hl7 medication and ukcprs julie james partner blue wave informatics
TRANSCRIPT
HL7 Medication and UKCPRS
• 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– 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
Institutional Supply Order( PORX_RM222000 )
Supply promise in an institutional setting
0..* subjectCoveragetypeCode*: <= PERT
pertainsTo
0..* alert
typeCode*: <= TRIGtriggerFor
0..* formulary
typeCode*: <= INSTdefinition
0..* justifyingObservationIndication
typeCode*: <= RSON
reason2
0..* encountertypeCode*: <= COMPcomponentOf1
Note:E.g. radioactive substance mustbe administered in secured location,
oral morphine in pharmacy
Note:This Act represents the core of the act ofordering a medication and administering to a
patient. It directly holds the route and dosageinstructions.
ObservationIndication
classCode*: <= OBS
moodCode *: <= EVNid: (used for future maintenance)statusCode: (Complete, Superceded)
effectiveTime:confidentialityCode:
value*: CE CWE [0..1] <= ObservationValue (e.g. ICD9)targetSiteCode:
Formulary
classCode*: <= SPLYmoodCode *: <= DEF
id*: [1..*] (catalogue #)
ObservationCriteria
classCode*: <= OBS
moodCode *: <= EVN.CRTcode: CE CWE <= ObservationType
text*:effectiveTime:value:
MedicationAdministration
classCode*: <= SBADM
moodCode*: <= ActMoodid*:text: (Summary of act)
effectiveTime:activityTime:
availabilityTime:priorityCode:confidentialityCode: "N"
routeCode: <= RouteOfAdministrationapproachSiteCode: <= ActSite
(Can't have this without a route)doseQuantity:
rateQuantity:doseCheckQuantity: SET<RTO<QTY,QTY>>maxDoseQuantity: SET<RTO<QTY,QTY>>
MedicationSupply
classCode*: <= SPLYmoodCode *: <= 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, frequencyrestrictions, etc.)
confidentialityCode:repeatNumber: INT "1" (ie this is issue 3 (of 5))
quantity*: [1..1]expectedUseTime: (days supply ordered)
CMET: (COV)A_Coverage
[universal]( COCT_MT180000 )
CMET: (ALRT)A_Alert
[universal]
( COCT_MT260000 )
CMET: (ENC )A_Encounter
[universal]( COCT_MT010000 )
CMET: (LOCE )
R_LocationLocatedEntity[universal]
( COCT_MT070000 )0..* playedRole
CMET: (ASSIGNED )
R_AssignedPerson[universal]
( COCT_MT090100 )
CMET: (LOCE)R_LocationLocatedEntity
[universal]( COCT_MT070000 )
0..* playedRole
CMET: (ASSIGNED)R_AssignedPerson
[universal]( COCT_MT090100 )
CMET: (ASSIGNED)
R_AssignedPerson[universal]
( COCT_MT090100 )
CMET: (ASSIGNED)
R_AssignedDevice[universal]
( COCT_MT090300 )
CMET: (ASSIGNED)R_AssignedPerson
[universal]( COCT_MT090100 )
CMET: (ASSIGNED)R_AssignedDevice
[universal]
( COCT_MT090300 )
0..* locatedEntity
typeCode*: <= DSTdestination
0..* assignedEntity
overseer
typeCode*: <= x_ParticipationVrfRespSprfWitmodeCode:signatureCode:signatureText:
0..* participant
author2
typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:
1..* participant *author2
typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:
0..* assignedEntitydataEnterer
typeCode*: <= ENT
0..* assignedEntity
author1
typeCode*: <= AUT
0..* assignedEntity
overseer
typeCode*: <= x_ParticipationVrfRespSprfWittime*: (verification or attestation)modeCode:signatureCode:signatureText:
0..* assignedEntity
dataEnterertypeCode*: <= ENT
0..* assignedEntity
author1
typeCode*: <= AUT
0..* orderedMedicine
typeCode*: <= CSM
consumable
1..* suppliedMedication *
typeCode*: <= PRD
product
0..* participant
typeCode*: <= PRFsignatureCode: <= ParticipationSignaturesignatureText:
performer
0..* locatedEntity
typeCode*: <= LOC
location
0..* pertinentCoverage
typeCode*: <= PERTpertinentInformation
0..* locatedEntity
typeCode*: <= ORG
origin
CMET: (ASSIGNED)
R_AssignedPerson[universal]
( COCT_MT090100 )
0..* assignedEntity
typeCode*: <= RCV
receiver
0..* a_SubstanceAdminMaster
typeCode*: <= INST
definition
Note:Used to refererencepharmacy protocols
governing how a drugshould be prescribed/
administered.
