ARCHETYPE Medication management (openEHR-EHR-ACTION.medication.v1)

Name: Medication management
License: http://creativecommons.org/licenses/by-sa/3.0/

ARCHETYPE ID	openEHR-EHR-ACTION.medication.v1
Concept	Medication management
Description	Any activity related to the planning, scheduling, prescription management, dispensing, administration, cessation and other use of a medication, vaccine, nutritional product or other therapeutic item.
Use	Use to record information about the activities required to support all aspects of medication management, including the planning, scheduling, suspension, cancellation and completion of medication orders, as well as the actual administration of medication items. This is done by the recording of data against specific activities, as defined by the 'Pathway' careflow steps in this archetype. This archetype is intended to be used for any type of medication and related order, whether prescribed by a health professional or available for purchase 'over the counter'. The scope of this medication archetype also includes orders for vaccinations, parenteral fluids or other therapeutic goods, such as bandages, nutritional products or other items that are applied or administered to have a therapeutic effect and which have a common pattern for data recording. Within the context of a Medication or Vaccination List, this archetype will be used to record only what medication or vaccination has been prescribed or administered. Additional structured and detailed information about the activity can be captured using purpose-specific archetypes inserted into the 'Preparations details', 'Amount', 'Structured body site', 'Administration device' or 'Additional details' SLOTs, where required. Timings related to medication management can be managed in one of two ways: - Using the reference model - the time for performance of any pathway step will use the ACTION time attribute for each step. - Archetyped data elements - the 'Original scheduled date/time' data element is intended to record the time when the medication item was intended to be administered. Note: the corresponding ACTION time attribute for the Scheduled pathway step will record the time that the clinical activity was scheduled into a system, not the intended date/time on which the activity is intended to be carried out. In practice, some medications (for example, during resuscitation in the emergency department) will be administered on the basis of a protocol or verbal order and not be ordered in advance. The details about the medication will be added against the pathway step 'Dose administered'. For an ongoing course of medication, data about the medication item will be recorded against the 'Dose administered' step at each administration, leaving the instruction in the active state. When the last occurrence is recorded the ‘Medication course completed' step is recorded showing that this order is now in the completed state. In other situations, such as secondary care, there may be a formal order for a medication item using a corresponding INSTRUCTION.medication_order archetype. This ACTION archetype can then be used to record the workflow of when and how the order has been carried out. Recording information using this ACTION archetype indicates that some sort of activity has actually occurred; this will most commonly be the administration of the medication item itself, but may be a delayed supply attempt or another activity such as suspending the medication item in preparation for a procedure. If there is a formal order for the medication item, the state of this order is represented by the Pathway step against which the data is recorded. For example, using this archetype the progressing state of a Paracetamol order may be recorded through separate entries in the EHR progress notes at each 'Pathway' step. When documenting the reason for why an activity was performed or a pathway step was chosen, for example why a dose was omitted or the medication was ceased, the element "Reason" may be used. When this ACTION archetype is used with the corresponding INSTRUCTION.medication_order archetype, information which hasn't changed from the order to the management activity aren't generally repeated in the action. It's considered good practice, though not mandatory, to record the medication item in the ACTION. The pathway steps make a distinction between those which relate directly to fulfillment of the order, such as authorisation, preparation and dose administration, and those which relate to handling of the prescription such as issue, re-authorisation, dispensing. In some jurisdictions these are regarded as a single pathway, in others it may be helpful to handle order fulfillment and prescription in separate templates. The names of most of the pathway steps in this archetype start with either "Medication" or "Prescription" to make it easier to differentiate between the pathway steps that are associated with prescription handling and those that are associated with handling the medication order itself. In some jurisdictions, a prescription can be re-authorised for the purpose of continuing an ongoing medication order, while in others an entirely new prescription must be issued in these circumstances. In the latter, the pathway step 'Prescription re-authorised' is not applicable.
Misuse	Not to be used for recording a medication order or instruction. Use the INSTRUCTION.medication_order archetype for this purpose. Not to be used to record the administration or dispensing of blood products, which involves a fundamentally different clinical process and is likely to require different supporting information. Use a different appropriate ACTION archetype for this purpose. Not to be used for recording details about therapeutic adherence, secondary effects or toxicity. Use other archetypes for these purposes. Not to be used for medication reconcilliation. Use other appropriate archetypes for this purpose. Not to be used for a formal review of an entire medication list, for example by a pharmacist. Use other appropriate archetypes for this purpose.
Purpose	For recording details about any activity related to the planning, scheduling, prescription management, dispensing, administration, cessation and other use of a medication, vaccine, nutritional product or other therapeutic item.
