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ref Template  eCurrentMedication

Id 2.16.756.5.30.1.1.10.1.3 Effective Date valid from 2016‑05‑13
Status draft Draft Version Label 2017
Name eCurrentMedication Display Name eCurrentMedication
Description
The eCurrentMedication aims to fully comprise the current medication of a patient.

Information in eCurrentMedication
  • Identification of the healthcare professional who created the current eCurrentMedication and his signature and the date of creation.
  • Patient for whom the treatment is intended.
  • For each listed medication, the following should be entered: the Medication Brand Name (proprietary name) and/or the corresponding active substance (DCI), the dose per unit, the dose quantity, the pharmaceutical dose form, the route of administration, the method of administration, the duration of treatment, the treatment reason, general information, as well as information provided by the health care professional in charge of the indication.
  • Parts of this information or additional information should be enterable in free text form.
Changing the eCurrentMedication
A change in the medication of a patient should, if necessary, be justified by the healthcare professional by use of the eMedicationComment. This will generally lead to a new version of the eCurrentMedication.

eCurrentMedication Parameters
Parameters recommended by the IPAG for implementation represent the current eMedication "Minimal Data Set" and can be found in the IPAG report. In the ART-DECOR Dataset they are marked with MDS for Minimal Data Set. The remaining parameters are not recommended for implementation at this point in time. The IPAG will continue to revise these.
Source: IPAG eMedikation, 7.6.2017

Relation to IHE Pharmacy
The eCurrentMedication it derived from the IHE Pharmacy PML Supplement (Pharmacy Medication List) and the IHE Pharmacy MTP Supplement (Medication Treatment Plan). The planned medication entries in the eCurrentMedication follow the contraints of the IHE MTP entries.
Context Parent nodes of template element with id 2.16.756.5.30.1.1.10.1.3
Classification CDA Document Level Template
Open/Closed Open (other than defined elements are allowed)
Associated with
Associated with 1 concept
Id Name Data Set
chdachpharm-dataelement-60 Ausstelldatum (Erstellungsdatum)
Used by / Uses
Used by 1 transaction and 0 templates, Uses 14 templates
Used by as Name Version
chdachpharm-transaction-16 Transaction draft eCurrentMedication 2016‑07‑01 15:02:34
Uses as Name Version
2.16.756.5.30.1.1.10.2.25 Include draft Realm (2017) DYNAMIC
2.16.756.5.30.1.1.10.2.24 Include active CDA TypeId DYNAMIC
2.16.756.5.30.1.1.10.2.18 Include draft Template Id (2017) DYNAMIC
2.16.756.5.30.1.1.10.9.3 Include active CDA Document Id DYNAMIC
2.16.756.5.30.1.1.10.2.19 Include draft Confidentiality Code (2017) DYNAMIC
2.16.756.5.30.1.1.10.2.22 Include draft Document language (2017) DYNAMIC
