeführt, bzw. referenziert.

Die Identifikation als ERPServiceRequestPrescriptionRequest (Verordnungsanfrage) wird über .code.coding.code = #prescription-request angegeben.

Kompatibilität

Dieses Profil basiert auf dem Profil ServiceRequest der FHIR-Core Spezifikation (R4).

Profil

Die folgende FHIR Ressource stellt eine Anfrage an eine verordnende LEI dar. Enthalten sein muss eine strukturelle angabe der angefragten Medikation.

EPrescriptionTokenS I0..1Extension(ERP Service Request EPrescription Token)
requestIdΣ1..1ERP Service Request Request Identifier
predisIdΣ0..1ERP Service Request Pre Dis Identifier
instantiatesCanonicalΣ0..*canonical(ActivityDefinition | PlanDefinition)
instantiatesUriΣ0..*uri
basedOnS Σ I1..1Reference(MedicationRequest)
replacesΣ I0..*Reference(ServiceRequest)
requisitionS Σ1..1ERP Service Request Procedure Identifier
statusS Σ ?!1..1codeBinding
intentΣ ?!1..1codeBindingFixed Value
categoryΣ0..*CodeableConcept
priorityΣ0..1codeBinding
doNotPerformΣ ?!0..1boolean
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
codingS Σ1..1CodingBinding
textΣ0..1string
quantityQuantityQuantity
quantityRatioRatio
quantityRangeRange
subjectS Σ I1..1Reference(Patient | Group | Location | Device)
encounterΣ I0..1Reference(Encounter)
occurrenceDateTimedateTime
asNeededBooleanboolean
asNeededCodeableConceptCodeableConcept
authoredOnS Σ1..1dateTime
requesterS Σ I1..1Reference(Organization | Practitioner)
performerTypeΣ0..1CodeableConcept
performerS Σ I0..*Reference(Practitioner)
locationCodeΣ0..*CodeableConcept
locationReferenceΣ I0..*Reference(Location)
reasonCodeS Σ0..*CodeableConceptBinding
reasonReferenceΣ I0..*Reference(ERP Service Request Remaining Medication)
insuranceI0..*Reference(Coverage | ClaimResponse)
referenceΣ I0..1string
typeΣ1..1uriBindingPattern
identifierΣ0..1Identifier
displayΣ0..1string
specimenΣ I0..*Reference(Specimen)
bodySiteΣ0..*CodeableConcept
noteS0..*Annotation
patientInstructionΣ0..1string
relevantHistoryI0..*Reference(Provenance)

Folgende Felder sind entsprechend zu befüllen, bzw. können befüllt werden:

idshortcomment
ServiceRequest
ServiceRequest.extension
ServiceRequest.extension:EPrescriptionTokenHere the e-prescription token can be made available for processing in a pharmacy.

The token is of the form '/Task/{PrescriptionID}/$accept?ac={AccessCode}. See gemSpec_DM_eRp'.

ServiceRequest.identifierDefines identifiers to be used in this profile.
ServiceRequest.identifier:requestIdIdentifier that uniquely references a ServiceRequest.

For referencing and assignment of ServiceRequest, e.g. if one ServiceRequest is to replace another, it is important to be able to make this assignment with the identifier. Can be mapped via a UUID, for example.

ServiceRequest.identifier:predisIdIdentifier that connects a prescription and a dispensing request.

Can be mapped via a UUID, for example.

ServiceRequest.basedOnRequested or fulfilled MedicationRequest.

Exactly one MedicationRequest is assigned to a ServiceRequest, so that independent processing is possible.

ServiceRequest.requisitionIdentifier of the process. All ServiceRequests within a process receive the same ID.

Is to be understood as a case or process ID (see mapping) in order to be able to track which request the ServiceRequest belongs to.

ServiceRequest.statusIndicates the processing status of a service request.

If the status changes, this value is overwritten.

ServiceRequest.intent
ServiceRequest.priority
ServiceRequest.codeIndicates the type of service request.
ServiceRequest.code.coding
ServiceRequest.code.coding.system
ServiceRequest.code.coding.code

#prescription-request defines this ServiceRequest as a prescription request from a doctor.

ServiceRequest.orderDetail
ServiceRequest.orderDetail.codingSpecifies how the recipe request should be fulfilled.

If the prescription goes to a pharmacy, a corresponding ServiceRequest must be included in the bundle.

