3Medication OrderPrescription/Medication Order Topic
HL7 V3 RX MO, R1
HL7 Version 3 Standard: Pharmacy; Medication Order, Release 1
Last Ballot: Normative Ballot 2 - May 2009
Content Last Edited:2011-07-29T02:44:17
View Revision MarksHide Revision Marks / Return to Domain Table of Contents2.1Introduction
3.2Application Roles
3.3Trigger Events
3.4Refined Message Information Models
3.5Hierarchical Message Descriptions
3.6Interactions
3..1Introduction
This topic deals with all content related to the ordering of medications, both for dispensing (supply) and for administration. It is intended to cover community prescribing, discharge prescriptions and institutional medication orders. The models are intended to support the requirements of all jurisdictions.
Storyboards (topic level, linked to domain level)
Basic institutional prescription
narrative 1
As part of the process of admission to Good Health Hospital, Dr. Hippocrates performs a clinical assessment of Adam Everyman. This clinical assessment includes a review of all medication Mr. Everyman was using before admission. Dr. Hippocrates decides to prescribe Paracetamol 1000 mg tablets[1], one orally three times a day, until further notice. The prescription then gets sent to the hospital pharmacy.
* It would be good to provide the medical context (diagnosis/indication), although it is totally up to the business context whether or not that information should (or is even allowed to) be sent to the pharmacy.
narrative 2
Same as #1, but the electronic prescribing system checks against the medication profile and known conditions, to make sure there are no interactions or contra-indications, before sending the prescription. [This is the situation where the prescribing system contains knowledge base features.]
3.2Application Roles
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►Application Roles (Sorted by Artifact Code)/ Prescribing System (PORX_AR990701UV)
/ Dispensing System (PORX_AR990702UV)
/ Medication Order Predetermination Placer (PORX_AR990703UV)
/ Medication Order Predeterminiation Fulfiller (PORX_AR990704UV)
/ Medication Order Record Request Placer (PORX_AR990705UV)
/ Medication Order Record Request Fulfiller (PORX_AR990706UV)
/ Medication Order Tracking System (PORX_AR990707UV)
▼Application Roles (Sorted by Display Order)
/ Dispensing System (PORX_AR990702UV)
/ Prescribing System (PORX_AR990701UV)
/ Medication Order Predetermination Placer (PORX_AR990703UV)
/ Medication Order Record Request Placer (PORX_AR990705UV)
/ Medication Order Tracking System (PORX_AR990707UV)
/ Medication Order Predeterminiation Fulfiller (PORX_AR990704UV)
/ Medication Order Record Request Fulfiller (PORX_AR990706UV)
Reference
For details on the interpretation of this section, see the discussion of application roles and their relationships in the Version 3 Guide.
3.2.1Dispensing System (PORX_AR990702UV)
Description
This is a system which supports a care provider with dispensing authority. This role specifically captures those interactions pertaining to the fulfillment of medication orders.
3.2.2Prescribing SystemPrescription Placer (PORX_AR990701UV)
Description
This is a system which application role supports a care provider with prescribing authority. This role specifically captures those interactions pertaining to the creation/managementstarting, updating or stoppingof medication ordersprescriptions, and to send them to other systems that validate, fulfill or track them. [To allow for safe management of prescriptions, any system supporting this role should have the medication profile and known conditions of the patient available.]
* The availability of supporting information is a business requirement and not essential to the process.
3.2.3Medication Order Predetermination Placer (PORX_AR990703UV)
Description
This is a system which supports a request to another system for review of a proposed medication order.
3.2.4Medication Order Record Request Placer (PORX_AR990705UV)
Description
This is a system which supports a request for the recording of a medication order.
3.2.5Medication Order Tracking System (PORX_AR990707UV)
Description
This is a system which tracks the creation of medication order but does not necessarily fulfill the order.
3.2.6Medication Order Predeterminiation Fulfiller (PORX_AR990704UV)
Description
This is a system which supports requests from another system for the review of a proposed medication order.