A_SubstanceAdminMaster
classCode*: <= SBADMmoodCode*: <= DEF
id*: [1..*] (catalogue #)
Pharmacy Domain ModelPORX_DM000000 v10.3
4 December 2003
Updated to Rim 2.01
Note:Eg: Use dose of 50mg
if pulse <40bpmor
Give medication untilpain relieved
0..* pertinentObservationDx
typeCode*: <= PERT
pertinentInformation
Note:Observations that supportthe decision on which medication
or what dose to use.Eg Body weight, Surface Area,
Allergies, Medical conditions
CMET: (OBS )A_ObservationDx
[minimal]( COCT_MT120104 )
CMET: (PAT)R_Patient
[universal]( COCT_MT050000 )
1..* patient *
subjecttypeCode*: <= SBJ
Note:
The medication ordered or administeredto the patient.
Eg Amoxicillin 250mg Tablets
Note:The patient who is going
to receive the medication
Note:The header for the visit
to the primary care physicianor a particular hospital stay.
Includes information on therelevant financial account
Note:The reason for the medfication order.
Eg Treatment of bronchitis
Note:
Who wrote the order,typically a doctor
Note:Who gave the medicationto the patient, typically unused in
community and a nurse insecondary care
Note:Who confirmed the order or the admin
Note:
Who entered the data sayingfor the order or the admin
Note:Who should be called for clarification
typically the same as the Author.
Note:Identifies information about an eligibilitycheck or authorization that has been
received in relation to an action. It is initiatedfrom the Supply and provides confirmation
back to the SubstanceAdministration
Note:Intended to identify problems or
warnings associated with an Actthat have previously been evaluated
and discounted.
This CMET is missing at presentand the mechanism will not work.
Note:Who confirmed the supply
typically a pharmacist
Note:
Who entered the data sayingwhat the supply is
Note:Who should be called for clarification
typically the same as the Author.
Note:Who wrote the supply requesttypically the doctor who wrote
the medication order,but could also be a nurse
or ward pharmacist
Note:
The formulary which governswhat can be supplied
Note:Who will receive the supply.
It may be the patient, a carer.
Note:The medication that is being suppliedeg Amoxil 250mg tables, 56 tablets
Note:For a supply, where the supply
came from and where it was sent to.Eg Pharmacy, Ward
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.
component / componentOf2
0..* medicationAdministration1
0..* medicationAdministration2
typeCode*: <= COMPNote:Links together a series of
orders or administrations that formpart of a series whether scheduled
or not or where an order fulfills partof a previous order.
Also used for complex doses, ormultiple routes.
component / componentOf
0..* medicationSupply1
0..* medicationSupply2
typeCode*: <= COMPNote:Links together a series of
supply acts that formpart of a series whether scheduledor not or where an order fulfills part
of a previous order.
0..* participant
typeCode*: <= PRFsignatureCode: <= ParticipationSignature
signatureText:
performer
Note:Changed from
COCT_MT070103, but is the the correct CMET?
Note:
Need to redo diagnosis code
0..* locatedEntity
typeCode*: <= DST
destination
1..1 manufacturedMedicine *
OrderedMedicine
0..1 playedOrderedMedicine *classCode*: <= THER
Medicine
classCode*: <= MMATdeterminerCode*: <= KINDcode*: [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
MaterialMedProduct( COCT_RM230000 )
CMET for Medication ordered
1..1 manufacturedSuppliedMedicine *
SuppliedMedication 0..* playedSuppliedMedication *
classCode*: <= THER
Manufacturer
classCode*: <= ORG
determinerCode*: <= INSTANCEcode: CE CWE [0..1] <= EntityCodename*:
0..1 scopingMedicine *
Equivalent1..* playedEquivalent *
classCode*: <= ROLcode: <= RoleCode
Note:This is only a link to theMedicinalMaterial entity
and carries no information
Note:This is anything from
an virtual therapeutic moeityto a virtual product pack to an
actual product or an actualproduct pack. It may hold multiple
IDs if say, VMP, AMP and AMPPhave been identified as partof the product selection process.
