Transcript HL7 Medication and UKCPRS

HL7 Medication and UKCPRS
Julie James
Partner
Blue Wave Informatics
HL7 Medication and UKCPRS
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HL7 Medication – Messaging about Medicines
The Pharmacy D-MIM
Describing the Medicine
Using the dm+d (UKCPRS) to describe a Medicine in a
Message
HL7 Medication – Messaging about Medicines
• Medication Information Special Interest Group (Med Info SIG)
– Messaging about the Patient-Clinician-Medicine interaction
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Prescribing medicines
Dispensing and supplying medicines
Administering medicines
Querying about individual patient’s medication(s)
• Patient Safety Special Interest Group
– Messaging about Adverse Events that Medicines may
cause (the “Yellow Card”) – the Individual Case Safety
Report (ICSR)
• Regulatory and Clinical Research Information Management
Technical Committee (RCRIM)
– The “Structured Product Label” (representation of the
Summary of Product Characteristics [SmPC] in a
structured format, for clinical and regulatory use
The Pharmacy DMIM
Pharmacy Domain Model
PORX_DM000000 v10.3
Community Combined Order
Institutional Combined Order
(PORX_RM132000)
(PORX_RM232000)
Administration and Supply Order
in a community setting
Administration and Supply Order
in an institutional setting
4 December 2003
Institutional Administration Order
Updated to Rim 2.01
(PORX_RM212000)
Administration promise in an institutional setting
Institutional Administration Promise
(PORX_RM213000)
Administration promise in an institutional setting
Institutional Administration Event
(PORX_RM214000)
Administration event in an institutional setting
Note:
This Act represents the core of the act of
ordering a medication and administering to a
patient. It directly holds the route and dosage
instructions.
Note:
The patient who is going
to receive the medication
CMET: (PAT)
R_Patient
[universal]
1..* patient *
MedicationAdministration
subject
classCode*: <= SBADM
moodCode*: <= ActMood
id*:
text: (Summary of act)
effectiveTime:
activityTime:
availabilityTime:
priorityCode:
confidentialityCode: "N"
routeCode: <= RouteOfAdministration
approachSiteCode: <= ActSite
(Can't have this without a route)
doseQuantity:
rateQuantity:
doseCheckQuantity: SET<RTO<QTY,QTY>>
maxDoseQuantity: SET<RTO<QTY,QTY>>
typeCode*: <= SBJ
(COCT_MT050000)
0..* locatedEntity
destination
Note:
E.g. radioactive substance must
be administered in secured location,
oral morphine in pharmacy
Note:
The reason for the medfication order.
Eg Treatment of bronchitis
Note:
Need to redo diagnosis code
typeCode*: <= DST
0..* locatedEntity
CMET: (LOCE)
R_LocationLocatedEntity
[universal]
location
(COCT_MT070000)
0..* playedRole
typeCode*: <= LOC
ObservationIndication
0..* justifyingObservationIndication
classCode*: <= OBS
moodCode*: <= EVN
id: (used for future maintenance)
statusCode: (Complete, Superceded)
effectiveTime:
confidentialityCode:
value*: CE CWE [0..1] <= ObservationValue (e.g. ICD9)
targetSiteCode:
Note:
Eg: Use dose of 50mg
if pulse <40bpm
or
Give medication until
pain relieved
reason2
typeCode*: <= RSON
classCode*: <= OBS
moodCode*: <= EVN.CRT
code: CE CWE <= ObservationType
text*:
effectiveTime:
value:
CMET: (ENC)
A_Encounter
[universal]
(COCT_MT090100)
0..* participant
performer
typeCode*: <= PRF
signatureCode: <= ParticipationSignature
signatureText:
0..* assignedEntity
typeCode*: <= x_ParticipationVrfRespSprfWit
time*: (verification or attestation)
modeCode:
signatureCode:
signatureText:
(COCT_MT090300)
CMET: (ASSIGNED)
R_AssignedPerson
[universal]
Note:
Who confirmed the order or the admin
(COCT_MT090100)
Note:
Who entered the data saying
for the order or the admin
0..* assignedEntity
precondition
dataEnterer
typeCode*: <= PRCN
checkpointCode:
negationInd:
conjunctionCode:
typeCode*: <= ENT
0..* assignedEntity
Note:
Who should be called for clarification
typically the same as the Author.
author1
typeCode*: <= AUT
outcome
typeCode*: <= OUTC
checkpointCode:
negationInd:
conjunctionCode:
0..* a_SubstanceAdminMaster
definition
componentOf1
Note:
Used to refererence
pharmacy protocols
governing how a drug
should be prescribed/
administered.
A_SubstanceAdminMaster
classCode*: <= SBADM
moodCode*: <= DEF
id*: [1..*] (catalogue #)
typeCode*: <= INST
typeCode*: <= COMP
(COCT_MT010000) 0..* encounter
pertinentInformation
triggerFor
typeCode*: <= PERT
typeCode*: <= TRIG
0..* alert
CMET: (ALRT)
A_Alert
[universal]
(COCT_MT260000)
inFulfillmentOf
Note:
Allows relation of different
moods of the act.
