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 Template  epSOS CDA substanceAdministration

Template 1.3.6.1.4.1.12559.11.10.1.3.1.3.2 - epSOSCDASubstanceAdministration
Id 1.3.6.1.4.1.12559.11.10.1.3.1.3.2
Classification CDA entry level template
Relationship Specialization: template 2.16.840.1.113883.10.12.308 (2005‑09‑07)
Context Parent nodes of template element with id 1.3.6.1.4.1.12559.11.10.1.3.1.3.2
Version valid from 2011‑07‑25 status Under develeopment
Open/Closed Open (other than defined elements are allowed)
Description The general model is to record each prescribed medication in a <substanceAdministration> intent (moodCode='INT'). The <substanceAdministration> element may contain subordinate <sub-stanceAdministration> elements in a related component entry to deal with special cases (see the following sections below on Special Cases). These cases include split, tapered, or conditional dosing, or combination medications.

The use of subordinate <substanceAdministration> elements to deal with these cases is optional. The comment field should always be used in these cases to provide the same information as free text in the top level <substanceAdministration> element. There are a variety of special cases for dosing that need to be accounted for. These are described below. Most of these special cases involve changing the dosage or frequency over time, or based on some measurement. When the dosage changes, then additional entries are required for each differing dosage. The last case deals with combination medications.

For the purposes of WP3.5 only the normal, the split dosing and the combination medications are addressed.

- Normal Dosing 1.3.6.1.4.1.19376.1.5.3.1.4.7.1
This template identifier is used to identify medication administration events that do not require any special processing. The parent template is 1.3.6.1.4.1.19376.1.5.3.1.4.7. Medications that use this template identifier shall not use subordinate <substanceAdministation> acts.

- Combination Medications 1.3.6.1.4.1.19376.1.5.3.1.4.11
This template identifier is used to identify medication administration events that require special processing to handle combination medications. The parent template is 1.3.6.1.4.1.19376.1.5.3.1.4.7. A combination medication is made up of two or more other medications. These may be prepackaged, such as Percocet, which is a combination of Acetaminophen and oxycodone in predefined ratios, or prepared by a pharmacist, such as a GI cocktail.

In the case of the prepackaged combination, it is sufficient to supply the name of the combination drug product, and its strength designation in a single <substanceAdministation> entry. The dosing information should then be recorded as simply a count of administration units.

In the latter case of a prepared mixture, the description of the mixture should be provided as the product name (e.g., "GI Cocktail") , in the <substanceAdministration> entry. That entry may, but is not required, to have subordinate <substanceAdministration> entries included beneath it to record the components of the mixture.