It isn’t a choice box because several
values may be required.
It doesn’t have an explicit name
because this is part of the code
0..1 ingredientIngredient *
IngredientStrength0..* scopedIngredientStrength
classCode*: <= INGRquantity: RTO<PQ,PQ> (Medicine strength)
Ingredient
classCode*: <= MMATdeterminerCode*: <= KIND
code: <= EntityCode
0..1 scopingPayor *
ReimbursementStatus
1..* playedReimbursementStatus *
classCode*: <= ROL
code*: [1..1] <= RoleCode
Payor
classCode*: <= ORG
determinerCode*: <= INSTANCEcode: <= EntityCodename:
SuppliedMedicine
classCode*: <= CONT
determinerCode*: <= KINDcode*: [1..1] <= PackagedDrugEntitylotNumberText:
expirationTime:stabilityTime:
1..1 containedSuppliedMedicine *
1..1 containerMedicine *
PackOf0..* scopedPackOf *
0..* playedPackOf *
classCode*: <= CONT
quantity: RTO<PQ,PQ> (Pack size)
0..1 justifiedMedicationAdministration *
0..* justifyingMedicationSupply *
typeCode*: <= RSON
reason1 /
reasonOf
MaterialMedProductPackaged( COCT_RM220000 )
CMET for Medication ordered
inFulfillmentOf
0..* priorMedicationAdministration
typeCode*: <= FLFS
predecessor
0..* priorMedicationAdministration
typeCode*: <= SUCCNote:
Allows for modeling revisionof an order
Note:
Allows relation of differentmoods of the act.
inFulfillmentOf
0..* priorMedicationSupply
typeCode*: <= FLFS
predecessor
0..* priorMedicationSupply
typeCode*: <= SUCC
Note:Allows for modeling revision
of an order
Note:Allows relation of different
moods of the act.
0..1 manufacturedMedicine
0..1 manufacturerManufacturer
ManufacturedBy 0..1 scopedManufacturedBy
0..* playedManufacturedByclassCode*: <= THER
AssignedPractitionerOrDevice
AssignedPractitionerOrDevice
Note:
See Q&A 31
Note:See Q&A 31
MedicationAdministrationInstructions
classCode*: <= SBADMmoodCode*: <= ActMoodtext: (Additional free text instructions)
0..* medicationAdministrationInstructions
typeCode*: <= COMP
component1
Community Supply Event( PORX_RM124000 )
Supply Event in a community setting
Institutional Combined Order( PORX_RM232000 )
Administration and Supply Order
in an institutional setting
Institutional SupplyPromise( PORX_RM223000 )
Supply promise in an institutional setting
Institutional Supply Event( PORX_RM224000 )
Supply event in an institutional setting
Community Combined Order( PORX_RM132000 )
Administration and Supply Order
in a community setting
Institutional Administration Order( 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
0..* outcomeObservationCriteria
outcome
typeCode*: <= OUTCcheckpointCode:negationInd:conjunctionCode:
0..* observationCriteria
precondition
typeCode*: <= PRCNcheckpointCode:negationInd:conjunctionCode:
Note:
Need to build a set ofdescriptions of equivalencesuch as:
- Generic - Allowed alternative brand
These will usually be Realm specific
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
1..1 manufacturedMedicine *
OrderedMedicine
0..1 playedOrderedMedicine *classCode *: <= THER
MedicineclassCode *: <= MMATdeterminerCode *: <= 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
MaterialMedProduct(COCT_RM230000)
CMET for Medication ordered
ManufacturerclassCode *: <= ORG
determinerCode *: <= INSTANCE
code: CE CWE [0..1] <= EntityCodename*:
0..1 scopingMedicine *
Equivalent1..* playedEquivalent *
classCode *: <= ROLcode: <= RoleCode
0..1 ingredientOfMedicine * IngredientStrength
1..* playedIngredientStrength *
classCode *: <= INGR
quantity: RTO<PQ,PQ> (medicine strength)
IngredientclassCode *: <= MMATdeterminerCode *: <= KIND
code: <= EntityCode
name: [1..*]
0..1 manufacturedMedicine
0..1 manufacturerManufacturer
ManufacturedBy 0..1 scopedManufacturedBy
0..* playedManufacturedByclassCode *: <= THER
The medicine entity plays the role of
