IPS Design conventions and principles 1 - Revision history

Gcangioli: /* The use of medication statements in the summary */

2018-07-17T09:53:55Z

‎The use of medication statements in the summary

Gcangioli: /* Provenance */

2018-07-17T08:47:49Z

‎Provenance

Gcangioli: /* Medicinal Product Identification */

2018-07-17T08:47:28Z

‎Medicinal Product Identification

Gcangioli: /* Medicinal Product Identification */

2018-06-28T09:13:56Z

‎Medicinal Product Identification

Gcangioli: /* Medicinal Product Identification */

2018-05-02T16:13:04Z

‎Medicinal Product Identification

Gcangioli: /* Representing "known absent" and "not known" */

2018-04-04T07:33:26Z

‎Representing "known absent" and "not known"

Gcangioli: /* Unmapped Coded Concepts */

2018-02-20T17:30:29Z

‎Unmapped Coded Concepts

Admin: /* Translation of designations */

2018-02-07T16:16:24Z

‎Translation of designations

Gcangioli: /* Representing "known absent" and "not known" */

2018-01-29T22:24:08Z

‎Representing "known absent" and "not known"

Rhausam: /* Representation of Names */

2017-12-17T14:59:00Z

‎Representation of Names

@@ Line 293: / Line 293: @@
 == The use of  medication statements in the summary ==
-What a medication list could be may strongly vary depending on the context of use (e.g. support for prescription or dispensation, drug reconciliation, etc. ) and on the type of information reported (e.g. patient-reported medication, prescribed, dispensed or administered medications, active or past medications, etc.).
+A medication list may strongly vary depending on the context of use (e.g. support for prescription or dispensation, drug reconciliation, etc. ) and on the type of information reported (e.g. patient-reported medication, prescribed, dispensed or administered medications, active or past medications, etc.).
-This plurality of attributes is still useful when limiting the scope to the medication summary within a Patient Summary. This medication summary could be, for instance, the list of all prescribed medicines whose indicated treatment period has not yet expired, regardless of whether they have been dispensed or not (European guidelines on Patient Summary <ref>EHN Guideline on the electronic exchange of health data under Cross-Border Directive 2011/24/EU. Release 2. (https://ec.europa.eu/health/sites/health/files/ehealth/docs/ev_20161121_co10_en.pdf</ref>). It could also be narrowed down to the actually dispensed medications. Or conversely, it could be a complete history including the full patient's prescription and dispensation history and information about intended drug monitoring (C-CDA <ref name="ccda21">HL7 C-CDA Implementation Guide DSTU R2.1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>). It could also be simply stated as a list of relevant medications for the patient (IHE PCC <ref>IHE Patient Care Coordination Technical Framework http://ihe.net/Technical_Frameworks/#pcc</ref>).
+This is still true also for the medication summary in a Patient Summary. It could be, for instance, a list of "Relevant prescribed medicines whose period of time indicated for the treatment has not yet expired whether it has been dispensed or not" (European guidelines on Patient Summary <ref>EHN Guideline on the electronic exchange of health data under Cross-Border Directive 2011/24/EU. Release 2. (https://ec.europa.eu/cefdigital/wiki/display/EHOPERATIONS/Business+Analysis+and+Requirements+Management?preview=/55878732/55878698/(Adopted)%20Patient%20Summary%20Guideline%20cross-border%20exchange%20of%20health%20data%20(release%202).pdf</ref>);  a list of actually dispensed medications;  a list of relevant medications for the patient (IHE PCC <ref>IHE Patient Care Coordination Technical Framework http://ihe.net/Technical_Frameworks/#pcc</ref>); or conversely, it could be a complete history including the full patient's prescription and dispensation history and information about intended drug monitoring (C-CDA <ref name="ccda21">HL7 C-CDA Implementation Guide DSTU R2.1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=379</ref>).
-Considering the scope of the IPS, however, the details about the medication order, supply, administration or monitoring are not relevant for an IPS. It is important, however, to know what medications are being taken by or have been given to a patient, independent of whether they are reported from the patient, another clinician or derived from supporting information. In any case, provenance information  is important.
+Moreover, for the scope of the International Patient Summary, it is important to know what medications are being taken by or have been given to a patient; without necessarily providing all the details about the medication order, supply, administration or monitoring. This information need, in line with the IPS principle of minimum non exhaustive data, is well expressed by the concept of Medication Statement (see https://www.hl7.org/fhir/medicationstatement.html).
-This information need, in line with the IPS principle of minimum non exhaustive data, is well expressed by the concept of Medication Statement (see https://www.hl7.org/fhir/medicationstatement.html).
+The IPS medication summary is therefore a list of relevant medication statements, possibly built from either a prescription list or a dispensation list. In fact, in many practical cases data included in a Patient Summary are derived from the list of the medicines prescribed by a GP and recorded in  its EHR-S; or extracted from a in regional/national prescribing and/or dispensation systems. In these cases, data obtained from actual dispensation and/or prescription records can be still recorded in the IPS as statements and the original request, supply or administration records referred by the statement if really needed.
 ==Medicinal Product Identification==