ServiceRequest.subjectPatient for whom a prescription is requested on behalf of the patient.
ServiceRequest.occurrence[x]Specifies the date on which the prescription is to be issued.

Can be used by the requester to make the timely urgency clear.

ServiceRequest.authoredOnCreation date of the request.

Is initially created and then no longer changed.

ServiceRequest.requesterInquiring facility or practitioner.

The KIM address is already stored in the message header. Therefore, the preferred specification is to store a KBV_PR_FOR_Practitioner.

ServiceRequest.performerDoctor who is to write the prescription.
ServiceRequest.reasonCodeCode indicating why a prescription is requested.

Also used to indicate why the transaction was canceled in the event of a cancellation.

ServiceRequest.reasonReferenceReference to an observation resource that indicates how long the current medication will last.

If a reference to the reason is provided, a human-readable entry in .note must also be added in case systems cannot process the referenced observation.

ServiceRequest.supportingInfo
ServiceRequest.supportingInfo:AuslieferndeApotheke
ServiceRequest.supportingInfo:AuslieferndeApotheke.type
ServiceRequest.noteFurther information on the prescription request.

Any use cases that are not specified can be placed here in free text.

Use-Case spezifische Anforderungen

Beispiel

Valides Beispiel einer Verordnungsanfrage:

{
    "resourceType": "Bundle",
    "id": "UC1-1-Prescription-Request-To-Prescriber",
    "meta": {
        "profile":  [
            "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-message-container"
        ]
    },
    "type": "message",
    "identifier": {
        "system": "urn:ietf:rfc:3986",
        "value": "urn:uuid:29888885-6639-481c-934e-4b7b51745084"
    },
    "timestamp": "2015-02-07T13:28:17.239+02:00",
    "entry":  [
        {
            "fullUrl": "http://erp-servicerequest-test.de/MessageHeader/UC1-HealthCareService-to-Practitioner-MessageHeader",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "UC1-HealthCareService-to-Practitioner-MessageHeader",
                "meta": {
                    "profile":  [
                        "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-request-header"
                    ]
                },
                "focus":  [
                    {
                        "reference": "ServiceRequest/UC1-Initial-Prescription-Request"
                    }
                ],
                "sender": {
                    "identifier": {
                        "system": "http://gematik.de/fhir/sid/KIM-Adresse",
                        "value": "pflegeheim.immergrün.arzt@sana-pflegeheime.kim.telematik"
                    },
                    "display": "Pflegeheim Immergrün"
                },
                "destination":  [
                    {
                        "receiver": {
                            "identifier": {
                                "system": "http://gematik.de/fhir/sid/KIM-Adresse",
                                "value": "hans@ytopp-gluecklich.kim.telematik"
                            },
                            "display": "Praxis Hans Topp-Glücklich"
                        },
                        "endpoint": "klaus@test.de"
                    }
                ],
                "source": {
                    "name": "HealthCare-Source",
                    "software": "HealthCare-Software",
                    "version": "1.0.0",
                    "contact": {
                        "system": "email",
                        "value": "info@healthcare.email"
                    },
                    "endpoint": "http://healthcare.endpoint"
                },
                "eventCoding": {
                    "code": "eRezept_Rezeptanforderung;Rezeptanfrage",
                    "system": "https://gematik.de/fhir/atf/CodeSystem/service-identifier-cs"
                }
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/ServiceRequest/UC1-Initial-Prescription-Request",
            "resource": {
                "resourceType": "ServiceRequest",
                "id": "UC1-Initial-Prescription-Request",
                "meta": {
                    "profile":  [
                        "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-prescription-request"
                    ]
                },
                "intent": "order",
                "requisition": {
                    "system": "https://gematik.de/fhir/erp-servicerequest/sid/NamingSystemProcedureIdentifier",
                    "value": "GroupID-UC1"
                },
                "code": {
                    "coding":  [
                        {
                            "code": "prescription-request",
                            "system": "https://gematik.de/fhir/erp-servicerequest/CodeSystem/service-request-type-cs"
                        }
                    ]
                },
                "identifier":  [
                    {
                        "system": "https://gematik.de/fhir/erp-servicerequest/sid/NamingSystemRequestIdentifier",
                        "value": "1"
                    },
                    {
                        "system": "https://gematik.de/fhir/erp-servicerequest/sid/NamingSystemPreDisIdentifier",
                        "value": "PreDis-1"
                    }
                ],
                "basedOn":  [
                    {
                        "reference": "MedicationRequest/Example-Initial-Medication-Request"
                    }
                ],
                "status": "active",
                "subject": {
                    "reference": "Patient/Example-Patient"
                },
                "orderDetail":  [
                    {
                        "coding":  [
                            {
                                "code": "return-to-requester",
                                "system": "https://gematik.de/fhir/erp-servicerequest/CodeSystem/prescription-fullfillment-type-cs"
                            }
                        ]
                    }
                ],
                "occurrenceDateTime": "2023-02-01",
                "authoredOn": "2023-01-27",
                "requester": {
                    "reference": "Organization/Example-HealthCareService-Organization"
                },
                "performer":  [