References	Based on Medication Action, Published Archetype [Internet]. Australian Digital Health Agency, Australian Digital Health Agency Clinical Knowledge Manager [cited: 2017-08-10]. Available from: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.876 Medication statement, [Internet]. Intermountain Healthcare. Available from http://www.opencem.org/#/20170613/Intermountain/MedicationStatement Messaging Implementation Manual (GP2GP messages) [Internet], NHS Digital England. Available from: https://data.developer.nhs.uk/dms/mim/6.3.01/Domains/GP2GP/Document%20files/GP2GP%20IM.htm#_Toc_Section_7.2 Standards for the clinical structure and content of patient records (Complete document) [Internet]. PRSB London. [cited 2017 Aug 29]. Available from: http://theprsb.org/download/document/7-standards-for-the-clinical-structure-and-content-of-patient-records Norwegian regulations for medication management (Forskrift om legemiddelhåndtering for virksomheter og helsepersonell som yter helsehjelp) [Internet]. Government of Norway. [cited 2017-10-26]. Available from: https://lovdata.no/forskrift/2008-04-03-320
Copyright	© openEHR Foundation
Authors	Author name: Ian McNicoll Organisation: freshEHR Clinical Informatics UK Email: ian@freshehr.com Date originally authored: 2017-05-29
Other Details Language	Author name: Ian McNicoll Organisation: freshEHR Clinical Informatics UK Email: ian@freshehr.com Date originally authored: 2017-05-29
OtherDetails Language Independent	{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., custodian_organisation=openEHR Foundation, references=Based on Medication Action, Published Archetype [Internet]. Australian Digital Health Agency, Australian Digital Health Agency Clinical Knowledge Manager [cited: 2017-08-10]. Available from: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.876 Medication statement, [Internet]. Intermountain Healthcare. Available from http://www.opencem.org/#/20170613/Intermountain/MedicationStatement Messaging Implementation Manual (GP2GP messages) [Internet], NHS Digital England. Available from: https://data.developer.nhs.uk/dms/mim/6.3.01/Domains/GP2GP/Document%20files/GP2GP%20IM.htm#_Toc_Section_7.2 Standards for the clinical structure and content of patient records (Complete document) [Internet]. PRSB London. [cited 2017 Aug 29]. Available from: http://theprsb.org/download/document/7-standards-for-the-clinical-structure-and-content-of-patient-records Norwegian regulations for medication management (Forskrift om legemiddelhåndtering for virksomheter og helsepersonell som yter helsehjelp) [Internet]. Government of Norway. [cited 2017-10-26]. Available from: https://lovdata.no/forskrift/2008-04-03-320, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=0650B5F8DDBF358C1E02ED6A5B17D978, build_uid=959b0e54-2ccb-46d8-8383-362c7a12f642, revision=1.3.0}
Keywords	medication, prescribe, dispense, administration, cessation, therapeutic good, supply, medicine, drug, preparation, medicinal, prescription, vaccine, vaccination, dosage, form, route, follow-up
Lifecycle	published
UID	0033ab5c-cde0-4402-8b64-d30c188adf79
Language used	en
Citeable Identifier	1013.1.123
Revision Number	1.3.0
All	Archetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Any activity related to the planning, scheduling, prescription management, dispensing, administration, cessation and other use of a medication, vaccine, nutritional product or other therapeutic item., archetypeConceptComment=This is not limited to activities performed based on medication orders from clinicians, but could also include for example taking over the counter medication., otherContributors=Morten Aas, Oslo Universitetssykehus, Norway Ole Andreas Bjordal, Webmed, Norway Erling Are Hole, Helse Bergen, Norway Vebjørn Arntzen, Oslo University Hospital, Norway (openEHR Editor) Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor) SB Bhattacharyya, Bhattacharyyas Clinical Records Research & Informatics LLP, India Dionizio Brentano, UFRGS - Universidade Federal do Rio Grande do Sul, Brazil Laila Bruun, Oslo universitetssykehus HF, Norway Ady Angelica Castro Acosta, CIBERES-Hospital 12 de Octubre, Spain Ruth Caudwell, retired, United Kingdom Bjørn Christensen, Helse Bergen HF, Norway Stephen Chu, NEHTA, Australia (Editor) Lisbeth Dahlhaug, Helse Midt - Norge IT, Norway Inderjit Daphu, Helse Bergen, Norway Samo Drnovšek, Marand, Slovenia (Editor) Robert Eager, Healthways, Australia Tone Engen, Norway Peter Fedorcsak, Oslo universitetssykehus, Norway Samuel Frade, Marand, Portugal Hildegard Franke, freshEHR Clinical Informatics Ltd., United Kingdom Jacquie Garton-Smith, Royal Perth Hospital and DoHWA, Australia Mikkel Gaup Grønmo, FSE, Helse Nord, Norway Heather