CMET for Medication ordered
This CMET is missing at present
and the mechanism will not work.
Manufacturer
Note:
The medication ordered or administered
to the patient.
Eg Amoxicillin 250mg Tablets
classCode*: <= ORG
determinerCode*: <= INSTANCE
code: CE CWE [0..1] <= EntityCode
name*:
Note:
This is only a link to the
MedicinalMaterial entity
and carries no information
0..1 manufacturerManufacturer
0..* orderedMedicine
1..* playedEquivalent *
consumable
OrderedMedicine
typeCode*: <= CSM
classCode*: <= THER
0..1 playedOrderedMedicine *
typeCode*: <= FLFS
0..* medicationAdministrationInstructions
0..* priorMedicationAdministration
component1
typeCode*: <= COMP
predecessor
Note:
Allows for modeling revision
of an order
MaterialMedProduct
(COCT_RM230000)
Note:
Intended to identify problems or
warnings associated with an Act
that have previously been evaluated
and discounted.
0..* pertinentObservationDx
(COCT_MT120104)
Note:
Observations that support
the decision on which medication
or what dose to use.
Eg Body weight, Surface Area,
Allergies, Medical conditions
Note:
Who gave the medication
to the patient, typically unused in
community and a nurse in
secondary care
CMET: (ASSIGNED)
R_AssignedDevice
[universal]
overseer
0..* outcomeObservationCriteria
CMET: (OBS)
A_ObservationDx
[minimal]
Note:
Who wrote the order,
typically a doctor
AssignedPractitionerOrDevice
CMET: (ASSIGNED)
R_AssignedPerson
[universal]
typeCode*: <= AUT
time*: (time of creation)
modeCode:
signatureCode:
signatureText:
0..* observationCriteria
ObservationCriteria
Note:
The header for the visit
to the primary care physician
or a particular hospital stay.
Includes information on the
relevant financial account
1..* participant *
author2
MedicationAdministrationInstructions
Equivalent
classCode*: <= ROL
code: <= RoleCode
ManufacturedBy
0..1 scopedManufacturedBy
classCode*: <= THER
classCode*: <= SBADM
moodCode*: <= ActMood
text: (Additional free text instructions)
These will usually be Realm
specific
0..* playedManufacturedBy
typeCode*: <= SUCC
Note:
Need to build a set of
descriptions of equivalence
such as:
- Generic
- Allowed alternative brand
Note:
See Q&A 31
0..* priorMedicationAdministration
component / componentOf2
Note:
Links together a series of
orders or administrations that form
part of a series whether scheduled
or not or where an order fulfills part
of a previous order.
typeCode*: <= COMP
0..* medicationAdministration1
pertainsTo
0..* medicationAdministration2
0..1 justifiedMedicationAdministration *
typeCode*: <= PERT
reason1 /
reasonOf
Also used for complex doses, or
multiple routes.
0..* justifyingMedicationSupply *
Note:
For a supply, where the supply
came from and where it was sent to.
Eg Pharmacy, Ward
CMET: (LOCE)
R_LocationLocatedEntity
[universal]
0..* playedRole
(COCT_MT070000)
destination
typeCode*: <= DST
0..* locatedEntity
0..* participant
author2
AssignedPractitionerOrDevice
typeCode*: <= AUT
time*: (time of creation)
modeCode:
signatureCode:
signatureText:
CMET: (ASSIGNED)
R_AssignedPerson
[universal]
CMET: (ASSIGNED)
R_AssignedPerson
[universal]
Note:
Who wrote the supply request
typically the doctor who wrote
the medication order,
but could also be a nurse
or ward pharmacist
Ingredient
0..* scopedPackOf *
typeCode*: <= PRF
signatureCode: <= ParticipationSignature
signatureText:
CMET: (ASSIGNED)
R_AssignedDevice
[universal]
ReimbursementStatus
1..1 containedSuppliedMedicine *
SuppliedMedicine
typeCode*: <= ORG
0..* assignedEntity
overseer
receiver
typeCode*: <= x_ParticipationVrfRespSprfWit
modeCode:
signatureCode:
signatureText:
typeCode*: <= RCV
(COCT_MT090100)
CMET: (ASSIGNED)
R_AssignedPerson
[universal]
classCode*: <= CONT
determinerCode*: <= KIND
1..1 manufacturedSuppliedMedicine * code*: [1..1] <= PackagedDrugEntity
lotNumberText:
expirationTime:
stabilityTime:
Note:
Who confirmed the supply
typically a pharmacist
(COCT_MT090100)
0..* assignedEntity
Note:
Who entered the data saying
what the supply is
typeCode*: <= ENT
Formulary
0..* formulary
classCode*: <= SPLY
moodCode*: <= DEF
id*: [1..*] (catalogue #)
definition
author1
typeCode*: <= INST
typeCode*: <= AUT
0..* assignedEntity
Note:
Who should be called for clarification
typically the same as the Author.