- Split Dosing 1.3.6.1.4.1.19376.1.5.3.1.4.9
This template identifier is used to identify medication administration events that require special processing to handle split dosing. The parent template is 1.3.6.1.4.1.19376.1.5.3.1.4.7. A split dose is often used when different dosages are given at different times (e.g., at different times of day, or on different days). This may be to account for different metabolism rates at different times of day, or to simply address drug packaging deficiencies (e.g., and order for Coumadin 2mg on even days, 2.5mg on odd days is used because Coumadin does not come in a 2.25mg dose form).
In this case a subordinate <substanceAdministration> entry is required for each separate dosage
Used in
Used in 2 templates
Id Name as of
1.3.6.1.4.1.12559.11.10.1.3.1.2.1 SectionPrescription  Section Prescription 2013‑11‑29 12:19:34
link11 Dependency: 1.3.6.1.4.1.12559.11.10.1.3.1.1.1 epSOS-eP  epSOS-ePrescription 2012‑05‑03
1.3.6.1.4.1.12559.11.10.1.3.1.3.3 epSOSCDASupply  epSOS CDA Supply 2013‑11‑29 16:30:29
link11 Dependency: 1.3.6.1.4.1.12559.11.10.1.3.1.2.2 SectionDispensation  Section Dispensation 2013‑11‑29 15:09:17
link11 Dependency: 1.3.6.1.4.1.12559.11.10.1.3.1.1.2 epSOS-eD  epSOS-eDispensation 2012‑05‑03
Item DT Card Conf Desc Label
hl7:substanceAdministration
(epSOSCDASubstanceAdministration)
treetree @classCode
1 .. 1 F SBADM
treetree @moodCode
cs 1 .. 1  
  CONF
The value of @moodCode shall be drawn from value set DocumentSubstanceMood (DYNAMIC)
alert Error: Cannot find value set "DocumentSubstanceMood"
Example
<substanceAdministration classCode="SBADM" moodCode="INT|EVN">
  <templateId root="2.16.840.1.113883.10.20.1.24"/>
  <templateId root="1.3.6.1.4.1.12559.11.10.1.3.1.3.4"/>
  <id root="" extension=""/>
  <!-- Optional NOT TO BE USED for medication being administered or prescribed -->
  <code code="" codeSystem="" displayName="" codeSystemName=""/>
  <text>
    <reference value="#med-1"/>
  </text>
  <statusCode code="completed"/>
  <effectiveTime xsi:type="IVL_TS">
    <low value=""/>
    <high value=""/>
  </effectiveTime>
  <effectiveTime operator="A" xsi:type="TS|PIVL_TS|EIVL_TS| SXPR_TS"> : </effectiveTime>
  <routeCode code="" codeSystem="" displayName="" codeSystemName=""/>
  <doseQuantity value="" unit=""/>
  <approachSiteCode code="" codeSystem="" displayName="" codeSystemName=""/>
  <rateQuantity value="" unit=""/>
  <consumable> : . </consumable>
  <author>
    <time/>
    <assignedAuthor>
      <id/>
      <assignedPerson>
        <name/>
      </assignedPerson>
    </assignedAuthor>
  </author>
  <!-- 0..* entries describing the components -->
  <entryRelationship typeCode="COMP">
    <sequenceNumber value=""/>
  </entryRelationship>
  <!-- An optional entry relationship that indicates the reason for use -->
  <entryRelationship typeCode="RSON">
    <act classCode="ACT" moodCode="EVN">
      <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.4.1"/>
      <id root="" extension=""/>
    </act>
  </entryRelationship>
  <!-- Optional instrctions for Phramacist -->
  <entryRelationship typeCode="SUBJ"> ... </entryRelationship>
  <precondition>
    <criterion>
      <text>
        <reference value=""/>
      </text>
    </criterion>
  </precondition>
</substanceAdministration>
treetree hl7:templateId
II 1 .. 1 M CCD templateId (epSOSCDASubstanceAdministration)
treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.1.24
treetree hl7:templateId
II 1 .. 1 M epSOS templateId (epSOSCDASubstanceAdministration)
treeblank treetree @root
1 .. 1 F 1.3.6.1.4.1.12559.11.10.1.3.1.3.2
treetree hl7:templateId
II 1 .. 1 M IHE PCC templateId Note: The usage of statusCode values different from “completed” makes this specification not formally compliant with the current IHE PCC specification of the Medication Item Entry Content Module. All the requirements of conformance assertion with these IHE PCC templates cannot therefore be applied until the revision – if any - of the referenced IHE PCC templates. (epSOSCDASubstanceAdministration)
treeblank treetree @root
1 .. 1 F 1.3.6.1.4.1.19376.1.5.3.1.4.7
treetree hl7:templateId
II 0 .. 1 A "normal" <substanceAdministration> act that may not contain any subordinate <substanceAdministration> acts (epSOSCDASubstanceAdministration)
treeblank treetree @root
1 .. 1 F 1.3.6.1.4.1.19376.1.5.3.1.4.7.1
treetree hl7:templateId
II 0 .. 1 A <substanceAdministration> act that records combination medication component information in subordinate <substanceAdministration> acts. (epSOSCDASubstanceAdministration)
treeblank treetree @root
1 .. 1 F 1.3.6.1.4.1.19376.1.5.3.1.4.11
treetree hl7:templateId
II 0 .. 1 A <substanceAdministration> act that records split dose information in subordinate <substanceAdministration> acts. (epSOSCDASubstanceAdministration)
treeblank treetree @root
1 .. 1 F 1.3.6.1.4.1.19376.1.5.3.1.4.9
treetree hl7:id
II 1 .. 1 The following must be true for the prescription item ID:

- The prescription item ID must be globally unique

- In countries where there can be only one item per prescription, the prescription item ID must be the same as the prescription ID

