Domain: Pharmacy



Domain: Pharmacy | |

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|Orders & Observations Co-Chair |

|Hans Buitendijk |

|Siemens Medical Solutions Health Services |

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|Vocabulary Facilitator |

|James Case, DVM, PhD. |

|University of California, Davis |

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|Medication SIG Co-Chair |

|Peter Johnson |

|Primary Care Development Ctr |

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|Orders & Observations Co-Chair |

|Clem McDonald, M.D. |

|Regenstrief Institute for Health Care |

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|Medication SIG Co-Chair |

|Lloyd McKenzie |

|IBM Canada & CIHI - HL7 Canada & Alberta Wellnet |

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|Medication SIG Co-Chair |

|Alan Rector, M.D. |

|University of Manchester |

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|Medication SIG Co-Chair |

|Scott Robertson |

|Kaiser Permanente |

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|Orders & Observations Co-Chair |

|Gunther Schadow, M.D., PhD. |

|Regenstrief Institute for Health Care |

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|Orders & Observations Co-Chair |

|Helen Stevens |

|McKesson Information Solutions |

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|Last Published: Thu 07/24/2003 1:13 PM |

|HL7® Version 3 Standard, © 2003 Health Level Seven®, Inc. All Rights Reserved. |

|HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off |

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|Table of Contents |

|1. Overview |

|    1.1. Introduction & Scope |

|    1.2. Message Design Element Navigation |

|    1.3. Domain Message Information Models |

|    1.4. Storyboards |

|2. Message Definitions |

|    2.1. Storyboards |

|    2.2. Application Roles |

|    2.3. Trigger Events |

|    2.4. Refined Message Information Models |

|    2.5. Hierarchical Message Descriptions |

|    2.6. Interactions |

|3.  Query Definitions |

|4.  Master File Definitions |

|5.  Indicies |

|    5.1. CMETs Derived From this Domain |

|    5.2. CMETs Used in this Domain |

|    5.3. Interaction Indexes |

|        5.3.1. By Application Role |

|        5.3.2. By Trigger Event |

|        5.3.3. By Message Type |

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|  |1 |Overview |

|[pi|1.1 |Introduction & Scope |

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|  |  |This domain deals with the order, promise (or intent) to perform and events that cover the dispensing and administration of |

| | |pharmaceutical and therapeutic products and dispensed devices. It also includes the communication flows that facilitate the |

| | |maintenance and appropriate use of these products. These concepts can be applied, for example, to inpatient (unit dose and |

| | |compound unit dose), outpatient, IV's and hyperalimentation IV's (nutritional IV's). The messages in this domain represent |

| | |the communication and relationship between care providers and pharmacies and treatment providers. |

| | |Here is a conceptual workflow of a subset of the supported events, which are described in greater detail within this domain. |

| | |When an order is initiated by a pharmacy order placer, the appropriate information pertaining to that order request is |

| | |transmitted to the pharmacy order fulfiller. This can include dispense and administration information requested by a care |

| | |provider |

| | |The pharmacy order filler then establishes its promise to perform and can register the order request with an encoding message|

| | |to the clinical system, which includes any additional or revised information from the pharmacy order filler. Additionally, |

| | |when the order is initiated directly into the pharmacy system, the encoded message can be sent to the clinical system, |

| | |notifying it about the existence of a new order and the pharmacy's promise to execute that order. |

| | |Each instance of dispensing a drug or treatment to fill an existing order or orders may result in a dispense message to the |

| | |clinical application when such information is required. This dispense message may describe a single dose, a half-day dose, a |

| | |daily dose, a refill of a prescription, start of an IV, an IV adjustment, etc. It is not intended to be a complete record of |

| | |an order, rather, it is documentation from the pharmacy order filler to the clinical application with drug/treatment dispense|

| | |data. Once a dispensed product has been received by a patient, financial information associated with the dispense can also be|

| | |transmitted. |

| | |A pharmacy order fulfiller can issue a message to the care provider when give instructions need to be transmitted for the |

| | |purpose of allowing the care provider to accurately administer the drug or treatment. The message contains drug or treatment |

| | |administration instructions for one or more scheduled administrations. |

| | |For each administration of an existing drug or treatment, a message can be issued from the care provider's application. It |

| | |contains the administration record with all pertinent information such as who performed the service, what was given and when |

| | |the service was done. |

| | |When an existing order is revised or maintained on either the pharmacy order filler or the clinical application, updated |

| | |order information can be transmitted. Updates may include dosage information, quantity and timing, number of refills, |

| | |discontinue (i.e., end date), etc. |

| | |Storyboard Introduction |

| | |Organization |

| | |Storyboards in the Pharmacy Domain are organized by practice settings. Primary, comprehensive storyboards exist for |

| | |Institutional (PORX_ST003500), and Community ( PORX_ST000800) practice settings. Additional storyboards in each practice |

| | |setting illustrate variations from the primary storyboards or alternate scenarios. Additional practice settings and |

| | |variations will be included as additional scenarios are defined. |

| | |The primary distinction between Institutional and Community practice settings relate to the potential complexity of the |

| | |order(s) and who ultimately administers the therapy to the patient: |

| | |Institutional Practice In institutional settings (hospital inpatient, emergency room, long term care facilities, some forms |

| | |of home care, among others) typically the therapeutic agent is supplied to an intermediary (typically a nurse or a nurses |

| | |aide) who subsequently administers the therapy to the patient. In such situations, orders may be very complex or detailed as |

| | |the person administering the therapy has specific education or training to understand and deal with the complexities. |

| | |Specific information on the administration of the therapy (e.g., the time) is very important in institutional settings. |

| | |Message content in institutional settings many include supply, administration, or both (combined) and may relate to the |

| | |overall therapy or to individually scheduled events. |

| | |Community Practice In community settings (ambulatory clinics, retail pharmacy, some forms of home care, among others) the |

| | |patient typically administers the therapy to themselves. In these situations, orders are typically less complex, both due to |

| | |specific knowledge limitations of the patient and the generally less-controlled environment. Specific information on the |

| | |administration of the therapy (e.g., the time) is usually not available in the community setting. Message content in the |

| | |community setting is usually limited to supply information. |

| | |Structured Sort Name Convention |

| | |Structured sort names for storyboards in the Pharmacy Domain begin with the practice setting (e.g., Institutional, |

| | |Community). The second term is either "Comprehensive" or describes the focal aspect where the storyboard departs from or |

| | |modifies the story-line of the comprehensive storyboard (e.g., Administration Event). Additional sort name terms provide |

| | |information on the setting or the focus of activity of the storyboard (e.g., TPN with duration). |

| | |Application Role Introduction |

| | |All Application Roles defined in Practice and Operations make use of 6 common stereotypes, and share a common hierarchical |

| | |approach. |

| | |The hierarchy of application roles is based on the Act state-transitions. At present, Practice and Observations deals with |

| | |the following state transitions: Activate, Suspend, Resume, Abort, Replace (a combination of 'Obsolete' and 'Activate'), |

| | |Complete and Re-activate. These states have been placed into a hierarchy representing what an application is capable of. The |

| | |hierarchy is as follows: |

| | |Basic: This application role is only capable of dealing with the 'Complete' state transition. It is only capable of sending |

| | |messages when a particular act is finished. |

| | |Lifetime: This application builds on the Basic role, but adds the concept of an Act having a period of existence, from the |

| | |time it begins (or becomes effective) and the time it ends. Applications supporting his role add the transitions of Activate |

| | |(meaning the act has begun/become active), and Abort (meaning that the act has been prematurely terminated.) The following |

| | |Application Roles all build upon the lifetime Role. They each require that the application have a concept of lifetime. A |

| | |system may mix and match more than one of these roles, depending on its capabilities. |

| | |Revision: This application is capable of dealing with changes to an act that do not require the assignment of a new |

| | |identifier. (Different jurisdictions may have different guidelines over what changes ay be made without requiring the |

| | |creation of a 'new' act.). |

| | |Replacement: This application is capable of creating a new act that replaces an existing act. This is similar to a revision, |

| | |except that a new identifier is assigned to the modified act. |

| | |Suspension: This application role is capable of dealing with the temporary de-activation of an act. (For example, temporarily|

| | |stopping a test, placing a prescription on hold). The application is also capable of dealing with the re-activation of the |

| | |act. This level does not deal with any transitions involving the 'new' state (which represents an Act that is still being |

| | |edited and is not yet 'active'). |

| | |Nullification: This application role is capable of dealing with the idea that a particular action may have happened in error |

| | |and may need to be reversed. This is supported by two state transitions - nullification which causes the act to be treated as|

| | |if it never really existed and Reactivation which allows an Act that had been marked as completed to be re-transitioned to |

| | |the Active state. |

| | |Within the hierarchy, there are 6 stereotypes, defined as follows: |

| | |Informer: An application that is capable of notifying another application about a significant event (the status change of a |

| | |focal class), but does not expect any action on the part of the receiver. Paired with 'Tracker'. |

| | |Tracker: An application that is capable of receiving information about a significant event (the status change of a focal |

| | |class), but is not expected by the receiver to perform any action. Paired with 'Informer'. |

| | |Placer: An application that is capable of requesting another application to perform some action. Paired with 'Fulfiller'. |

| | |Fulfiller: An application that is capable of receiving a request from a Placer application and responding with the action(s) |

| | |that have been, or will be, taken relative to the request. |

| | |Confirmer: An application that is capable of accepting a request from a Placer application and responding with promise to |

| | |perform the requested action. This is a hidden application role, a specialization of 'Fulfiller', and paired with |

| | |'Confirmation Receiver'. |

| | |Confirmation Receiver: An application that is capable of accepting promise(es) to perform action(s). This is a hidden |

| | |application role, a specialization of 'Placer', and paired with 'Confirmer'. |

|  |1.2 |Message Design Element Navigation |

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| | |Pharmacy Supply PORX_RM000021 |

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| | |Pharmacy Institutional Order PORX_RM000011 |

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| | |Pharmacy Medication Administration Query Response PORX_RM000031 |

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| | |Pharmacy Community Dispense PORX_RM000002 |

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| | |Pharmacy Community Prescription PORX_RM000001 |