“ordered medicine”
Equivalent concepts (e.g. brand/generic) can be represented
here
The medicine’s ingredients can be represented using the role of “ingredient strength”
and “ingredient” entities
The medicine’s manufacturer can be represented using the
role of “manufactured by” and “manufacturer” entity
Material Medicinal Product - Identified
1..1 manufacturedMedicine *
OrderedMedicine
0..1 playedOrderedMedicine *classCode*: <= THER
MedicineclassCode*: <= MMATdeterminerCode*: <= KINDcode*: [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)
MaterialMedProductIdentified(COCT_RM230001)
CMET for Medication ordered
Just carry the dm+d identifier for the medicine in
here
Material Medicinal Product Pack - Universal
MedicineclassCode*: <= MMATdeterminerCode*: <= KINDcode*: [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
1..1 manufacturedSuppliedMedicine *
SuppliedMedication0..* playedSuppliedMedication *
classCode*: <= THER
ManufacturerclassCode *: <= ORGdeterminerCode*: <= INSTANCEcode: CE CWE [0..1] <= EntityCodename*:
0..1 scopingMedicine *
Equivalent1..* playedEquivalent *
classCode*: <= ROLcode: <= RoleCode
0..1 ingredientIngredient *
IngredientStrength0..* scopedIngredientStrength
classCode*: <= INGRquantity: RTO<PQ,PQ> (Medicine strength)
IngredientclassCode*: <= MMATdeterminerCode*: <= KINDcode: <= EntityCode
SuppliedMedicineclassCode *: <= CONTdeterminerCode *: <= KINDcode*: [1..1] <= PackagedDrugEntitylotNumberText:expirationTime:stabilityTime:
1..1 containedSuppliedMedicine *
1..1 containerMedicine *
PackOf0..* scopedPackOf *
0..* playedPackOf *classCode*: <= CONTquantity: RTO<PQ,PQ> (Pack size)
0..1 manufacturedMedicine
0..1 manufacturerManufacturer
ManufacturedBy 0..1 scopedManufacturedBy
0..* playedManufacturedByclassCode*: <= THER
The supplied medicine entity plays the role of “supplied medication”
The supplied medicine entity has batch number and expiry information; it
will be a dm+d AMPP code
The supplied medicine entity scopes the role of
“pack of”
Material Medicinal Product Pack - Identified
1..1 manufacturedSuppliedMedicine *
SuppliedMedication 0..* playedSuppliedMedication *
classCode *: <= THERSuppliedMedicineclassCode*: <= CONTdeterminerCode*: <= KINDcode*: [1..1] <= PackagedDrugEntitylotNumberText:
MaterialMedProductPackagedIdentified(COCT_RM220001 )
CMET for Medication ordered
Just carry the dm+d identifier for the AMPP in
here
Route of Administration & Dosage Information
MedicationAdministrationRequestclassCode*: <= SBADMmoodCode*: <= RQOid*: (placer number, etc.)text: (Summary of act)statusCode*: "ACTIVE"effectiveTime:priorityCode:confidentialityCode: "N"routeCode: <= RouteOfAdministrationapproachSiteCode: <= ActSite (Must have a route to go with)doseQuantity:rateQuantity:doseCheckQuantity: SET<RTO<QTY,QTY>>maxDoseQuantity: SET<RTO<QTY,QTY>>
MedicationAdministrationInstructionsclassCode*: <= SBADMmoodCode*: <= RQOtext: (Additional free text instructions)
0..* medicationAdministrationInstructions
typeCode *: <= COMP
component3
Mood = RequestEffective time = when to give
(frequency)Route code = dm+d route of
administration codeDose quantity = how much
of the medicine to give[Rate quantity – for a rate,
rather than a unit dose]
Additional textual instructions, if required
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
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 oneor many
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
10/11/2003Blue WaveInformatics
ver 2.0c
dm +d Object Model
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
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 thefundamental 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.