- The prescription item ID can be used by the prescribing system or provider to identify the prescription to which it belongs. This provides the link from the dispensed medicine to the prescription.
(epSOSCDASubstanceAdministration)
Example
<id extension="23" root="1.2.246.556.12001.4.93.1.1"/>
treetree hl7:code
CD 0 .. 1 The <code> element is used to supply a code that describes the <substanceAdminstration> act, not the medication being administered or prescribed. This may be a procedure code, such as those found in ICD-10, or may describe the method of medication administration, such as by intravenous injection. The type of medication is coded in the consumable; do not supply the code for the medication in this element. This element is optional.
Note: One of the values from the Value Set epSOSCodeNoMedication shall be used in the <code> element to record that a patient is either not on medications, or that medications are not known.
(epSOSCDASubstanceAdministration)
CONF
The value of @code shall be drawn from value set SubstanceAdministrationActCode (DYNAMIC)
alert Error: Cannot find value set "SubstanceAdministrationActCode"
or
The value of @code shall be drawn from value set epSOSCodeNoMedication (DYNAMIC)
treetree hl7:text
ST 0 .. 1 (epSOSCDASubstanceAdministration)
Example
<text>...</text>
treeblank treetree hl7:reference
0 .. * The URI given in the value attribute of the <reference> element points to an element in the narrative content that contains the complete text describing the medication. In a CDA document, the URI given in the value attribute of the <reference> element points to an element in the narrative content that contains the complete text describing the medication. (epSOSCDASubstanceAdministration)
treeblank treeblank treetree @value
1 .. 1 F #eP_as_text
Example
<reference value="#eP_as_text">...</reference>
Contains inherited template rules CDA Reference (DYNAMIC) with overridden cardinality 0 .. *
treetree hl7:statusCode
CS 0 .. * The status of all <substanceAdministration> elements must be either "active" or "completed". Status of "active" indicates a currently valid prescription, status of completed indicates a previously taken medication. (epSOSCDASubstanceAdministration)
treeblank treetree @code
1 .. 1   @code shall be out of choice:
  • active
  • completed
Example
<statusCode code="active">...</statusCode>
treetree hl7:effectiveTime
IVL_TS 0 .. * The first <effectiveTime> element encodes the start and stop time of the medication regimen. This an interval of time (xsi:type='IVL_TS'), and must be specified as shown. This is an additional constraint placed upon CDA Release 2.0 by this profile, and simplifies the exchange of start/stop and frequency information between EMR systems.
The <low> and <high> values of the first <effectiveTime> element represent the start and stop times for the medication. The <low> value represents the start time, and the <high> value represents the stop time. If either the <low> or the <high> value is unknown, this shall be recorded by setting the nullFlavor attribute to UNK.

The <high> value records the end of the medication regime according to the information provided in the prescription or order. For example, if the prescription is for enough medication to last 30 days, then the high value should contain a date that is 30 days later then the <low> value. The rationale is that a provider, seeing an un-refilled prescription would normally assume that the medication is no longer being taken, even if the intent of the treatment plan is to continue the medication indefinitely.
(epSOSCDASubstanceAdministration)
Example
<effectiveTime xsi:type="IVL_TS">
  <low value="20130321"/>
  <high value="20140321"/>
</effectiveTime>
treetree hl7:effectiveTime
0 .. * The second <effectiveTime> element records the frequency of administration.
This <effectiveTime> element must be intersected with the previous time specification (operator='A'), producing the bounded set containing only those time specifications that fall within the start and stop time of the medication regimen. Several common frequency expressions appear in the table below, along with their XML representations.
This effectiveTime has a xsi:type of either TS, PIVL_TS, EIVL_TS, or SXPR_TS.
Frequency Description XML Representation
b.i.d. Twice a day <effectiveTime xsi:type='PIVL_TS' institutionSpecified='true' operator='A'> <period value='12' unit='h' /></effectiveTime>
q12h Every 12 hours <effectiveTime xsi:type='PIVL_TS' institutionSpecified='false' operator='A'> <period value='12' unit='h' /></effectiveTime>
Once Once, on 2005-09-01 at 1:18am. <effectiveTime xsi:type='TS' value='200509010118'/>
t.i.d. Three times a day, at times determined by the person administering the medication . <effectiveTime xsi:type='PIVL_TS' institutionSpecified='true' operator='A'> <period value='8' unit='h' /></effectiveTime>
q8h Every 8 hours <effectiveTime xsi:type='PIVL_TS' institutionSpecified='false' operator='A'> <period value='8' unit='h' /></effectiveTime>
qam In the morning <effectiveTime xsi:type='EIVL' operator='A'> <event code='ACM'/></effectiveTime>
  Every day at 8 in the morning for 10 minutes <effectiveTime xsi:type='PIVL_TS' operator='A'> <phase> <low value="198701010800" inclusive="true"/> <width value="10" unit="min"/> </phase> <period value='1' unit='d'/></effectiveTime>
q4-6h Every 4 to 6 hours. <effectiveTime xsi:type="PIVL_TS" institutionSpecified="false" operator="A"> <period xsi:type="PPD_PQ" value="5" unit="h"> <standardDeviation value="1" unit="h"/> </period></effectiveTime>