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| |1.3 |Domain Message Information Models |

| | |Domain Table of Contents |

| | |Pharmacy Domain Model  (PORX_DM000000) |

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| | |Description |

| |  |Pharmacy Domain Message Information Model |

| | |Description |

| | |This is the global messaging model to support therapeutic "substance administration" and "supply". |

| | |The real life processes being represented are, in essence, making a prescription or medication order to actually give |

| | |(administer) a medicine (in)to a patient and organizing a supply of a medication to allow it to be administered. |

| | |Analysis of the way this real life process works in systems terms requires some of the real life objects to be |

| | |represented as more than one class. We also have to recognize that each class will progress through a number of |

| | |distinct states before the process is complete. |

| | |Revision History |

| | |Notes: Version 8 release 3 - 14th July 2003 |

| | |Changes: |

| | |1) Manufacturer, Medicine, MedicineSupplied, Ingredient and Supplier changed froim using ID to code. The equivalents |

| | |available in data type CE do what was required from the ID field. Following emails between Hugh & Lloyd |

| | |2) Split RMIM - Community Supply into RMIM - Community Prescription and RMIM - CommuntyDispense. Removed the recursion.|

| | |Following MED-SIGg conf call 19 June 2003 |

| | |3) Removed shadowing because it is not allowed in that form. Following emails between Hugh and Lloyd+Woody |

| | |4) Changed RMIMs to use medication CMETs to avoid endless repetition and associated maintenance issues. |

| | |5) Corrected CMETs where MedicationAdministration and MedicationSupply were incorrectly included. |

| | |6) Revised entry points |

| | |7) Split CMETs into Universal, Identified and Identified & Confirmable and made use of them for the two MEDSig CMETs. |

| | |8) Removed A_Observation CMETs linked to both MedicationAdministration and MedicationSupply. These were annotated as a |

| | |link to patient notes but the justification is not clear. A_Observation as a CMET has now been removed so the model |

| | |must be reviewed anyway. |

| | |9) Revised moods |

| | |10) Added in the AdministeredMedication CMET |

| | |To do: |

| | |1) Select appropriate flavours for all CMETs not from Pharmacy and check they are still appropriate. |

| | |2) Review all the observation CMETs |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

| |1.4 |Storyboard Overview |

| | |Domain Table of Contents |

| |  |Message Definition Storyboards |

| | |6 Message Definition Storyboards (Sorted by Title) |

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| | |Combined Event Query ( PORX_ST100000 )   |

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| | |Community Pharmacy, Comprehensive #2 ( PORX_ST000810 )   |

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| | |Community Practice, Comprehensive #1 ( PORX_ST000800 )   |

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| | |Community Practice, UK Variation ( PORX_ST003000 )   |

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| | |Hospital Administration with Duration ( PORX_ST000700 )   |

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| | |Institutional Practice, Comprehensive ( PORX_ST003500 )   |

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| | |6 Message Definition Storyboards (Sorted by Structured Sort Name) |

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| | |Community ( PORX_ST000800 )   |

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| | |Community ( PORX_ST000810 )   |

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| | |Community, UK Variation ( PORX_ST003000 )   |

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| | |Institutional ( PORX_ST003500 )   |

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| | |Institutional, Administration with Start/End ( PORX_ST000700 )   |

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| | |Pharmacy Combined Event Query ( PORX_ST100000 )   |

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| |2 |Message Definitions |

| | |Domain Table of Contents |

| |2.1 |Message Definition Storyboards |

| |  |6  (Sorted by Title) |

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| | |Combined Event Query ( PORX_ST100000 )   |

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| | |Community Pharmacy, Comprehensive #2 ( PORX_ST000810 )   |

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| | |Community Practice, Comprehensive #1 ( PORX_ST000800 )   |

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| | |Community Practice, UK Variation ( PORX_ST003000 )   |

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| | |Hospital Administration with Duration ( PORX_ST000700 )   |

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| | |Institutional Practice, Comprehensive ( PORX_ST003500 )   |

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| | |6  (Sorted by Structured Sort Name) |

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| | |Community ( PORX_ST000800 )   |

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| | |Community ( PORX_ST000810 )   |

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| | |Community, UK Variation ( PORX_ST003000 )   |

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| | |Institutional ( PORX_ST003500 )   |

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| | |Institutional, Administration with Start/End ( PORX_ST000700 )   |

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| | |Pharmacy Combined Event Query ( PORX_ST100000 )   |

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| | |Reference |

| |  |For details on the interpretation of this section, see the storyboard discussion in the Version 3 Guide. |

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| | |Introduction |

| |  |At the time of ballot, a limited number of Storyboards exist in the Pharmacy Domain. This is not to imply the these |

| | |are the only scenarios that will be addressed in this domain. This initial set of Storyboards represent several cases|

| | |of broad interest and applicability. Additional Storyboards will be developed to support additional, both general and|

| | |specific, use cases. The reader is encouraged to bring their experience and requirements to the committee and to join|

| | |in the development process. |

| |2.1.1 |Combined Event Query  (PORX_ST100000) |

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| | |Purpose |

| |  |There are a number of scenarios in which care providers need to have an overview of the medication(s) of a patient. |

| | |The various scenarios outlined below are based upon a common set of assumptions: |

| | |there is an information infrastructure available |

| | |electronic patient records exist which serve as the source of medication information |

| | |the most reliable medication information is available at pharmacies |

| | |those prescriptions that are not filled are eliminated from the overview |

| | |over the counter medication is not considered to be available in the overview |

| | |The parties who are potential clients of the medication overview include, but are not limited to: |

| | |General Practitioner |

| | |Local Pharmacy |

| | |Hospital Pharmacy |

| | |Medical Specialist |

| | |Home care |

| | |Paramedical care |

| | |Nursing Homes |

| | |Emergency care |

| | |Dental care |

| | |General Practitioner |

| | |Prescribing a new drug A GP who prescribes a new drug should compare it with the current medication. |

| | |Double-medication and possible interactions must be avoided. By comparing the intended drug with the current |

| | |medication (either visually or automatically), problems can be avoided before the prescription is actually made. |

| | |Repeating a medication Repeat prescribing is a recurring activity in general practice. In many cases, the GP is the |

| | |author of the originating prescription, but in many instances a drug is originally prescribed by a clinical |

| | |specialist in an outpatient clinic. |

| | |A GP repeats a self-originating prescription A GP may decide that a prescription should be repeated. In that case, |

| | |the number of repetitions can be given by a number. It is also possible to give the medication the predicate |

| | |'chronic'. The prescription that originates in the own practice is stored in the practice system database. It is |

| | |possible to repeat from this prescription, and provide the pharmacy with the prescription in the regular manner. An |

| | |alternative is to base the repeat prescription on the medication overview. Advantages are: |

| | |Related to the real start-date (drug supply instead of the prescription order); ? If the pharmacy that the patient |

| | |would visit was unknown at the original prescription, it will be available in the overview, and can be selected; |

| | |It is known what has been dispensed. The manufactured product can be repeated specifically |

| | |If the patient visits more than one pharmacy, the medication overview from all sources will help to overcome this |

| | |problem (at the overview-level) There should be a coupling between the prescription that is repeated and the new |

| | |prescription. In the local system this can be realized using e.g. an episode coupling. NB. The repetition is often |

| | |performed by the practice assistant or practice nurse. The authorization should be done afterwards by the responsible|

| | |physician |

| | |A GP repeats the prescription from a medical specialist Often a specialist writes out a prescription in an outpatient|

| | |clinic, which will be continued by a GP. The same may happen after discharge from a clinical period. Regulations are,|

| | |that the first time a drug is prescribed, it is allowed for a limited period of time (15 days, to prevent waste in |

| | |case the product causes problems, does not have the wanted effect, or in case the patient does not take the |

| | |medication). So the specialist prescribes for a limited period of time, and the patient sees the GP for a repeat (for|

| | |a prolonged period). In fact, it is not a repetition, but a new prescription by the GP, related to the treatment |

| | |policy that was started by the specialist. The original prescriber must be available, either in the prescription or |

| | |in a coupling to the original prescription (e.g. through an episode). The medication can be retrieved from the |

| | |medication overview. The data can be taken from this, and transferred to a new prescription. |

| | |Modify and Stop Modification and cancellation of prescriptions may occur, for various reasons: |

| | |There are problems during use (e.g. side-effects); |

| | |The medication has been prescribed more than once; |

| | |The drug does not have the desired effect, and is replaced by another; |

| | |The dosage is too strong, or the prescribed amount is not effective. |

| | |In these circumstances, the original prescription can be cancelled, and a new one written. The link must be retained.|

| | |In case the prescription originated from another physician, this physician must be notified. This can be done |

| | |directly, or it must be made clear in the overview. |

| | |GP after hours services A physician who acts as a locum for another physician must have access to relevant part of |

| | |the electronic patient record. The overview of the current medication is part of that. The overview is not only |

| | |relevant in cases where no medication is being prescribed, because it provides an insight in the patient's health |

| | |status. |

| | |Clinical Specialist |

| | |Outpatient clinic The outpatient treatment is comparable to the treatment in general practice. In most cases, a |

| | |patient takes the prescription to the community pharmacy. |

| | |Clinical period: admission During admission of a patient, the responsible clinician needs an overview of the current |

| | |medication. On the basis of this it is decided which medication is to be continued during the treatment in the |

| | |hospital, and which medication is put on hold. The clinician makes a selection from the overview, possibly makes |

| | |modifications (dosage, hospital administration regimen) and transfers this as a medication order to the hospital |

| | |pharmacy. During the clinical period, the hospital pharmacy is responsible for the total medication of the patient, |

| | |including the continued medication. |

| | |Clinical prescribing During the clinical period, prescribing is done through the order communication facilities that |

| | |exist in the hospital. In general, the current medication overview is readily available, either directly from the |

| | |hospital pharmacy system, or through the hospital information system. |

| | |Discharge from the clinic When a patient is discharged, the responsible physician makes a decision which medication |

| | |should be continued. The medication that the patient was using at the time of admission must also be considered. It |

| | |is possible that the dosage is modified. The overview from the hospital pharmacy must be used to make a selection for|

| | |medication to be continued. The information must be translated into a medication order that can be handled by the |

| | |community pharmacy. There may be a problem with medication that is given to the patient to continue at home. The |

| | |hospital pharmacy may have supplied this, but the information may only be available indirectly, as the hospital |

| | |pharmacy system is generally linked to the hospitals communication engine. |

| | |Community Pharmacy |

| | |Dispensing The pharmacy is responsible for safe delivery of a drug. The current medication overview is instrumental |

| | |in a correct handling of the medication surveillance. The overview is especially important in case the patient uses |

| | |drugs that were dispensed by another pharmacy, either in the community or in the hospital. |

| | |Dispensing during locum services During the after hour services, a pharmacy must be aware of the current medication |

| | |of the patient. In general, the medication that is provided during these hours will be incidental, because |

| | |chronically used medication will not be addressed outside the normal business hours. |

| | |Emergency care |

| | |If a patient is admitted on an acute care unit, the availability of relevant information may be critical for decision|

| | |making. The medication overview is a very important part of the medical record. It does not only tell which drug a |

| | |patient is on, but also indicates important health problems |

| |  |Diagram |

| |  |[pic] |

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| |2.1.2 |Institutional Practice, Comprehensive  (PORX_ST003500) |

