Electronic Transfer of Prescriptions

DRAFT ONLY 2 DRAFT ONLY

Draft ATS 4700.3.1 Platform independent (logical) information model to support electronic transfer of prescriptions_v1 -

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Standards Australia 1 Information in fields should be filled in if known or left as is. 2

Electronic Transfer of Prescriptions Part Title: Platform independent (logical) information model to support electronic transfer of

prescriptions

Designation: ATS 4700.3.X

Part Number: 1

Supersedes Standard No: NA

AustralianORJoint: Australian

Creation Date: 2011-03-30

Revision Date:

Issue Date: 2011-03-30

Committee Number: IT-014

Committee Title: Health Informatics

Subcommittee Number: IT-014-06-04

Subcommittee Title: Prescription Messages

Project Manager: Click here and type Project Managers name in full

PMs Email Address: [email protected]

Shadow Project Manager: Click here and type Shadow Project Manager's name

Shadow PM’s Email

Address:

Click here and type email address

WP Operator: Type Surname of WP Operator/PM (eg: Smith, Jones, Smith)

Project Office ID Number: Click here and type Project Office ID Number

Project Number: Click here and type Project Number (ignoring leading zeros)

Combined Procedure?: Click here and type Yes or No

Committee Doc No.: ONE Alpha followed by FOUR numerical (eg: N9999)

Stage: PRE PUBLICATION

Committee Reps: Click here and type committee reps using shift return for new line

Additional Interests: Click here and type organisation names using shift return for new line

Product Type ATS

3 Amendment 4

Amendment No.: Click here and type Amendment Number

Amdt Published Date: Click here and type Date to be Published (yyyy-mm-dd)

Std Published Year: Click here and type Published Year



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PREFACE 5

6 7

This Technical Specification was prepared by Standards Australia Committee IT-014, Health 8 Informatics. The purpose of this document is to define the role behaviours and service interfaces for the 9

Electronic Transfer of Prescription Specification. 10 11

The terms ‗normative‘ and ‗informative‘ have been used in this Technical Specification to define the 12 application of the appendix to which they apply. A ‗normative‘ appendix is an integral part of a 13

Technical Specification, whereas an ‗informative‘ appendix is only for information and guidance. 14 15

Funding for this publication has been provided by the Commonwealth Department of Health and 16 Ageing. The Commonwealth makes no representation or warranty that the information in this 17

publication is correct and accurate. 18

19

20



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CONTENTS 21

22

23

PREFACE 3 24

SECTION 1 SCOPE AND GENERAL 2 25

1.1 SCOPE ............................................................................................................................. 2 26

1.2 Document Purpose ................................................................................................................ 2 27

1.3 Intended Audience ................................................................................................................ 2 28

1.4 Overview ............................................................................................................................. 2 29

1.5 Document Scope ................................................................................................................... 3 30

1.6 Known Issues ........................................................................................................................ 3 31

2 ePrescription Structured Document 5 32

2.1 EPRESCRIPTION ................................................................................................................ 5 33

3 ePrescription Context 8 34

3.1 SUBJECT OF CARE ............................................................................................................ 8 35

3.2 PRESCRIBER .................................................................................................................... 10 36

3.3 PRESCRIBER ORGANISATION ...................................................................................... 12 37

3.4 Prescription Identifier ......................................................................................................... 14 38

4 Prescription Item 15 39

4.1 PRESCRIPTION ITEM ...................................................................................................... 15 40

4.2 DateTime Prescription Written ........................................................................................... 16 41

4.3 DateTime Prescription Expires ........................................................................................... 17 42

4.4 Prescription Item Identifier ................................................................................................. 18 43

4.5 Therapeutic Good Identification ......................................................................................... 19 44

4.6 Therapeutic Good Identification Values ............................................................................. 20 45

4.7 Formula ........................................................................................................................... 21 46

4.8 DOSAGE ........................................................................................................................... 22 47



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4.9 Dose Instruction .................................................................................................................. 24 48

4.10 Instructions for Use ........................................................................................................... 25 49

4.11 Quantity of Therapeutic Good........................................................................................... 25 50

4.12 Brand Substitute Allowed ................................................................................................. 26 51

4.13 Maximum Number of Repeats .......................................................................................... 27 52

4.14 Minimum Interval Between Repeats ................................................................................. 28 53

4.15 Medical Benefit Category Type ........................................................................................ 29 54

4.16 Medical Benefit Category Type Values ............................................................................ 30 55

4.17 Grounds for Concurrent Supply ........................................................................................ 31 56

4.18 Grounds for Concurrent Supply Values ............................................................................ 33 57

4.19 PBS/RPBS Authority Approval Number ........................................................................... 34 58

4.20 State Authority Number .................................................................................................... 35 59

4.21 Reason for Therapeutic Good ........................................................................................... 36 60

4.22 Additional Comments ....................................................................................................... 37 61

5 Observations Section 39 62

5.1 OBSERVATIONS .............................................................................................................. 39 63

5.2 BODY WEIGHT ................................................................................................................ 39 64

5.3 Body Weight Value ............................................................................................................ 40 65

5.4 DateTime of Observation .................................................................................................... 41 66

5.5 BODY HEIGHT ................................................................................................................. 42 67

5.6 Body Height Value ............................................................................................................. 43 68

5.7 DateTime of Observation .................................................................................................... 44 69

6 Prescription Note Detail 46 70

6.1 PRESCRIPTION NOTE DETAIL ...................................................................................... 46 71

6.2 Note ........................................................................................................................... 46 72

7 UML Class Diagram 48 73

8 Dispense Record Structured Document 2 74



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8.1 DISPENSE RECORD ........................................................................................................... 2 75

10 Dispense Record Context 4 76

10.1 SUBJECT OF CARE .......................................................................................................... 4 77

10.2 Subject of Care Entitlement Type Values ........................................................................... 5 78

10.3 DISPENSER ....................................................................................................................... 6 79

10.4 DISPENSING ORGANISATION ....................................................................................... 8 80

11 4 Dispense Item 10 81

11.1 4.1 DISPENSE ITEM ....................................................................................................... 10 82

11.2 Dispense Item Identifier .................................................................................................... 11 83

11.3 DateTime of Dispense Event ............................................................................................. 12 84

11.4 Prescription Item Identifier ............................................................................................... 12 85

11.5 Therapeutic Good Identification ....................................................................................... 13 86

11.6 Therapeutic Good Identification Values ............................................................................ 15 87

11.7 Formula ........................................................................................................................... 15 88


11.9 Brand Substitution Occurred ............................................................................................. 17 90

11.10 Maximum Number of Repeats ........................................................................................ 18 91

11.11 Number of this Dispense ................................................................................................. 19 92

11.12 Claim Category Type ...................................................................................................... 20 93

11.13 Claim Category Type Values .......................................................................................... 21 94

11.14 Label Instruction ............................................................................................................. 22 95

11.15 Early Supply with Pharmaceutical Benefit ...................................................................... 23 96

11.16 Additional Comments ..................................................................................................... 24 97

12 UML Class Diagram 25 98

13 Prescription Request Structured Document 26 99

13.1 PRESCRIPTION REQUEST ............................................................................................ 26 100

14 Prescription Request Context 28 101



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14.1 SUBJECT OF CARE ........................................................................................................ 28 102

14.2 Subject of Care Entitlement Type Values ......................................................................... 29 103

14.3 DISPENSER ..................................................................................................................... 30 104

14.4 DISPENSING ORGANISATION ..................................................................................... 32 105

14.5 PRESCRIBER .................................................................................................................. 33 106

14.6 PRESCRIBER ORGANISATION .................................................................................... 35 107

14.7 Prescription Request Identifier .......................................................................................... 36 108

14.8 DateTime Prescription Request Written ............................................................................ 37 109

15 Prescriber Instruction Detail 38 110

15.1 PRESCRIBER INSTRUCTION DETAIL ......................................................................... 38 111

15.2 PRESCRIBER INSTRUCTION RECIPIENT ................................................................... 39 112

15.3 DateTime Prescriber Instruction Received ........................................................................ 41 113

15.4 Prescriber Instruction ........................................................................................................ 41 114

15.5 Prescriber Instruction Source ............................................................................................ 42 115

15.6 Prescriber Instruction Communication Medium ................................................................ 43 116

15.7 Prescriber Instruction Communication Medium Values .................................................... 44 117

16 Prescription Request Item 46 118

16.1 PRESCRIPTION REQUEST ITEM .................................................................................. 46 119

16.2 Therapeutic Good Identification ....................................................................................... 47 120

16.3 Therapeutic Good Identification Values ............................................................................ 49 121

16.4 Formula ........................................................................................................................... 49 122

16.5 DOSAGE .......................................................................................................................... 50 123

16.6 Dose Instruction ................................................................................................................ 52 124

16.7 Instructions for Use ........................................................................................................... 53 125


16.9 Brand Substitute Allowed ................................................................................................. 54 127

16.10 Medical Benefit Category Type ...................................................................................... 55 128

16.11 Medical Benefit Category Type Values .......................................................................... 56 129



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16.12 PBS/RPBS Authority Approval Number ......................................................................... 57 130

16.13 State Authority Number .................................................................................................. 58 131

16.14 Additional Comments ..................................................................................................... 59 132

17 Requester Note 61 133

17.1 REQUESTER NOTE ........................................................................................................ 61 134

APPENDIX A Participations 64 135

A1 Subject of Care ................................................................................................................... 64 136

A2 Prescriber ........................................................................................................................... 68 137

A3 Prescriber Organisation ....................................................................................................... 71 138

A4 Dispenser ........................................................................................................................... 73 139

A5 Dispensing Organisation ....................................................................................................... 6 140

APPENDIX B Structured Dose Detailed Clinical Model 10 141

APPENDIX C : Comparison Between Printed and Electronic Prescriptions 12 142

C1 A Blank Printed Prescription ............................................................................................... 12 143

C2 Mapping From Printed to Electronic Prescriptions .............................................................. 13 144 145



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STANDARDS AUSTRALIA 146 147

Australian Standard 148

Electronic Transfer of Prescriptions 149 150

Part 1: Platform independent (logical) information model to support electronic transfer 151 of prescriptions 152

153

SECTION 1 SCOPE AND GENERAL 154

155

1.1 SCOPE 156

This document is a Platform Independent (logical) information model (PIM) for an electronic 157 prescription (e-Prescription). It specifies the information structure of t electronic prescriptions in order 158 to support the Electronic Transfer of Prescription (ETP). 159

160

1.2Document Purpose 161

This document describes the Platform Independent (logical) information model for an electronic 162 prescription, an e-Prescription, from a clinical communication perspective. 163

For the purposes of this document: 164

Electronic Prescription means an electronic prescription which is generated in accordance with a 165 process by which a prescription is electronically generated by a prescriber, authenticated 166 (electronically signed), securely transmitted (either directly or indirectly) for dispensing and supply, 167 seamlessly integrated into the pharmacy dispensing software and, in the case of Pharmaceutical 168 Benefits Scheme (PBS) prescriptions, is available to be electronically sent to Medicare Australia for 169 claiming purposes. This definition does not preclude the use of paper-based processes to support 170 ePrescribing activity. 171

— [DHA2010a] 172

It is also a key input to ATS 4700.3.3-5 which describes how to implement this logical model in 173 electronic prescriptions using the HL7 Clinical Document Architecture [HL7CDAR2]. 174

1.3 Intended Audience 175

This document is aimed at software development teams, architects, designers, clinicians and 176 informatics researchers who are responsible for the delivery of clinical applications, infrastructure 177 components and messaging interfaces 178

1.4 Overview 179

The processes behind e-Prescriptions are: 180

1. A prescriber, using an Electronic Prescribing System (EPS), creates an electronic prescription 181 (e-Prescription) and transmits it to a Prescription Exchange Service (PES). A PES is an online service 182 for the exchange of prescriptions; it is operated by a PES provider and is accessible in any participating 183 pharmacy. 184

2. The dispenser retrieves the electronic prescription from the PES. 185

3. Dispensing takes place, which may entail a number of tasks, including further interaction 186 between the dispenser and the subject of care, between the dispenser and the prescriber or other 187 authorities such as Medicare Australia. 188



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4. After the dispensing is completed, an electronic dispense record, called a PES–DR, containing 189 information pertinent to that event is created and stored in the PES. 190

191

1.5 Document Scope 192

This document specifies the essential clinical data groups and elements to be captured in an electronic 193 prescription exchange and the constraints that should be applied. Its scope is to support prescriptions 194 that are generated by medical practitioners and dispensed by pharmacists. 195

The types of prescriptions are: 196

• PBS/RPBS prescriptions; 197

• PBS/RPBS authority prescriptions; and 198

• non-PBS prescriptions (private prescriptions). 199

This is not a guide to implementing any specific messaging standard. 200

201

1.6 Known Issues 202

This following are the known issues with this specification at the time of publishing. 203

204

Reference Description

DOSAGE In the NEHTA eTP R1.1 Structured Document Template Specification, dose

description is specified as a single text field. This modeling decision was

based on the initial requirement gathering and stakeholder consultations

leading up to the development of eTP R1.1 suite of specifications. NEHTA

receives extensive feedbacks on eTP R1.1 documents since its release in 2010.

One common feedback theme highlights the need/desirability to have fully

structured/atomic dose instruction component in addition to the free text dose

description data item.

A fully structured dose instruction information component has been developed

as part of the NEHTA Medication Detailed Clinical Models development

processes. The data hierarchy that defines the structured dose instruction

component is included in this draft ATS (APPENDIX B) for public

comments. It is intended that, if accepted by the Standards community, this

data structure will be included in the final ATS for publication. The

requirements for and modeling of complex dosing instructions will need to be

explored further.

