Stream: german/kbv
Topic: 74_PR_VoS_Rezept_v1.10.010
Li Gui (Jun 25 2020 at 13:53):
I found definition of 74_PR_VoS_Rezept version 1.10.010 at https://simplifier.net/verordnungssoftware-schnittstelle/74prvosrezept
I am confused with the Element "MedicationRequest.dispenseRequest.quantity"
According KBV_ITA_VGEX_Anforderungskatalog_SST_VoS_V1.10.010.pdf,
"MedicationRequest.dispenseRequest.quantity.value" is "Angabe eines Vielfachen der Packungsgröße".
That "value" is definitively a number.
But what shall I set to "unit" and "code" ??
I found in 74_PR_VoS_Rezept, the
"MedicationRequest.dispenseRequest.quantity.code"
and
"MedicationRequest.dispenseRequest.quantity.unit"
have cardinality "1..1".
That means I MUST put something to the field.
But I really don't know what value shall I set.
Any help will be appreciated.
Another question is about "MedicationRequest.dispenseRequest.quantity.system".
Why is it set to be fixed value "http://unitsofmeasure.org"?
I found in basisprofil_de, that there is CodeSystem "http://fhir.de/CodeSystem/kbv/s-bmp-dosiereinheit".
Is that more fit to this "system"?
Christof Gessner (Jun 25 2020 at 16:32):
What might help for understanding the problem is the Description of the rule with id=cnt-3 for "Count" here: http://hl7.org/fhir/datatypes.html#Quantity
Christof Gessner (Jun 25 2020 at 16:38):
For your second question: If the requirement is "Angabe eines Vielfachen der Packungsgröße", why would you want to refer to dosiereinheit (engl. dosage unit)? This sounds more like something related to MedicationStatement.dosage or MedicationRequest.dosageInstruction.
Li Gui (Jun 26 2020 at 09:31):
@Christof Gessner
Thanks for your advice. I learn now that the "quantity.code" should be "1".
But what should be set to "quantity.unit"?
The second question is originally found in 74_PR_VoS_Dosierung(https://simplifier.net/verordnungssoftware-schnittstelle/74prvosdosierung)
from the definition of the Element "MedicationStatement.dosage:kodiert.doseQuantity:doseQuantity"
The "system" is also fixed value "http://unitsofmeasure.org". "unit", "code" are defined as "1..1".
And the KBV_ITA_VGEX_Anforderungskatalog_SST_VoS_V1.10.010.pdf said that
"Die einzelne Dosierungsangabe wird als Wert-Einheit-Paar angegeben. Die Einheiten sind auf Basis der BMP-Dosierungseinheiten übertragbar."
I am not sure that what to set to "doseQuantity.code" and "doseQuantity.unit"
Shall I pick up a code from CodeSystem "http://fhir.de/CodeSystem/kbv/s-bmp-dosiereinheit" ?
And let doseQuantity.code = code, doseQuantity.unit=display ?
Christof Gessner (Jun 26 2020 at 10:07):
Quantity.unit is a String, it can be seen as the display value of the unit code in quantity.code: "The unit element contains a displayable unit that defines what is measured. The unit may additionally be coded in some formal way using the code and the system"
the second question sounds to me like a misunderstanding or ambiguity of the word "Einheit": It could mean a unit of measure, or it could mean some kind of countable thing or entity like a tablet. Semantically the latter is an attribute of the medicinal product (pharmaceutical dose form, administrable dose form) and is often named "unit of presentation". I have often seen dose instructions using "units of presentation"in dosage instructions, which is a bit like saying "please take (3 tablets per day) of this (100 mg Aspirin tablet).
Li Gui (Jun 26 2020 at 14:38):
@Christof Gessner
Thanks for replay.
For the "MedicationStatement.dosage:kodiert.doseQuantity"
let me show an example:
I have structured prescription: "2-1-1-0",
"Darreichungsform" is "BEU"-"Beutel",
Each "Beutel" contains 100mg Asprin.
And in https://simplifier.net/BasisprofilDE/s-bmp-dosiereinheit there are Code "4=Beutel" and Code "v=mg"
Then the fhir object (for "morning") should be:
dosageQuantity.value=2
dosageQuantity.unit=Beutel
dosageQuantity.code=4
or
dosageQuantity.value=200
dosageQuantity.unit=mg
dosageQuantity.code=v
which is correct?
Christof Gessner (Jun 26 2020 at 17:20):
Note that dosage.doseQuantity specifies the quantity of the specified medication, not the quantity for each active ingredient(s).
MedicationStatement.dosage refers to the "thing" defined in MedicationStatement.medicationReference, which points to a Medication Resource. This medication Resource tells you precisely what form that "thing" has, and possibly what its ingredients are and their strengths (per volume or per dose-form-item etc.) and in what package it comes (with content.amount and a batch.lotNumber). Or all these details are just indicated using a Medication.code (e. g. a PZN).
With http://fhir.de/CodeSystem/kbv/s-bmp-darreichungsform you could express that you are referring to "Beutel" (Medication.form.coding.code=BEU), or that you talk about maybe a "Pulver zur Herstellung einer Lösung zum Einnehmen" (Medication.form.coding.code=PLE).
For "Beutel" then dosage.doseQuantity.value=2, dosage.doseQuantity.unit=1, dosage.doseQuantity.code=1 would indicate "2 Beutel".
Note however that for "Pulver" dosage.doseQuantity.value=200, dosage.doseQuantity.unit=mg, dosage.doseQuantity.code=mg means "200 mg Pulver" and not "200 mg Aspirin" ! (also see the explanation for Dosage.dose[x] at http://hl7.org/fhir/STU3/dosage-definitions.html#Dosage.dose_x_ )
As you said above, in this specification "dosage.doseQuantity.system" is fixed to "http://unitsofmeasure.org", this applies to both cases.
Li Gui (Jun 29 2020 at 14:50):
@Christof Gessner
Thanks for your replay.
I am still tinking about to use the CodeSystem https://simplifier.net/BasisprofilDE/s-bmp-dosiereinheit.
In bmp_v2.6.xsd I found that each prescription (line) can have "Dosiereinheit"
see "MP.S.M.du". It uses code from the "s-bmp-dosiereinheit".
The relation between "Dareichungsform" and "Dosiereinheit" is not a mapping.
It is Multi-to-Multi relation.
Multiple kinds of "Dosiereinheit" can refer to one "Dareichungsform", and vice versa.
For example for the "Dareichungsform" is "FLE=Flüssigkeit zum Einnehmen",
"Dosiereinheit" "7=Teelöffel" or "8=Esslöffel" both can be used as "MP.S.M.du".
Therefore I think, that the dosage.doseQuantity.code in MedicationStatement should be a code from CodeSystem "s-bmp-dosiereinheit".
How do you think about it?
Christof Gessner (Jul 02 2020 at 18:55):
I don't know if you are aiming at implementation of VoS as it is, or at discussing how specifications could be better harmonized across the board? Two different discussions, both are relevant.
Last updated: Apr 12 2022 at 19:14 UTC