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| | |Purpose |

| |  |This Storyboard employs an older design that exposes detailed (hidden) application roles. Further development of this|

| | |Storyboard will reduce the design complexity by exposing only the general, or "good-practice" Application Roles. |

| | |However, while the visible complexity will be reduced, the fundamental scenario described is not expected to be |

| | |altered, except as needed to accurately reflect the real-world scenario. |

| | |To provide a comprehensive example of Institutional Pharmacy Practice: Medication orders, changes, discontinuation, |

| | |suggested/requested changes, and administration events. This scenario covers basic pharmacy-related interactions from|

| | |admission through discharge. All possible variations and decision points are not included in this storyboard. |

| | |Additional storyboards examine variations by building on the context and structure of this storyboard. |

| | |Interactions in this storyboard that fall outside of the Pharmacy Domain are detailed in other sections. The reader |

| | |is referred to the following: |

| | |Patient Administration Domain (PRPA_DO000001) |

| | |Laboratory Domain (PRPA_DO000001) |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

| |2.1.2.1 |Institutional, Comprehensive (PORX_SN003500) |

| |  |Presentation and Admission Eve Everywoman presents at Good Health Hospital Emergency Room complaining of shortness of|

| | |breath, cough and dyspnea on exertion. Upon examination, Dr. Eric Emergency notes a blood pressure of 170/95, jugular|

| | |vein distention and bilateral basal rales. Ms. Everywoman informs Dr Emergency that she is taking the following |

| | |medications for hypertension: |

| | |verapamil sustained release 120mg qd |

| | |hydrochlorothiazide 25mg qd |

| | |Dr Emergency has Ms Everywoman admitted with a diagnosis of decompensated congestive heart failure, for observation, |

| | |fluid management and cardiology consult. Admission orders include: Admission |

| | |Diagnosis: Decompensated CHF, Hypertension |

| | |Cardiac Care Unit |

| | |Cardiac Consult |

| | |Chest X-ray |

| | |ECG |

| | |Strict I and O |

| | |low sodium diet |

| | |Lab Tests |

| | |Electolytes stat and q4h |

| | |CPK |

| | |Medications |

| | |D5W IV TKO |

| | |furosemide 80mg ivp q8h |

| | |KCl 20meq in D5W 250ml, ivpb, q8h |

| | |metolozone 2.5mg po qd |

| | |verapapmil sr 120mg qd |

| | |The orders are routed to multiple departments [refer to other domains for non-pharmacy interactions: Admission, Lab, |

| | |Radiology, and Dietary]. In particular, GHH's Hospital Information system sends the medication orders to the Pharmacy|

| | |System [Pharmacy Combined Order Activate Fulfillment Request, Institutional (PORX_IN002122)]. The Pharmacy System |

| | |creates new orders as requested (these objects, all in the New state, exist in the Pharmacy System, but are not |

| | |"visible" to external systems until they becomes "Active"). The Pharmacy System performs relevent clinical evaluation|

| | |of the medication orders and, with no contradictory information, acknowledges the orders as requested [Pharmacy |

| | |Combined Intent Activate Confirmation, Institutional (PORX_IN003112)]. The Pharmacy System develops a specific |

| | |administration schedule and communicates the schedule to the Nursing System [Pharmacy Scheduled Administration Intent|

| | |Activate Fulfillment Request, Institutional (PORX_IN033122)]. The Nursing System establishes the administration |

| | |events on the Eve Everywoman's MAR and acknowledges this action to the Pharmacy System [Pharmacy Scheduled |

| | |Administration Event Activate Confirmation, Institutional (PORX_IN034132)]. Recording an Scheduled Administration |

| | |Event In the CCU, Nancy Nightingale checks Eve Everywoman's MAR and sees that it is time for her metolazone. She |

| | |retrieves the unit-dose medication previously delivered by the Pharmacy. In the patient's room, she scans her staff |

| | |ID barcode to access the charting system, scans the patient's ID bracelet barcode to bring the correct patient |

| | |profile onto the charting screen. She then scans the barcode on the unit-dose metolazone to identify the product |

| | |being administered. The nursing system retrieves the administration information for this medication administration |

| | |(previously sent by the Pharmacy System) and displays the order for metolazone on the screen. Having verified the |

| | |correct medication, dose, time and patient, she gives the medication to Ms Nightingale. The nurse charts that she has|

| | |administered the metolazone and saves the data. The Nursing System sends a message to the Pharmacy System indicating |

| | |that this administration event has occurred [Pharmacy Scheduled Administration Event Complete Notification, |

| | |Institutional (PORX_IN034412)]. Suggestion for medication change On one of the subsequent electrolyte analyses for |

| | |Eve Everywoman, the Lab System sends a result notification including a potassium level of 5.3 mEq/L [see Laboratory |

| | |Domain for interaction details]. The Pharmacy System, as a tracker of relevant lab results, receives and records this|

| | |lab result against Eve Everywoman's profile and notes that this high result suggests that alteration of the KCl order|

| | |may be warranted. The Pharmacy System sends a suggestion to the Hospital Information System to reduce or discontinue |

| | |the KCl for Eve Everywoman [Pharmacy Combined Intent Replace Fulfillment Request, Institutional (PORX_IN033322)]. The|

| | |Hospital Information System prompts the internist on duty, Dr Otto Osler, regarding the pharmacy suggestion. On |

| | |reviewing Ms Everywoman's case to date, Dr Osler elects to discontinue the KCl pending the results of the Cardiology |

| | |Consult. Dr Osler enters the discontinuation into the Hospital Information System, which communicates the |

| | |discontinuation to the Pharmacy System [Pharmacy Combined Order Abort Confirmation, Institutional (PORX_IN002632)]. |

| | |The Pharmacy System receives the discontinuation message, discontinues the KCl order and acknowledges the action to |

| | |the Hospital Information System [Pharmacy Combined Intent Abort Notification, Institutional (PORX_IN033612)]. The |

| | |Pharmacy System informs the Nursing System to discontinue the KCl administration [Pharmacy Scheduled Administration |

| | |Intent Abort Fulfillment Request, Institutional (PORX_IN033622)]. The Nursing System updates Eve Everywoman's MAR and|

| | |acknowledges this action to the Pharmacy System [Pharmacy Scheduled Administration Event Abort Confirmation, |

| | |Institutional (PORX_IN034632)]. Medication Order Changes The Cardiologist, Dr Patrick Pump, completes the cardiology |

| | |consult. Dr Pump notes that Eve's fluid balance has been normalized and that the immediate symptoms of decompensation|

| | |have been abated. Based upon the test results, Dr Pump initiates beta-blocker and ACE-I therapy. Dr Pump enters the |

| | |following medication orders into the Hospital Information System: |

| | |Discontinue verapamil |

| | |Discontinue iv furosemide |

| | |metoprolol 12.5mg po bid |

| | |lisinopril 20mg po qd |

| | |furosemide 20mg po bid |

| | |increase metolazone to 2.5mg po bid |

| | |KCl 10meq po bid |

| | |The Hospital Information System sends these orders to the Pharmacy System as: |

| | |For the verapamil and iv furosemide, the Hospital Information System sends discontinue messages to the Pharmacy |

| | |System [Pharmacy Combined Order Abort Fulfillment Request, Institutional (PORX_IN002722)]. The Pharmacy System |

| | |discontinues the verapamil and furosemide orders and sends acknowledgement back to the Hospital Information System |

| | |[Pharmacy Combined Intent Abort Confirmation, Institutional (PORX_IN003632)]. The Pharmacy System also communicates |

| | |with the Nursing System to discontinue administration of these orders [Pharmacy Scheduled Administration Intent Abort|

| | |Fulfillment Request, Institutional (PORX_IN033622)]. The Nursing System updates Eve Everywoman's MAR and acknowledges|

| | |this action back to the Pharmacy Application [Pharmacy Scheduled Administration Event Abort Confirmation, |

| | |Institutional (PORX_IN034632)]. |

| | |The Hospital Information System sends new order messages for the metoprolol, lisinopril, oral furosemide and KCl to |

| | |the Pharmacy System [Pharmacy Combined Order Activate Fulfillment Request, Institutional (PORX_IN002122)]. The |

| | |Pharmacy System establishes the medication orders (see note regarding new order object, above). The Pharmacy System |

| | |performed relevant clinical evaluation and, with no contradictory information, acknowledges the orders to the |

| | |Hospital Information System [Pharmacy Combined Intent Activate Confirmation, Institutional (PORX_IN003112)]. The |

| | |Pharmacy System develops a specific administration schedule and communicates schedule to the Nursing System [Pharmacy|

| | |Scheduled Administration Intent Activate Fulfillment Request, Institutional (PORX_IN033122)]. The Nursing System |

| | |updates Eve Everywoman's MAR and acknowledges this action back to the Pharmacy System [Pharmacy Scheduled |

| | |Administration Event Activate Confirmation, Institutional (PORX_IN034132)]. |

| | |For the metolazone, the HIS send a revision messages to the Pharmacy System [Pharmacy Combined Order Revise |

| | |Fulfillment Request, Institutional (PORX_IN002222)]. The Pharmacy System revises the metolazone order as requested |

| | |and acknowledges back to the Hospital Information System [Pharmacy Combined Intent Revise Confirmation, Institutional|

| | |(PORX_IN003232)]. The Pharmacy System re-evaluates the metolazone order and creates a new administration schedule. |