@@ Line 344: / Line 344: @@
 *Not attempt to implement the US Realm CDA data provenance templates.
-Note: Discussions with the EHR work group suggest that a possible future project should be an IPS functional profile, once there is greater clarity and operational experience of using the IPS.
+''Note: Discussions with the EHR work group suggest that a possible future project should be an IPS functional profile, once there is greater clarity and operational experience of using the IPS.''
 == Representation of Names ==

@@ Line 321: / Line 321: @@
 <ref group="Figure">Representation of medicines in CDA</ref> Representation of medicines in CDA
-Hence, in order to describe these attributes the CDA model has been extended enhancing the Manufactured Material class with attributes and relationships derived from the latest published version of the R_Medication CMET (see HL7 V3 Normative Edition 2017) based on the HL7 Common Product Model.
+Hence, in order to describe these attributes the CDA model has been extended enhancing the Manufactured Material class with attributes and relationships derived from the latest published version of the R_Medication CMET (see HL7 V3 Normative Edition 2017) based on the HL7 Common Product Model  (''“The common product model is used to improve the alignment between the different representations of products used within the body of HL7 Version 3 models. One goal of this effort is to make it possible to have a single  representation, which could then be used as a common message element type (CMET) across those models.”'') .
 <ref group="Figure" name="cdaextensions"></ref> shows how the CDA model has been enhanced with the R_Medication CMET.

@@ Line 321: / Line 321: @@
 <ref group="Figure">Representation of medicines in CDA</ref> Representation of medicines in CDA
-Hence, in order to describe these attributes the CDA model has been extended enhancing the Manufactured Material class with attributes and relationships derived from the R_Medication CMET.
+Hence, in order to describe these attributes the CDA model has been extended enhancing the Manufactured Material class with attributes and relationships derived from the latest published version of the R_Medication CMET (see HL7 V3 Normative Edition 2017) based on the HL7 Common Product Model.
 This choice has been made:

@@ Line 321: / Line 321: @@
 <ref group="Figure">Representation of medicines in CDA</ref> Representation of medicines in CDA
-Hence, in order to describe these attributes an extension of the CDA model needs to be applied, and this was done in epSOS enhancing the Manufactured Product and Material classes from the CDA model with the attributes and relationships derived from the Medication and Medicine classes of the R_Medication CMET.
+Hence, in order to describe these attributes the CDA model has been extended enhancing the Manufactured Material class with attributes and relationships derived from the R_Medication CMET.
 This choice has been made:
@@ Line 329: / Line 327: @@
 * to eventually have a common implementable solution to represent future IDMP identifiers and attributes in the IPS and in other document based standards such as SPL
-<ref group="Figure" name="cdacpm"></ref> shows how the CDA model has been enhanced with the Common Product Model: the relationships and attributes of the CPM manufactured material (Product) class have been added as extensions to that of the CDA manufacturedMaterial class ; the same has been done for the ManufacturedProduct classes.
+<ref group="Figure" name="cdaextensions"></ref> shows how the CDA model has been enhanced with the R_Medication CMET.
-{{IncludeImage|IPS_CMP_model.png|700px|90%}}
+{{IncludeImage|IPS extensions.png|700px|90%}}
-<ref group="Figure" name="cdacpm">CDA model has been enhanced with the Common Product Model</ref>Extension of the CDA model from the content of the Common Product Model
+<ref group="Figure" name="cdaextensions">CDA model has been enhanced with the R_Medication</ref>Extension of the CDA model from the content of the R_Medication CMET.
 == Provenance ==

@@ Line 39: / Line 39: @@
 * To make clinical content representation less dependent on a particular format or syntax, enabling a more practical path to transforming and exchanging data from one standard format (e.g. CDA R2) to another (e.g. FHIR).
 * to provide one single method to express the presence or absence of a particular condition (e.g. an allergy) or activity (e.g. an immunization), or the lack of knowledge regarding this kind of condition or activity, resulting in a more robust and easily implementable specification.
 For the other kinds of negations, not explicitly mentioned in this guide, it is suggested to apply – where possible – the same approach.