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
HideName
If this flag is set the name is hidden from view
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 FlagIndicates if the product is normal, a compound product or a constituent product.
VMP
A VTM is the abstract conceptual
representation of the material defining the
prescriber's therapeutic intent, divorced fromformulation, dose or strength.
A VTM cannot exist unless it is linked to a VMP
Name
The current name in short and full forms
VTM
Dictionary of terms for the
physical conformation of thedrug as normally dispensed.
A Dose Form may be
orphaned from any VMP
NameA description of the dose form.
DoseForm
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 ofderivative.-
2) Base substances which may or may not be
available as actual ingredients. For example,
heparin or cyclizine.
An ingredient may be orphaned from any VMP or
AMP or from another parent or base ingredient.
Name
Name of the ingredient - no history or short forms
Base Ingredient
For salts etc a recursive pointer to the base
ingredient.
Ingredients
VMP_Ingredient
Links VMP to the set of active ingredientscommon to the AMPs linked to the VMP
For each link the quantity of the ingredient or
of its base is stored.
A VMP may have no ingredients attached orit may have one or more.
An ingredient may not be be attached to any
VMP or it may be attached to one or more.
StrengthAn indication of the quantity of the ingredient
in the product
Strength Basis
An indication of whether the strength refers
to the ingredient or its base
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.
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 acceptednormal sub-unit used as the basis of administration
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 cannot exist unless it is linked to one or more AMPPs
NameThe 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.
Availability
The licence and “specials” status.
Regulation
Information on reglatory restrictions and rules about the product such as CSM
notification.
Reimbursement
Information on reimbursement
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
AMP
AMP_Ingredient
Links AMPs to ingredients marked as
“Interesting Excipients”.
The quantity of ingredient is not stored.
An AMP may be linked to no ingredientsor to one or more.
An ingredient may not be linked to any
AMP or it may be linked to one or more.
AMP_VMP
Links a set of AMPs to their corresponding VMP
An AMP must have a VMP but only one VMP
A VMP must be linked to at least one AMP and can be linked to several AMPs
A licensed route of administration
of a medicinal product.
A route may be orphaned from any
VMP or AMP.
NameDescription of the route of
administration
Route
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 itmay 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
AMP_Route
Links an AMP to the set of routes that have
been licensed for the product.
An AMP may have no linked Routes or it may
have one or more routes.
A route may not be linked to any AMP or
it may be linked to one or more AMPs
A list of Suppliers of medicinal products. The name
used will be that which appears on the productpackage and may be a manufacturer, a wholesaler
or a marketing agent.
A supplier may be an orphan with no link to anAMP or to another supplier.
Name
The name of the supplier together with a previous
name for that company
Suppliers
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.
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.
An AMPP may also be the representation of the number of “dose units” of an AMPpresent 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
NameThe current name in full and short Semantic Normal Form.
Availability
The licence and “specials” status.
RegulationInformation 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 FlagIndicates if the pack is normal, a compound pack or a constituent pack.
AMPP
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
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.
A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP
Name
A description of the pack in full and shortened Semantic Normal Forms.
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.
VMPP
AMPP_VMPP
Links a set of AMPPs to the corresponding VMPP
Each AMPP must have one and only one VMPP
Each VMPP may be linked to one or more AMPPs
VMPP_VMP
A VMPP is linked to one and
only one VMP
A VMP must have one or
more VMPPs
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
ChildAMPP_ParentAMPP
A recursive link from a constituent child AMPP to the corresponding parentcompound AMPP
Each Child AMPP must have one and only one Parent AMPP
Each Parent AMPP may be linked to one or more CHILD AMPPs
The “Five Core Classes” of dm+d
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 maybe linked to one VTM.
Each VTM must be attached to
one or more VMPs
A VMP is the conceptual representation of one or more clinically equivalent ActualMedicinal Products the purpose of which is to support the representation of thefundamental reality of the concept. Its core description requires product name, strength
and dosage form, but is devoid of explicit or implicit information attributable tomanufacturer or pack.