| | |The Pharmacy System informs the Nursing System that the prior administration schedule for the metolazone order should|

| | |be discontinued [Pharmacy Scheduled Administration Intent Abort Fulfillment Request, Institutional (PORX_IN033622)]. |

| | |The new administration schedule for the metolazone order is sent by the Pharmacy System to the Nursing System |

| | |[Pharmacy Scheduled Administration Intent Activate Fulfillment Request, Institutional (PORX_IN033122)]. The Nursing |

| | |System updates Eve Everywoman's MAR and sends acknowledgements for the deleted schedule [Pharmacy Scheduled |

| | |Administration Event Abort Confirmation, Institutional (PORX_IN034632)] and the newly scheduled items [Pharmacy |

| | |Scheduled Administration Event Activate Confirmation, Institutional (PORX_IN034132)] |

| | |Dr Pump also recommends that, after 24 hours of stable symptoms and labs, Ms Everywoman can be discharged with prompt|

| | |(one week) referral to the CHF clinic for follow-up and medication titration. Discharge with medications The resident|

| | |following Ms Everywoman, Dr Rachel Resident, evaluates her on rounds. The resident, and the team, note that Ms |

| | |Everywoman's symptoms have been under control for more than 24 hours, that she is in good spirits and anxious to |

| | |return home. Dr Resident, following Dr Pump's suggestion, enters discharge orders into the Hospital Information |

| | |System: |

| | |Discharge to home [see Patient Administration Domain] |

| | |CHF Clinic referral within 1 week [see Scheduling Domain] |

| | |Medications |

| | |metoprolol 12.5mg po bid, 2 week supply |

| | |lisinopril 20mg po qd, 2 week supply |

| | |furosemide 20mg po bid, 2 week supply |

| | |increase metolazone to 2.5mg po bid, 2 week supply |

| | |KCl 10meq po bid, 2 week supply |

| | |The Hospital Information System, as a component of a Discharge order, informs the pharmacy to discontinue all |

| | |medications for Eve Everywoman [Pharmacy Combined Order Abort Fulfillment Request, Institutional (PORX_IN002722)]. In|

| | |addition, the discharge medication orders are also sent to the Pharmacy System [Pharmacy Supply Order Activate |

| | |Fulfillment Request, Institutional (PORX_IN022124)]. The Pharmacy System receives the discontinue of inpatient |

| | |medications and the discharge medication orders. The current inpatient medication orders are discontinued on the |

| | |Pharmacy System, with acknowledgement of same to the Hospital Information System [Pharmacy Combined Intent Abort |

| | |Confirmation, Institutional (PORX_IN003632)]. The discharge medications orders are created in the Pharmacy System. |

| | |After appropriate clinical review, with no contradictory information, they are acknowledged back to the Hospital |

| | |Information System [Pharmacy Supply Intent Activate Confirmation, Institutional (PORX_IN023134)]. Additionally, the |

| | |Pharmacy System informs the Nursing System to discontinue all medications for Eve Everywoman [Pharmacy Scheduled |

| | |Administration Intent Abort Fulfillment Request, Institutional (PORX_IN033622)]. The Nursing System updates Ms |

| | |Everywoman's MAR and acknowledges the action back to the Pharmacy System [Pharmacy Scheduled Administration Event |

| | |Abort Confirmation, Institutional (PORX_IN034632)] |

| | |The pharmacy prepares the discharge medication. The pharmacist, Susan Script, takes the discharge medications to Ms |

| | |Everywoman. Dr Script counsels Ms Everywoman on the proper way to take the medications and possible untoward effects.|

| | |Dr Script notes in the Pharmacy System that the medications were supplied to the patient with appropriate counseling.|

| | |The Pharmacy System notifies the Hospital Information System that the supply events have occurred [Pharmacy Supply |

| | |Event Complete Notification, Institutional (PORX_IN024414)]. |

|  |

|  |

| |2.1.3 |Hospital Administration with Duration  (PORX_ST000700) |

| |  | |

| | |Purpose |

| |  |This Storyboard employs an older design that exposes detailed (hidden) application roles. Further development of this|

| | |Storyboard will reduce the design complexity by exposing only the general, or "good-practice" Application Roles". |

| | |However, while the visible complexity will be reduced, the fundamental scenario described is not expected to be |

| | |altered, except as needed to accurately reflect the real-world scenario. |

| | |In most circumstances reflected in the general inpatient storyboard (PORX_ST003500), inpatient medication |

| | |administrations are only recorded when complete. However, some types of administrations occur over a period of time, |

| | |and both the beginning and end are recorded. This storyboard illustrates such an administration event, occurring over|

| | |a period of time, where the beginning and ending times are significant and reported. |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

| |2.1.3.1 |Institutional, Administration, Event, TPN with dur (PORX_SN000701) |

| |  |Record Administration Start |

| | |On the ICU, Nancy Nightingale checks Adam Everyman's MAR and sees that it is time to start a new TPN IV. She |

| | |retrieves the next TPN bag for the patient and notes that it is number 4. She scans her staff ID barcode to access |

| | |the charting system, scans the patient's ID bracelet barcode to bring the correct patient profile onto the charting |

| | |screen, and then scans the TPN barcode on the IV label to identify the specific product being administered. The |

| | |nursing system retrieves the administration information for this TPN bag previously sent by the pharmacy application.|

| | |The nursing system displays the order for TPN number 4 containing: |

| | |500 ml of Amino Acids 8.5% |

| | |Dextrose 50% 500 ml |

| | |Potassium Chloride 40 mEq |

| | |MVI 10 ml |

| | |MTE 4 ml |

| | |Calcium Chloride 1 g |

| | |Magnesium Sulfate 4 mEq |

| | |Vitamin K 10 mg |

| | |and the appropriate bottle schedule (number 4) on the screen. The nurse charts that she has started the IV, |

| | |validating that the correct patient, IV, bottle number (and that all ingredients are accurately identified on the |

| | |bottle information online) and the charted date and time are correct. The infusion rate for the bag is 150 ml/hr. She|

| | |saves the data. The Nursing sends a message to the pharmacy system indicating that this administration event has |

| | |begun [Pharmacy Scheduled Administration Event Revise Notification, Institutional (PORX_IN034212)]. |

| | |Record Administration Intermediate Reading |

| | |Several hours later the nurse needs to document how much of the IV has been infused into the patient. Using the |

| | |barcode functionality she again identifies herself and the patient. She then manually selects the hanging IV bag from|

| | |the IV charting system. She checks the IV bag and confirms the amount remaining in the bag. She enters the remaining |

| | |volume and the amount infused is automatically calculated and displayed. She validates that the displayed data |

| | |(infused amount, date, time, patient) is correct and saves the data. The nursing system sends a message to the |

| | |pharmacy system with the infused volume information for this administration event [Pharmacy Scheduled Administration |

| | |Event Revise Notification, Institutional (PORX_IN034212)]. |

| | |Record Administration Completion |

| | |Nurse Nightingale returns to the Mr. Everyman's room at the anticipated completion time for the TPN. She notes that |

| | |the infusion has completee. Using the barcode functionality she again identifies herself and the patient. She then |

| | |selects the hanging IV bag from the IV charting system. She enters that the bag has been completely infused. She |

| | |validates that the displayed data (infused amount, date, time, patient) is correct and saves the data. The nursing |

| | |system sends a message to the pharmacy system that this specific administration has completed [Pharmacy Scheduled |

| | |Administration Event Complete Notification, Institutional (PORX_IN034412)]. |

|  |

|  |

| |2.1.4 |Community Practice, Comprehensive #1  (PORX_ST000800) |

| |  | |

| | |Purpose |

| |  |This Storyboard employs an older design that exposes detailed (hidden) application roles. Further development of this|

| | |Storyboard will reduce the design complexity by exposing only the general, or "good-practice" Application Roles. |

| | |However, while the visible complexity will be reduced, the fundamental scenario described is not expected to be |

| | |altered, except as needed to accurately reflect the real-world scenario. |

| | |To provide a comprehensive example of Community Pharmacy Practice: Prescribe and fill an outpatient retail or |

| | |community pharmacy prescription where drug authorization is required and the order is placed on hold until |

| | |authorization, history and insurance are available. All possible variations and decision points are not included in |

| | |this storyboard. Additional storyboards examine variations by building on the context and structure of this |

| | |storyboard. Interactions in this storyboard that fall outside of the Pharmacy Domain are detailed in other sections. |

| | |The reader is referred to the following: |

| | |Claims and Reimbursement Domain (FICR_DO000001), a pertinent storyboard being "Pre-Determination, Pharmacy" |

| | |(DOCR_ST400200) |

| | |Patient Administration Domain (FICR_DO000001) |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

| |2.1.4.1 |Community, Comprehensive (PORX_SN000800) |

| |  |Outpatient prescription requiring authorization |

| | |Dr. Harold Hippocrates performs an exam of Mr. Neville Nuclear at Good Health Hospital Outpatient Clinic. A diagnosis|

| | |of Amyotrophic Lateral Sclerosis is made (ICD-9-CM 335.20). |

| | |Dr. Hippocrates enters a prescription for Rilutek 50 mg Oral Tablets (NDDF Dispensable Drug ID 42585; generic |

| | |ingredient "riluzole") #60, Sig: one tablet every 12 hours before meals with 1 refill, into the Clinical Information |

| | |System at Good Health Hospital Outpatient Clinic. Mr. Nuclear indicates that he would like to have the medication |

| | |dispensed at Good Neighbor Pharmacy. |

| | |The Clinic System transmits the prescription to Good Neighbor Pharmacy [Pharmacy Supply Order Activate Fulfillment |

| | |Request, Community (PORX_IN022122)]. Good Neighbor's Pharmacy System receives the prescription and creates a |

| | |corresponding order (this object, in the New state, exists in the Pharmacy System, but is not "visible" to external |

| | |systems until becomes "Active"). Good Neighbor Pharmacy does not have Mr. Nuclear enrolled as a patient and the |

| | |prescription message did not contain all of the information that the Pharmacy System tracks for patients. The |

| | |prescription is placed on hold (an internal state change in the Pharmacy System) until patient information can be |

| | |obtained from Good Health Hospital. The Pharmacy System requests additional patient information from the Clinic |

| | |System, which responds with the requested information [see Patient Administration Domain for details on patient |