@@ Line 83: / Line 83: @@
 == Unmapped Coded Concepts ==
-In several real world situations the records used as source for the Patient Summaries may use locally adopted terminologies mapped into the reference value sets. When the original coded concept cannot be mapped in one of the coded concepts included in the reference value sets, it is recommended that the original code is reported in the IPS instance as well as the indication that the mapping didn’t occur. (See also the [[#Concept code mapping| Concept code mapping]] in the functional requirements section.)
+In several real world situations the records used as source for the Patient Summaries may use locally adopted terminologies mapped into the reference value sets. When the original coded concept cannot be mapped in one of the coded concepts included in the reference value sets, it is recommended to populate the original code in the IPS instance (in a 'translation' sub-element), with a nullFlavor indicating that the mapping didn’t occur. (See also the [[#Concept code mapping| Concept code mapping]] in the functional requirements section.). The nullFlavor value depends upon the coding strength of the binding.
 Two circumstances are considered here: the case in which the coding strength is Required (CNE) and when it is Extensible (CWE).

@@ Line 194: / Line 194: @@
 <code code="60591-5" codeSystem="2.16.840.1.113883.6.1"
    codeSystemName="LOINC" displayName="Patient Summary">
-   <ips:designation lang="it-IT" value="Profilo Sanitario Sintetico"/>
+   <ips:designation language="it-IT">Profilo Sanitario Sintetico</ips:designation>
-   <ips:designation lang="fr-FR" value="Patient Summary"/>
+   <ips:designation language="fr-FR">Patient Summary</ips:designation>
-   <ips:designation lang="en" value="Patient Summary"/>
+   <ips:designation language="en">Patient Summary</ips:designation>
 </code>
 </syntaxhighlight>
@@ Line 204: / Line 204: @@
 <value xsi:type="CD" code="42338000" codeSystem="2.16.840.1.113883.6.96"
    displayName="Salmonella-gastroenterit">
-   <ips:designation lang="da-DK" value=" Salmonella-gastroenterit"/>
+   <ips:designation language="da-DK">Salmonella-gastroenterit</ips:designation>
-   <ips:designation lang="en" value="Salmonella gastroenteritis (disorder)" type="FSN"/>
+   <ips:designation language="en">Salmonella gastroenteritis (disorder)</ips:designation>
+   [
      <originalText>

@@ Line 31: / Line 31: @@
 Other kinds of negations such as: (a) the negation of an allergy to a specific agent; (b) the absence of a particular disease; or (c) the fact that a specific vaccination has not been performed, have been considered beyond the set of essential data for an IPS.
-This specification represents this core set of negations (“general condition/activity unknown” and “general condition/activity/known absent” ) by leveraging the expressiveness of SNOMED CT and other primary terminologies to use explicit coded elements rather than relying on specific mechanisms of HL7 CDA such as nullFlavor and negationInd attributes.
+This specification represents this core set of negations (“general condition/activity unknown” and “general condition/activity/known absent” )  using explicit coded elements rather than relying on specific mechanisms of HL7 CDA such as nullFlavor and negationInd attributes or human readable text (possibly not understood by the foreign country receiver).
 The main reasons for this choice are:

@@ Line 358: / Line 358: @@
 Even though it is recognized that there is not in all cultures the same concept of “family name”, no evidence has been collected in analyzing the international context (e.g. Japan, Korea; China) that justifies the retirement of this requirement.
-Moreover, due to the global scope of the International Patient Summary, the case of non-alphabetic representations of the names have been also considered.
+Moreover, due to the global scope of the International Patient Summary, the case of non-alphabetic representations of the names has also been considered.
 In this case, to facilitate the global use of the IPS, at least one alphabetic representation of the name SHALL be provided.