                    {
                        "identifier": {
                            "system": "http://gematik.de/fhir/sid/KIM-Adresse",
                            "value": "hans@ytopp-gluecklich.kim.telematik"
                        }
                    }
                ],
                "reasonCode":  [
                    {
                        "coding":  [
                            {
                                "code": "medication-runs-out",
                                "system": "https://gematik.de/fhir/erp-servicerequest/CodeSystem/medication-request-reason-cs"
                            }
                        ]
                    }
                ],
                "reasonReference":  [
                    {
                        "reference": "Observation/Medication-Runs-Out-Example-dateTime"
                    },
                    {
                        "reference": "Observation/Medication-Runs-Out-Example-Quantity"
                    }
                ],
                "note":  [
                    {
                        "text": "Medikament läuft am 31.01.2023 aus. Es sind noch 7 stk übrig. "
                    }
                ]
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/MedicationRequest/Example-Initial-Medication-Request",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "Example-Initial-Medication-Request",
                "meta": {
                    "profile":  [
                        "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-medication-request"
                    ]
                },
                "extension":  [
                    {
                        "valueIdentifier": {
                            "system": "https://gematik.de/fhir/erp/NamingSystem/GEM_ERP_NS_PrescriptionId",
                            "value": "160.100.000.000.001.36"
                        },
                        "url": "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/prescription-id-ex"
                    }
                ],
                "dispenseRequest": {
                    "quantity": {
                        "system": "http://unitsofmeasure.org",
                        "code": "{Package}",
                        "value": 1
                    }
                },
                "status": "active",
                "intent": "order",
                "medicationReference": {
                    "reference": "Medication/Example-Initial-Medication"
                },
                "subject": {
                    "reference": "Patient/Example-Patient"
                },
                "authoredOn": "2022-05-20",
                "dosageInstruction":  [
                    {
                        "text": "2mal tägl. 5ml"
                    }
                ],
                "substitution": {
                    "allowedBoolean": true
                }
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/Medication/Example-Initial-Medication",
            "resource": {
                "resourceType": "Medication",
                "id": "Example-Initial-Medication",
                "meta": {
                    "profile":  [
                        "https://fhir.kbv.de/StructureDefinition/KBV_PR_ERP_Medication_PZN|1.1.0"
                    ]
                },
                "extension":  [
                    {
                        "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_Base_Medication_Type",
                        "valueCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "version": "http://snomed.info/sct/900000000000207008/version/20220331",
                                    "code": "763158003",
                                    "display": "Medicinal product (product)"
                                }
                            ]
                        }
                    },
                    {
                        "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Medication_Category",
                        "valueCoding": {
                            "code": "00",
                            "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_ERP_Medication_Category"
                        }
                    },
                    {
                        "url": "https://fhir.kbv.de/StructureDefinition/KBV_EX_ERP_Medication_Vaccine",
                        "valueBoolean": false
                    },
                    {
                        "url": "http://fhir.de/StructureDefinition/normgroesse",
                        "valueCode": "N1"
                    }
                ],
                "code": {
                    "coding":  [
                        {
                            "system": "http://fhir.de/CodeSystem/ifa/pzn",
                            "code": "08585997"
                        }
                    ],
                    "text": "Prospan® Hustensaft 100ml"
                },
                "form": {
                    "coding":  [
                        {
                            "system": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM",
                            "code": "FLE"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/Patient/Example-Patient",
            "resource": {
                "resourceType": "Patient",
                "id": "Example-Patient",
                "meta": {
                    "profile":  [
                        "https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Patient|1.1.0"
                    ]
                },
                "identifier":  [
                    {
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://fhir.de/CodeSystem/identifier-type-de-basis",
                                    "code": "GKV"
                                }
                            ]
                        },
                        "system": "http://fhir.de/sid/gkv/kvid-10",
                        "value": "X234567890"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "family": "Königsstein",
                        "_family": {
                            "extension":  [
                                {
                                    "url": "http://hl7.org/fhir/StructureDefinition/humanname-own-name",
                                    "valueString": "Königsstein"
                                }
                            ]
                        },
                        "given":  [