| | |information query and response interactions]. With all required information now in place, the Pharmacy System |

| | |acknowledges the prescription order to the Clinic System [Pharmacy Supply Intent Activate Confirmation, Community |

| | |(PORX_IN023132)]. |

| | |Good Neighbor Pharmacy attempts to fill the prescription (National Drug Code 00075-7700-60). While electronically |

| | |submitting the prescription for payment, reimbursement is denied by Bargain Prescription Benefits because the drug |

| | |requires prior authorization [see Claims & Reimbursement Domain for details on the claim and response interactions]. |

| | |The prescription is suspended [Pharmacy Supply Intent Suspend Notification, Community (PORX_IN023812)] and a |

| | |suggested revision to include prior authorization information is sent from the Pharmacy System to the Clinic System |

| | |[Pharmacy Supply Intent Revise Fulfillment Request, Community (PORX_IN023222)]. |

| | |In order to expedite the situation, Good Neighbor Pharmacy calls Dr. Hippocrates's office to alert them to the status|

| | |and pending request on Mr. Nuclear's prescription. Dr. Hippocrates locates the message from the pharmacy, reviews the|

| | |prescription and medical history and submits a prior authorization request to HC Payor, Inc., Mr. Nuclear's |

| | |Healthcare insurer. HC Payor, Inc. responds with an authorization for the medication [refer to the Claims & |

| | |Reimbursement Domain for details on the prior authorization request and approval interactions]. Dr. Hippocrates notes|

| | |and saves the prior authorization approval with the prescription order. The Clinic System informs the Pharmacy System|

| | |of the updated prescription order, now with prior authorization included [Pharmacy Supply Order Revise Confirmation, |

| | |Community (PORX_IN022232)]. |

| | |Good Neighbor Pharmacy submits the prescription for payment to Bargain Prescription Benefits. Bargain Prescription |

| | |Benefits approves payment and transmits remittance advice to Good Neighbor Pharmacy [see Claims & Reimbursement |

| | |Domain for details on the claim and response interactions]. |

| | |Good Neighbor Pharmacy completes the prescription. Mr. Nuclear picks up the prescription and receives counseling |

| | |advice from Susan Script, Registered Pharmacist. Mr. Nuclear signs a form acknowledging receipt of the prescription. |

| | |The prescription is now officially dispensed. The Pharmacy System notifies the Clinic System that the prescription |

| | |has been dispensed [Pharmacy Supply Event Complete Notification, Community (PORX_IN024412)]. |

| | |Refill request by non-patient family member when active refills remain |

| | |55 days later, Mrs. Nelda Nuclear telephones Good Neighbor Pharmacy and requests a refill of the Rilutek. Good |

| | |Neighbor Pharmacy submits the prescription for payment to Bargain Prescription Benefits. Bargain Prescription |

| | |Benefits approves payment and transmits remittance advice to Good Neighbor Pharmacy [see Claims & Reimbursement |

| | |Domain for details on the claim and response interactions]. |

| | |Good Neighbor Pharmacy completes the prescription. Mrs. Nuclear picks up the prescription and signs a form |

| | |acknowledging receipt of the prescription. No additional counseling advice is requested or given. The prescription |

| | |refill is now officially dispensed. The Pharmacy System notifies the Clinic System that the prescription has been |

| | |dispensed [Pharmacy Supply Event Complete Notification, Community (PORX_IN024412)]. |

| | |Refill request by non-patient family member when active refills do not remain |

| | |60 days later Mrs. Nuclear telephones Good Neighbor Pharmacy and requests a refill of the Rilutek. Good Neighbor |

| | |Pharmacy's system detects that no refills remain. A refill authorization request is electronically sent to Dr. |

| | |Hippocrates' system [Pharmacy Supply Intent Reactivate Fulfillment Request, Community (PORX_IN023522)]. |

| | |Dr. Hippocrates receives the refill authorization request. Dr. Hippocrates contacts Bargain Prescription Benefits |

| | |Pharmacy [see Claims & Reimbursement Domain for details on the claim and response interactions] and obtains |

| | |authorization for six more refills. The Clinic System updates the prescription order and notifies the Pharmacy System|

| | |that additional refills have been authorized by the prescriber [Pharmacy Supply Order Reactivate Confirmation, |

| | |Community (PORX_IN022532)]. Good Neighbor Pharmacy updates the number of authorized refills and the prior |

| | |authorization. |

| | |Good Neighbor Pharmacy completes the prescription. Mrs. Nuclear picks up the prescription and signs a form |

| | |acknowledging receipt of the prescription. No additional counseling advice is requested or given. The prescription |

| | |refill is now officially dispensed. The Pharmacy System notifies the Clinic System that the prescription has been |

| | |dispensed [Pharmacy Supply Event Complete Notification, Community (PORX_IN024412)]. |

|  |

|  |

| |2.1.5 |Community Pharmacy, Comprehensive #2  (PORX_ST000810) |

| |  | |

| | |Purpose |

| |  |This storyboard was developed at the Cleveland WGM. This may respresent an alternative to PORX_ST000800 , or the two |

| | |may be maintained as separate scenarios. |

| | |This scenario covers a range of typical community or outpatient prescribing where dispensing occurs in a community |

| | |pharmacy. The interaction occurs between the prescribing system and the pharmacy dispensing system. Examples of a |

| | |prescribing system include: GP System, Dentist System, Outpatient/Polyclinic System. Pharmacy systems include: |

| | |Community Pharmacy, Outpatient Dispensing. Only the Prescriber-Pharmacy system interactions have been modelled. |

| | |Potential messages relating to reimbursement and interaction between pharmacy and payment agency have not been |

| | |covered. Further messaging for reimbursement are out of scope. Any intermediate links are also out of scope for this |

| | |story. |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

| |  |Interaction List |

| |  |Community Pharmacy Supply Event Complete, Notification |

| | |PORX_IN000008 |

| | | |

| |2.1.5.1 |Community (PORX_SN000810) |

| |  |Dr. Harold Hippocrates is consulted by Mr Adam Everyman for hypertension and sinusitis and a request for a medication|

| | |prescribed by his neurologist. Dr. Hippocrates prescribes three items on the one prescription form |

| | |Hydrochlorothiazide 25 mg Oral Tablets to be taken : one tablet daily. Supply (50) with 1 refill |

| | |Doxycycline 100mg capsuls, 2 to be taken immediately and then one daily. Supply (7) with no refill |

| | |Riluzole 50 mg Oral Tablets, one tablet every 12 hours before meals; supply 60 with 1 refill |

| | |Dr. Hippocrates electronically transmits the prescription form containing the three items to Good Neighbor Pharmacy. |

| | |(Community Pharmacy Order Activate, Fulfilment Request (PORX_?????7) |

| | |Good Neighbor Pharmacy receives the prescription and identifies Mr Everyman as a patient registered on their pharmacy|

| | |system. The prescription is placed on hold while insurance authorisation is obtained. Good Neighbor Pharmacy receives|

| | |the necessary insurance information. They attempt to fulfill the prescription, but note that a prior authorisation is|

| | |required for the Rilutek due to the cost of this drug. |

| | |Good Neighbor Pharmacy leaves a message for Dr. Hippocrates to inform him that he needs to contact Bargain |

| | |Prescription Benefits to obtain authorization. This is done and Dr. Hippocrates's nurse, (Nancy Nightingale) |

| | |telephones Good Neighbor Pharmacy with notification of insurance authorization which is added to the prescription |

| | |details. |

| | |The pharmacy system performs a safety review of the prescription and identifies a major contraindication for this |

| | |patient. |

| | |A second call is made to Dr.Hippocrates to attempt to identify a suitable alternative item being prescribed on a new |

| | |prescription. A new item is identified and fresh prescription is issued for this new item. The prescription for the |

| | |problem item is cancelled. (Pharmacy Combined Order Activate, Rejection PORX_IN?????9) |

| | |Good Neighbor pharmacy dispenses the remaining two medications in this order (as well as the new item which is |

| | |separately processed through another message). |

| | |Good Neighbor Pharmacy sends a notification of supply for two medications to Dr. Hipprocates (Community Pharmacy |

| | |Supply Event Complete, Notification (PORX_IN?????8) |

| | |Diagram notes |

| | |Message No: 1 |

| | |Real World Event: Prescribe drug |

| | |Initiator: Dr |

| | |Receiver: Pharmacist |

| | |Name: Community Pharmacy Combined Order Activate, Fulfilment Request (PORX_?????7) |

| | |Message No: 4 (This is repeated for each of the two drugs supplied) |

| | |Real World Event: Dispense drug |

| | |Initiator: Pharmacist |

| | |Receiver: Dr |

| | |Name: Community Pharmacy Supply Event Complete, Notification (PORX_IN?????8 |

| | |Message No: 6 |

| | |Real World Event: Refuse supply |

| | |Initiator: Pharmacist |

| | |Receiver: Dr |

| | |Name: Community Pharmacy Combined Order Activate, Rejection PORX_IN?????9 |

|  |

|  |

| |2.1.6 |Community Practice, UK Variation  (PORX_ST003000) |

| |  | |

| | |Purpose |

| |  |This Storyboard employs an older design that exposes detailed (hidden) application roles. Further development of this|

| | |Storyboard will reduce the design complexity by exposing only the general, or "good-practice" Application Roles. |

| | |However, while the visible complexity will be reduced, the fundamental scenario described is not expected to be |

| | |altered, except as needed to accurately reflect the real-world scenario. |

| | |Localization considerations result is some vairation in community pharmacy terminology and practice. This storyboard |

| | |illustrates some of the variations from the generalized community practice storyboard (PORX_ST000800) that exist in |

| | |the UK pharmacy practice model. |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

| |2.1.6.1 |Community, UK Variation, Prescription with Multipl (PORX_SN003000) |

| |  |Prescription for multiple products |

| | |Dr. Fay Family sees Mr. Adam Everyman for a urine infection and repeat of regular hypertension and cholesterol |

| | |medications. A prescription is generated by the computerised medication management system for a specific brand name |

| | |equivalent of the following 3 items: |

| | |Amoxycillin 250mg caps (pack of 20), 1 tds, Supply 1, no repeats |

| | |Metoprolol 100mg tabs (pack of 30), 1 mane, Supply 1, 5 repeats |

| | |Simvastatin 20mg tabs (pack of 30), 1 mane, Supply 1, 5 repeats |

| | |The prescription is sent to a central script repository (CPR) which is held by HC Payor, Inc, the pharmaceutical plan|