2.16.756.5.30.1.1.10.9.7 Include active CDA SetId VersionNumber DYNAMIC
2.16.756.5.30.1.1.10.2.31 Include draft recordTarget (2017) DYNAMIC
2.16.756.5.30.1.1.10.2.32 Include draft author (2017) DYNAMIC
2.16.756.5.30.1.1.10.2.3 Include active CDA custodian DYNAMIC
2.16.756.5.30.1.1.10.2.5 Include active CDA legalAuthenticator DYNAMIC
2.16.756.5.30.1.1.10.2.13 Include draft Document Replacement (2017) DYNAMIC
2.16.756.5.30.1.1.10.3.9 Containment draft eCurrentMedication Section Content Module (2017) DYNAMIC
2.16.756.5.30.1.1.10.3.2 Containment draft Remarks Section (2017) DYNAMIC
Relationship Specialization: template 2.16.840.1.113883.10.12.2 (DYNAMIC)
Specialization: template 2.16.756.5.30.1.1.1.1 (DYNAMIC)
Example
header
<cda:ClinicalDocument>
  <cda:realmCode code="CHE"/>  <cda:typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>  <!-- IHE PCC -->
  <cda:templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <!-- IHE PML -->
  <cda:templateId root="1.3.6.1.4.1.19376.1.9.1.1.5"/>  <!-- CDA-CH -->
  <cda:templateId root="2.16.756.5.30.1.1.1.1" extension="CDA-CH"/>  <!-- CDA-CH-PHARM eCurrentMedication -->
  <cda:templateId root="2.16.756.5.30.1.1.10.1.3"/>  <!-- id of this eCurrentMedication -->
  <cda:id root="2.16.756.5.30.1.1.10.1.3" extension="658ab5ea-1f63-11e6-b6ba-3e1d05defe78"/>  <!-- Coding equivalent IHE PHARM PML -->
  <cda:code code="56445-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication summary Document"/>  <cda:title>eCurrentMedication</cda:title>  <cda:effectiveTime value="20111129110000+0100"/>  <cda:confidentialityCode code="30003" codeSystem="2.16.756.5.30.1.127.3.10.1.5" displayName="Medical data"/>  <cda:languageCode code="de-CH"/>  <!-- snip -->
</cda:ClinicalDocument>
Item DT Card Conf Description Label
hl7:ClinicalDocument
(eCurrentMedication)
Included 1 … 1 M from 2.16.756.5.30.1.1.10.2.25 Realm (DYNAMIC)
hl7:realmCode
CS 1 … 1 M (eCurrentMedication)
@code
CONF 1 … 1 F CHE
Included 1 … 1 M from 2.16.756.5.30.1.1.10.2.24 CDA TypeId (DYNAMIC)
hl7:typeId
II 1 … 1 M (eCurrentMedication)
@root
uid 1 … 1 F 2.16.840.1.113883.1.3
@extension
st 1 … 1 F POCD_HD000040
hl7:templateId
II 1 … 1 M (eCurrentMedication)
@root
uid 1 … 1 F 1.3.6.1.4.1.19376.1.5.3.1.1.1
  IHE PCC
hl7:templateId
II 1 … 1 M (eCurrentMedication)
@root
uid 1 … 1 F 1.3.6.1.4.1.19376.1.9.1.1.5
  IHE PHARM PML
Included from 2.16.756.5.30.1.1.10.2.18 Template Id (DYNAMIC)
hl7:templateId
II 1 … 1 R (eCurrentMedication)
@extension
st 1 … 1 F CDA-CH
@root
uid 1 … 1 F 2.16.756.5.30.1.1.1.1
hl7:templateId
II 1 … 1 M (eCurrentMedication)
@root
uid 1 … 1 F 2.16.756.5.30.1.1.10.1.3
  CDA-CH-PHARM eCurrentMedication
Included 1 … 1 M from 2.16.756.5.30.1.1.10.9.3 CDA Document Id (DYNAMIC)
hl7:id
II 1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-59 Referenz-ID des Dokuments
hl7:code
CE 1 … 1 M (eCurrentMedication)
@code
CONF 1 … 1 F 56445-0
@codeSystem
1 … 1 F 2.16.840.1.113883.6.1 (Logical Observation Identifier Names and Codes)