The word MUST

in Conditions of

Use

In conformance statements this document uses the term MUST in place of

NEHTA's preferred term SHALL.

Participation

Type and Role

The data elements Participation Type and Role (used in the in the

Participation data groups SUBJECT OF CARE, DISPENSER, DISPENSING

ORGANISATION, PRESCRIBER, PRESCRIBER ORGANISATION and

PRESCRIBER INSTRUCTION RECIPIENT) do not have defined value

domains.



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Reference Description

Value domains The following data elements have value domains which have not yet been

published:

Medical Benefit Category Type,

Grounds for Concurrent Supply, and

Claim Category Type, and

Prescriber Instruction Communication Medium

Entitlement Type (used in the in the Participation data groups SUBJECT OF

CARE, DISPENSING ORGANISATION, PRESCRIBER and PRESCRIBER

INSTRUCTION RECIPIENT)

It is expected that the list of values in this document will be released as part of

SNOMED CT®-AU

1with no additions or omissions.

205 206



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207

208

2 ePrescription Structured Document 209

2.1 EPRESCRIPTION 210

Identification 211

212

Name EPRESCRIPTION

Metadata Type Structured Document

Identifier SD-16100

OID 1.2.36.1.2001.1001.101.100.16100

Definition 213

214

Definition An ePrescription is an electronic prescription defined as follows:

Electronic Prescription means an electronic prescription which is

generated in accordance with a process by which a prescription

is electronically generated by a prescriber, authenticated

(electronically signed), securely transmitted (either directly or

indirectly) for dispensing and supply, seamlessly integrated into

the pharmacy dispensing software and, in the case of

Pharmaceutical Benefits Scheme (PBS) prescriptions, is

available to be electronically sent to Medicare Australia for

claiming purposes. This definition does not preclude the use of

paper-based processes to support ePrescribing activity

[DHA2010a].

Definition Source Department of Health and Ageing

Synonymous Names

Scope This is limited to prescriptions made by an authorised medical

practitioner for dispensing by a pharmacist.

Scope Source NEHTA

Data Hierarchy 215

216

EPRESCRIPTION 1..1

CONTEXT

SUBJECT OF CARE 1..1

PRESCRIBER 1..1

PRESCRIBER ORGANISATION 1..1



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Prescription Identifier 1..1

CONTENT

PRESCRIPTION ITEM 1..1

DateTime Prescription Written 1..1

DateTime Prescription Expires 1..1

Prescription Item Identifier 1..1

Therapeutic Good Identification 1..1

Formula 0..1

DOSAGE 0..1

Dose Instruction 1..1

Instructions for Use 0..1

Quantity of Therapeutic Good 1..1

Brand Substitute Allowed 1..1

Maximum Number of Repeats 1..1

Minimum Interval Between Repeats 0..1

Medical Benefit Category Type 1..1

Grounds for Concurrent Supply 1..1

PBS/RPBS Authority Approval Number 0..1

State Authority Number 0..1

Reason for Therapeutic Good 0..1

Additional Comments 0..1

OBSERVATIONS 0..1

BODY WEIGHT 0..1

Body Weight Value 1..1

DateTime of Observation 1..1

BODY HEIGHT 0..1

Body Height Value 1..1

DateTime of Observation 1..1



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PRESCRIPTION NOTE DETAIL 0..1

Note 1..1

217



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3 218

3 ePrescription Context 219

3.1 SUBJECT OF CARE 220

Identification 221

222

Name SUBJECT OF CARE

Metadata Type Data Group

Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296

External Identifier AS 5017-2006 [SA2006b]

Definition 223

224

Definition The person the prescription is for. The intended recipient of the

prescribed items.

Definition Source NEHTA

Synonymous Names

Patient

Healthcare Individual

Usage 225

226

Conditions of Use These are described in more detail in A.1: Subject of Care.

This is a reuse of the PARTICIPATION data group, which

is described in Participation Data Specification

[NEHT2010i].

The following constraints are additional to those specified

in Participation Data Specification [NEHT2010i].

Constraints are explained in Data Specifications and

Structured Document Templates - Guide for Use

[NEHT2010d].

Additional obligation and occurrence constraints:

• Participation Period is PROHIBITED.

• LOCATION OF PARTICIPATION is

PROHIBITED.

• Entity Identifier is ESSENTIAL.

• ADDRESS is ESSENTIAL.

• Relationship to Subject of Care is PROHIBITED.



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• EMPLOYMENT DETAIL is PROHIBITED.

• DATE OF DEATH DETAIL is PROHIBITED.

• Source of Death Notification is PROHIBITED.

• Mother's Original Family Name is PROHIBITED.

• Country of Birth is PROHIBITED.

• State/Territory of Birth is PROHIBITED.

• Indigenous Status is PROHIBITED.

• Qualifications is PROHIBITED.

Other additional constraints:

• Participation Type MUST have an implementation-

specific fixed value meaning ―Subject‖.

• The value of Entity Identifier MUST be an

Australian IHI.

• ADDRESS MUST have an Address Purpose value

meaning ―Residential‖ or ―Temporary Accommodation‖.

• PERSON OR ORGANISATION OR DEVICE

MUST be instantiated as a PERSON.

• Entitlement Type MUST have a value from Subject

of Care Entitlement Type Values.

Conditions of Use Source NEHTA

Relationships 227

Parents 228

229

Data

Type Name Obligation Condition Occurrence

EPRESCRIPTION Essential Single

3.2 Subject of Care Entitlement Type Values 230

Identification 231

232

Name Subject of Care Entitlement Type Values

Metadata Type Value Domain

Identifier VD-16047

OID 1.2.36.1.2001.1001.101.104.16047

Definition 233

234



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Definition The set of values for the description of the scope of a Subject of

Care's entitlement.


Value Domain 235

236

Source NEHTA

Permissible Values 1 Medicare Benefits

2 Pensioner Concession

3 Commonwealth Seniors Health Concession

4 Health Care Concession

5 Repatriation Health Gold Benefits

6 Repatriation Health White Benefits

7 Repatriation Health Orange Benefits

8 Safety Net Concession

9 Safety Net Entitlement

Relationships 237

Parents 238

239

Data


SUBJECT OF CARE Essential Single

3.2 PRESCRIBER 240

Identification 241

242

Name PRESCRIBER


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296

External Identifier AS 4846-2006 [SA2006a]

Definition 243

244

Definition The healthcare provider who wrote the prescription.




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Synonymous Names

Usage 245

246

Conditions of Use These are described in more detail in A.2: Prescriber.



[NEHT2010i].





[NEHT2010d].




PROHIBITED.



• EMPLOYER ORGANISATION is PROHIBITED.

• Employment Type is PROHIBITED.

• Occupation is ESSENTIAL.

• Position In Organisation is PROHIBITED.

• Date of Birth is Calculated From Age is

PROHIBITED.

• DATE OF BIRTH ACCURACY INDICATOR is

PROHIBITED.

• AGE DETAIL is PROHIBITED.

• Birth Plurality is PROHIBITED.

• Birth Order is PROHIBITED.








• Participation Type MUST have an implementation

specific fixed value meaning ―Prescriber‖.




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Australian HPI-I.

• AUSTRALIAN OR INTERNATIONAL

ADDRESS MUST be instantiated as an AUSTRALIAN

ADDRESS.



• If the value of Medical Benefit Category Type is

―1‖ ( PBS), ―2‖ ( RPBS) or ―3‖ ( CTG), exactly one

ENTITLEMENT MUST have an Entitlement Type with

the value ―10‖ (Medicare Prescriber Number).


Relationships 247

Parents 248

249

Data



3.3 PRESCRIBER ORGANISATION 250

Identification 251

252

Name PRESCRIBER ORGANISATION


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 253

254

Definition The organisation which the prescriber is working for when they

write the prescription.


Synonymous Names

Usage 255

256

Conditions of Use These are described in more detail in A.3: Prescriber

Organisation.




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[NEHT2010i].





[NEHT2010d].


• Participation Period is prohibited.

• Location of Participation is prohibited.

• Entity Identifier is essential.

• ADDRESS is essential.

• ADDRESS is single.

• ELECTRONIC COMMUNICATION DETAIL is

essential.

• ENTITLEMENT is prohibited.

• Qualifications is prohibited.


• Participation Type MUST have a fixed value of

―Healthcare Facility‖.


Australian HPI-O.



ADDRESS.


of ―Business‖.

• At least one ELECTRONIC COMMUNICATION

DETAIL MUST have Electronic Communication Medium

with a value of ―Telephone‖ or ―Mobile‖.


MUST be instantiated as an ORGANISATION.


Relationships 257

Parents 258

259

Data





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3.4 Prescription Identifier 260

Identification 261

262

Name Prescription Identifier

Metadata Type Data Element

Identifier DE-16092

OID 1.2.36.1.2001.1001.101.103.16092

Definition 263

264

Definition A string generated by an EPS (Electronic Prescribing System) to

uniquely identify a prescription.


Synonymous Names

Data Type

UniqueIdentifier

Usage 265

266

Examples See: NEHTA Data Specifications and Structured Document

Templates - Guide for Use [NEHT2010d].

Relationships 267

Parents 268

269

Data



270



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271

4 Prescription Item 272

4.1 PRESCRIPTION ITEM 273

Identification 274

275

Name PRESCRIPTION ITEM


Identifier DG-16211

OID 1.2.36.1.2001.1001.101.102.16211

Definition 276

277

Definition Details of a therapeutic good with its use by a subject of care and

related information.


Synonymous Names

Prescribed Item

Usage 278

279

Misuse Recording stock on hand of a therapeutic good.

Relationships 280

Parents 281

282

Data



Children 283

284

Data


DateTime Prescription Written Essential Single

DateTime Prescription Expires Essential Single

Prescription Item Identifier Essential Single

Therapeutic Good Identification Essential Single



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Data


Formula Optional Single

DOSAGE Optional Single

Instructions for Use Optional Single

Quantity of Therapeutic Good Essential Single

Brand Substitute Allowed Essential Single

Maximum Number of Repeats Essential Single

Minimum Interval Between Repeats Optional Single

Medical Benefit Category Type Essential Single

Grounds for Concurrent Supply Essential Single

PBS/RPBS Authority Approval

Number Optional Single

State Authority Number Optional Single

Reason for Therapeutic Good Optional Single

Additional Comments Optional Single

4.2DateTime Prescription Written 285

Identification 286

287

Name DateTime Prescription Written


Identifier DE-16091

OID 1.2.36.1.2001.1001.101.103.16091

Definition 288

289

Definition The date (and optionally time) of the completion of the writing

of the prescription.


Synonymous Names

Notes In common practice this is the date the prescription was signed

by the prescriber.



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Data Type

DateTime

Usage 290

291



Relationships 292

Parents 293

294

Data


PRESCRIPTION ITEM Essential Single

4.3 DateTime Prescription Expires 295

Identification 296

297

Name DateTime Prescription Expires


Identifier DE-10104

OID 1.2.36.1.2001.1001.101.103.10104

Definition 298

299

Definition The date (and optionally time) after which the prescription can

no longer be dispensed against.


Synonymous Names

Notes The prescription expiry date will be dependent on local, national

rules and controlled by protocols. As an example, the

prescriptions issued under the Pharmaceutical Benefits Schedule

usually expire after 12 months. Local policy may shorten this

time frame (e.g. to 6 months for Schedule 8 drugs).

The Prescriber may nominate an expiry date that falls within the

default expiry period.

Data Type

DateTime

Usage 300



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301



Relationships 302

Parents 303

304

Data



4.4 Prescription Item Identifier 305

Identification 306

307

Name Prescription Item Identifier


Identifier DE-10136

OID 1.2.36.1.2001.1001.101.103.10136

Definition 308

309


uniquely identify an instruction to use a therapeutic good.


Synonymous Names

Data Type

UniqueIdentifier

Usage 310

311



Relationships 312

Parents 313

314

Data





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4.5 Therapeutic Good Identification 315

Identification 316

317

Name Therapeutic Good Identification


Identifier DE-10194

OID 1.2.36.1.2001.1001.101.103.10194

Definition 318

319

Definition Identifies a therapeutic good, which is broadly defined as a good

which is represented in any way to be, or is likely to be taken to

be, for therapeutic use (unless specifically excluded or included

under Section 7 of the Therapeutic Goods Act 1989).

Therapeutic use means use in or in connection with:

• preventing, diagnosing, curing or alleviating a disease,

ailment, defect or injury;

• influencing, inhibiting or modifying a physiological

process;

• testing the susceptibility of persons to a disease or

ailment;

• influencing, controlling or preventing conception;

• testing for pregnancy; or

• replacement or modification of parts of the anatomy.

Definition Source Therapeutic Goods Administration

Synonymous Names

Item Name

Context This includes medications and medical devices. It includes

drugs, appliances, dressings and reagents.

Context Source NEHTA

Notes The formal definition of a therapeutic good (from the

Therapeutic Goods Act 1989) can be found at: [TGA2008a].

Data Type

CodeableText

Value Domain Therapeutic Good Identification Values

Usage 320

321



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Conditions of Use Where the therapeutic good can be identified by an AMT

(Australian Medicines Terminology) concept, this must be

the AMT ConceptID and Preferred Term. For details see

Therapeutic Good Identification Values.