Note:
The medication that is being supplied
eg Amoxil 250mg tables, 56 tablets
Note:
Allows relation of different
moods of the act.
product
inFulfillmentOf
0..* playedSuppliedMedication *
classCode*: <= THER
0..* priorMedicationSupply
predecessor
typeCode*: <= SUCC
MaterialMedProductPackaged
0..* priorMedicationSupply
(COCT_RM220000)
Note:
Links together a series of
supply acts that form
part of a series whether scheduled
or not or where an order fulfills part
of a previous order.
component / componentOf
typeCode*: <= COMP
CMET for Medication ordered
0..* medicationSupply1
Note:
This act represents the act of supplying
medication to a patient or their representative.
It does NOT deal with administering it to the patient.
0..* medicationSupply2
Community Supply Event
(PORX_RM124000)
Supply Event in a community setting
Institutional Supply Order
Institutional Supply Event
(PORX_RM224000)
Supply event in an institutional setting
Institutional SupplyPromise
(PORX_RM222000)
(PORX_RM223000)
Supply promise in an institutional setting
Supply promise in an institutional setting
Payor
It doesn’t have an explicit name
because this is part of the code
SuppliedMedication
typeCode*: <= PRD
typeCode*: <= FLFS
0..1 scopingPayor *
Note:
This is anything from
an virtual therapeutic moeity
to a virtual product pack to an
actual product or an actual
product pack. It may hold multiple
IDs if say, VMP, AMP and AMPP
have been identified as part
of the product selection process.
It isn’t a choice box because several
values may be required.
Note:
See Q&A 31
1..* suppliedMedication *
Note:
Allows for modeling revision
of an order
classCode*: <= ROL
1..* playedReimbursementStatus * code*: [1..1] <= RoleCode
(COCT_MT090300)
origin
dataEnterer
Note:
The formulary which governs
what can be supplied
classCode*: <= MMAT
determinerCode*: <= KIND
code: <= EntityCode
PackOf
classCode*: <= CONT
0..* playedPackOf * quantity: RTO<PQ,PQ> (Pack size)
0..* participant
performer
0..1 scopingMedicine *
classCode*: <= MMAT
determinerCode*: <= KIND
0..* scopedIngredientStrength IngredientStrength
code*: [1..1] <= DrugEntity
(The main entry specified by the user. Use the equivalents for
classCode*: <= INGR
1..1 manufacturedMedicine * other more or les specific codes. EG AMP is th emain code, but
quantity: RTO<PQ,PQ> (Medicine strength)
VTM, VMP and a set of AMPPs are also known)
formCode*: <= MaterialForm
0..1 ingredientIngredient *
1..1 containerMedicine *
(COCT_MT090100)
0..* assignedEntity
Note:
Who will receive the supply.
It may be the patient, a carer.
0..1 manufacturedMedicine
Medicine
0..* pertinentCoverage
typeCode*: <= PERT
classCode*: <= SPLY
moodCode*: <= ActMood
id: (defaults to Sub_admin_order.id)
code: <= ActPharmacySupplyType
(partial, trial, etc. - this would be used to indicate authorization
for
trial/partial dispense)
text: (pharm. instructions)
effectiveTime: (Earliest/last allowed dispense, frequency
restrictions, etc.)
confidentialityCode:
repeatNumber: INT "1" (ie this is issue 3 (of 5))
quantity*: [1..1]
expectedUseTime: (days supply ordered)
0..* locatedEntity
Note:
Identifies information about an eligibility
check or authorization that has been
received in relation to an action. It is initiated
from the Supply and provides confirmation
back to the SubstanceAdministration
pertinentInformation
MedicationSupply
Note:
Changed from
COCT_MT070103, but is
the the correct CMET?
CMET: (COV)
A_Coverage
[universal]
0..* subjectCoverage (COCT_MT180000)
typeCode*: <= RSON
classCode*: <= ORG
determinerCode*: <= INSTANCE
code: <= EntityCode
name:
Describing the Medicine
• The Importance of the correctly describing a Medicine
• HL7 Information Model (the RIM) for messaging
• Realm-specific (use case driven) Terminology Model for
description
• The need for Harmonisation
• The Medication CMETs (harmony, not melody)
Material Medicinal Product - Universal
Equivalent concepts (e.g.