3.2.7Medication Order Record Request Fulfiller (PORX_AR990706UV)
Description
This is a system which fulfills requests for the recording of a medication order.
3.3Trigger Events
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►Trigger Events (Sorted by Title)/ Decision to not record medication order (PORX_TE010700UV)
/ Medication Order Record Obsolte Request (PORX_TE010410UV)
/ Medication order problems found (PORX_TE010690UV)
/ New medication order recorded (PORX_TE010660UV)
/ No medication order problems found (PORX_TE010670UV)
/ Request to evaluate proposed medication order (PORX_TE010720UV)
/ Request to record medication order (PORX_TE010730UV)
/ Send medication order to pharmacy (PORX_TE010770UV)
▼Trigger Events (Sorted by Display Order)
/ Request to evaluate proposed medication order (PORX_TE010720UV)
/ Medication order problems found (PORX_TE010690UV)
/ No medication order problems found (PORX_TE010670UV)
/ Request to record medication order (PORX_TE010730UV)
/ Send medication order to pharmacy (PORX_TE010770UV)
/ Decision to not record medication order (PORX_TE010700UV)
/ New medication order recorded (PORX_TE010660UV)
/ Medication Order Record Obsolte Request (PORX_TE010410UV)
Reference
For details on the interpretation of this section, see the discussion of trigger events in the Version 3 Guide.
3.3.1Request to evaluate proposed medication order (PORX_TE010720UV)
Description
Type: / User requestUser attempts to identify any contraindications or other issues that would be associated with creating a specific medication prescription for a patient.
3.3.2Medication order problems found (PORX_TE010690UV)
Description
Type: / User requestThere are contraindications associated with the possibility of prescribing a proposed medication prescription to a patient.
3.3.3No medication order problems found (PORX_TE010670UV)
Description
Type:There are no known issues with prescribing the proposed draft medication prescription to the identified patient.
3.3.4Request to record medication order (PORX_TE010730UV)
Description
Type: / User requestA user attempts to record a new medication prescription for storage in a central repository.
3.3.5Send medication order prescription to pharmacy (PORX_TE010770UV)
Description
Type: / User requestA user or system requests a fulfiller to perform a fulfill against a medication order.
[Open question whether the role of pharmaceutical advisor needs to be separated out.]
3.3.6Decision to not record medication order (PORX_TE010700UV)
Description
Type: / User requestThe request to record a new medication prescription in a central repository has been refused. For example, un-recognized drug code, unmanaged contraindications, lack of permission, etc.
3.3.7New medication order recorded (PORX_TE010660UV)
Description
Type:A new medication prescription has been recorded.
3.3.8Medication Order Record Obsolte Request (PORX_TE010410UV)
Description
Type:Requests that a medication prescription be recorded against the patient's record and that the previous order identified in the request have its status changed to obsolete.
Prescription Order
Data elementReq.HL7v2 fieldRep.HL7v3 element
Date/Time of prescribing R ORC-9CMR.author.time
Item ID R ORC-2CMR.id
Frequency/Posology RE TQ1 YCMR.SAR.effectiveTime [incl. duration of treatment]
Route R RXR-1CMR.SAR.routeCode
Site RE RXR-2CMR.SAR.approachSiteCode
Dose RE RXO-2CMR.SAR.doseQuantity
Rate RE RXO-21CMR.SAR.rateQuantity
Instructions RE RXO-6 Y??
Fulfilment instructions RE RXO-7 Y??
Missing elements in IHE HMW profile:
- DiluentWhat is medication dissolved in?
- Device useat administration
- Methodat administration
- Heigth, weightof patient
- Strengthof medication
- Substitution allowed?If so, what kind is allowed?
- Dosing patternFor complex dose schemes.
- Preconditionsincluding pause interval
- Follow-up treatment including pause interval
In general, the IHE HMW list of data elements needs more granularity.
Also, ORC is not listed under Common Data, but is then referenced there.
[1] This is based on business rules that encourage prescription based on generic names. In other environments, it might be common to prescribe based on active ingredients, or on brand names. This doesn’t change the essence of the institutional prescription process.