@codeSystemName
1 … 1 F LOINC
@displayName
1 … 1 F Medication summary Document
hl7:title
ST 0 … 1 eCurrentMedication (eCurrentMedication)
hl7:effectiveTime
TS.CH.TZ 1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-60 Ausstelldatum (Erstellungsdatum)
Included 1 … 1 M from 2.16.756.5.30.1.1.10.2.19 Confidentiality Code (DYNAMIC)
hl7:confidentialityCode
CE CNE 1 … 1 M (eCurrentMedication)
  CONF
The value of @code shall be drawn from value set 2.16.756.5.30.1.1.11.1 Swiss Confidentiality Codes (DYNAMIC)
Included 1 … * M from 2.16.756.5.30.1.1.10.2.22 Document language (DYNAMIC)
hl7:languageCode
CS 1 … * M (eCurrentMedication)
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 HumanLanguage (DYNAMIC)
Included 0 … 1 from 2.16.756.5.30.1.1.10.9.7 CDA SetId VersionNumber (DYNAMIC)
hl7:setId
II 0 … 1 R (eCurrentMedication)
  Example <setId extension="807563C2-5146-11D5-A672-00B0D022E945" root="2.16.756.5.30.1.1.1.1"/>
hl7:versionNumber
INT.NONNEG 0 … 1 R (eCurrentMedication)
  Example <versionNumber value="1"/>
Included 1 … 1 M from 2.16.756.5.30.1.1.10.2.31 recordTarget (DYNAMIC)
hl7:recordTarget
1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-3 Patient
hl7:patientRole
1 … 1 M (eCurrentMedication)
hl7:id
II 1 … * R Contains the patient identifiers. The OID (root attribute) SHALL be published in the oid registry of switzerland. Identifiers can be from a Master Patient Index (MPI) or internal numbers from institutions. (eCurrentMedication)
  Example <id extension="807569999999999930200" root="2.16.756.5.30.4.9.1.1.1000.200.3"/>
hl7:addr
AD 0 … * (eCurrentMedication)
hl7:streetAddressLine
ADXP 0 … * (eCurrentMedication)
hl7:postalCode
ADXP 0 … * (eCurrentMedication)
hl7:city
ADXP 0 … * (eCurrentMedication)
hl7:country
ADXP 0 … * (eCurrentMedication)
hl7:telecom
TEL 0 … * (eCurrentMedication)
hl7:patient
1 … 1 M (eCurrentMedication)
hl7:name
PN 1 … 1 M (eCurrentMedication)
hl7:given
ENXP 1 … * M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-24 Vorname
hl7:family
ENXP 1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-23 Name
hl7:administrativeGenderCode
CE 1 … 1 R (eCurrentMedication)
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.1 AdministrativeGender (DYNAMIC)
hl7:birthTime
TS 1 … 1 M The birthday SHALL be provided at least to the birth year. (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-25 Geburtsjahr
chdachpharm-dataelement-26 Geburtsdatum
Included 1 … * R from 2.16.756.5.30.1.1.10.2.32 author (DYNAMIC)
hl7:author
1 … * R (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-2 Behandelnder
hl7:functionCode
CE 0 … 1 (eCurrentMedication)
hl7:time
TS 1 … 1 R (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-52 Verabreichungsweg
hl7:assignedAuthor
1 … 1 M (eCurrentMedication)
@classCode
cs 0 … 1 F ASSIGNED
hl7:id
II 1 … * R The GLN identifier for the health care professional SHOULD be provided. (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-9 GLN-Nr.