| | |manager, via the Internet [Pharmacy Supply Order Activate Fulfillment Request, Community (PORX_IN022122)] (using |

| | |agreed electronic signature and encryption protocols). The CPR verifies the patient's eligibility for benefits by |

| | |checking the patient's details and membership number, that each item is on the formulary, and that no dispensing |

| | |rules have been breached (such as earlier than expected return for a repeat). In the situation of an ineligible |

| | |script, a message is returned electronically to the prescriber [Pharmacy Supply Intent Activate Rejection, Community |

| | |(PORX_IN023142)]. In other cases, a unique prescription number is allocated, transmitted to the prescriber [Pharmacy |

| | |Supply Order Activate Confirmation, Community (PORX_IN023134)] and printed on the prescription (as a number and |

| | |barcode) which contains the 3 items. The details of the prescription and the 3 items nested in it are stored in the |

| | |repository awaiting a request from any pharmacy to supply this information. |

| | |Community Pharmacy operation |

| | |Mr. Everyman takes the printed and signed script to Good Neighbor Pharmacy, presents the script which is passed under|

| | |a barcode scanner to read the prescription identifier. A message is sent to the HC Payor, Inc. [Pharmacy Supply |

| | |Intent Query o in development] who returns the prescription details to the Pharmacy System [Pharmacy Supply Intent |

| | |Query Response o in development]. The Pharmacy System populates the prescriptions pending action area with the 3 |

| | |items (these three objects, all in the New state, exist in the Pharmacy System, but are not "visible" to external |

| | |systems until they become "Active"). |

| | |Mr. Everyman is asked for direction on how to dispense the 3 items. He requests the Amoxycillin and Metoprolol, as |

| | |these are needed now. |

| | |Amoxycillin. The patient is noted to be allergic to this medication. A message is sent to both the plan manager and |

| | |doctor canceling this item and requesting another [Pharmacy Supply Intent Replace Fulfillment Request, Community |

| | |(PORX_IN023322)]. The pharmacist phones Dr. Family to bring the matter to her immediate attention. Dr. Family reviews|

| | |Mr. Everyman's case and agrees to replace the Amoxycillin with Triprim 300mg 1 daily for 3 days. This is entered in |

| | |the computerized medication management system, and a message is sent to the CPR at HC Payor and to Good Neighbor |

| | |Pharmacy [Pharmacy Supply Order Replace Confirmation, Community (PORX_IN022332)]. Good Neighbor Pharmacy completes |

| | |the replacement of the amoxycillin order and dispenses Triprim. A notification of this dispense is sent to HC Payor, |

| | |Inc. [refer to Claims and Reimbursement Domain for details on reimbursement interactions] and to the prescribing |

| | |doctor [Pharmacy Supply Event Complete Notification, Community (PORX_IN024412)]. |

| | |Metoprolol. This is dispensed as requested except that a generic equivalent brand is used. The Pharmacy System sends |

| | |notification of dispense, with the generic product specified, to HC Payor, Inc. (refer to Claims and Reimbursement |

| | |Domain for details on reimbursement interactions) and to the prescribing doctor [Pharmacy Supply Event Complete |

| | |Notification, Community (PORX_IN024412)]. The record of the number of dispenses available on this script is amended |

| | |and an authorisation for the remaining repeats is printed by the Pharmacy System. |

| | |Simvastatin. The patient requests that this not be dispensed as he has just started a new bottle. Since no dispense |

| | |occurs for this medication, no corresponding dispense message is sent to the CPR at HL Payor, Inc. An authorisation |

| | |for the original script and repeats is printed. |

|  |

|  |

| |2 |Message Definitions |

| | |Domain Table of Contents |

| |2.2 |Message Definition Application Roles |

| |  |6Message Definition Application Roles (Sorted by Structured Sort Name) |

| | | |

| | |  |

| | |[pic] |

| | |Pharmacy Supply Order Global Placer PORX_AR022132 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Order Global Fulfiller PORX_AR022142 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Order Global Confirmer PORX_AR022152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Order Global Confirmation Receiver PORX_AR022162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Event Global Informer PORX_AR024112 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Event Global Tracker PORX_AR024122 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Promise Global Confirmer PORX_AR023152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Promise Global Confirmation Receiver PORX_AR023162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Placer PORX_AR002132 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Fulfiller PORX_AR002142 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Confirmer PORX_AR002152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Confirmation Receiver PORX_AR002162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Event Query Placer PORX_AR100010 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Event Query Fulfiller PORX_AR100020 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Promise Global Confirmer PORX_AR003152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Promise Global Confirmation Receiver PORX_AR003162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Confirmer PORX_AR035125 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Confirmation Receiver PORX_AR035162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Informer PORX_AR035112 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Tracker PORX_AR035122 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Promise Global Placer PORX_AR033132 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Promise Global Fulfiller PORX_AR033142 |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | | |

| | | |

| |  | |

| | |Reference |

| |  |For details on the interpretation of this section, see the discussion of application roles and their relationships|

| | |in the Version 3 Guide. |

| |  | |

| | |Introduction |

| |  |At time of ballot, the Application Roles described in the Pharmacy Domain was limited to those necessary to |

| | |support the other content in this domain. Additional Roles have been identified but are not fully developed at |

| | |this time. |

| |2.2.1 |Pharmacy Supply Placer  (PORX_AR022132) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Placer |

| | | |

| |  |An application that is capable of completing the actions necessary to deal with the issuing, completion and |

| | |discontinuing of a service request for a dispensing a drug or similar therapy. |

|  |

| |2.2.2 |Pharmacy Supply Fulfiller  (PORX_AR022142) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Fulfiller |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a dispensing a drug or similar therapy. |

|  |

| |2.2.3 |Pharmacy Supply Confirmer  (PORX_AR022152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a dispensing a drug or similar therapy. |

|  |

| |2.2.4 |Pharmacy Supply Confirmation Receiver  (PORX_AR022162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a service request for a dispensing a drug or |

| | |similar therapy. |

|  |

| |2.2.5 |Pharmacy Supply Event Global Informer  (PORX_AR024112) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Event Global Informer |

| | | |

| |  |An application that performs or manages pharmacy supply events and sends notifications of those events to one or |

| | |more receiving applications. The informer has no expectation that any action or activity will result on the |

| | |receiving application(s). |

|  |

| |2.2.6 |Pharmacy Supply Event Global Tracker  (PORX_AR024122) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Event Global Tracker |

| | | |

| |  |An application that can receive pharmacy supply event information. While the tracker will most likely store some |

| | |or all of the event information, no specific action or further interact will result from the receipt of the |

| | |pharmacy supply event informaiton. |

|  |

| |2.2.7 |Pharmacy Supply Confirmer  (PORX_AR023152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Promise Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a commitment for a dispensing a drug or similar therapy. |

|  |

| |2.2.8 |Pharmacy Supply Confirmation Receiver  (PORX_AR023162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Promise Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a commitment for a dispensing a drug or |

| | |similar therapy |

|  |

| |2.2.9 |Combined Pharmacy Placer  (PORX_AR002132) |

| |  |Description  [pic] |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Placer |

| | | |

| |  |An application that is capable of completing the actions necessary to deal with the issuing, completion and |

| | |discontinuing of a service request for a administration and dispensing of a drug or similar therapy. |

|  |

| |2.2.10 |Combined Pharmacy Fulfiller  (PORX_AR002142) |

| |  |Description  [pic] |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Fulfiller |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a administration and dispensing of a drug or similar |

| | |therapy. |

|  |

| |2.2.11 |Combined Pharmacy Confirmer  (PORX_AR002152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a administration and dispensing of a drug or similar |

| | |therapy. |

|  |

| |2.2.12 |Combined Pharmacy Confirmation Receiver  (PORX_AR002162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a service request for a administration and |

| | |dispensing of a drug or similar therapy. |

|  |

| |2.2.13 |Combined Event Query Placer  (PORX_AR100010) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Event Query Placer |

| | | |

| |  |An application that can send a request for pharmacy order supply and administration event information. |

|  |

| |2.2.14 |Combined Event Query Fulfiller  (PORX_AR100020) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Event Query Fulfiller |

| | | |

| |  |An application than can respond to a request for pharmacy order supply and administration event information. |

|  |

| |2.2.15 |Combined Pharmacy Confirmer  (PORX_AR003152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Promise Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a commitment for a administration and dispensing of a drug or similar therapy. |

|  |

| |2.2.16 |Combined Pharmacy Confirmation Receiver  (PORX_AR003162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Promise Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a commitment for a administration and |

| | |dispensing of a drug or similar therapy. |

|  |

| |2.2.17 |Scheduled Administration Event Global Confirmer  (PORX_AR035125) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Confirmer |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2.2.18 |Scheduled Admin Event Global Confirmation Receiver  (PORX_AR035162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Confirmation Receiver |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2.2.19 |Scheduled Administration Event Global Informer  (PORX_AR035112) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Informer |

| | | |

| |  |An application that performs or manages pharmacy administration events and sends notifications of those events to |

| | |one or more receiving applications. The informer has no expectation that any action or activity will result on the|

| | |receiving application(s). |

|  |

| |2.2.20 |Scheduled Administration Event Global Tracker  (PORX_AR035122) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Tracker |

| | | |

| |  |An application that can receive pharmacy administration event information. While the tracker will most likely |

| | |store some or all of the event information, no specific action or further interact will result from the receipt of|

| | |the pharmacy administration event informaiton. |

|  |

| |2.2.21 |Scheduled Administration Promise Global Placer  (PORX_AR033132) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Promise Global Placer |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2.2.22 |Scheduled Administration Promise Global Fulfiller  (PORX_AR033142) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Promise Global Fulfiller |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2 |Message Definitions |