brand/generic) can be
represented here
The medicine’s manufacturer can
be represented using the role of
“manufactured by” and
“manufacturer” entity
Manufacturer
classCode*: <= ORG
determinerCode*: <= INSTANCE
code: CE CWE [0..1] <= EntityCode
name*:
0..1 manufacturerManufacturer
1..* playedEquivalent *
Equivalent
classCode*: <= ROL
code: <= RoleCode
ManufacturedBy
0..1 scopedManufacturedBy
classCode*: <= THER
0..* playedManufacturedBy
The medicine entity plays the
role of “ordered medicine”
0..1 manufacturedMedicine
0..1 scopingMedicine *
Medicine
MaterialMedProduct
(COCT_RM230000)
CMET for Medication ordered
OrderedMedicine
classCode*: <= THER
0..1 ingredientOfMedicine *
classCode*: <= MMAT
IngredientStrength
determinerCode*: <= KIND
classCode*: <= INGR
code*:
[1..1]
<=
DrugEntity
0..1 playedOrderedMedicine *
1..* playedIngredientStrength * quantity: RTO<PQ,PQ> (medicine strength)
(The main entry specified by the user. Use the equivalents for
1..1 manufacturedMedicine * other more or les specific codes. EG AMP is th emain code, but
VTM, VMP and a set of AMPPs are also known)
formCode*: <= MaterialForm
Ingredient
The medicine’s ingredients can be
represented using the role of
“ingredient strength” and
“ingredient” entities
classCode*: <= MMAT
determinerCode*: <= KIND
code: <= EntityCode
name: [1..*]
Material Medicinal Product - Identified
MaterialMedProductIdentified
(COCT_RM230001)
CMET for Medication ordered
OrderedMedicine
classCode*: <= THER
Medicine
classCode*: <= MMAT
determinerCode*: <= KIND
0..1 playedOrderedMedicine *
code*: [1..1] <= DrugEntity
1..1 manufacturedMedicine * (The main entry specified by the user. Use the equivalents for
other more or les specific codes. EG AMP is th emain code, but
VTM, VMP and a set of AMPPs are also known)
Just carry the dm+d identifier for
the medicine in here
Material Medicinal Product Pack - Universal
Manufacturer
classCode*: <= ORG
determinerCode*: <= INSTANCE
code: CE CWE [0..1] <= EntityCode
name*:
0..1 manufacturerManufacturer
1..* playedEquivalent *
The supplied medicine entity
scopes the role of “pack of”
Equivalent
classCode*: <= ROL
code: <= RoleCode
ManufacturedBy
0..1 scopedManufacturedBy
classCode*: <= THER
0..* playedManufacturedBy
0..1 manufacturedMedicine
0..1 scopingMedicine *
Medicine
classCode*: <= MMAT
determinerCode*: <= KIND
code*: [1..1] <= DrugEntity
(The main entry specified by the user. Use the equivalents for
other more or les specific codes. EG AMP is th emain code, but
VTM, VMP and a set of AMPPs are also known)
formCode*: <= MaterialForm
The supplied medicine entity
plays the role of “supplied
medication”
1..1 containerMedicine *
0..* scopedIngredientStrength
IngredientStrength
classCode*: <= INGR
quantity: RTO<PQ,PQ> (Medicine strength)
0..1 ingredientIngredient *
Ingredient
classCode*: <= MMAT
determinerCode*: <= KIND
code: <= EntityCode
0..* scopedPackOf *
PackOf
classCode*: <= CONT
0..* playedPackOf * quantity: RTO<PQ,PQ> (Pack size)
1..1 containedSuppliedMedicine *
SuppliedMedicine
classCode*: <= CONT
determinerCode*: <= KIND
1..1 manufacturedSuppliedMedicine * code*: [1..1] <= PackagedDrugEntity
lotNumberText:
expirationTime:
0..*
playedSuppliedMedication
*
SuppliedMedication
stabilityTime:
classCode*: <= THER
The supplied medicine entity
has batch number and expiry
information; it will be a dm+d
AMPP code
Material Medicinal Product Pack - Identified
MaterialMedProductPackagedIdentified
(COCT_RM220001)
CMET for Medication ordered
SuppliedMedication
0..* playedSuppliedMedication *
classCode*: <= THER
SuppliedMedicine
1..1 manufacturedSuppliedMedicine * classCode*: <= CONT
determinerCode*: <= KIND
code*: [1..1] <= PackagedDrugEntity
lotNumberText:
Just carry the dm+d identifier for
the AMPP in here
Route of Administration & Dosage Information
MedicationAdministrationRequest
classCode*: <= SBADM
moodCode*: <= RQO
id*: (placer number, etc.)
text: (Summary of act)
statusCode*: "ACTIVE"
effectiveTime:
priorityCode:
confidentialityCode: "N"
routeCode: <= RouteOfAdministration
approachSiteCode: <= ActSite (Must have a route to go with)
doseQuantity:
rateQuantity:
doseCheckQuantity: SET<RTO<QTY,QTY>>
maxDoseQuantity: SET<RTO<QTY,QTY>>
Mood = Request
Effective time = when to give
(frequency)
Route code = dm+d route of
administration code
Dose quantity = how much of
the medicine to give
[Rate quantity – for a rate,
rather than a unit dose]
Additional textual instructions, if
required
0..* medicationAdministrationInstructions
component3
typeCode*: <= COMP
MedicationAdministrationInstructions
classCode*: <= SBADM
moodCode*: <= RQO
text: (Additional free text instructions)
The UKCPRS Programme
• The “dm+d” – the NHS Dictionary of Medicines and Devices
– Modelled vocabulary of medicinal product concepts
– Supporting vocabulary of ingredient, dose forms, suppliers
– Supporting vocabulary of dosage syntax (separate
deliverable)
dm+d – a modelled vocabulary
VTM
dm+d Object Model
Blue Wave
Informatics
10/11/2003
ver 2.0c
Change History:
V2.0a - First version in this layout
v2.0b - Added constituent pack concepts
v2.0c - Removed incorrect coments on history from
suppliers and supplier llink
Ingredients
A VTM is the abstract conceptual
representation of the material defining the
prescriber's therapeutic intent, divorced from
formulation, dose or strength.