The mean (average) of the low and high values is specified for the period. The mean of 4 and 6 is 5. The standard deviation is recorded as one half the differences between the high and low values, with an unspecified distribution. The type attribute of the <effectiveTime> element describes the kind of frequency specification it contains. More detail is given for each type in the table below.
xsi:type Description
TS An xsi:type of TS represents a single point in time, and is the simplest of all to represent. The value attribute of the <effectiveTime> element specifies the point in time in HL7 date-time format (CCYYMMDDHHMMSS)
PIVL_TS An xsi:type of PIVL_TS is the most commonly used, representing a periodic interval of time. The <low> element of <phase> may be present. If so it specifies the starting point, and only the lower order components of this value are relevant with respect to the <period>. The <width> element represents the duration of the dose administration (e.g., for IV administration). The <period> indicates how often the dose is given. Legal values for the unit attribute of <period> are s, min, h, d, wk and mo representing seconds, minutes, hours, days, weeks, and months respectively.
EIVL_TS An xsi:type of EIVL_TS represents an event based time interval, where the event is not a precise time, but is often used for timing purposes (e.g. with meals, between meals, before breakfast, before sleep). Refer to the HL7 TimingEvent vocabulary for the codes to use for the <event> element. This interval may specify an <offset> which provides information about the time offset from the specified event (e.g., <offset><low value='-1' unit='h'/><width value='10' unit='min'/></offset> means 1 hour before the event. In that same example, the <width> element indicates the duration for the dose to be given.
SXPR_TS An xsi:type of SXPR_TS represents a parenthetical set of time expressions. This type is used when the frequency varies over time (e.g., for some cases of tapered dosing, or to handle split dosing). The <comp> elements of this <effectiveTime> element are themselves time expressions (using any of the types listed above). Each <comp> element may specify an operator (e.g. to intersect or form the union of two sets).
(epSOSCDASubstanceAdministration)
treetree hl7:routeCode
CE 0 .. 1 The <routeCode> element specifies the route of administration using the EDQM route of administration vocabulary. A code must be specified if the route is known, and the displayName attribute should be specified. If the route is unknown, this element shall not be sent. (epSOSCDASubstanceAdministration)
treeblank treetree @codeSystem
1 .. 1 F 1.3.6.1.4.1.12559.11.10.1.3.1.44.1 (EDQM)
treeblank treetree @codeSystemName
1 .. 1 F EDQM
treetree hl7:doseQuantity
IVL_PQ 0 .. 1 The dose is specified in the <doseQuantity> element. If a dose range is given (e.g., 1-2 tablets, or 325-750mg), then the <low> and <high> bounds are specified in their respective elements, otherwise both <low> and <high> have the same value. If the dose is in countable units (tablets, caplets, "eaches"), then the unit should be valorized = ‘1’The unit attribute – when expresses measureable units - shall be derived from the Value Sets epSOSUnits, 1.3.6.1.4.1.12559.11.10.1.3.1.42.16 based on the UCUM code system. The countable units attribute shall be derived from the value set epSOSDoseForm, OID 1.3.6.1.4.1.12559.11.10.1.3.1.42.2.
Any <low> and <high> elements used for <doseQuantity> or <rateQuantity> should contain a <translation> element that provides a <reference> to the <originalText> found in the narrative body of the document.

In a CDA document, any <low> and <high> elements used for <doseQuantity> or <rateQuantity> SHOULD contain a <translation> element that provides a <reference> to the <originalText> found in the narrative body of the document.
(epSOSCDASubstanceAdministration)
treeblank treetree @unit
1 .. 1  
  CONF
The value of @unit shall be drawn from value set epSOSUnits (DYNAMIC)
or
The value of @unit shall be drawn from value set epSOSDoseForm (DYNAMIC)
Example
<doseQuantity nullFlavor="UNK">...</doseQuantity>
treetree hl7:rateQuantity
IVL_PQ 0 .. 1 The rate is specified in the <rateQuantity> element. The rate is given in units that have measure over time. In this case, the units should be specified as a string made up of a unit of measure (see doseQuantity above), followed by a slash (/), followed by a time unit (s, min, h or d).
Again, if a range is given, then the <low> and <high> elements contain the lower and upper bound of the range, otherwise, they contain the same value.
Any <low> and <high> elements used for <doseQuantity> or <rateQuantity> should contain a <translation> element that provides a <reference> to the <originalText> found in the narrative body of the document.

In a CDA document, any <low> and <high> elements used for <doseQuantity> or <rateQuantity> SHOULD contain a <translation> element that provides a <reference> to the <originalText> found in the narrative body of the document.
(epSOSCDASubstanceAdministration)
Example
treetree hl7:consumable
where
[hl7:manufacturedProduct [hl7:templateId [@root='1.3.6.1.4.1.12559.11.10.1.3.1.3.1']]]
1 .. 1 (epSOSCDASubstanceAdministration)
treeblank treetree @typeCode
1 .. 1 F CSM
Contains inherited template rules epSOS CDA ManufacturedProduct (DYNAMIC) with overridden cardinality 1 .. 1
treetree hl7:entryRelationship
0 .. * Any medication may be the subject of further instructions to the pharmacist, for example to indicate that it should be labeled in Spanish, et cetera. This structure is included in the target substance administration or supply act using the <entryRelationship> element defined in the CDA Schema. The figure below is an example of recording an instruction for an <entry>, and is used as context for the sections to follow. (epSOSCDASubstanceAdministration)
Contains an element from template CDA Clinical Statement (DYNAMIC) with overridden cardinality 0 .. *