For items without an AMT code (including some

extemporaneous preparations), a text description is

suitable. For a medication this must include the name of the

medication (brand name or generic name equivalent),

strength and dose form, where appropriate.


Examples Some examples of AMT ConceptID and their AMT

Preferred Term are:

1. 293049011000036110, paracetamol 500 mg +

codeine phosphate 30 mg tablet

2. 327004011000036118, paracetamol 500 mg +

codeine phosphate 30 mg tablet, 20

3. 234184011000036115, Panadeine Forte tablet:

uncoated, 20 tablets

4. 192727011000036112, Panadeine Forte

(paracetamol 500 mg + codeine phosphate 30 mg) tablet:

uncoated, 1 tablet


uncoated, 20 tablets, blister pack

6. 315236011000036113, bandage compression 10

cm x 3.5 m bandage: high stretch, 1 bandage

7. 186324011000036116, Eloflex (2480) (bandage

compression 10 cm x 3.5 m) bandage: high stretch, 1

bandage

Misuse Detailing the formula of a compounded (extemporaneous)

medication.

Relationships 322

Parents 323

324

Data



4.6 Therapeutic Good Identification Values 325

Identification 326

327

Name Therapeutic Good Identification Values



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Identifier VD-16115

OID 1.2.36.1.2001.1001.101.104.16115

Definition 328

329

Definition The set of values consists of ConceptIDs and Preferred Terms from

AMT (Australian Medicines Terminology) concepts which have one

of the following modelled relationships:

• IS A Medicinal Product Unit of Use (MPUU);

• IS A Medicinal Product Pack (MPP);

• IS A Trade Product Unit of Use (TPUU);

• IS A Trade Product Pack (TPP); or

• IS A Containered Trade Product Pack (CTPP).

Specifically for MPUU: only MPUU concepts that have no child

MPUUs are to be included. Where an MPUU concept is a parent of

another MPUU, the parent MPUU is to be omitted.


Notes An explanation of AMT concepts can be found in Australian

Medicines Terminology Editorial Rules [NEHT2009r].

Prescribing and dispensing use different sets of values.

Value Domain 330

331

Source Australian Medicines Terminology

Relationships 332

Parents 333

334

Data



4.7 Formula 335

Identification 336

337

Name Formula


Identifier DE-16272



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OID 1.2.36.1.2001.1001.101.103.16272

Definition 338

339

Definition The recipe for compounding a medicine.


Synonymous Names

Data Type

Text

Usage 340

341

Examples 1. BORIC ACID, OLIVE OIL AND ZINC OXIDE (BOZ)

Ointment:

Boric Acid 1% in Paraffin Ointment B.P. 25

Olive Oil 25

Zinc Oxide Ointment to 100

Misuse Describing off-the-shelf medications.

Relationships 342

Parents 343

344

Data


PRESCRIPTION ITEM Optional Single

4.8 DOSAGE 345

Identification 346

347

Name DOSAGE


Identifier DG-16007

OID 1.2.36.1.2001.1001.101.102.16007

Definition 348

349

Definition The regimen governing the amount (in a single administration,

i.e. dose quantity), the frequency, the route, and the number of

doses of a therapeutic agent to be administered to a subject of



14/04/2011 15:08:07

care.

Definition Source Based on Mosby's Medical Dictionary, 8th Edition

[MOSB2008a].

Synonymous Names

Scope This data group is used to provide details of dose instructions for

medication dispensing and administration.

Scope Source NEHTA

Notes The dosage data group in this release of the PIM is designed to

support simple dosage instructions. Clinical input is being

sought to modify the data group in order to support more

complex dosing instructions such as variable and alternate

dosing and multi-component medicines. This is an evolving

process and will be supported by the development of an

implementation guide outlining how the dosage data group is to

be implemented.

In the meantime, implementers may wish to examine the NHS

Dose Syntax Model [NHS2009a]. That model, while different to

this data group, provides many similarities.

Usage 350

351

Conditions of Use If the Therapeutic Good is a medication, this is essential,

otherwise it is prohibited.


Misuse Using this data group for non-medication items, such as

bandages. Instruction on the use of non-medication items

can be recorded as text in the Instructions for Use data

element.

Relationships 352

Parents 353

354

Data



Children 355

356

Data


Dose Instruction Essential Single



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4.9 Dose Instruction 357

Identification 358

359

Name Dose Instruction


Identifier DE-16008

OID 1.2.36.1.2001.1001.101.103.16008

Definition 360

361

Definition A description of the dose quantity, frequency, route instruction

and cautionary advice that determines how the prescribed

therapeutic substance is administered to, or taken by, the subject

of care.


Synonymous Names

Dosage Instruction

Data Type

Text

Usage 362

363

Conditions of Use This should include the dose quantity, frequency, route,

administration schedule and any additional instructions

required to safely describe the appropriate dosage. If

appropriate, this may also include the site of

administration.


Examples 1. One tablet twice a day every 12 hours, before or

with the first mouthful of food.

2. Apply thin layer to affected area 3-4 times daily;

reassess after 7 days if no response.

Relationships 364

Parents 365

366

Data


DOSAGE Essential Single



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4.10 Instructions for Use 367

Identification 368

369

Name Instructions for Use


Identifier DE-16276

OID 1.2.36.1.2001.1001.101.103.16276

Definition 370

371

Definition Directions for the use of a therapeutic good other than a

medication.


Synonymous Names

Data Type

Text

Usage 372

373

Conditions of Use If the Therapeutic Good is a medication, this is prohibited,

otherwise it is essential.


Examples 1. For use with Spiriva Capsules containing powder

for oral inhalation. (About a Spiriva HandiHaler.)

2. Portable Pulse Oximeter measurement to be taken

by clipping the sensor onto the tip of a finger.

Misuse Using this data group for medication items.

Relationships 374

Parents 375

376

Data



4.11 Quantity of Therapeutic Good 377

Identification 378

379



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Name Quantity of Therapeutic Good


Identifier DE-10145

OID 1.2.36.1.2001.1001.101.103.10145

Definition 380

381

Definition A statement of the total number of units or physical amount of

the therapeutic good that is prescribed.


Synonymous Names

Quantity Prescribed

Quantity Ordered

Unit of Use Quantity Prescribed

Data Type

Text

Usage 382

383

Examples 1. ―40 tablets‖ (In the case of 2 packs of 20 tablets.)

2. ―10 vials‖ (In the case of 1 box of 10 vials of an injection,

e.g. Injection 600 micrograms in 10 x 1 mL vials.)

Relationships 384

Parents 385

386

Data



4.12 Brand Substitute Allowed 387

Identification 388

389

Name Brand Substitute Allowed


Identifier DE-10107

OID 1.2.36.1.2001.1001.101.103.10107



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Definition 390

391

Definition Indicates whether or not the substitution of a prescribed

medication with a different brand name of the same medication,

which has been determined as bioequivalent, is allowed when

the medication is dispensed/supplied.


Synonymous Names

Allow substitutions

Notes PBS prescriptions must not be prepared using a computer

prescribing program that contains a default which would result in

all prescriptions being indicated as Brand Substitution Not

Permitted [DHA2009a].

Data Type

Boolean

Usage 392

393

Misuse Using this data element for therapeutic substitution.

Using this data element for medical appliances.

Default Value "true"

Relationships 394

Parents 395

396

Data



4.13 Maximum Number of Repeats 397

Identification 398

399

Name Maximum Number of Repeats


Identifier DE-10169

OID 1.2.36.1.2001.1001.101.103.10169

Definition 400

401



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Definition The number of times the supply of the prescribed item may be

repeated under the terms of the prescription.


Synonymous Names

Notes Note that the initial supply under the prescription is not counted

as a repeat.

PBS and RPBS items specify a maximum number of permitted

repeats within the Schedules. This number must not be exceeded

on a prescription without the appropriate authorisation.

When a prescription for a PBS medicine asks for repeat supplies,

the pharmacist shall prepare a Repeat Authorisation Form to be

attached to the ―Pharmacist/Subject of Care‖ copy. An exception

to this is when the prescription is marked ―Regulation 24‖,

where all repeats are supplied at once with the original

prescription. A similar exception is permitted for RPBS

prescriptions endorsed with ―hardship conditions apply‖. The

Repeat Authorisation is to be detailed in a separate Structured

Document Template.

Data Type

Integer

Usage 402

403

Conditions of Use If the value of Grounds for Concurrent Supply is ―Pursuant

to Regulation 24‖ or ―hardship conditions apply‖, the value

of this data element must be greater than 0.




Default Value 0

Relationships 404

Parents 405

406

Data



4.14 Minimum Interval Between Repeats 407

Identification 408

409



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Name Minimum Interval Between Repeats


Identifier DE-10164

OID 1.2.36.1.2001.1001.101.103.10164

Definition 410

411

Definition The minimum time before the therapeutic good can be dispensed

again.


Synonymous Names

Notes Where the prescription is for a Schedule 8 medicine and the

dispensing of the prescription is authorised to be repeated, the

minimum intervals at which it may be dispensed must be written

on the prescription by the prescriber.

The dispensing interval for other scripts is a dispensing issue and

is governed by PBS rules. However, there may be other

situations where a prescriber may want to limit access – e.g. if

there are safety concerns or if the subject of care is taking greater

than the prescribed dose.

Data Type

Duration

Usage 412

413

Examples 1. 20 days

Relationships 414

Parents 415

416

Data



4.15 Medical Benefit Category Type 417

Identification 418

419

Name Medical Benefit Category Type




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Identifier DE-16095

OID 1.2.36.1.2001.1001.101.103.16095

Definition 420

421

Definition Indicates the category of subsidy appropriate to the item being

prescribed.


Synonymous Names

Notes This indicates whether the item has been prescribed for a use

which attracts a subsidy.

Not to be confused with Claim Category Type.

Data Type

CodedText

Value Domain Medical Benefit Category Type Values

Usage 422

423

Examples

Relationships 424

Parents 425

426

Data



4.16 Medical Benefit Category Type Values 427

Identification 428

429

Name Medical Benefit Category Type Values


Identifier VD-16095

OID 1.2.36.1.2001.1001.101.104.16095

Definition 430

431

Definition The set of values of Medical Benefit Category Type.



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Value Domain 432

433

Source NEHTA

Permissible Values 1, PBS A subsidy under the Pharmaceutical Benefits Scheme1

applies to this item.

2, RPBS A subsidy under the Repatriation Pharmaceutical

Benefits Scheme2 applies to this item.

3, CTG A subsidy under the Closing the Gap-PBS Co-Payment

Measure3 applies to this item.

9, No benefit This item is not covered by a medical subsidy.

Relationships 434

Parents 435

436

Data



4.17 Grounds for Concurrent Supply 437

Identification 438

439

Name Grounds for Concurrent Supply


Identifier DE-16139

OID 1.2.36.1.2001.1001.101.103.16139

Definition 440

441

Definition Indicates the grounds which authorise a PBS or RPBS subsidy

for the concurrent supply of an item specified in a prescription

and all of its repeats.


Synonymous Names

Notes Concurrent supply means supplying an item from a prescription


14/04/2011 15:08:07 1 http://www.medicareaustralia.gov.au/provider/pbs/index.jsp 2 http://www.dva.gov.au/service_providers/doctors/Pages/rpbs.aspx 3 http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/closing-the-gap.jsp

http://www.medicareaustralia.gov.au/provider/pbs/index.jsp

http://www.dva.gov.au/service_providers/doctors/Pages/rpbs.aspx


http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/closing-the-gap.jsp







14/04/2011 15:08:07

together with all of its repeats at the one time.

There are different rules for the concurrent supply of prescribed

items, depending upon whether they are subsidised by the PBS

or the RPBS.

For PBS prescriptions (Regulation 24):

Generally, a pharmaceutical benefit may not be supplied to the

same person more than once in any four clear days (or 20 clear

days for items listed in the Schedule with five repeats or more).

Under Regulation 24 of the National Health (Pharmaceutical

Benefits) Regulations 1960, a prescriber can direct that the

original and all repeats of a PBS medicine ordered on a

prescription be supplied at the one time, provided that the

prescriber is satisfied that all of the following circumstances

apply:

• The maximum quantity or number of units applicable in

relation to the pharmaceutical benefit is insufficient for the

treatment of the person for whom the prescription is written.

• The person requires the pharmaceutical benefit for the

treatment of a chronic illness or is residing in a place remote

from the approved pharmacist nearest to that person's place of

residence.

• The person could not, without great hardship, obtain the

required quantity or number of units of the pharmaceutical

benefit by means of repeated supplies on separate occasions.

A PBS prescription must be endorsed by the prescriber with

―Regulation 24‖ as certification that all the above conditions

apply.

An example of where a prescription would need to be endorsed

as Regulation 24 for each item would be where a subject of care

taking antihypertensive medicine plans to travel overseas and

requires the dispensing of the original and repeats at one time.

For RPBS prescriptions (Hardship conditions apply):

The original and repeat supplies of an item ordered on a

prescription may be supplied at the one time if:

• the veteran lives a long way from the nearest pharmacy;

or

• the circumstances of the veteran's condition would

impose hardship if separate visits for supply of repeats was

required.

The words ―hardship conditions apply‖ (or ―Regulation 24‖)

written on the prescription will be sufficient authority for a

pharmacist to supply the items and repeats at the one time.

Data Type

CodedText



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Value Domain Grounds for Concurrent Supply Values

Usage 442

443

Conditions of Use Only applicable to PBS and RPBS prescriptions. Not

applicable to private prescriptions.


