Stream: v2 to FHIR
Topic: What is the relation between RXE, RXR and R
Vikram Ranabhatt (Aug 29 2020 at 21:22):
As per the HL7 v2
http://www.hl7.eu/refactored/segRXE.html
16.7.166 RDE - Pharmacy/Treatment Encoded Order Message (Event O11) (4.A.5)
RXR appears at two place one at ORDER level(let us say outer) and other ORDER_DETAIL level(inner).
What each RXR refers to…?
will both inner and outer RXR may be present in a message ? as per the spec it looks both may be present?
How do we relate RXE, RXR and RXC that appears at outer ORDER LEVEL…
Here RXR can have 1…* cardinal while RXE and RXC is 1-1 cardinal.how to relate each segments ?
Jose Costa Teixeira (Aug 30 2020 at 12:00):
Hi Vikram. Not sure this helps, but you can see the Order Detail part as "what was originally ordered". The RDE message is an encoded order, for example a message containing what the pharmacist needs to deliver, responding to what the physician ordered.
Jose Costa Teixeira (Aug 30 2020 at 12:05):
For example the physician orders something IV but the pharmacist complements this and mentions IV Bolus as route. The "outer" RXR refers to the pharmacist's instruction, the 'inner' is about what was originally ordered
Vikram Ranabhatt (Aug 31 2020 at 04:24):
THanks @Jose Costa Teixeira for replying ....RXR field cardinality is one to many...Does this means that inner and outer RXR would be having exactly same number of segments in a message...sometime I observed that RXO is not present in the RDE O11 message...howto interpret this....does this means that there is no physician order or original order only ...MSH|^~\&|EPIC|XXXX|MURAL|XXXX|20190815153909||RDE^O11|52239703|P|2.4
PID|||XXXXXXXX^^^PA0^MR||XXXX-XXXXX^XXXX^XXXX||19XXXX06|M|XXXX^XXXX^XXXX|M
PV1||I|XX^XXXX^01^XXXX^R^^^^XXX XX XXXXXXX ICU||||19XXXX1751^XXXX^XXXX^^^^^^^^^^NP|XXXXXXXXXX^XXXXX^XXXX^H^^^^^^^^^NP|||||||||XXXXXXXXX^XXXX^XXXXX^A^^^^^^^^^NP||1083358513
ORC|NW|263926120^EPC|||||^ONCE&1615^X1^20200815161500^20200816041400^NORMAL||20200815153125|XXXX^XXXX^XXXX|XXXXXXXXXX^XXXX^XXXXX^^^^^^^^^^NP|XXXXXXXXXX^XXXX^XXXX^^^^^^^^^^NP|||||||||XXXX INPATIENT REV LOC|XXXX XX XXX XXXXX XXXX RD^^XXXXXX^XX^XXXXX-XXXX|(XXX)XXX-XXXX|XXXX XX XXX XXXXX XXXX XX^^XXXXXXX^XX^XXXXX-XXXX^US
RXE|^ONCE&1615^X1^20200815161500^20200816041400^NORMAL|FUR10I4^4 ML VIAL : FUROSEMIDE 10 MG/ML INJECTION^MED^^LASIX|80||mg|47^soln|Administer IV push over 3 minutes|||2|VL||AEXXXXXXX-XXXX^XXXX^XXXX|||||||||||||||||ADS|^LASIX
RXR|IV^intravenous
RXC||FUR10I4^4 ML VIAL : FUROSEMIDE 10 MG/ML INJECTION^MED^^LASIX|80|mg|40|mg|^LASIX
ZTA|||||1037
Craig Newman (Aug 31 2020 at 12:20):
For future reference, there is a dedicated v2 stream (https://chat.fhir.org/#narrow/stream/229447-V2) for topics like this. This stream is for discussion of conversions from v2 to FHIR.
Craig Newman (Aug 31 2020 at 12:22):
@Jean Duteau @John Hatem @Melva Peters - does the Pharmacy WG have anything to add?
Melva Peters (Aug 31 2020 at 13:56):
@Scott Robertson can you look at this and respond?
Daniel Zhang (Aug 31 2020 at 15:49):
@Vikram Ranabhatt
RXO is optional in an RDE^O11 Pharmacy Encoded Order Message, that's why it's not always present. As @Jose Costa Teixeira mentioned above, RXO has what is originally ordered by a physician. It can be included for comparison with what is encoded by a pharmacist.
Your sample message is likely an inpatient medication order (one time Furosemide IV) that was placed by a provider (in ORC-12) and has now been verified ("encoded") by the pharmacy (ORC-13) and is being sent to a dispensing system. The administration route is Intravenous as shown in RXR-1.
HL7 v2 allows multiple RXR's for alternatives of admin route/site/method combination, and that's probably why the corresponding cardinality in the v2-to-FHIR mapping is 1...*. Though, I personally have never seen an encoded order with multiple RXR's.
John Silva (Aug 31 2020 at 19:02):
A similar thing happens with the MedAdmin -- in RAS messages the RXR could be one of the routes specified in the RXO/RXE. For example, there can be multiple allowed routes of admin, e.g. PO, NG, etc. but at the time of administration, only one of these routes is actually used and in the RAS's RXR route.
Scott Robertson (Sep 02 2020 at 20:11):
(sorry didn't see all of the responses)
Yes, the first RXR is associated with the optional RXO. This RXO structure allows the encoded order to include a "copy" of the original order from the prescriber. The second RXR is with the required RXE. This is the pharmacy's instantiation of the prescriber's order. So the first RXR, if present, is the route the prescriber requested and the second RXR is the route the pharmacy is using.
In our (old) implementation, we never included the RXO structure in RDE messages.
As in John's example, multiple routes could be allowed by the prescriber and then constrained either by the pharmacy or at administration. Another simplistic example is when a topical product is being applied to multiple parts of the body - the route code would be the same but the site would be different.
Last updated: Apr 12 2022 at 19:14 UTC