                            "Ludger"
                        ]
                    }
                ],
                "address":  [
                    {
                        "type": "both",
                        "line":  [
                            "Musterstr. 1"
                        ],
                        "_line":  [
                            {
                                "extension":  [
                                    {
                                        "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber",
                                        "valueString": "1"
                                    },
                                    {
                                        "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName",
                                        "valueString": "Musterstr."
                                    }
                                ]
                            }
                        ],
                        "city": "Berlin",
                        "postalCode": "10623"
                    }
                ],
                "birthDate": "1935-06-22"
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/Organization/Example-HealthCareService-Organization",
            "resource": {
                "resourceType": "Organization",
                "id": "Example-HealthCareService-Organization",
                "meta": {
                    "profile":  [
                        "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-organization"
                    ]
                },
                "identifier":  [
                    {
                        "type": {
                            "coding":  [
                                {
                                    "code": "kim-2.0",
                                    "system": "https://gematik.de/fhir/directory/CodeSystem/EndpointDirectoryConnectionType"
                                }
                            ]
                        },
                        "system": "http://gematik.de/fhir/sid/KIM-Adresse",
                        "value": "pflegeheim.immergrün.arzt@sana-pflegeheime.kim.telematik"
                    },
                    {
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "PRN"
                                }
                            ]
                        },
                        "system": "https://gematik.de/fhir/sid/telematik-id",
                        "value": "1-031234567"
                    },
                    {
                        "type": {
                            "coding":  [
                                {
                                    "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                                    "code": "BSNR"
                                }
                            ]
                        },
                        "system": "https://fhir.kbv.de/NamingSystem/KBV_NS_Base_BSNR",
                        "value": "031234567"
                    }
                ],
                "address":  [
                    {
                        "type": "both",
                        "line":  [
                            "Musterstr. 2"
                        ],
                        "_line":  [
                            {
                                "extension":  [
                                    {
                                        "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber",
                                        "valueString": "2"
                                    },
                                    {
                                        "url": "http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName",
                                        "valueString": "Musterstr."
                                    }
                                ]
                            }
                        ],
                        "city": "Berlin",
                        "postalCode": "10623"
                    }
                ],
                "name": "Pflegeheim Immergrün",
                "telecom":  [
                    {
                        "system": "phone",
                        "value": "0301234567"
                    }
                ]
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/Observation/Medication-Runs-Out-Example-dateTime",
            "resource": {
                "resourceType": "Observation",
                "id": "Medication-Runs-Out-Example-dateTime",
                "meta": {
                    "profile":  [
                        "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-remaining-medication"
                    ]
                },
                "status": "final",
                "subject": {
                    "reference": "Patient/Example-Patient"
                },
                "code": {
                    "coding":  [
                        {
                            "code": "range-of-medication",
                            "system": "https://gematik.de/fhir/erp-servicerequest/CodeSystem/medication-observation-cs"
                        }
                    ]
                },
                "valueDateTime": "2023-01-31"
            }
        },
        {
            "fullUrl": "http://erp-servicerequest-test.de/Observation/Medication-Runs-Out-Example-Quantity",
            "resource": {
                "resourceType": "Observation",
                "id": "Medication-Runs-Out-Example-Quantity",
                "meta": {
                    "profile":  [
                        "https://gematik.de/fhir/erp-servicerequest/StructureDefinition/erp-service-request-remaining-medication"
                    ]
                },
                "status": "final",
                "subject": {
                    "reference": "Patient/Example-Patient"
                },
                "code": {
                    "coding":  [
                        {
                            "code": "range-of-medication",
                            "system": "https://gematik.de/fhir/erp-servicerequest/CodeSystem/medication-observation-cs"
                        }
                    ]
                },
                "valueQuantity": {
                    "value": 7,
                    "unit": "stk"
                }
            }
        }
    ]
}