Examples

Relationships 444

Parents 445

446

Data



4.18 Grounds for Concurrent Supply Values 447

Identification 448

449

Name Grounds for Concurrent Supply Values


Identifier VD-16085

OID 1.2.36.1.2001.1001.101.104.16085

Definition 450

451

Definition The set of values of Concurrent Supply Grounds.


Value Domain 452

453

Source NEHTA

Permissible Values 1, Pursuant to Regulation 24 Supply is in accord with

Regulation 24 of the National Health (Pharmaceutical Benefits)

Regulations 1960.

2, Hardship conditions apply Supply is in accord with the

―Hardship conditions‖ provision of RPBS prescribing guidelines.

9, No grounds There are no grounds for concurrent supply.

Relationships 454



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Parents 455

456

Data


Grounds for Concurrent Supply Essential Single

4.19 PBS/RPBS Authority Approval Number 457

Identification 458

459

Name PBS/RPBS Authority Approval Number


Identifier DE-10159

OID 1.2.36.1.2001.1001.101.103.10159

Definition 460

461

Definition An identification number obtained by the prescriber and

included in the prescription to show that the prescription meets

agreed prescribing requirements and has authority to prescribe

the medication and/or the quantity of the medication.

Definition Source Medicare Australia

Synonymous Names

Notes Each authority prescription requires a unique approval number

provided by Medicare Australia or the Department of Veterans'

Affairs.

Data Type

Text

Usage 462

463



For PBS prescriptions: Authority prescriptions are required

for certain PBS medicines, and where the prescriber feels

the patient requires an increased number of repeats or a

quantity greater than the maximum listed in the Schedule of

Pharmaceutical Benefits.

For RPBS prescriptions: An authority required approval

can be recorded on a script for private items which results

in reduced or no out-of-pocket expenses for the patient.



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(Medicare Australia)

1. This MUST be populated if:

• the Medical Benefit Category type is PBS; and

• the item is listed as ―authority required‖.

2. This MUST NOT be populated if:


• the item is not listed as ―authority required‖.


• the Medical Benefit Category type is neither PBS

nor RPBS.

Conditions of Use Source Medicare Australia and NEHTA

Examples 1. Z1234AB (Authority Required)

2. 9876 (Authority Required (Streamlined))

Relationships 464

Parents 465

466

Data



4.20 State Authority Number 467

Identification 468

469

Name State Authority Number


Identifier DE-16018

OID 1.2.36.1.2001.1001.101.103.16018

Definition 470

471

Definition An identification number issued by an Australian state or

territory health authority as proof that the prescriber has obtained

written authority to prescribe drugs of dependence for a drug-

dependent person, or for the treatment of a person with drug

addiction for a period in accordance with State or Territory

regulations.




14/04/2011 15:08:07

Synonymous Names

Notes The PBS refers to the requirement to also observe state

legislation when prescribing Schedule 8 medicines. Such

legislation may require a state-issued authority number. These

authority numbers may be required in addition to a PBS/RPBS

Authority Approval Number.

Data Type

Text

Usage 472

473

Conditions of Use If state authorisation is required to prescribe this item, this

information must be provided in the prescription.


Examples 1. S18A0812

2. CNS 123654

3. S28c 132465

4. 123658-10-2009

5. CL/24586

6. RA/34536

Relationships 474

Parents 475

476

Data



4.21 Reason for Therapeutic Good 477

Identification 478

479

Name Reason for Therapeutic Good


Identifier DE-10141

OID 1.2.36.1.2001.1001.101.103.10141

Definition 480

481



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Definition The clinical justification (e.g. specific therapeutic effect

intended) for this subject of care‘s use of the therapeutic good.


Synonymous Names

Reason for prescribing

Data Type

Text

Usage 482

483

Examples 1. Long-term maintenance treatment of bronchospasm and

dyspnoea.

Relationships 484

Parents 485

486

Data



4.22 Additional Comments 487

Identification 488

489

Name Additional Comments


Identifier DE-16044

OID 1.2.36.1.2001.1001.101.103.16044

Definition 490

491

Definition Any additional information that may be needed to ensure the

continuity of supply, proper use, or appropriate medication

management.


Synonymous Names

Data Type

Text

Usage 492



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493

Examples 1. Patient requires an administration aid.

Misuse Use for information that could be recorded as structured data.

Relationships 494

Parents 495

496

Data



497



14/04/2011 15:08:07

498

5 Observations Section 499

5.1 OBSERVATIONS 500

Identification 501

502

Name OBSERVATIONS

Metadata Type Section

Identifier S-16280

OID 1.2.36.1.2001.1001.101.101.16280

Definition 503

504

Definition A collection of observations of the Subject of Care which are

relevant to the prescription.


Synonymous Names

Relationships 505

Parents 506

507

Data


EPRESCRIPTION Optional Single

Children 508

509

Data


BODY WEIGHT Optional Single

BODY HEIGHT Optional Single

5.2 BODY WEIGHT 510

Identification 511

512

Name BODY WEIGHT


Identifier DG-16124



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OID 1.2.36.1.2001.1001.101.102.16124

Definition 513

514

Definition Details pertinent to the physical measurement of the weight

(mass) of a Subject of Care‘s body.

Definition Source Adapted from AIHW/METeOR definition of ‗body weight

(measured) in Kilograms‘

Synonymous Names

Body Weight

Notes The weight of a Subject of Care is a key observation used for

dosage calculation for paediatric and chemotherapy

prescriptions.

Usage 515

516

Conditions of Use For children 12 years old or younger a body weight must be

recorded.


Relationships 517

Parents 518

519

Data


OBSERVATIONS Optional Single

Children 520

521

Data


Body Weight Value Essential Single

DateTime of Observation Essential Single

5.3 Body Weight Value 522

Identification 523

524

Name Body Weight Value




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Identifier DE-16125

OID 1.2.36.1.2001.1001.101.103.16125

Definition 525

526

Definition The weight (body mass) of a person.


Synonymous Names

Person Weight

Data Type

Quantity

Usage 527

528

Conditions of Use The unit of measurement must be kilograms.


Examples 1. 73 kg

2. 0.89 kg

Relationships 529

Parents 530

531

Data


BODY WEIGHT Essential Single

5.4 DateTime of Observation 532

Identification 533

534

Name DateTime of Observation


Identifier DE-15561

OID 1.2.36.1.2001.1001.101.103.15561

Definition 535

536

Definition The date (and optionally time) that an observation value is taken.



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Synonymous Names

Data Type

DateTime

Usage 537

538

Conditions of Use This item must include a date component and may include

a time component if it is known and relevant to record.




Relationships 539

Parents 540

541

Data


BODY WEIGHT Essential Single

5.5 BODY HEIGHT 542

Identification 543

544

Name BODY HEIGHT


Identifier DG-16123

OID 1.2.36.1.2001.1001.101.102.16123

Definition 545

546

Definition Details pertinent to the physical measurement of the height OR

length of a Subject of Care‘s body.


Synonymous Names

Body Length

Notes The height, together with the weight, of a subject of care enables

derivation of Body Mass Index (BMI) which is a key

observation that may be used for dosage calculation for certain



14/04/2011 15:08:07

medication prescription protocols, such as chemotherapy.

Relationships 547

Parents 548

549

Data


OBSERVATIONS Optional Single

Children 550

551

Data


Body Height Value Essential Single

DateTime of Observation Essential Single

5.6 Body Height Value 552

Identification 553

554

Name Body Height Value


Identifier DE-16120

OID 1.2.36.1.2001.1001.101.103.16120

Definition 555

556

Definition The height or length of a person.


Synonymous Names

Data Type

Quantity

Usage 557

558

Conditions of Use The unit of measurement must be centimetres.


Examples 1. 54.3 cm



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2. 172 cm

Relationships 559

Parents 560

561

Data


BODY HEIGHT Essential Single

5.7 DateTime of Observation 562

Identification 563

564

Name DateTime of Observation


Identifier DE-15561

OID 1.2.36.1.2001.1001.101.103.15561

Definition 565

566

Definition The date (and optionally time) that an observation value is taken.


Synonymous Names

Data Type

DateTime

Usage 567

568

Conditions of Use This item must include a date component and may include

a time component if it is known and relevant to record.




Relationships 569

Parents 570

571

Data




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Data


BODY HEIGHT Essential Single

572

573



14/04/2011 15:08:07

574

6 Prescription Note Detail 575

6.1 PRESCRIPTION NOTE DETAIL 576

Identification 577

578

Name PRESCRIPTION NOTE DETAIL


Identifier DG-16212

OID 1.2.36.1.2001.1001.101.102.16212

Definition 579

580

Definition Details pertinent to additional or supplementary information

about the prescription, which is not captured by other

information structures contained in the prescription.


Synonymous Names

Clinical Note

Notes This data group contains details of information/note at the

prescription level.

It provides for the capture of general prescriber remarks that

target the dispenser. A note may contain details for such things

as counselling instructions, Adverse Drug Reactions (ADR), and

explanations regarding activities such as brand substitution.

Relationships 581

Parents 582

583

Data


EPRESCRIPTION Optional Single

Children 584

585

Data


Note Essential Single

6.2 Note 586

Identification 587



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588

Name Note


Identifier DE-16213

OID 1.2.36.1.2001.1001.101.103.16213

Definition 589

590

Definition Free text comments relevant to the concept.


Synonymous Names

Data Type

Text

Usage 591

592

Examples 1. Subject of care does not speak English, provide appropriate

counselling.

2. Please deliver to the subject of care, at home.

Relationships 593

Parents 594

595

Data


PRESCRIPTION NOTE DETAIL Essential Single

596 597



14/04/2011 15:08:07

598

7 UML Class Diagram 599

The following figure presents the data hierarchy using a UML 2.0 class diagram. The diagram displays 600 data groups and data elements, together with their names, data types and multiplicities. Data groups are 601 displayed as classes and data elements are displayed as attributes. The diagram shows the data 602 hierarchy excluding the details of participation. The default multiplicity is 1..1. 603

604

605

UML class diagram of the e-Prescription data hierarchy. 606 607



14/04/2011 15:08:07

608



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8 Dispense Record Structured Document 609

8.1 DISPENSE RECORD 610

Identification 611

612

Name DISPENSE RECORD


Identifier SD-16112

OID 1.2.36.1.2001.1001.101.100.16112

Definition 613

614

Definition Information pertaining to the process of an authorised dispenser

dealing out and making ready for supply a therapeutic good that

requires a prescription, for the use of a subject of care.


Synonymous Names

Scope This is limited to dispensing by a pharmacist against

prescriptions made by an authorised medical practitioner.

Scope Source NEHTA

Notes A dispense act may be completed with no item being supplied to

the subject of care and still require the creation of a dispense

record to record the fact.

Data Hierarchy 615

616

DISPENSE RECORD 1..1

CONTEXT


DISPENSER 1..1

DISPENSING ORGANISATION 1..1

CONTENT

DISPENSE ITEM 1..1

Dispense Item Identifier 1..1

DateTime of Dispense Event 1..1

Prescription Item Identifier 1..1



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Formula 0..1


Brand Substitution Occurred 1..1

Maximum Number of Repeats 1..1

Number of this Dispense 1..1

Claim Category Type 1..1

Label Instruction 0..1

Early Supply with Pharmaceutical Benefit 0..1


617 618



14/04/2011 15:08:07

9 619

10 Dispense Record Context 620


Identification 622

623



Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 624

625


prescribed item.


Synonymous Names

Patient


Usage 626

627




[NEHT2010i].





[NEHT2010d].




PROHIBITED.







14/04/2011 15:08:07












Australian IHI.


of ―Residential‖ or ―Temporary Accommodation‖.






Relationships 628

Parents 629

630

Data


DISPENSE RECORD Essential Single


Identification 632

633



Identifier VD-16047

OID 1.2.36.1.2001.1001.101.104.16047

Definition 634

635


Care's entitlement.




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Value Domain 636

637

Source NEHTA










Relationships 638

Parents 639

640

Data



10.3 DISPENSER 641

Identification 642

643

Name DISPENSER


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 644

645

Definition The healthcare provider who made the therapeutic good

available.


Synonymous Names

Usage 646

647

Conditions of Use These are described in more detail in A.2: Dispenser.



14/04/2011 15:08:07



[NEHT2010i].





[NEHT2010d].




PROHIBITED.





PROHIBITED.


PROHIBITED.










• ENTITLEMENT is PROHIBITED.



―Performer‖.

• Role MUST have a fixed value of ―Dispenser‖.


Australian HPI-I.



ADDRESS.






14/04/2011 15:08:07

Relationships 648

Parents 649

650

Data



10.4 DISPENSING ORGANISATION 651

Identification 652

653

Name DISPENSING ORGANISATION


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 654

655

Definition The organisation which the dispenser is working for when they

dispense the item.


Synonymous Names

Usage 656

657

Conditions of Use These are described in more detail in A.3: Dispensing

Organisation.



[NEHT2010i].





[NEHT2010d].



• Location of Participation is PROHIBITED.





14/04/2011 15:08:07

• ADDRESS is SINGLE.


ESSENTIAL.




―Performer‖.

• Role MUST have a fixed value of ―Dispensing

Organisation‖.


Australian HPI-O.



ADDRESS.


of ―Business‖.



• If the value of Medical Benefit Category Type in

the associated prescription is ―1‖ ( PBS), ―2‖ ( RPBS) or

―3‖ ( CTG), exactly one ENTITLEMENT MUST have an

Entitlement Type with the value ―11‖ (Medicare Pharmacy

Approval Number).