List of ingredients and excipients .
Note Within the file of ingredient substances will
be entries relating to the following:1) Complete substances which act as actual
ingredients of medicinal products. For example:
heparin sodium or cyclizine lactate (as distinct from
heparin and cyclizine). This class of substances
may or may not be a salt or other type of
derivative.-
A VTM cannot exist unless it is linked to a VMP
Name
The current name in short and full forms
VMP_Ingredient
Links VMP to the set of active ingredients
common to the AMPs linked to the VMP
VMP_VTM
Links a set of VMPs to a VTM
A VMP that is a drug may not
be linked to a VTM or it may
be linked to one VTM.
Each VTM must be attached to
one or more VMPs
DoseForm
Dictionary of terms for the
physical conformation of the
drug as normally dispensed.
A Dose Form may be
orphaned from any VMP
Name
A description of the dose form.
VMP
VMP_Form
Links a VMP to its dose form.
Every VMP that is a drug has exactly
one dose form.
A dose form may not be linked to a
VMP or it may be linked to one
or many
A VMP is the conceptual representation of one or more clinically equivalent Actual
Medicinal Products the purpose of which is to support the representation of the
fundamental reality of the concept. Its core description requires product name, strength
and dosage form, but is devoid of explicit or implicit information attributable to
manufacturer or pack.
2) Base substances which may or may not be
available as actual ingredients. For example,
heparin or cyclizine.
For each link the quantity of the ingredient or
of its base is stored.
An ingredient may be orphaned from any VMP or
AMP or from another parent or base ingredient.
A VMP may have no ingredients attached or
it may have one or more.
Name
Name of the ingredient - no history or short forms
An ingredient may not be be attached to any
VMP or it may be attached to one or more.
Base Ingredient
For salts etc a recursive pointer to the base
ingredient.
Strength
An indication of the quantity of the ingredient
in the product
AMP_Ingredient
Links AMPs to ingredients marked as
“Interesting Excipients”.
The quantity of ingredient is not stored.
An AMP may be linked to no ingredients
or to one or more.
AMP
An ingredient may not be linked to any
AMP or it may be linked to one or more.
An AMP is the representation of a single unit dose of a medicinal product that is (or has
been) made or marketed by a specific manufacturer or supplier. Its core description
requires product name, strength, dosage form and manufacturer, but is devoid of
explicit information attributable to pack size.
Strength Basis
An indication of whether the strength refers
to the ingredient or its base
The unit dose is the smallest single entity of the product that can be physically
handled with the following defined deviations:
Continuous liquids excluding eye-drops: where the unit dose is expressed in
terms of the accepted normal sub-unit used as the basis of administration
AMP_Suppliers
Links a set of AMPs to the company that
supplies them.
Each AMP is supplied by one and
only one supplier.
A Supplier may not have any AMPs or it may
have one or more products.
Suppliers
A list of Suppliers of medicinal products. The name
used will be that which appears on the product
package and may be a manufacturer, a wholesaler
or a marketing agent.
Continuous solids: where the unit dose is expressed in terms of the accepted
normal sub-unit used as the basis of administration
A VMP cannot exist unless it is linked to one or more AMPs and to one or more VMPPs
Continuous semi-solids and eye-drops: where a consistent, physically
measurable unit or sub-unit cannot be defined and which is therefore not
instantiated.
Name
The current name in full and short Semantic Normal Form together with the official
source of the name, a previous name and reasons for change
AMP_VMP
HideName
If this flag is set the name is hidden from view
A VMP must be linked to at least one AMP and can be linked to several AMPs
Links a set of AMPs to their corresponding VMP
An AMP must have a VMP but only one VMP
An AMP cannot exist unless it is linked to one or more AMPPs
Name
The current name in full and short Semantic Normal Form, a previous value and reason
for change. Each flavour of a AMP has a separate entry.
Prescribability
Indicates if product should not be prescribed by VMP
Freeness
A set of flags indicating if VMP is sugar free, CFC free etc.
Regulation
Information on regulatory restrictions and rules about the product such as Controlled
Drug Schedule
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
VMPP_VMP
Availability
The licence and “specials” status.
Route
AMP_Route
Regulation
Information on reglatory restrictions and rules about the product such as CSM
notification.
Links an AMP to the set of routes that have
been licensed for the product.
Reimbursement
Information on reimbursement
An AMP may have no linked Routes or it may
have one or more routes.
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
VMP_Route
Links VMP to the set of licensed routes
common to the AMPs linked to the VMP.
A VMP may have no routes linked, or it
may be linked to one o r more routes.
A route may not be linked to any VMP or
it may be linked to one or more VMPs
A VMPP is linked to one and
only one VMP
A VMP must have one or
more VMPPs
A licensed route of administration
of a medicinal product.
A route may be orphaned from any
VMP or AMP.
Name
Description of the route of
administration
A route may not be linked to any AMP or
it may be linked to one or more AMPs
AMPP_AMP
Links a set of AMPPs to
their “parent” AMP.