A VMP cannot exist unless it is linked to one or more AMPs and to one or more VMPPs
NameThe current name in full and short Semantic Normal Form together with the officialsource of the name, a previous name and reasons for change
HideNameIf this flag is set the name is hidden from view
PrescribabilityIndicates if product should not be prescribed by VMP
Freeness
A set of flags indicating if VMP is sugar free, CFC free etc.
RegulationInformation on regulatory restrictions and rules about the product such as Controlled
Drug Schedule
Component FlagIndicates if the product is normal, a compound product or a constituent product.
VMP
A VTM is the abstract conceptualrepresentation of the material defining theprescriber's therapeutic intent, divorced fromformulation, dose or strength.
A VTM cannot exist unless it is linked to a VMP
Name
The current name in short and full forms
VTM
An AMP is the representation of a single unit dose of a medicinal product that is (or hasbeen) made or marketed by a specific manufacturer or supplier. Its core descriptionrequires product name, strength, dosage form and manufacturer, but is devoid ofexplicit information attributable to pack size.
The unit dose is the smallest single entity of the product that can be physicallyhandled with the following defined deviations:
Continuous liquids excluding eye-drops : where the unit dose is expressed interms of the accepted normal sub-unit used as the basis of administration
Continuous solids: where the unit dose is expressed in terms of the acceptednormal sub-unit used as the basis of administration
Continuous semi-solids and eye-drops : where a consistent, physically
measurable unit or sub-unit cannot be defined and which is therefore notinstantiated.
An AMP cannot exist unless it is linked to one or more AMPPs
NameThe current name in full and short Semantic Normal Form, a previous value and reasonfor change. Each flavour of a AMP has a separate entry.
AvailabilityThe licence and “specials” status.
Regulation
Information on reglatory restrictions and rules about the product such as CSMnotification.
Reimbursement
Information on reimbursement
Component FlagIndicates if the product is normal, a compound product or a constituent product.
AMP
AMP_VMP
Links a set of AMPs to their corresponding VMP
An AMP must have a VMP but only one VMP
A VMP must be linked to at least one AMP and can be linked to several AMPs
An AMPP is the representation of each and every saleable/available pack (container ofdose units) of an AMP, in terms of description of quantity, of how many 'dose units' ofthe AMP (or weight, for solids and semi-solids) are present in the pack.
An AMPP may also be the representation of the number of “dose units” of an AMPpresent as a constituent of a compound pack. This constituent pack may exist only in aconceptual form or it may also be a saleable/available AMPP.
An AMPP cannot exist without a parent AMP
NameThe current name in full and short Semantic Normal Form.
Availability
The licence and “specials” status.
RegulationInformation 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 FlagIndicates if the pack is normal, a compound pack or a constituent pack.
AMPP
AMPP_AMP
Links a set of AMPPs totheir “parent” AMP.
Each AMPP must link to
one and only one AMP.
Each AMP must have oneor more AMPPs
A VMPP is the conceptual representation of each and every AMPP that exists for thelinked AMPs. This includes a conceptual representation of AMPPs that exist torepresent the components of a compound AMPP.
A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP
Name
A description of the pack in full and shortened Semantic Normal Forms.
SizeThe size of the pack is described in quantity and units.
ReimbursementInformation on reimbursement including “official” reimbursement price where it exists.
Component FlagIndicates if the pack is normal, a compound pack or a constituent pack.
VMPP
AMPP_VMPP
Links a set of AMPPs to the corresponding VMPP
Each AMPP must have one and only one VMPP
Each VMPP may be linked to one or more AMPPs
VMPP_VMP
A VMPP is linked to one andonly one VMP
A VMP must have one or
more VMPPs
ChildVMPP_ParentVMPP
A recursive link from a constituent child VMPP to the corresponding parentcompound VMPP
Each Child VMPP must have one and only one Parent VMPP
Each Parent VMPP may be linked to one or more CHILD VMPPsChildAMPP_ParentAMPP
A recursive link from a constituent child AMPP to the corresponding parentcompound 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
Medicine Entity Code (Ordered Medicine)
VTM, VMP, VMPP, AMP, AMPP
VTM, VMP, VMPP, AMP, AMPP
VTM, VMP, VMPP, AMP, AMPP
AMPP
Supplied Medicine Entity Code (Supplied Medication)
AMPP AMPP AMPP AMPP
dm+d – Supporting Attribute Vocabulary
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 oneor many
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
10/11/2003Blue WaveInformatics
ver 2.0c
dm +d Object Model
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
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 thefundamental 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.