Relationships 658

Parents 659

660

Data



661 662



14/04/2011 15:08:07

663

114 Dispense Item 664

11.14.1 DISPENSE ITEM 665

Identification 666

667

Name DISPENSE ITEM


Identifier DG-16210

OID 1.2.36.1.2001.1001.101.102.16210

Definition 668

669

Definition Details of a therapeutic good with its use by a subject of care and

related information.


Synonymous Names

Relationships 670

Parents 671

672

Data



Children 673

674

Data


Dispense Item Identifier Essential Single

DateTime of Dispense Event Essential Single

Prescription Item Identifier Essential Single




Brand Substitution Occurred Essential Single

Maximum Number of Repeats Essential Single



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Data


Number of this Dispense Essential Single

Claim Category Type Essential Single

Label Instruction Optional Single

Early Supply with Pharmaceutical

Benefit Optional Single


11.2 Dispense Item Identifier 675

Identification 676

677

Name Dispense Item Identifier


Identifier DE-16104

OID 1.2.36.1.2001.1001.101.103.16104

Definition 678

679

Definition A string generated by an EDS (Electronic Dispensing System) to

uniquely identify an action of dispensing a therapeutic good.


Synonymous Names

Data Type

UniqueIdentifier

Usage 680

681



Relationships 682

Parents 683

684

Data


DISPENSE ITEM Essential Single



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11.3 DateTime of Dispense Event 685

Identification 686

687

Name DateTime of Dispense Event


Identifier DE-16216

OID 1.2.36.1.2001.1001.101.103.16216

Definition 688

689

Definition The date (and optionally time) when an authorised pharmacist or

dispenser dispensed (or attempted to dispense) a prescribed item.


Synonymous Names

Data Type

DateTime

Usage 690

691



Relationships 692

Parents 693

694

Data



11.4 Prescription Item Identifier 695

Identification 696

697

Name Prescription Item Identifier


Identifier DE-10136

OID 1.2.36.1.2001.1001.101.103.10136

Definition 698

699



14/04/2011 15:08:07


uniquely identify an instruction to use a therapeutic good.


Synonymous Names

Data Type

UniqueIdentifier

Usage 700

701



Relationships 702

Parents 703

704

Data




Identification 706

707



Identifier DE-10194

OID 1.2.36.1.2001.1001.101.103.10194

Definition 708

709









process;


ailment;




14/04/2011 15:08:07




Synonymous Names

Item Name






Data Type

CodeableText


Usage 710

711












Preferred Term are:



2. 192727011000036112, Panadeine Forte


uncoated, 1 tablet



4. 186324011000036116, Eloflex (2480) (bandage


bandage


medication.



14/04/2011 15:08:07

Relationships 712

Parents 713

714

Data




Identification 716

717



Identifier VD-16115

OID 1.2.36.1.2001.1001.101.104.16115

Definition 718

719











Value Domain 720

721


Relationships 722

Parents 723

724

Data



11.7 Formula 725

Identification 726



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727

Name Formula


Identifier DE-16272

OID 1.2.36.1.2001.1001.101.103.16272

Definition 728

729



Synonymous Names

Data Type

Text

Usage 730

731


Ointment:


Olive Oil 25



Relationships 732

Parents 733

734

Data


DISPENSE ITEM Optional Single


Identification 736

737



Identifier DE-10145

OID 1.2.36.1.2001.1001.101.103.10145

Definition 738



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739


the therapeutic good that is dispensed or supplied to the subject

of care.


Synonymous Names

Quantity Supplied

Unit of Use Quantity Supplied

Dispensed Unit of Use Quantity

Data Type

Text

Usage 740

741




Relationships 742

Parents 743

744

Data



11.9 Brand Substitution Occurred 745

Identification 746

747

Name Brand Substitution Occurred


Identifier DE-16064

OID 1.2.36.1.2001.1001.101.103.16064

Definition 748

749


medication with a different brand name of the same medication

occurred when the medication was dispensed/supplied.


Synonymous Names



14/04/2011 15:08:07

Data Type

Boolean

Usage 750

751





Relationships 752

Parents 753

754

Data



11.10 Maximum Number of Repeats 755

Identification 756

757

Name Maximum Number of Repeats


Identifier DE-10169

OID 1.2.36.1.2001.1001.101.103.10169

Definition 758

759

Definition The number of times the supply of the prescribed item may be

repeated under the terms of the prescription.


Synonymous Names

Notes Note that the initial supply under the prescription is not counted

as a repeat.

PBS and RPBS items specify a maximum number of permitted

repeats within the Schedules. This number must not be exceeded

on a prescription without the appropriate authorisation.

When a prescription for a PBS medicine asks for repeat supplies,

the pharmacist shall prepare a Repeat Authorisation Form to be

attached to the ―Pharmacist/Subject of Care‖ copy. An exception

to this is when the prescription is marked ―Regulation 24‖,

where all repeats are supplied at once with the original



14/04/2011 15:08:07

prescription. A similar exception is permitted for RPBS

prescriptions endorsed with ―hardship conditions apply‖. The

Repeat Authorisation is to be detailed in a separate Structured

Document Template.

Data Type

Integer

Usage 760

761



Default Value 0

Relationships 762

Parents 763

764

Data



11.11 Number of this Dispense 765

Identification 766

767

Name Number of this Dispense


Identifier DE-16106

OID 1.2.36.1.2001.1001.101.103.16106

Definition 768

769

Definition A numeric value that represents the dispense number or

sequence number that has been reached for a therapeutic good

prescribed with repeats. This count includes the first dispense. It

has the value 1 when there are no repeats.


Synonymous Names

Notes Each prescribed item logically possesses a pre-determined

number of times that it may be dispensed; the number is 1 (for

the original prescription) + the maximum number of repeats.

This data element (Number of this Dispense) indicates which

dispensing of the item is being attempted by the dispense act that

this dispense record documents.



14/04/2011 15:08:07

Its value is one more than the number of times the prescribed

item has successfully been dispensed prior to this dispensing.

Its value increments by one each time a dispense act is

successfully completed.

The value of this term is one more than the commonly used term

―number this repeat‖.

Data Type

Integer

Usage 770

771



Relationships 772

Parents 773

774

Data



11.12 Claim Category Type 775

Identification 776

777

Name Claim Category Type


Identifier DE-16060

OID 1.2.36.1.2001.1001.101.103.16060

Definition 778

779

Definition Indicates the category of pharmaceutical benefits applicable to

the item being dispensed.


Synonymous Names

Notes The primary purpose of this data element is to enable the

determination of the source of any applicable financial subsidy

for the item.

Not to be confused with Medical Benefit Category Type.

Data Type



14/04/2011 15:08:07

CodeableText

Value Domain Claim Category Type Values

Usage 780

781

Examples

Relationships 782

Parents 783

784

Data



11.13 Claim Category Type Values 785

Identification 786

787

Name Claim Category Type Values


Identifier VD-16060

OID 1.2.36.1.2001.1001.101.104.16060

Definition 788

789

Definition The set of values of Claim Category Type.


Value Domain 790

791

Source NEHTA

Permissible Values 1, G General benefit.

2, C Concessional or Safety Net Concession benefit.

3, E Safety Net Entitlement Card benefit.

4, R RPBS benefit.

5, CTG Closing the Gap benefit.

9, No benefit This item is not covered by any Medicare

registered benefit.

Relationships 792

Parents 793



14/04/2011 15:08:07

794

Data


Claim Category Type Essential Single

11.14 Label Instruction 795

Identification 796

797

Name Label Instruction


Identifier DE-16109

OID 1.2.36.1.2001.1001.101.103.16109

Definition 798

799

Definition Dispenser instructions to the subject of care concerning the

therapeutic good.


Synonymous Names

Notes Instructions may include such things as:

• storage instructions and conditions;

• special or cautionary directions associated with

preparation or administration of dosages;

• actions to be taken if a dose is missed;

• relevant drug/drug, drug/food, drug/alcohol interactions;

or

• directions for the correct use of medicine.

Such directions will usually be printed on a label and attached to

the dispensed container.

There are standard cautionary advisory labels developed and

maintained by the Pharmaceutical Society of Australia (PSA).

These labels are published in The Australian Pharmaceutical

Formulary and Handbook [PSA2009a].

Data Type

Text

Usage 800

801

Examples

Relationships 802



14/04/2011 15:08:07

Parents 803

804

Data



11.15 Early Supply with Pharmaceutical Benefit 805

Identification 806

807

Name Early Supply with Pharmaceutical Benefit


Identifier DE-16348

OID 1.2.36.1.2001.1001.101.103.16348

Definition 808

809

Definition Indicates whether or not the supply of the therapeutic good

meets the criteria of a pharmaceutical benefit despite being

supplied within the specified minimum supply interval.


Synonymous Names

Notes Regulations for repeat dispensing set a minimum time interval

between subsidised dispense events (the Safety Net 4/20 Day

Rule). This minimum may be waived. This field indicates

whether or not the minimum has been waived. The relevant

regulations are National Health (Pharmaceutical Benefits)

Regulations 1960 Regulation 25 paragraphs (3)(b), (3)(c), (4)(b)

and (4)(c).

Data Type

Boolean

Usage 810

811

Conditions of Use Only relevant for supply of pharmaceutical benefit repeat

supply within the regulated minimum supply interval.


Examples

Relationships 812

Parents 813

814



14/04/2011 15:08:07

Data




Identification 816

817



Identifier DE-16044

OID 1.2.36.1.2001.1001.101.103.16044

Definition 818

819



management.


Synonymous Names

Data Type

Text

Usage 820

821


2. Consulted prescriber concerning dose.


Relationships 822

Parents 823

824

Data



825 826



14/04/2011 15:08:07

827



833

834

835

836

837 838

Figure 1 UML class diagram of the dispense record data hierarchy.



14/04/2011 15:08:07

839

13Prescription Request Structured Document 840

13.1 PRESCRIPTION REQUEST 841

Identification 842

843

Name PRESCRIPTION REQUEST


Identifier SD-16285

OID 1.2.36.1.2001.1001.101.100.16285

Definition 844

845

Definition A request by a dispenser for a formal prescription to legitimate

the dispensing of therapeutic goods following an instruction

from a prescriber to supply a therapeutic good without a

prescription.


Synonymous Names

Data Hierarchy 846

847

PRESCRIPTION REQUEST 1..1

CONTEXT


DISPENSER 1..1

DISPENSING ORGANISATION 1..1

PRESCRIBER 1..1

PRESCRIBER ORGANISATION 1..1

Prescription Request Identifier 1..1

DateTime Prescription Request Written 1..1

CONTENT

PRESCRIBER INSTRUCTION DETAIL 1..1

PRESCRIBER INSTRUCTION RECIPIENT 1..1

DateTime Prescriber Instruction Received 1..1

Prescriber Instruction 1..1

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_COMPOSITION_prescription_re

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_COMPOSITION_prescription2








../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_ADMIN_ENTRY_prescriber_inst

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_ADMIN_ENTRY_prescriber_i2




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Prescriber Instruction Source 1..1

Prescriber Instruction Communication

Medium

1..1

PRESCRIPTION REQUEST ITEM 1..1


Formula 0..1

DOSAGE 0..1

Dose Instruction 1..1

Instructions for Use 0..1


Brand Substitute Allowed 0..1

Medical Benefit Category Type 0..1

PBS/RPBS Authority Approval Number 0..1

State Authority Number 0..1


REQUESTER NOTE 0..1

Note 1..1

848 849





../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_ITEM_TREE_therapeutic_good_

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_ITEM_TREE_therapeutic_go3











../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_EVALUATION_note_detail_v2_n



14/04/2011 15:08:07

850

14 Prescription Request Context 851


Identification 853

854



Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 855

856


prescribed items.


Synonymous Names

Patient


Usage 857

858




[NEHT2010i].





[NEHT2010d].




PROHIBITED.






../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#SA2006b

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_subject_of_care

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#NEHT2010i



../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#NEHT2010d





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Australian IHI.


of ―Residential‖ or ―Temporary Accommodation‖.






Relationships 859

Parents 860

861

Data


PRESCRIPTION REQUEST Essential Single


Identification 863

864



Identifier VD-16047

OID 1.2.36.1.2001.1001.101.104.16047

Definition 865

866


Care's entitlement.


Value Domain 867

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#subject_of_care_entitlement_type_values

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#subject_of_care_entitlement_type_values




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868

Source NEHTA










Relationships 869

Parents 870

871

Data



14.3 DISPENSER 872

Identification 873

874

Name DISPENSER


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 875

876

Definition The healthcare provider who made the therapeutic good

available.


Synonymous Names

Usage 877

878

Conditions of Use These are described in more detail in B.1: Dispenser.



../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#SA2006a

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_dispenser



14/04/2011 15:08:07


[NEHT2010i].





[NEHT2010d].




PROHIBITED.





PROHIBITED.


PROHIBITED.













specific fixed value meaning ―Dispenser‖.


Australian HPI-I.



ADDRESS.




Relationships 879

Parents 880









14/04/2011 15:08:07

881

Data



14.4 DISPENSING ORGANISATION 882

Identification 883

884

Name DISPENSING ORGANISATION


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 885

886

Definition The organisation which the dispenser is working for when they

dispense the item.


Synonymous Names

Usage 887

888

Conditions of Use These are described in more detail in B.2: Dispensing

Organisation.



[NEHT2010i].





[NEHT2010d].








ESSENTIAL.



../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_dispensing_organisation

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_dispensing_organisation









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specific fixed value meaning ―Dispensary‖.


Australian HPI-O.



ADDRESS.


of ―Business‖.






the value ―11‖ (Medicare Pharmacy Approval Number).