Each AMPP must link to
one and only one AMP.
Each AMP must have one
or more AMPPs
AMPP
VMPP
A VMPP is the conceptual representation of each and every AMPP that exists for the
linked AMPs. This includes a conceptual representation of AMPPs that exist to
represent the components of a compound AMPP.
An AMPP is the representation of each and every saleable/available pack (container of
dose units) of an AMP, in terms of description of quantity, of how many 'dose units' of
the AMP (or weight, for solids and semi-solids) are present in the pack.
AMPP_VMPP
A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP
Links a set of AMPPs to the corresponding VMPP
Name
A description of the pack in full and shortened Semantic Normal Forms.
Each AMPP must have one and only one VMPP
Size
The size of the pack is described in quantity and units.
Reimbursement
Information on reimbursement including “official” reimbursement price where it exists.
Component Flag
Indicates if the pack is normal, a compound pack or a constituent pack.
Each VMPP may be linked to one or more AMPPs
An AMPP may also be the representation of the number of “dose units” of an AMP
present as a constituent of a compound pack. This constituent pack may exist only in a
conceptual form or it may also be a saleable/available AMPP.
An AMPP cannot exist without a parent AMP
Name
The current name in full and short Semantic Normal Form.
Availability
The licence and “specials” status.
Regulation
Information on regulatory restrictions and rules about the product such as Legal
Category, restrictive formularies, allowed prescription forms etc.
Reimbursement
Information on reimbursement including indicative price
ChildVMPP_ParentVMPP
Component Flag
Indicates if the pack is normal, a compound pack or a constituent pack.
A recursive link from a constituent child VMPP to the corresponding parent
compound VMPP
Each Child VMPP must have one and only one Parent VMPP
Each Parent VMPP may be linked to one or more CHILD VMPPs
ChildAMPP_ParentAMPP
A recursive link from a constituent child AMPP to the corresponding parent
compound AMPP
Each Child AMPP must have one and only one Parent AMPP
Each Parent AMPP may be linked to one or more CHILD AMPPs
A supplier may be an orphan with no link to an
AMP or to another supplier.
Name
The name of the supplier together with a previous
name for that company
The “Five Core Classes” of dm+d
VTM
A VTM is the abstract conceptual
representation of the material defining the
prescriber's therapeutic intent, divorced from
formulation, dose or strength.
A VTM cannot exist unless it is linked to a VMP
Name
The current name in short and full forms
VMP_VTM
Links a set of VMPs to a VTM
A VMP that is a drug may not
be linked to a VTM or it may
be linked to one VTM.
AMP
Each VTM must be attached to
one or more VMPs
An AMP is the representation of a single unit dose of a medicinal product that is (or has
been) made or marketed by a specific manufacturer or supplier. Its core description
requires product name, strength, dosage form and manufacturer, but is devoid of
explicit information attributable to pack size.
VMP
A VMP is the conceptual representation of one or more clinically equivalent Actual
Medicinal Products the purpose of which is to support the representation of the
fundamental reality of the concept. Its core description requires product name, strength
and dosage form, but is devoid of explicit or implicit information attributable to
manufacturer or pack.
The unit dose is the smallest single entity of the product that can be physically
handled with the following defined deviations:
Continuous liquids excluding eye-drops: where the unit dose is expressed in
terms of the accepted normal sub-unit used as the basis of administration
Continuous solids: where the unit dose is expressed in terms of the accepted
normal sub-unit used as the basis of administration
A VMP cannot exist unless it is linked to one or more AMPs and to one or more VMPPs
Name
The current name in full and short Semantic Normal Form together with the official
source of the name, a previous name and reasons for change
AMP_VMP
HideName
If this flag is set the name is hidden from view
A VMP must be linked to at least one AMP and can be linked to several AMPs
Links a set of AMPs to their corresponding VMP
Continuous semi-solids and eye-drops: where a consistent, physically
measurable unit or sub-unit cannot be defined and which is therefore not
instantiated.
An AMP must have a VMP but only one VMP
An AMP cannot exist unless it is linked to one or more AMPPs
Name
The current name in full and short Semantic Normal Form, a previous value and reason
for change. Each flavour of a AMP has a separate entry.
Prescribability
Indicates if product should not be prescribed by VMP
Freeness
A set of flags indicating if VMP is sugar free, CFC free etc.
Availability
The licence and “specials” status.
Regulation
Information on regulatory restrictions and rules about the product such as Controlled
Drug Schedule
Regulation
Information on reglatory restrictions and rules about the product such as CSM
notification.
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
Reimbursement
Information on reimbursement
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
VMPP_VMP
A VMPP is linked to one and
only one VMP
AMPP_AMP
A VMP must have one or
more VMPPs
Links a set of AMPPs to
their “parent” AMP.
Each AMPP must link to
one and only one AMP.
Each AMP must have one
or more AMPPs
AMPP
VMPP
A VMPP is the conceptual representation of each and every AMPP that exists for the
linked AMPs. This includes a conceptual representation of AMPPs that exist to
represent the components of a compound AMPP.