  Example <id root="2.51.1.3" extension="7601000000000"/>
hl7:code
CE 0 … 1 (eCurrentMedication)
hl7:addr
AD 0 … * (eCurrentMedication)
hl7:telecom
TEL 0 … * (eCurrentMedication)
hl7:assignedPerson
1 … 1 M (eCurrentMedication)
Included M from 2.16.756.5.30.1.1.10.2.37 name (DYNAMIC)
hl7:name
PN 1 … * M (eCurrentMedication)
hl7:given
ENXP 1 … * M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-8 Vorname
hl7:family
ENXP 1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-7 Name
hl7:representedOrganization
1 … 1 M (eCurrentMedication)
Included from 2.16.756.5.30.1.1.10.2.34 representedOrganisationPart (DYNAMIC)
hl7:id
II 1 … * R (eCurrentMedication)
hl7:name
ON 1 … * R (eCurrentMedication)
hl7:addr
AD 1 … 1 R (eCurrentMedication)
hl7:streetAddressLine
ADXP 1 … * M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-16 Adresse
hl7:postalCode
ADXP 1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-17 PLZ
hl7:city
ADXP 1 … 1 M (eCurrentMedication)
  target Associated with concepts:
chdachpharm-dataelement-18 Ort
hl7:telecom
TEL 1 … * R (eCurrentMedication)
Included 1 … 1 R from 2.16.756.5.30.1.1.10.2.3 CDA custodian (DYNAMIC)
hl7:custodian
1 … 1 R (eCurrentMedication)
@typeCode
cs 0 … 1 F CST
hl7:assignedCustodian
1 … 1 R (eCurrentMedication)
@classCode
cs 0 … 1 F ASSIGNED
hl7:representedCustodianOrganization
1 … 1 R (eCurrentMedication)
@classCode
cs 0 … 1 F ORG
@determinerCode
cs 0 … 1 F INSTANCE
hl7:id
II 1 … * M (eCurrentMedication)
hl7:name
ON 0 … 1 (eCurrentMedication)
hl7:telecom
TEL 0 … 1 (eCurrentMedication)
hl7:addr
AD 0 … 1 (eCurrentMedication)
Included 0 … 1 from 2.16.756.5.30.1.1.10.2.5 CDA legalAuthenticator (DYNAMIC)
hl7:legalAuthenticator
0 … 1 (eCurrentMedication)
@typeCode
cs 0 … 1 F LA
@contextControlCode
cs 0 … 1 F OP
  target Associated with concepts:
chdachpharm-dataelement-37 Signatur des Erstellers
hl7:time
TS 1 … 1 R (eCurrentMedication)
hl7:signatureCode
CS 1 … 1 R (eCurrentMedication)
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10282 ParticipationSignature (DYNAMIC)
hl7:assignedEntity
1 … 1 R Contains 2.16.756.5.30.1.1.10.9.12 CDA AssignedEntity (DYNAMIC) (eCurrentMedication)
Included 0 … 1 from 2.16.756.5.30.1.1.10.2.13 Document Replacement (DYNAMIC)
hl7:relatedDocument
0 … 1 (eCurrentMedication)
@typeCode
cs 1 … 1 F RPLC
 
hl7:parentDocument
1 … 1 R (eCurrentMedication)
hl7:id
II 1 … 1 M (eCurrentMedication)
@extension
st 1 … 1 R
@root
uid 1 … 1 R
hl7:setId
II 1 … 1 M (eCurrentMedication)
@extension
st 1 … 1 R
@root
uid 1 … 1 R
  Schematron assert role red error  
  test (@root=/ClinicalDocument/id/@root) and (@extension=/ClinicalDocument/id/@extension)  
  Message ClinicalDocument/setId: MUST be identical to the one of the replaced document  
hl7:versionNumber
INT 1 … 1 M (eCurrentMedication)
  Schematron assert role red error  
  test @value > /ClinicalDocument/versionNumber/@value  
  Message ClinicalDocument/versionNumber: MUST be higher than the one of the replaced document  
hl7:component
1 … 1 R (eCurrentMedication)
@contextConductionInd
bl 1 … 1 R
hl7:structuredBody
1 … 1 M (eCurrentMedication)
hl7:component
1 … 1 M Contains 2.16.756.5.30.1.1.10.3.9 eCurrentMedication Section Content Module (DYNAMIC) (eCurrentMedication)
treeblank treeblank treeblank where [hl7:section [hl7:templateId [@root='2.16.756.5.30.1.1.10.3.9']] [hl7:templateId [@root='1.3.6.1.4.1.19376.1.9.1.2.5']]]
hl7:component
0 … 1 Contains 2.16.756.5.30.1.1.10.3.2 Remarks Section (DYNAMIC) (eCurrentMedication)
treeblank treeblank treeblank where [hl7:section [hl7:templateId [@root='2.16.756.5.30.1.1.10.3.2']]]