Relationships 889

Parents 890

891

Data



14.5 PRESCRIBER 892

Identification 893

894

Name PRESCRIBER


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 895

896

Definition The healthcare provider from whom a prescription is sought.


Synonymous Names






14/04/2011 15:08:07

Notes This will be the healthcare provider who wrote the prescriber

instruction.

Usage 897

898

Conditions of Use These are described in more detail in C.1: Prescriber.



[NEHT2010i].





[NEHT2010d].




PROHIBITED.



• EMPLOYER ORGANISATION is PROHIBITED.

• Employment Type is PROHIBITED.

• Occupation is ESSENTIAL.

• Position In Organisation is PROHIBITED.


PROHIBITED.


PROHIBITED.












specific fixed value meaning ―Prescriber‖.


Australian HPI-I.

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_prescriber









14/04/2011 15:08:07



ADDRESS.






the value ―10‖ (Medicare Prescriber Number).


Relationships 899

Parents 900

901

Data



14.6 PRESCRIBER ORGANISATION 902

Identification 903

904

Name PRESCRIBER ORGANISATION


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 905

906

Definition The organisation which the prescriber is working for when they

write the prescription.


Synonymous Names

Usage 907

908

Conditions of Use These are described in more detail in C.2: Prescriber

Organisation.



[NEHT2010i].




../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_prescriber_organisation

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#participations_prescriber_organisation





14/04/2011 15:08:07





[NEHT2010d].








ESSENTIAL.





specific fixed value meaning ―Healthcare Facility‖.


Australian HPI-O.



ADDRESS.


of ―Business‖.

• At least one ELECTRONIC COMMUNICATION

DETAIL MUST have Electronic Communication Medium

with a value of ―Telephone‖ or ―Mobile‖.




Relationships 909

Parents 910

911

Data



14.7 Prescription Request Identifier 912

Identification 913

914








14/04/2011 15:08:07

Name Prescription Request Identifier


Identifier DE-16287

OID 1.2.36.1.2001.1001.101.103.16287

Definition 915

916

Definition The dispenser's identifier for the request.


Synonymous Names

Data Type

UniqueIdentifier

Usage 917

918



Relationships 919

Parents 920

921

Data



14.8 DateTime Prescription Request Written 922

Identification 923

924

Name DateTime Prescription Request Written


Identifier DE-16288

OID 1.2.36.1.2001.1001.101.103.16288

Definition 925

926

Definition The date (and optionally time) that the prescription request is

written.







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Synonymous Names

Data Type

DateTime

Usage 927

928



Relationships 929

Parents 930

931

Data



932

15 Prescriber Instruction Detail 933

15.1 PRESCRIBER INSTRUCTION DETAIL 934

Identification 935

936

Name PRESCRIBER INSTRUCTION DETAIL


Identifier DG-16290

OID 1.2.36.1.2001.1001.101.102.16290

Definition 937

938

Definition A summary of the instruction from the prescriber to supply a

therapeutic good to a subject of care.


Synonymous Names

Relationships 939

Parents 940

941

Data



Children 942







14/04/2011 15:08:07

943

Data


PRESCRIBER INSTRUCTION

RECIPIENT

Essential Single

DateTime Prescriber Instruction

Received

Essential Single

Prescriber Instruction Essential Single

Prescriber Instruction Source Essential Single


Medium

Essential Single

15.2 PRESCRIBER INSTRUCTION RECIPIENT 944

Identification 945

946

Name PRESCRIBER INSTRUCTION RECIPIENT


Identifier DG-10296

OID 1.2.36.1.2001.1001.101.102.10296


Definition 947

948

Definition The healthcare provider who received the prescriber instruction.


Synonymous Names

Usage 949

950

Conditions of Use Except for the value of Participation Type, these are the

same constraints as those on DISPENSER .



[NEHT2010i].





[NEHT2010d].




















14/04/2011 15:08:07



PROHIBITED.





PROHIBITED.


PROHIBITED.













―Prescriber Instruction Recipient‖.


Australian HPI-I.



ADDRESS.




Relationships 951

Parents 952

953

Data



DETAIL

Essential Single





14/04/2011 15:08:07

15.3 DateTime Prescriber Instruction Received 954

Identification 955

956

Name DateTime Prescriber Instruction Received


Identifier DE-16292

OID 1.2.36.1.2001.1001.101.103.16292

Definition 957

958

Definition The date (and optionally time) that the prescriber instruction is

received or accessed by the dispenser.


Synonymous Names

Data Type

DateTime

Usage 959

960



Relationships 961

Parents 962

963

Data



DETAIL

Essential Single

15.4 Prescriber Instruction 964

Identification 965

966

Name Prescriber Instruction


Identifier DE-16293

OID 1.2.36.1.2001.1001.101.103.16293

Definition 967

968







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Definition A statement of the instruction itself, including the therapeutic

good.


Synonymous Names

Data Type

Text

Usage 969

970

Examples

Relationships 971

Parents 972

973

Data



DETAIL

Essential Single

15.5 Prescriber Instruction Source 974

Identification 975

976

Name Prescriber Instruction Source


Identifier DE-16295

OID 1.2.36.1.2001.1001.101.103.16295

Definition 977

978

Definition The origin for the content of the prescriber instruction.


Synonymous Names

Data Type

CodeableText

Value Domain Not specified.

In the absence of national standard code sets, the code sets used





14/04/2011 15:08:07

must be registered code sets, i.e. registered through the HL7 code

set registration procedure1 with an appropriate object identifier

(OID), and must be publicly available.

When national standard code sets become available, they must

be used and the non-standard code sets must be deprecated.

Usage 979

980

Examples 1. standing order

2. protocol

3. medical record

4. medication chart

5. verbal instruction

Relationships 981

Parents 982

983

Data



DETAIL

Essential Single

15.6 Prescriber Instruction Communication Medium 984

Identification 985

986

Name Prescriber Instruction Communication Medium


Identifier DE-16297

OID 1.2.36.1.2001.1001.101.103.16297

Definition 987

988

Definition The mechanism or mode of communication used to transmit the

Prescriber Instruction to the dispenser.


Synonymous Names

Data Type

CodeableText


14/04/2011 15:08:07 1 http://www.hl7.org/oid/index.cfm?ref=footer

http://www.hl7.org/oid/index.cfm?ref=footer







14/04/2011 15:08:07

Value Domain Prescriber Instruction Communication Medium Values

Usage 989

990

Examples 1. phone

2. fax

3. email

4. face-to-face

Relationships 991

Parents 992

993

Data



DETAIL

Essential Single

15.7 Prescriber Instruction Communication Medium Values 994

Identification 995

996

Name Prescriber Instruction Communication Medium Values


Identifier VD-16296

OID 1.2.36.1.2001.1001.101.104.16296

Definition 997

998

Definition The set of values of Prescriber Instruction Communication Medium.


Value Domain 999

1000

Source NEHTA

Permissible Values 1 phone

2 fax

3 email

4 face-to-face

Relationships 1001

Parents 1002

1003






14/04/2011 15:08:07

Data



Medium

Essential Single

1004 1005





14/04/2011 15:08:07

1006

16 Prescription Request Item 1007

16.1 PRESCRIPTION REQUEST ITEM 1008

Identification 1009

1010

Name PRESCRIPTION REQUEST ITEM


Identifier DG-16211

OID 1.2.36.1.2001.1001.101.102.16211

Definition 1011

1012

Definition Details of the anticipated prescription item.


Synonymous Names

Notes This is written by the dispenser from the prescriber instruction.

Relationships 1013

Parents 1014

1015

Data



Children 1016

1017

Data




DOSAGE Optional Single

Instructions for Use Optional Single


Brand Substitute Allowed Optional Single

Medical Benefit Category Type Optional Single

PBS/RPBS Authority Approval Optional Single












14/04/2011 15:08:07

Data


Number

State Authority Number Optional Single



Identification 1019

1020



Identifier DE-10194

OID 1.2.36.1.2001.1001.101.103.10194

Definition 1021

1022









process;


ailment;





Synonymous Names

Item Name









../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#TGA2008a



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Data Type

CodeableText


Usage 1023

1024












Preferred Term are:

1. 293049011000036110, paracetamol 500 mg +

codeine phosphate 30 mg tablet

2. 327004011000036118, paracetamol 500 mg +

codeine phosphate 30 mg tablet, 20



4. 192727011000036112, Panadeine Forte


uncoated, 1 tablet



6. 315236011000036113, bandage compression 10

cm x 3.5 m bandage: high stretch, 1 bandage

7. 186324011000036116, Eloflex (2480) (bandage


bandage


medication.

Relationships 1025

Parents 1026

1027

Data


PRESCRIPTION REQUEST ITEM Essential Single






14/04/2011 15:08:07


Identification 1029

1030



Identifier VD-16115

OID 1.2.36.1.2001.1001.101.104.16115

Definition 1031

1032




• IS A Medicinal Product Unit of Use (MPUU);

• IS A Medicinal Product Pack (MPP);




Specifically for MPUU: only MPUU concepts that have no child

MPUUs are to be included. Where an MPUU concept is a parent of

another MPUU, the parent MPUU is to be omitted.





Value Domain 1033

1034


Relationships 1035

Parents 1036

1037

Data



16.4 Formula 1038

Identification 1039

1040

Name Formula

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#NEHT2009r

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#NEHT2009r




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Identifier DE-16272

OID 1.2.36.1.2001.1001.101.103.16272

Definition 1041

1042



Synonymous Names

Data Type

Text

Usage 1043

1044


Ointment:


Olive Oil 25



Relationships 1045

Parents 1046

1047

Data


PRESCRIPTION REQUEST ITEM Optional Single

16.5 DOSAGE 1048

Identification 1049

1050

Name DOSAGE


Identifier DG-16007

OID 1.2.36.1.2001.1001.101.102.16007

Definition 1051

1052

Definition The regimen governing the amount (in a single administration,




14/04/2011 15:08:07

i.e. dose quantity), the frequency, the route, and the number of

doses of a therapeutic agent to be administered to a subject of

care.

Definition Source Based on Mosby's Medical Dictionary, 8th Edition

[MOSB2008a].

Synonymous Names

Scope This data group is used to provide details of dose instructions for

medication dispensing and administration.

Scope Source NEHTA

Notes The dosage data group in this release of the PIM is designed to

support simple dosage instructions. Clinical input is being

sought to modify the data group in order to support more

complex dosing instructions such as variable and alternate

dosing and multi-component medicines. This is an evolving

process and will be supported by the development of an

implementation guide outlining how the dosage data group is to

be implemented.

In the meantime, implementers may wish to examine the NHS

Dose Syntax Model [NHS2009a]. That model, while different to

this data group, provides many similarities.

Usage 1053

1054

Conditions of Use If the Therapeutic Good is a medication, this is essential,

otherwise it is prohibited.


Misuse Using this data group for non-medication items, such as

bandages. Instruction on the use of non-medication items

can be recorded as text in the Instructions for Use data

element.

Relationships 1055

Parents 1056

1057

Data



Children 1058

1059

Data


Dose Instruction Essential Single

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#MOSB2008a

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#NHS2009a

../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#NHS2009a






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16.6 Dose Instruction 1060

Identification 1061

1062

Name Dose Instruction


Identifier DE-16008

OID 1.2.36.1.2001.1001.101.103.16008

Definition 1063

1064

Definition A description of the dose quantity, frequency, route instruction

and cautionary advice that determines how the prescribed

therapeutic substance is administered to, or taken by, the subject

of care.


Synonymous Names

Dosage Instruction

Data Type

Text

Usage 1065

1066

Conditions of Use This should include the dose quantity, frequency, route,

administration schedule and any additional instructions

required to safely describe the appropriate dosage. If

appropriate, this may also include the site of

administration.


Examples 1. One tablet twice a day every 12 hours, before or

with the first mouthful of food.

2. Apply thin layer to affected area 3-4 times daily;

reassess after 7 days if no response.

Relationships 1067

Parents 1068

1069

Data


DOSAGE Essential Single




14/04/2011 15:08:07

16.7 Instructions for Use 1070

Identification 1071

1072

Name Instructions for Use


Identifier DE-16276

OID 1.2.36.1.2001.1001.101.103.16276

Definition 1073

1074

Definition Directions for the use of a therapeutic good other than a

medication.


Synonymous Names

Data Type

Text

Usage 1075

1076

Conditions of Use If the Therapeutic Good is a medication, this is prohibited,

otherwise it is essential.


Examples 1. For use with Spiriva Capsules containing powder

for oral inhalation. (About a Spiriva HandiHaler.)

2. Portable Pulse Oximeter measurement to be taken

by clipping the sensor onto the tip of a finger.

Misuse Using this data group for medication items.

Relationships 1077

Parents 1078

1079

Data




Identification 1081

1082





14/04/2011 15:08:07


Identifier DE-10145

OID 1.2.36.1.2001.1001.101.103.10145

Definition 1083

1084


the therapeutic good that is prescribed.


Synonymous Names

Quantity Prescribed

Quantity Ordered

Unit of Use Quantity Prescribed

Data Type

Text

Usage 1085

1086




Relationships 1087

Parents 1088

1089

Data


PRESCRIPTION REQUEST ITEM Essential Single

16.9 Brand Substitute Allowed 1090

Identification 1091

1092

Name Brand Substitute Allowed


Identifier DE-10107

OID 1.2.36.1.2001.1001.101.103.10107

Definition 1093

1094




14/04/2011 15:08:07


medication with a different brand name of the same medication,

which has been determined as bioequivalent, is allowed when

the medication is dispensed/supplied.