| | |Domain Table of Contents |

| |2.2 |Message Definition Application Roles |

| |  |6Message Definition Application Roles (Sorted by Structured Sort Name) |

| | | |

| | |  |

| | |[pic] |

| | |Pharmacy Supply Order Global Placer PORX_AR022132 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Order Global Fulfiller PORX_AR022142 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Order Global Confirmer PORX_AR022152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Order Global Confirmation Receiver PORX_AR022162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Event Global Informer PORX_AR024112 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Event Global Tracker PORX_AR024122 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Promise Global Confirmer PORX_AR023152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Supply Promise Global Confirmation Receiver PORX_AR023162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Placer PORX_AR002132 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Fulfiller PORX_AR002142 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Confirmer PORX_AR002152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Order Global Confirmation Receiver PORX_AR002162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Event Query Placer PORX_AR100010 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Event Query Fulfiller PORX_AR100020 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Promise Global Confirmer PORX_AR003152 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Combined Promise Global Confirmation Receiver PORX_AR003162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Confirmer PORX_AR035125 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Confirmation Receiver PORX_AR035162 [Elemental] |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Informer PORX_AR035112 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Event Global Tracker PORX_AR035122 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Promise Global Placer PORX_AR033132 |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |Pharmacy Scheduled Administration Promise Global Fulfiller PORX_AR033142 |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | | |

| | | |

| |  | |

| | |Reference |

| |  |For details on the interpretation of this section, see the discussion of application roles and their relationships|

| | |in the Version 3 Guide. |

| |  | |

| | |Introduction |

| |  |At time of ballot, the Application Roles described in the Pharmacy Domain was limited to those necessary to |

| | |support the other content in this domain. Additional Roles have been identified but are not fully developed at |

| | |this time. |

| |2.2.1 |Pharmacy Supply Placer  (PORX_AR022132) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Placer |

| | | |

| |  |An application that is capable of completing the actions necessary to deal with the issuing, completion and |

| | |discontinuing of a service request for a dispensing a drug or similar therapy. |

|  |

| |2.2.2 |Pharmacy Supply Fulfiller  (PORX_AR022142) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Fulfiller |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a dispensing a drug or similar therapy. |

|  |

| |2.2.3 |Pharmacy Supply Confirmer  (PORX_AR022152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a dispensing a drug or similar therapy. |

|  |

| |2.2.4 |Pharmacy Supply Confirmation Receiver  (PORX_AR022162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Order Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a service request for a dispensing a drug or |

| | |similar therapy. |

|  |

| |2.2.5 |Pharmacy Supply Event Global Informer  (PORX_AR024112) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Event Global Informer |

| | | |

| |  |An application that performs or manages pharmacy supply events and sends notifications of those events to one or |

| | |more receiving applications. The informer has no expectation that any action or activity will result on the |

| | |receiving application(s). |

|  |

| |2.2.6 |Pharmacy Supply Event Global Tracker  (PORX_AR024122) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Event Global Tracker |

| | | |

| |  |An application that can receive pharmacy supply event information. While the tracker will most likely store some |

| | |or all of the event information, no specific action or further interact will result from the receipt of the |

| | |pharmacy supply event informaiton. |

|  |

| |2.2.7 |Pharmacy Supply Confirmer  (PORX_AR023152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Promise Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a commitment for a dispensing a drug or similar therapy. |

|  |

| |2.2.8 |Pharmacy Supply Confirmation Receiver  (PORX_AR023162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Supply Promise Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a commitment for a dispensing a drug or |

| | |similar therapy |

|  |

| |2.2.9 |Combined Pharmacy Placer  (PORX_AR002132) |

| |  |Description  [pic] |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Placer |

| | | |

| |  |An application that is capable of completing the actions necessary to deal with the issuing, completion and |

| | |discontinuing of a service request for a administration and dispensing of a drug or similar therapy. |

|  |

| |2.2.10 |Combined Pharmacy Fulfiller  (PORX_AR002142) |

| |  |Description  [pic] |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Fulfiller |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a administration and dispensing of a drug or similar |

| | |therapy. |

|  |

| |2.2.11 |Combined Pharmacy Confirmer  (PORX_AR002152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a service request for a administration and dispensing of a drug or similar |

| | |therapy. |

|  |

| |2.2.12 |Combined Pharmacy Confirmation Receiver  (PORX_AR002162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Order Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a service request for a administration and |

| | |dispensing of a drug or similar therapy. |

|  |

| |2.2.13 |Combined Event Query Placer  (PORX_AR100010) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Event Query Placer |

| | | |

| |  |An application that can send a request for pharmacy order supply and administration event information. |

|  |

| |2.2.14 |Combined Event Query Fulfiller  (PORX_AR100020) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Event Query Fulfiller |

| | | |

| |  |An application than can respond to a request for pharmacy order supply and administration event information. |

|  |

| |2.2.15 |Combined Pharmacy Confirmer  (PORX_AR003152) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Promise Global Confirmer |

| | | |

| |  |An application that is capable of confirming agreement to perform the actions necessary to deal with the issuing, |

| | |completion and discontinuing of a commitment for a administration and dispensing of a drug or similar therapy. |

|  |

| |2.2.16 |Combined Pharmacy Confirmation Receiver  (PORX_AR003162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Combined Promise Global Confirmation Receiver |

| | | |

| |  |An application that is capable of accepting a confirmation from a system that has agreed to perform the actions |

| | |necessary to deal with the issuing, completion and discontinuing of a commitment for a administration and |

| | |dispensing of a drug or similar therapy. |

|  |

| |2.2.17 |Scheduled Administration Event Global Confirmer  (PORX_AR035125) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Confirmer |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2.2.18 |Scheduled Admin Event Global Confirmation Receiver  (PORX_AR035162) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Confirmation Receiver |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2.2.19 |Scheduled Administration Event Global Informer  (PORX_AR035112) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Informer |

| | | |

| |  |An application that performs or manages pharmacy administration events and sends notifications of those events to |

| | |one or more receiving applications. The informer has no expectation that any action or activity will result on the|

| | |receiving application(s). |

|  |

| |2.2.20 |Scheduled Administration Event Global Tracker  (PORX_AR035122) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Event Global Tracker |

| | | |

| |  |An application that can receive pharmacy administration event information. While the tracker will most likely |

| | |store some or all of the event information, no specific action or further interact will result from the receipt of|

| | |the pharmacy administration event informaiton. |

|  |

| |2.2.21 |Scheduled Administration Promise Global Placer  (PORX_AR033132) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Promise Global Placer |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2.2.22 |Scheduled Administration Promise Global Fulfiller  (PORX_AR033142) |

| |  |Description  |

| |  |Structured Name:  |

| | |Pharmacy Scheduled Administration Promise Global Fulfiller |

| | | |

| |  |TO BE WRITTEN |

|  |

| |2 |Message Definitions |

| | |Domain Table of Contents |

| |2.4 |Refined Message Information Models |

| |  | |

| | |Reference |

| |  |For details on the interpretation of this section, see the description of RMIMs in the Version 3 Guide. |

| |  | |

| | |Introduction |

| |  |At time of ballot, the RMIM's described in the Pharmacy Domain was limited to those necessary to support the other |

| | |content in this domain. Additional RMIM's have been identified but are not fully developed at this time. These |

| | |additional RMIM's are listed here in order to document the concepts for further development. |

| | |PORX_RM023000 Pharmacy Supply Promise |

| | |PORX_RM003000 Pharmacy Combined Promise |

| | |PORX_RM004000 Pharmacy Combined Event |

| | |PORX_RM013000 Pharmacy Administration Promise |

| | |PORX_RM012000 Pharmacy Administration Order |

| | |PORX_RM042000 Pharmacy Scheduled Supply Order |

| | |PORX_RM022000 Pharmacy Supply Order |

| | |PORX_RM002000 Pharmacy Combined Order |

| | |PORX_RM043000 Pharmacy Scheduled Supply Promise |

| | |PORX_RM014000 Pharmacy Administration Event |

| | |PORX_RM033000 Pharmacy Scheduled Administration Promise |

| | |PORX_RM032000 Pharmacy Scheduled Administration Order |

| |2.4.1 |Pharmacy Supply  (PORX_RM000021) |

| |  |Description |

| |  |Parent:   |

| | |Pharmacy Domain Model (PORX_DM000000) |

| | | |

|  |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

|  |

| |2.4.2 |Pharmacy Institutional Order  (PORX_RM000011) |

| |  |Description |

| |  |Parent:   |

| | |Pharmacy Domain Model (PORX_DM000000) |

| | | |

|  |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

|  |

| |2.4.3 |Pharmacy Medication Administration Query Response  (PORX_RM000031) |

| |  |Description |

| |  |Parent:   |

| | |Pharmacy Domain Model (PORX_DM000000) |

| | | |

|  |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

|  |

| |2.4.4 |Pharmacy Community Dispense  (PORX_RM000002) |

| |  |Description |

| |  |Parent:   |

| | |Pharmacy Domain Model (PORX_DM000000) |

| | | |

|  |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

|  |

| |2.4.5 |Pharmacy Community Prescription  (PORX_RM000001) |

| |  |Description |

| |  |Parent:   |

| | |Pharmacy Domain Model (PORX_DM000000) |

| | | |

|  |

| |  |Diagram |

| |  |Link to graphic (opens in a new window) |

|  |

|  |

| |2 |Message Definitions |

| | |Domain Table of Contents |

| |2.5 |Hierarchical Message Descriptions |

| |  | |

| | |Reference |

| |  |For details on the interpretation of this section, see the description of HMDs in the Version 3 Guide. |

| |  | |

| | |Introduction |

| |  |At time of ballot, the HMD's described in the Pharmacy Domain was limited to those necessary to support the other |

| | |content in this domain. Additional HMD's have been identified but are not fully developed at this time. These additional|

| | |HMD's are listed here in order to document the concepts for further development. |