An AMPP is the representation of each and every saleable/available pack (container of
dose units) of an AMP, in terms of description of quantity, of how many 'dose units' of
the AMP (or weight, for solids and semi-solids) are present in the pack.
AMPP_VMPP
A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP
Links a set of AMPPs to the corresponding VMPP
Name
A description of the pack in full and shortened Semantic Normal Forms.
Each AMPP must have one and only one VMPP
Size
The size of the pack is described in quantity and units.
Reimbursement
Information on reimbursement including “official” reimbursement price where it exists.
Component Flag
Indicates if the pack is normal, a compound pack or a constituent pack.
Each VMPP may be linked to one or more AMPPs
An AMPP may also be the representation of the number of “dose units” of an AMP
present as a constituent of a compound pack. This constituent pack may exist only in a
conceptual form or it may also be a saleable/available AMPP.
An AMPP cannot exist without a parent AMP
Name
The current name in full and short Semantic Normal Form.
Availability
The licence and “specials” status.
Regulation
Information on regulatory restrictions and rules about the product such as Legal
Category, restrictive formularies, allowed prescription forms etc.
Reimbursement
Information on reimbursement including indicative price
ChildVMPP_ParentVMPP
Component Flag
Indicates if the pack is normal, a compound pack or a constituent pack.
A recursive link from a constituent child VMPP to the corresponding parent
compound VMPP
Each Child VMPP must have one and only one Parent VMPP
Each Parent VMPP may be linked to one or more CHILD VMPPs
ChildAMPP_ParentAMPP
A recursive link from a constituent child AMPP to the corresponding parent
compound AMPP
Each Child AMPP must have one and only one Parent AMPP
Each Parent AMPP may be linked to one or more CHILD AMPPs
Using the dm+d codes for Pharmacy CMETs
Propose Promise Request
Event
VTM,
VMP,
VMPP,
AMP,
AMPP
VTM,
VMP,
VMPP,
AMP,
AMPP
VTM,
VMP,
VMPP,
AMP,
AMPP
AMPP
Supplied
AMPP
Medicine
Entity Code
(Supplied
Medication)
AMPP
AMPP
AMPP
Medicine
Entity Code
(Ordered
Medicine)
dm+d – Supporting Attribute Vocabulary
VTM
dm+d Object Model
Blue Wave
Informatics
10/11/2003
Ingredients
A VTM is the abstract conceptual
representation of the material defining the
prescriber's therapeutic intent, divorced from
formulation, dose or strength.
ver 2.0c
Change History:
V2.0a - First version in this layout
v2.0b - Added constituent pack concepts
v2.0c - Removed incorrect coments on history from
suppliers and supplier llink
List of ingredients and excipients .
Note Within the file of ingredient substances will
be entries relating to the following:1) Complete substances which act as actual
ingredients of medicinal products. For example:
heparin sodium or cyclizine lactate (as distinct from
heparin and cyclizine). This class of substances
may or may not be a salt or other type of
derivative.-
A VTM cannot exist unless it is linked to a VMP
Name
The current name in short and full forms
VMP_Ingredient
Links VMP to the set of active ingredients
common to the AMPs linked to the VMP
VMP_VTM
Links a set of VMPs to a VTM
A VMP that is a drug may not
be linked to a VTM or it may
be linked to one VTM.
Each VTM must be attached to
one or more VMPs
DoseForm
VMP
VMP_Form
Dictionary of terms for the
physical conformation of the
drug as normally dispensed.
A Dose Form may be
orphaned from any VMP
Name
A description of the dose form.
Links a VMP to its dose form.
Every VMP that is a drug has exactly
one dose form.
A dose form may not be linked to a
VMP or it may be linked to one
or many
A VMP is the conceptual representation of one or more clinically equivalent Actual
Medicinal Products the purpose of which is to support the representation of the
fundamental reality of the concept. Its core description requires product name, strength
and dosage form, but is devoid of explicit or implicit information attributable to
manufacturer or pack.
Ingredient
vocabulary
2) Base substances which may or may not be
available as actual ingredients. For example,
heparin or cyclizine.
For each link the quantity of the ingredient or
of its base is stored.
An ingredient may be orphaned from any VMP or
AMP or from another parent or base ingredient.
A VMP may have no ingredients attached or
it may have one or more.
Name
Name of the ingredient - no history or short forms
An ingredient may not be be attached to any
VMP or it may be attached to one or more.
Base Ingredient
For salts etc a recursive pointer to the base
ingredient.
Strength
An indication of the quantity of the ingredient
in the product
AMP_Ingredient
Links AMPs to ingredients marked as
“Interesting Excipients”.
The quantity of ingredient is not stored.
An AMP may be linked to no ingredients
or to one or more.
AMP
An ingredient may not be linked to any
AMP or it may be linked to one or more.
An AMP is the representation of a single unit dose of a medicinal product that is (or has
been) made or marketed by a specific manufacturer or supplier. Its core description
requires product name, strength, dosage form and manufacturer, but is devoid of
explicit information attributable to pack size.