Synonymous Names

Allow substitutions

Notes PBS prescriptions must not be prepared using a computer

prescribing program that contains a default which would result in

all prescriptions being indicated as Brand Substitution Not

Permitted [DHA2009a].

Data Type

Boolean

Usage 1095

1096



Default Value "true"

Relationships 1097

Parents 1098

1099

Data



16.10 Medical Benefit Category Type 1100

Identification 1101

1102

Name Medical Benefit Category Type


Identifier DE-16095

OID 1.2.36.1.2001.1001.101.103.16095

Definition 1103

1104

Definition Indicates the category of subsidy appropriate to the item being

prescribed.


../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#DHA2009a




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Synonymous Names

Notes This indicates whether the item has been prescribed for a use

which attracts a subsidy.

Not to be confused with Claim Category Type.

Data Type

CodedText

Value Domain Medical Benefit Category Type Values

Usage 1105

1106

Examples

Relationships 1107

Parents 1108

1109

Data



16.11 Medical Benefit Category Type Values 1110

Identification 1111

1112

Name Medical Benefit Category Type Values


Identifier VD-16095

OID 1.2.36.1.2001.1001.101.104.16095

Definition 1113

1114

Definition The set of values of Medical Benefit Category Type.


Value Domain 1115

1116

Source NEHTA

Permissible Values 1, PBS A subsidy under the Pharmaceutical Benefits Scheme1

applies to this item.

2, RPBS A subsidy under the Repatriation Pharmaceutical


14/04/2011 15:08:07 1 http://www.medicareaustralia.gov.au/provider/pbs/index.jsp








14/04/2011 15:08:07

Benefits Scheme2 applies to this item.

3, CTG A subsidy under the Closing the Gap-PBS Co-Payment

Measure3 applies to this item.

9, No benefit This item is not covered by a medical subsidy.

Relationships 1117

Parents 1118

1119

Data



16.12 PBS/RPBS Authority Approval Number 1120

Identification 1121

1122

Name PBS/RPBS Authority Approval Number


Identifier DE-10159

OID 1.2.36.1.2001.1001.101.103.10159

Definition 1123

1124

Definition An identification number obtained by the prescriber and

included in the prescription to show that the prescription meets

agreed prescribing requirements and has authority to prescribe

the medication and/or the quantity of the medication.


Synonymous Names

Notes Each authority prescription requires a unique approval number

provided by Medicare Australia or the Department of Veterans'

Affairs.

Data Type

Text

Usage 1125

1126



For PBS prescriptions: Authority prescriptions are required


14/04/2011 15:08:07 2 http://www.dva.gov.au/service_providers/doctors/Pages/rpbs.aspx 3 http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/closing-the-gap.jsp









14/04/2011 15:08:07

for certain PBS medicines, and where the prescriber feels

the patient requires an increased number of repeats or a

quantity greater than the maximum listed in the Schedule of

Pharmaceutical Benefits.

For RPBS prescriptions: An authority required approval

can be recorded on a script for private items which results

in reduced or no out-of-pocket expenses for the patient.

(Medicare Australia)

1. This MUST be populated if:


• the item is listed as ―authority required‖.



• the item is not listed as ―authority required‖.


• the Medical Benefit Category type is neither PBS

nor RPBS.

Conditions of Use Source Medicare Australia and NEHTA

Examples 1. Z1234AB (Authority Required)

2. 9876 (Authority Required (Streamlined))

Relationships 1127

Parents 1128

1129

Data



16.13 State Authority Number 1130

Identification 1131

1132

Name State Authority Number


Identifier DE-16018

OID 1.2.36.1.2001.1001.101.103.16018

Definition 1133

1134

Definition An identification number issued by an Australian state or

territory health authority as proof that the prescriber has obtained

written authority to prescribe drugs of dependence for a drug-




14/04/2011 15:08:07

dependent person, or for the treatment of a person with drug

addiction for a period in accordance with State or Territory

regulations.


Synonymous Names

Notes The PBS refers to the requirement to also observe state

legislation when prescribing Schedule 8 medicines. Such

legislation may require a state-issued authority number. These

authority numbers may be required in addition to a PBS/RPBS

Authority Approval Number.

Data Type

Text

Usage 1135

1136

Conditions of Use If state authorisation is required to prescribe this item, this

information must be provided in the prescription.


Examples 1. S18A0812

2. CNS 123654

3. S28c 132465

4. 123658-10-2009

5. CL/24586

6. RA/34536

Relationships 1137

Parents 1138

1139

Data




Identification 1141

1142



Identifier DE-16044

OID 1.2.36.1.2001.1001.101.103.16044






14/04/2011 15:08:07

Definition 1143

1144



management.


Synonymous Names

Data Type

Text

Usage 1145

1146


2. Consulted prescriber concerning dose.


Relationships 1147

Parents 1148

1149

Data



1150

1151




14/04/2011 15:08:07

1152

17 Requester Note 1153

17.1 REQUESTER NOTE 1154

Identification 1155

1156

Name REQUESTER NOTE


Identifier DG-16212

OID 1.2.36.1.2001.1001.101.102.16212

Definition 1157

1158

Definition A note from the requester to the prescriber.


Synonymous Names

Relationships 1159

Parents 1160

1161

Data


PRESCRIPTION REQUEST Optional Single

Children 1162

1163

Data


Note Essential Single

6.2 Note 1164

Identification 1165

1166

Name Note


Identifier DE-16213

OID 1.2.36.1.2001.1001.101.103.16213

Definition 1167

1168


../../Source%20Docs/NEHTA-00101-Prescription_Request-Specification-word.doc#openEHR_EHR_EVALUATION_note_detail_v2_n



14/04/2011 15:08:07

Definition Free text comments relevant to the prescription request.


Synonymous Names

Data Type

Text

Usage 1169

1170

Examples 1. Subject of care does not speak English, provide appropriate

counselling.

2. Please deliver to the subject of care, at home.

Relationships 1171

Parents 1172

1173

Data


REQUESTER NOTE Essential Single

1174

1175




14/04/2011 15:08:07

1176 1177



1183

1184

1185

1186

1187

1188

Figure 2 UML class diagram of the Prescription Request data hierarchy.



14/04/2011 15:08:07

APPENDIX AParticipations 1189

This appendix details the participation data groups used in the e-Prescription PIM. Each participation 1190 data group is described with a data hierarchy and a list of value constraints. The data hierarchies have 1191 been constrained from the general participation data hierarchy, which is described in Participation Data 1192 Specification [NEHT2010i]. Data elements which are prohibited (constrained out from appearing in a 1193 particular data hierarchy) have been printed in strikeout font in shaded rows. The constraints have the 1194 same form as those in the body of the PIM. 1195

A1 Subject of Care 1196

This is a reuse of the PARTICIPATION data group, which is described in Participation Data 1197 Specification [NEHT2010i]. 1198

The following data hierarchy is the result of constraining that data group for Subject of Care. 1199 Constraints on data values are listed after the data hierarchy. 1200

Data Hierarchy 1201

1202

PARTICIPATION

Participation Type 1..1

Role 1..1

Participation Period 0..0

LOCATION OF PARTICIPATION 0..0

PARTICIPANT 1..1

Entity Identifier 1..1

ADDRESS 1..1

No Fixed Address Indicator 1..1

AUSTRALIAN OR INTERNATIONAL

ADDRESS 1..1

INTERNATIONAL ADDRESS 0..1

International Address Line 0..*

International State/Province 0..1

International Postcode 0..1

Country 0..1

AUSTRALIAN ADDRESS 0..1

Unstructured Australian

Address Line 0..*

STRUCTURED 0..1



14/04/2011 15:08:07

AUSTRALIAN ADDRESS

LINE

Australian Unit Type 0..1

Australian Unit

Number 0..1

Australian Address

Site Name 0..1

Australian Level

Type 0..1

Australian Level

Number 0..1

Australian Street

Number 0..1

Australian Lot

Number 0..1

Australian Street

Name 0..1

Australian Street

Type 0..1

Australian Street

Suffix 0..1

Australian Postal

Delivery Type 0..1

Australian Postal

Delivery Number 0..1

Australian

Suburb/Town/Locality 0..1

Australian State/Territory 0..1

Australian Postcode 0..1

Australian Delivery Point

Identifier 0..1

Address Purpose 1..1

ELECTRONIC COMMUNICATION DETAIL 0..*

Electronic Communication Medium 1..1

Electronic Communication Usage Code 0..1

Electronic Communication Address 1..1



14/04/2011 15:08:07

PERSON OR ORGANISATION OR DEVICE 1..1

DEVICE 0..0

ORGANISATION 0..0

PERSON 1..1

PERSON NAME 1..1

Name Title 0..*

Family Name 1..1

Given Name 0..*

Name Suffix 0..*

Preferred Name Indicator 0..1

Person Name Usage 0..1

Relationship to Subject of Care 0..0

EMPLOYMENT DETAIL 0..0

DEMOGRAPHIC DATA 1..1

Sex 1..1

DATE OF BIRTH DETAIL 1..1

Date of Birth 1..1

Date of Birth is

Calculated From Age 0..1

DATE OF BIRTH

ACCURACY

INDICATOR

0..1

Date of

Birth Day

Accuracy

Indicator

1..1

Date of

Birth

Month

Accuracy

Indicator

1..1

Date of

Birth Year

Accuracy

Indicator

1..1



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AGE DETAIL 0..1

Age 1..1

Age Accuracy

Indicator 0..1

Birth Plurality 0..1

Birth Order 0..1

DATE OF DEATH DETAIL 0..0

Source of Death Notification 0..0

Mothers Original Family

Name 0..0

Country of Birth 0..0

State/Territory of Birth 0..0

Indigenous Status 0..0

ENTITLEMENT 0..*

Entitlement Number 1..1

Entitlement Type 1..1

Entitlement Validity Duration 0..1

Qualifications 0..0

Constraints on data values 1203

• Participation Type MUST have an implementation specific fixed value meaning ―Subject‖. 1204

• The value of Entity Identifier MUST be an Australian IHI. 1205

• ADDRESS MUST have an Address Purpose value of ―Residential‖ or ―Temporary 1206 Accommodation‖. 1207

• Entitlement Type MUST have a value from Subject of Care Entitlement Type Values. 1208

Notes 1209

• The value of Participation Type may be explicit, e.g. recordTarget.typeCode = 'RCT' (Record 1210 Target) in HL7 CDA R2, but it may also be implicit in the record structure, e.g. PID segment in HL7 1211 V2. For further information, please see the Participation Type definition in Participation Data 1212 Specification [NEHT2010i]. 1213

• The value of Role will be an implementation specific value with a meaning of ―Patient‖, 1214 ―Client‖ or similar. 1215

• The subject of care's Medicare card number is recorded in ENTITLEMENT, not Entity 1216 Identifier. 1217

1218



14/04/2011 15:08:07

1219

A2 Prescriber 1220


The following data hierarchy is the result of constraining that data group for Prescriber. Constraints on 1223 data values are listed after the data hierarchy. 1224

Data Hierarchy 1225

1226

PARTICIPATION


Role 1..1



PARTICIPANT 1..1


ADDRESS 0..1



ADDRESS 1..1




Address Line 0..*

STRUCTURED

AUSTRALIAN ADDRESS

LINE

0..1

Australian Unit

Type 0..1

Australian Unit

Number 0..1

Australian

Address Site

Name

0..1

Australian Level

Type 0..1



14/04/2011 15:08:07

Australian Level

Number 0..1

Australian Street

Number 0..1

Australian Lot

Number 0..1

Australian Street

Name 0..1

Australian Street

Type 0..1

Australian Street

Suffix 0..1

Australian Postal

Delivery Type 0..1

Australian Postal

Delivery Number 0..1

Australian





Identifier 0..1







DEVICE 0..0

ORGANISATION 0..0

PERSON 1..1

PERSON NAME 1..1

Name Title 0..*

Family Name 1..1



14/04/2011 15:08:07

Given Name 0..*

Name Suffix 0..*

Preferred Name Indicator 0..1




EMPLOYER

ORGANISATION 0..0

Employment Type 0..0

Occupation 1..*

Position in Organisation 0..0


Sex 1..1

DATE OF BIRTH DETAIL 1..1

Date of Birth 1..1

Date of Birth is

Calculated From

Age

0..0

DATE OF

BIRTH

ACCURACY

INDICATOR

0..0

AGE DETAIL 0..0


Birth Order 0..0

DATE OF DEATH DETAIL 0..0

Source of Death Notification 0..0


Name 0..0




ENTITLEMENT 0..*



14/04/2011 15:08:07




Qualifications 0..1


• Participation Type MUST have an implementation specific fixed value meaning ―Prescriber‖. 1228

• The value of Entity Identifier MUST be an Australian HPI-I. 1229

• If the value of Medical Benefit Category Type is ―1‖ ( PBS), ―2‖ ( RPBS) or ―3‖ ( CTG), 1230 exactly one ENTITLEMENT MUST have an Entitlement Type with the value ―10‖ (Medicare 1231 Prescriber Number). 1232

Notes 1233

• The value of Participation Type may be explicit, e.g. author.typeCode = 'AUT' (Author) in HL7 1234 CDA R2, but it may also be implicit in the record structure, e.g. some HL7 V2 segments. For further 1235 information, please see the Participation Type definition in Participation Data Specification 1236 [NEHT2010i]. 1237