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
HideName
If this flag is set the name is hidden from view
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 FlagIndicates if the product is normal, a compound product or a constituent product.
VMP
A VTM is the abstract conceptual
representation of the material defining the
prescriber's therapeutic intent, divorced fromformulation, dose or strength.
A VTM cannot exist unless it is linked to a VMP
Name
The current name in short and full forms
VTM
Dictionary of terms for the
physical conformation of thedrug as normally dispensed.
A Dose Form may be
orphaned from any VMP
NameA description of the dose form.
DoseForm
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 ofderivative.-
2) Base substances which may or may not be
available as actual ingredients. For example,
heparin or cyclizine.
An ingredient may be orphaned from any VMP or
AMP or from another parent or base ingredient.
Name
Name of the ingredient - no history or short forms
Base Ingredient
For salts etc a recursive pointer to the base
ingredient.
Ingredients
VMP_Ingredient
Links VMP to the set of active ingredientscommon to the AMPs linked to the VMP
For each link the quantity of the ingredient or
of its base is stored.
A VMP may have no ingredients attached orit may have one or more.
An ingredient may not be be attached to any
VMP or it may be attached to one or more.
StrengthAn indication of the quantity of the ingredient
in the product
Strength Basis
An indication of whether the strength refers
to the ingredient or its base
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.
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 acceptednormal sub-unit used as the basis of administration
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 cannot exist unless it is linked to one or more AMPPs
NameThe 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.
Availability
The licence and “specials” status.
Regulation
Information on reglatory restrictions and rules about the product such as CSM
notification.
Reimbursement
Information on reimbursement
Component Flag
Indicates if the product is normal, a compound product or a constituent product.
AMP
AMP_Ingredient
Links AMPs to ingredients marked as
“Interesting Excipients”.
The quantity of ingredient is not stored.
An AMP may be linked to no ingredientsor to one or more.
An ingredient may not be linked to any
AMP or it may be linked to one or more.
AMP_VMP
Links a set of AMPs to their corresponding VMP
An AMP must have a VMP but only one VMP
A VMP must be linked to at least one AMP and can be linked to several AMPs
A licensed route of administration
of a medicinal product.
A route may be orphaned from any
VMP or AMP.
NameDescription of the route of
administration
Route
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 itmay 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
AMP_Route
Links an AMP to the set of routes that have
been licensed for the product.
An AMP may have no linked Routes or it may
have one or more routes.
A route may not be linked to any AMP or
it may be linked to one or more AMPs
A list of Suppliers of medicinal products. The name
used will be that which appears on the productpackage and may be a manufacturer, a wholesaler
or a marketing agent.
A supplier may be an orphan with no link to anAMP or to another supplier.
Name
The name of the supplier together with a previous
name for that company
Suppliers
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.
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.
An AMPP may also be the representation of the number of “dose units” of an AMPpresent 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
NameThe current name in full and short Semantic Normal Form.
Availability
The licence and “specials” status.
RegulationInformation 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 FlagIndicates if the pack is normal, a compound pack or a constituent pack.
AMPP
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
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.
A VMPP cannot exist unless it is linked to one or more AMPPs and to a VMP
Name
A description of the pack in full and shortened Semantic Normal Forms.
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.
VMPP
AMPP_VMPP
Links a set of AMPPs to the corresponding VMPP
Each AMPP must have one and only one VMPP
Each VMPP may be linked to one or more AMPPs
VMPP_VMP
A VMPP is linked to one and
only one VMP
A VMP must have one or
more VMPPs
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
ChildAMPP_ParentAMPP
A recursive link from a constituent child AMPP to the corresponding parentcompound AMPP
Each Child AMPP must have one and only one Parent AMPP
Each Parent AMPP may be linked to one or more CHILD AMPPs
Dose Form vocabulary
Ingredient vocabulary
Route of Administrati
on vocabulary
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