| | |PORX_HD033200 Pharmacy Scheduled Administration Promise Revise |

| | |PORX_HD002200 Pharmacy Combined Order Revise |

| | |PORX_HD042500 Pharmacy Scheduled Supply Order Reactivate |

| | |PORX_HD042200 Pharmacy Scheduled Supply Order Revise |

| | |PORX_HD003400 Pharmacy Combined Promise Complete |

| | |PORX_HD042400 Pharmacy Scheduled Supply Order Complete |

| | |PORX_HD042100 Pharmacy Scheduled Supply Order Activate |

| | |PORX_HD003300 Pharmacy Combined Promise Replace |

| | |PORX_HD033300 Pharmacy Scheduled Administration Promise Replace |

| | |PORX_HD043300 Pharmacy Scheduled Supply Promise Replace |

| | |PORX_HD032200 Pharmacy Scheduled Administration Order Revise |

| | |PORX_HD014400 Pharmacy Administration Event Complete |

| | |PORX_HD013300 Pharmacy Administration Promise Replace |

| | |PORX_HD032100 Pharmacy Scheduled Administration Order Activate |

| | |PORX_HD042300 Pharmacy Scheduled Supply Order Replace |

| |2 |Message Definitions |

| | |Domain Table of Contents |

| |2.6 |Interactions |

| |  |6 List of Interactions (Sorted by Title) |

| | | |

| | |  |

| | |[pic] |

| | |TO BE SPECIFIED ( PORX_IN000009 )   |

| | | |

| | | |

| | | |

| | | |

| | |  |

| | |[pic] |

| | |TO BE SPECIFIED ( PORX_IN000007 )   |

| | | |

| | | |

| | | |

| | | |

| | |  |

| | |[pic] |

| | |TO BE SPECIFIED ( PORX_IN000008 )   |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | |6 List of Interactions (Sorted by Structured Sort Name) |

| | | |

| | |  |

| | |[pic] |

| | |Community Pharmacy Combined Order Activate, Fulfilment Request ( PORX_IN000007 )   |

| | | |

| | | |

| | | |

| | | |

| | |  |

| | |[pic] |

| | |Community Pharmacy Combined Order Activate, Rejection ( PORX_IN000009 )   |

| | | |

| | | |

| | | |

| | | |

| | |  |

| | |[pic] |

| | |Community Pharmacy Supply Event Complete, Notification ( PORX_IN000008 )   |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |[pic] |

| | | |

|  |

| |  | |

| | |Reference |

| |  |For details on the interpretation of this section, see the definition of Interactions in the Version 3 Guide. |

| |  | |

| | |Introduction |

| |  |At time of ballot, the Interactions described in the Pharmacy Domain was limited to those necessary to support the |

| | |other content in this domain. Additional Interactions have been identified but are not fully developed at this time. |

| | |These additional Interactions are listed here in order to document the concepts for further development. |

| |2.6.1 |TO BE SPECIFIED  (PORX_IN000009) |

| |  |Description |

| |  |Structured Name:  |

| | |Community Pharmacy Combined Order Activate, Rejection |

| | | |

| |  |Note: temporary id assigned for this interaction. Subject to change as development continues and this interaction is |

| | |further integrated into the standard. |

| | |Note: Message Type not set (PORX_MT999999 Preface used as a place holder for missing information) |

| | |Note: Interaction not set (PORX_IN999999 Preface used as a place holder for missing information) |

| | |This interaction is used by a Pharmacy Dispensing application (combined pharmacy order fulfiller) to notify the |

| | |Medication Management/Order Entry application that the fulfillment request cannot be honored. |

|  |

| |  |Sending Role |

| | |Pharmacy Combined Order Global Fulfiller |

| | |PORX_AR002142 |

| | | |

| | |Receiving Role |

| | |Pharmacy Combined Order Global Placer |

| | |PORX_AR002132 |

| | | |

| | |Trigger Event |

| | |Preface |

| | |PORX_TE999999 |

| | | |

| | |Message Type |

| | |Preface |

| | |PORX_MT999999 |

| | | |

|  |

|  |

| |2.6.2 |TO BE SPECIFIED  (PORX_IN000007) |

| |  |Description |

| |  |Structured Name:  |

| | |Community Pharmacy Combined Order Activate, Fulfilment Request |

| | | |

| |  |Note: temporary id assigned for this interaction. Subject to change as development continues and this interaction is |

| | |further integrated into the standard. |

| | |Note: Message Type not set (PORX_MT999999 Preface used as a place holder for missing information) |

| | |This interaction is used by a Medication Management/Order Entry application (combined pharmacy order placer) to |

| | |request that the participating pharmacy dispensing application (combined pharmacy order fulfiller) dispense |

| | |medication(s) persuant to an order. |

|  |

| |  |Sending Role |

| | |Pharmacy Combined Order Global Placer |

| | |PORX_AR002132 |

| | | |

| | |Receiving Role |

| | |Pharmacy Combined Order Global Fulfiller |

| | |PORX_AR002142 |

| | | |

| | |Trigger Event |

| | |Pharmacy Combined Order Activate, Fulfillment Request |

| | |PORX_TE002120 |

| | | |

| | |Message Type |

| | |Preface |

| | |PORX_MT999999 |

| | | |

|  |

|  |

| |2.6.3 |TO BE SPECIFIED  (PORX_IN000008) |

| |  |Description |

| |  |Structured Name:  |

| | |Community Pharmacy Supply Event Complete, Notification |

| | | |

| |  |Note: temporary id assigned for this interaction. Subject to change as development continues and this interaction is |

| | |further integrated into the standard. |

| | |Note: Message Type not set (PORX_MT999999 Preface used as a place holder for missing information) |

| | |This interaction is used by a Pharmacy Dispensing application (combined pharmacy order fulfiller) to notify other |

| | |participating applications that a dispense event has occurred. |

| | |As a combined pharmacy event, either the supply and adminstration are combined or the medication was supplied and no |

| | |distinct message for the adminstration will be sent. |

| | |As a notification, no actions are required or expected of other participating applications. |

|  |

| |  |Sending Role |

| | |Pharmacy Combined Order Global Fulfiller |

| | |PORX_AR002142 |

| | | |

| | |Receiving Role |

| | |Pharmacy Combined Order Global Placer |

| | |PORX_AR002132 |

| | | |

| | |Trigger Event |

| | |Combined Pharmacy Event Complete, Notification |

| | |PORX_TE004410 |

| | | |

| | |Message Type |

| | |Preface |

| | |PORX_MT999999 |

| | | |

|  |

|  |

| |3 |Query Definitions |

| | |Domain Table of Contents |

No content

| |4 |Master File Definitions |

| | |Domain Table of Contents |

No Content

| |5 |Common Message Elements Indexes |

| |5.1 |Derived From this Domain |

| |  |A_AdministeredMedication universal |

| | |COCT_RM690000 |

| | | |

| | |A_AlertNoText universal |

| | |COCT_RM260003 |

| | | |

| | |A_MedicationOrderedAndSupplied universal |

| | |COCT_RM720000 |

| | | |

| | |R_MaterialMedProduct identified |

| | |COCT_RM230001 |

| | | |

| | |R_MaterialMedProduct identified-confirmable |

| | |COCT_RM230002 |

| | | |

| | |R_MaterialMedProductPackaged identified |

| | |COCT_RM220001 |

| | | |

| | |R_MaterialMedProductPackaged identified-confirmabl |

| | |COCT_RM220002 |

| | | |

| | |R_MaterialMedProductPackaged universal |

| | |COCT_RM220000 |

| | | |

| | |R_MaterialMedProduct universal |

| | |COCT_RM230000 |

| | | |

|  |

| |5.2 |Used In this Domain |

| |  |Pharmacy Administration Event Complete (PORX_HD014400) |

| |  |A_EncounterDetailed |

| | |COCT_MT010101 |

| | | |

| | |A_ObservationAnnotationDetailed |

| | |COCT_MT120401 |

| | | |

| | |A_ObservationSupportingUniversal |

| | |COCT_MT120200 |

| | | |

| | |R_AssignedDeviceIdentified |

| | |COCT_MT090302 |

| | | |

| | |R_AssignedPersonIdentified |

| | |COCT_MT090102 |

| | | |

| | |R_MaterialMedProductUniversal |

| | |COCT_MT230000 |

| | | |

| | |R_PatientUniversal |

| | |COCT_MT050000 |

| | | |

|  |

| |  |Dutch Med Review (PORX_HD100400) |

| |  |A_CoverageUniversal |

| | |COCT_MT180000 |

| | | |

| | |R_AssignedPersonUniversal |

| | |COCT_MT090100 |

| | | |

| | |R_MaterialMedPackagedUniversal |

| | |COCT_MT220000 |

| | | |

| | |R_MaterialMedProductUniversal |

| | |COCT_MT230000 |

| | | |

| | |R_PatientUniversal |

| | |COCT_MT050000 |

| | | |

|  |

|  |

| |5.3 |Interaction Indexes |

| | |Domain Table of Contents |

| |5.3.1 |Interaction Index by Application Role  |

| |  |Pharmacy Combined Order Global Placer (PORX_AR002132) |

| |  |Interactions in which this application role is the sender: |

| |  |Community Pharmacy Combined Order Activate, Fulfilment Request |

| | |PORX_IN000007 |

| | | |

| |  |Interactions in which this application role is the receiver: |

| |  |Community Pharmacy Supply Event Complete, Notification |

| | |PORX_IN000008 |

| | | |

| | |Community Pharmacy Combined Order Activate, Rejection |

| | |PORX_IN000009 |

| | | |

| |  |Pharmacy Combined Order Global Fulfiller (PORX_AR002142) |

| |  |Interactions in which this application role is the sender: |

| |  |Community Pharmacy Supply Event Complete, Notification |

| | |PORX_IN000008 |

| | | |

| | |Community Pharmacy Combined Order Activate, Rejection |

| | |PORX_IN000009 |

| | | |

| |  |Interactions in which this application role is the receiver: |

| |  |Community Pharmacy Combined Order Activate, Fulfilment Request |

| | |PORX_IN000007 |

| | | |

| |5.3.2 |Interaction Index by Trigger Event  |

| |  |Pharmacy Combined Order Activate, Fulfillment Request (PORX_TE002120) |

| |  |Community Pharmacy Combined Order Activate, Fulfilment Request |

| | |PORX_IN000007 |

| | | |

| |  |Combined Pharmacy Event Complete, Notification (PORX_TE004410) |

| |  |Community Pharmacy Supply Event Complete, Notification |

| | |PORX_IN000008 |

| | | |

| |5.3.3 |Interaction Index by Message Type  |

| |  |Preface (PORX_MT999999) |

| |  |Preface |

| | |PORX_IN999999 |

| | | |

| | |Community Pharmacy Combined Order Activate, Rejection |

| | |PORX_IN000009 |

| | | |

| | |Community Pharmacy Combined Order Activate, Fulfilment Request |

| | |PORX_IN000007 |

| | | |

| | |Community Pharmacy Supply Event Complete, Notification |

| | |PORX_IN000008 |

| | | |

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