• The value of Role will be an implementation specific value with a meaning of ―General 1238 Practitioner‖, ―Dermatologist‖, ―Nurse Practitioner‖ or a similar occupation. 1239

A3 Prescriber Organisation 1240


The following data hierarchy is the result of constraining that data group for Prescriber Organisation. 1243 Constraints on data values are listed after the data hierarchy. 1244

Data Hierarchy 1245

1246

PARTICIPATION


Role 1..1



PARTICIPANT 1..1


ADDRESS 1..1



ADDRESS 1..1




14/04/2011 15:08:07



Address Line 0..*

STRUCTURED

AUSTRALIAN ADDRESS

LINE

0..1

Australian Unit

Type 0..1

Australian Unit

Number 0..1

Australian

Address Site

Name

0..1

Australian

Level Type 0..1

Australian

Level Number 0..1

Australian

Street Number 0..1

Australian Lot

Number 0..1

Australian

Street Name 0..1

Australian

Street Type 0..1

Australian

Street Suffix 0..1

Australian

Postal Delivery

Type

0..1

Australian

Postal Delivery

Number

0..1

Australian





Identifier 0..1



14/04/2011 15:08:07







DEVICE 0..0

ORGANISATION 1..1

Organisation Name 1..1

Department/Unit 0..1

Organisation Name Usage 0..1

PERSON 0..0

ENTITLEMENT 0..0

Qualifications 0..0


• Participation Type MUST have an implementation specific fixed value meaning ―Healthcare 1248 Facility‖. 1249

• The value of Entity Identifier MUST be an Australian HPI-O. 1250

• ADDRESS MUST have an Address Purpose value of ―Business‖. 1251

• A least one ELECTRONIC COMMUNICATION DETAIL MUST have an Electronic 1252 Communication Medium value of ―Telephone‖ or ―Mobile‖. 1253

Notes 1254

• The value of Participation Type may be explicit, e.g. author.typeCode = 'AUT' (Author) in HL7 1255 CDA R2, but it may also be implicit in the record structure, e.g. some HL7 V2 segments. For further 1256 information, please see the Participation Type definition in Participation Data Specification 1257 [NEHT2010i]. 1258

• The value of Role will be an implementation specific value with a meaning of ―General 1259 Practice Clinic‖, ―Dental Surgery‖ or similar. 1260 1261

1262

A4 Dispenser 1263


The following data hierarchy is the result of constraining that data group for Dispenser. Constraints on 1266 data values are listed after the data hierarchy. 1267

Data Hierarchy 1268



14/04/2011 15:08:07

1269

PARTICIPATION


Role 1..1



PARTICIPANT 1..1


ADDRESS 0..1



ADDRESS 1..1




Address Line 0..*

STRUCTURED

AUSTRALIAN

ADDRESS LINE

0..1

Australian

Unit Type 0..1

Australian

Unit Number 0..1

Australian

Address Site

Name

0..1

Australian

Level Type 0..1

Australian

Level Number 0..1

Australian

Street Number 0..1

Australian Lot

Number 0..1

Australian 0..1



14/04/2011 15:08:07

Street Name

Australian

Street Type 0..1

Australian

Street Suffix 0..1

Australian

Postal Delivery

Type

0..1

Australian

Postal Delivery

Number

0..1

Australian


Australian

State/Territory 0..1


Australian Delivery

Point Identifier 0..1







DEVICE 0..0

ORGANISATION 0..0

PERSON 1..1

PERSON NAME 1..1

Name Title 0..*

Family Name 1..1

Given Name 0..*

Name Suffix 0..*



14/04/2011 15:08:07

Preferred Name

Indicator 0..1





Sex 1..1

DATE OF BIRTH

DETAIL 1..1

Date of Birth 1..1

Date of Birth

is Calculated

From Age

0..0

DATE OF

BIRTH

ACCURACY

INDICATOR

0..0

AGE DETAIL 0..0


Birth Order 0..0

DATE OF DEATH

DETAIL 0..0

Source of Death

Notification 0..0


Name 0..0




ENTITLEMENT 0..0

Qualifications 0..1


Participation Type MUST have an implementation specific fixed value meaning ―Dispenser‖. 1271



14/04/2011 15:08:07

The value of Entity Identifier MUST be an Australian HPI-I. 1272 Notes 1273

The value of Participation Type may be explicit, e.g. author.typeCode = 'AUT' (Author) in HL7 CDA 1274 R2, but it may also be implicit in the record structure, e.g. some HL7 V2 segments. For further 1275 information, please see the Participation Type definition in Participation Data Specification 1276 [NEHT2010i]. 1277

The value of Role will be an implementation specific value with a meaning of ―Pharmacist‖ or a similar 1278 occupation from the ANSCO. 1279

1280

1281

A5 Dispensing Organisation 1282


The following data hierarchy is the result of constraining that data group for Dispensing Organisation. 1285 Constraints on data values are listed after the data hierarchy. 1286

Data Hierarchy 1287

1288

PARTICIPATION


Role 1..1



PARTICIPANT 1..1


ADDRESS 1..1



ADDRESS 1..1



Unstructured

Australian Address

Line

0..*

STRUCTURED

AUSTRALIAN 0..1



14/04/2011 15:08:07

ADDRESS LINE

Australian

Unit Type 0..1

Australian

Unit Number 0..1

Australian

Address Site

Name

0..1

Australian

Level Type 0..1

Australian

Level

Number

0..1

Australian

Street

Number

0..1

Australian

Lot Number 0..1

Australian

Street Name 0..1

Australian

Street Type 0..1

Australian

Street Suffix 0..1

Australian

Postal

Delivery Type

0..1

Australian

Postal

Delivery

Number

0..1

Australian


Australian

State/Territory 0..1


Australian Delivery

Point Identifier 0..1






14/04/2011 15:08:07




DEVICE 0..0

ORGANISATION 1..1

Organisation Name 1..1

Department/Unit 0..1

Organisation Name Usage 0..1

PERSON 0..0

ENTITLEMENT 0..*




Qualifications 0..0


Participation Type MUST have an implementation specific fixed value meaning ―Dispensary‖. 1290

The value of Entity Identifier MUST be an Australian HPI-O. 1291

ADDRESS MUST have an Address Purpose value of ―Business‖. 1292

If the value of Medical Benefit Category Type in the associated prescription is ―1‖ ( PBS), ―2‖ ( RPBS) 1293 or ―3‖ ( CTG), exactly one ENTITLEMENT MUST have an Entitlement Type with the value ―11‖ 1294 (Medicare Pharmacy Approval Number). 1295

Notes 1296

The value of Participation Type may be explicit, e.g. author.typeCode = 'AUT' (Author) in HL7 CDA 1297 R2, but it may also be implicit in the record structure, e.g. some HL7 V2 segments. For further 1298 information, please see the Participation Type definition in Participation Data Specification 1299 [NEHT2010i]. 1300

The value of Role will be an implementation specific value with a meaning of ―Pharmacy‖ or similar. 1301

1302

1303



14/04/2011 15:08:07

1304



14/04/2011 15:08:07

APPENDIX B Structured Dose Detailed Clinical Model1305



14/04/2011 15:08:07

1306



14/04/2011 15:08:07

APPENDIX C: Comparison Between Printed and Electronic Prescriptions 1307

Printed prescriptions and electronic prescriptions have been designed for use in different situations. 1308 Printed prescriptions can be used without any supporting computer system. Use of electronic 1309 prescriptions requires a supporting computer system. Consequently, the layout of a printed prescription 1310 is a poor guide to where data elements are recorded in the associated electronic prescription. This 1311 chapter identifies the data elements of a typical printed prescription and describes how they are 1312 recorded in the structure of an electronic prescription. 1313

C1 A Blank Printed Prescription 1314

1315

1316

1317

This is an annotated image of a typical blank prescription form. The next section of this document 1318 describes how the information in each labeled region of a printed prescription is recorded in an 1319 electronic prescription. 1320

Figure 3 Annotated blank prescription



14/04/2011 15:08:07

C2 Mapping From Printed to Electronic Prescriptions 1321

This section describes how the information in each region of a printed prescription is recorded in an 1322 electronic prescription. 1323

Mapping of Printed Prescription Data Items to Electronic Prescription Data Items 1324

These tables describe, for each data item in a typical printed prescription, where an electronic 1325 prescription will record the same information. 1326

Prescriber details 1327

1328

Prescription item

name

PIM item name

Doctor‘s Name Prescriber.Participant.Person.Person Name

Surgery Address Prescriber Organisation.Participant.Address

Surgery Telephone Prescriber Organisation.Participant.Electronic

Communication Detail

Prescriber no. Prescriber.Participant.Entity Identifier

Subject of care details 1329

1330

Prescription item

name

PIM item name

Patient‘s IHI Subject of Care.Participant.Entity Identifier

Patient‘s Medicare

no.

Subject of Care.Participant.Entitlement.Entitlement Number

Pharmaceutical

benefits

entitlement

number

Subject of Care.Participant.Entitlement.Entitlement Number

Safety Net

entitlement card

holder

Subject of Care.Participant.Entitlement.Entitlement Type

Concessional or

dependent RPBS

beneficiary or

Safety Net

concession card

holder

Subject of Care.Participant.Entitlement.Entitlement Type

Patient‘s name Subject of Care.Participant.Person.Person Name

Patient‘s Address Subject of Care.Participant.Address

Prescription details 1331

1332



14/04/2011 15:08:07

Prescription item

name

PIM item name

Date DateTime Prescription Written

PBS Prescription Item.Medical Benefit Category Type

RPBS Prescription Item.Medical Benefit Category Type

Brand substitution

not permitted

Prescription Item.Dispensing Information.Brand Substitute

Allowed

Prescription no. Prescription Identifier

Number of items This is derived, it is not carried in an electronic prescription.

Prescribed item details 1333

1334

Prescription item

name

PIM item name

Item Description This is carried in various data items in the data group

PRESCRIPTION ITEM. The therapeutic good is identified in

the data element Therapeutic Good Identification. The

quantity is in Quantity of Therapeutic Good. The number of

repeats is in Maximum Number of Repeats. The dose

instruction is in Dose Instruction.

Regulation 24 Prescription Item.Concurrent Supply Grounds

Hardship

conditions apply

Prescription Item.Concurrent Supply Grounds

Document retrieval key 1335

1336

Prescription item

name

PIM item name

Document

Retrieval Key

(barcode)

This is carried in the PES (Prescription Exchange Service)

header, not in the prescription document. For more details see

the NEHTA ETP Technical Architecture [NEHT2009l].

1337 1338



14/04/2011 15:08:07

1339

1340

Reference List 1341

[AIHW2009] Australian Institute of Health and Welfare, November 2009, AIHW's

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http://meteor.aihw.gov.au/

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Section_1_2_Explanatory_Notes

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Community_Pharmacy_Agreement/-

Fifth%20Agreement%20Document%20signed.pdf

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[MOSB2008a] Mosby, 2008, 8 December 2008, Mosby's Medical Dictionary, 8th

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[NEHT2009k] National E-Health Transition Authority, 30 October 2009, ETP Logical

Information Model, Release 1, accessed 1 April 2010.

http://www.nehta.gov.au/e-communications-in-practice/emedication-

management

[NEHT2009l] National E-Health Transition Authority, 30 October 2009, ETP

Technical Architecture, Release 1, accessed 1 April 2010.


management

[NEHT2009r] National E-Health Transition Authority, 30 June 2009, Australian

Medicines Terminology Editorial Rules, Version 3.0, accessed 9 June

2010.

http://www.nehta.gov.au/component/docman/doc_download/742-

australian-medicines-terminology-editorial-rules-v30

[NEHT2010c] National E-Health Transition Authority, September 2010, Data Types

in NEHTA Specifications: A Profile of the ISO 21090 Specification,

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data-types-in-nehta-specifications-v10

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http://www.guild.org.au/uploadedfiles/National/Public/Community_Pharmacy_Agreement/Fifth%20Agreement%20Document%20signed.pdf



http://www.hl7.org/implement/standards/cda.cfm

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14/04/2011 15:08:07

[NEHT2010d] National E-Health Transition Authority, September 2010, Data

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data-specifications-and-structured-document-templates-guide-for-use-

v11

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participation-data-specification-v30

[NEHT2010m] National E-Health Transition Authority, November 2010, e-

Prescription v3.1 CDA Implementation Guide, Version 1.0, accessed

[To Be Published].

[NEHT2010n] National E-Health Transition Authority, November 2010, Prescription

Request v1.1 CDA Implementation Guide, Version 1.0, accessed [To Be

Published].

[NEHT2010o] National E-Health Transition Authority, November 2010, Dispense

Record v3.1 CDA Implementation Guide, Version 1.0, accessed [To Be

Published].

[NEHT2010p] National E-Health Transition Authority, 2010, ETP Release 1.1

Concept of Operations, Version 1.0, accessed [To Be Published].


management

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Request Structured Document Template, Version 1.1, accessed [To Be

Published].

[NEHT2010t] National E-Health Transition Authority, November 2010, Dispense

Record Structured Document Template, Version 3.1, accessed [To Be

Published].

[NEHT2010u] National E-Health Transition Authority, November 2010, Detailed

Requirements Definition - ETP Release 1.1, Version 1.1, accessed [To

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[NHS2009a] National Health Service, NHS Dose Syntax Model, accessed 11

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14/04/2011 15:08:07

Identification, accessed 12 November 2009.


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determine whether my product is a “therapeutic good”?, accessed 4

June 2010.

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1342


http://www.tga.gov.au/docs/html/determine.htm

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Electronic Transfer of Prescriptions

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