Strength Basis
An indication of whether the strength refers
to the ingredient or its base
The unit dose is the smallest single entity of the product that can be physically
handled with the following defined deviations:
Continuous liquids excluding eye-drops: where the unit dose is expressed in
terms of the accepted normal sub-unit used as the basis of administration
AMP_Suppliers
Links a set of AMPs to the company that
supplies them.
Each AMP is supplied by one and
only one supplier.
A Supplier may not have any AMPs or it may
have one or more products.
Suppliers
A list of Suppliers of medicinal products. The name
used will be that which appears on the product
package and may be a manufacturer, a wholesaler
or a marketing agent.
Continuous solids: where the unit dose is expressed in terms of the accepted
normal sub-unit used as the basis of administration
A VMP cannot exist unless it is linked to one or more AMPs and to one or more VMPPs
Continuous semi-solids and eye-drops: where a consistent, physically
measurable unit or sub-unit cannot be defined and which is therefore not
instantiated.
Name
The current name in full and short Semantic Normal Form together with the official
source of the name, a previous name and reasons for change
AMP_VMP
HideName
If this flag is set the name is hidden from view
A VMP must be linked to at least one AMP and can be linked to several AMPs
Links a set of AMPs to their corresponding VMP
An AMP must have a VMP but only one VMP
Name
The current name in full and short Semantic Normal Form, a previous value and reason
for change. Each flavour of a AMP has a separate entry.
Freeness
A set of flags indicating if VMP is sugar free, CFC free etc.
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
VMPP_VMP
Name
The name of the supplier together with a previous
name for that company
An AMP cannot exist unless it is linked to one or more AMPPs
Prescribability
Indicates if product should not be prescribed by VMP
Regulation
Information on regulatory restrictions and rules about the product such as Controlled
Drug Schedule
A supplier may be an orphan with no link to an
AMP or to another supplier.
Availability
The licence and “specials” status.
Route
AMP_Route
Regulation
Information on reglatory restrictions and rules about the product such as CSM
notification.
Links an AMP to the set of routes that have
been licensed for the product.
Reimbursement
Information on reimbursement
An AMP may have no linked Routes or it may
have one or more routes.
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
VMP_Route
Links VMP to the set of licensed routes
common to the AMPs linked to the VMP.
A VMP may have no routes linked, or it
may be linked to one o r more routes.
A route may not be linked to any VMP or
it may be linked to one or more VMPs
A VMPP is linked to one and
only one VMP
A licensed route of administration
of a medicinal product.
A route may be orphaned from any
VMP or AMP.
Name
Description of the route of
administration
A route may not be linked to any AMP or
it may be linked to one or more AMPs
A VMP must have one or
more VMPPs
AMPP_AMP
Links a set of AMPPs to
their “parent” AMP.
Each AMPP must link to
one and only one AMP.
Each AMP must have one
or more AMPPs
AMPP
VMPP
A VMPP is the conceptual representation of each and every AMPP that exists for the
linked AMPs. This includes a conceptual representation of AMPPs that exist to
represent the components of a compound AMPP.
Dose Form
vocabulary
An AMPP is the representation of each and every saleable/available pack (container of
dose units) of an AMP, in terms of description of quantity, of how many 'dose units' of
the AMP (or weight, for solids and semi-solids) are present in the pack.
AMPP_VMPP
A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP
Links a set of AMPPs to the corresponding VMPP
Name
A description of the pack in full and shortened Semantic Normal Forms.
Each AMPP must have one and only one VMPP
Each VMPP may be linked to one or more AMPPs
Size
The size of the pack is described in quantity and units.
An AMPP may also be the representation of the number of “dose units” of an AMP
present as a constituent of a compound pack. This constituent pack may exist only in a
conceptual form or it may also be a saleable/available AMPP.
An AMPP cannot exist without a parent AMP
Name
The current name in full and short Semantic Normal Form.
Reimbursement
Information on reimbursement including “official” reimbursement price where it exists.
Availability
The licence and “specials” status.
Component Flag
Indicates if the pack is normal, a compound pack or a constituent pack.
Regulation
Information on regulatory restrictions and rules about the product such as Legal
Category, restrictive formularies, allowed prescription forms etc.
Reimbursement
Information on reimbursement including indicative price
Component Flag
Indicates if the pack is normal, a compound pack or a constituent pack.
ChildVMPP_ParentVMPP
A recursive link from a constituent child VMPP to the corresponding parent
compound VMPP
Each Child VMPP must have one and only one Parent VMPP
Each Parent VMPP may be linked to one or more CHILD VMPPs
Route of
Administration
vocabulary
ChildAMPP_ParentAMPP
A recursive link from a constituent child AMPP to the corresponding parent
compound AMPP
Each Child AMPP must have one and only one Parent AMPP
Each Parent AMPP may be linked to one or more CHILD AMPPs
Manufacturer
or supplier
vocabulary
Dosage Syntax
• A deliverable from a separate UKCPRS/HL7 Med Info SIG
workstream
– A standardised, modelled structure and vocabulary to
describe medication dosage for electronic systems
– Will “fit” into the Substance Administration act sections to
message dosage instructions
Questions???
Thank you