Grain, Llewelyn Grain Informatics, Australia Sam Heard, Ocean Health Systems, Australia Geir Hoff, Sykehuset Telemark HF, Norway Annette Hole Sjøborg, DIPS ASA, Norway Hilde Hollås, DIPS AS, Norway Roar Holm, Helse Vest IKT A/S, Norway Alfred Honore, Haukeland, Norway Evelyn Hovenga, EJSH Consulting, Australia Lars Ivar Mehlum, Helse Bergen HF, Norway Tom Jarl Jakobsen, Helse Bergen, Norway Gunnar Jårvik, Nasjonal IKT HF, Norway Hilde Karen Ofte, Nordlandssykehuset HF, Norway Nils Kolstrup, Skansen Legekontor og Nasjonalt Senter for samhandling og telemedisin, Norway Harmony Kosola, Alberta Health Services, Canada Anne Kristin Strand, Sykehuspartner HF, Norway Robert L'egan, NEHTA, Australia Heather Leslie, Atomica Informatics, Australia (openEHR Editor) Marit Ludvigsen, St Olavs Hospital, Norway Colin Macfarlane, Elsevier, United Kingdom Siv Marie Lien, DIPS ASA, Norway James McClay, University of Nebraska Medical Center, United States Hildegard McNicoll, freshEHR Clinical Informatics Ltd., United Kingdom Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (openEHR Editor) Jude Michel, Queensland Health, Australia Chris Mitchell, RACGP, Australia Lars Morgan Karlsen, DIPS ASA, Norway Andrej Orel, Marand d.o.o., Slovenia Doug Pankoski, Alberta Health Services, Canada Vladimir Pizzo, Clínica Parente Pizzo, Finland Jodie Pycroft, Adelaide Northern Division of General Practice Ltd, Australia Jussara Rotzsch, Hospital Alemão Oswaldo Cruz, Brazil Danielle Santos Alves, ARS Semantica, Brazil Anoop Shah, University College London, United Kingdom Line Silsand, Universitetssykehuset i Nord-Norge, Norway Sam Stokes, Citizen Scientist, United States Iztok Stotl, UKCLJ, Slovenia Norwegian Review Summary, Norwegian Public Hospitals, Norway Nyree Taylor, Ocean Health Systems, Australia Tesfay Teame, Folkehelseinstituttet, Norway Rowan Thomas, St. Vincent's Hospital Melbourne, Australia Anders Thurin, VGR, Sweden Gordon Tomes, Australian Institute of Health and Welfare, Australia Stian Torleif Varpe, Helse Bergen, Norway Richard Townley-O'Neill, NEHTA, Australia (Editor) Karl Trygve Kalleberg, Oslo Universitetssykehus, Norway Gro-Hilde Ulriksen, Norwegian center for ehealthresearch, Norway John Tore Valand, Helse Vest IKT, Norway (openEHR Editor) Ines Vaz, UFN, Portugal Kylie Young, The Royal Australian College of General Practitioners, Australia Iztok Štotl, UKCLJ, Slovenia, originalLanguage=en, translators= German: Ramona Wellmann, Natalia Strauch, Medizinische Hochschule Hannover, strauch.natalia@mh-hannover.de, Strauch.Natalia@mh-hannover.de Russian: Art Latyp; Артур Латыпов, RusBITech; Русбитех, Москва, hmm Swedish: Emma Malm, Karolinska Universitetssjukhuset, emma.malm@cambio.se Spanish (Argentina): Guillermo Palli Norwegian Bokmål: Vebjørn Arntzen, Silje Ljosland Bakke, John Tore Valand, Oslo universitetssykehus HF, Helse Vest IKT AS, Norway, john.tore.valand@helse-vest-ikt.no, silje.ljosland.bakke@helse-vest-ikt.no Portuguese (Brazil): Débora Farage, Fernanda Maia, Adriana Kitajima, Ana Paula Andrade, Clóvis Puttini, Core Consulting, contato@coreconsulting.com.br, Hospital Alemão Oswaldo Cruz Arabic (Syria): Mona Saleh Slovenian: Biljana Prinčič, Marand, Ljubljana, biljana.princic@marand.si Chinese (PRC): Lin Zhang, Taikang Insurance Group, linforest@163.com, ? Catalan: Jaqueline Peredo, Julio de Sosa, Servei Català de la Salut, jperedo2003@gmail.com, juliodesosa@catsalut.cat Spanish (Spain): Julio de Sosa, Servei Català de la Salut, juliodesosa@catsalut.cat , subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={identities=[], other_participations=[], events=[], details=[], provider=[], items=[], description=[ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0020], code=at0020, itemType=ELEMENT, level=2, text=Medication item, description=Name of the medication, vaccine or other therapeutic/prescribable item which was the focus of the activity., comment=For example: 'Atenolol 100mg' or 'Tenormin tablets 100mg'. It is strongly recommended that the 'Medication item' is coded with a terminology capable of triggering decision support, where possible. The extent of coding may vary from the simple name of the medication item through to structured details about the actual medication pack used. Free text entry should only be used if there is no appropriate terminology available., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0104], code=at0104, itemType=SLOT, level=2, text=Medication details, description=Structured details about the medication including strength, form and constituent substances., comment=Use this SLOT where the detailed description of the dispensed, authorised or administered item needs to be explicitly stated. For example: the form, strength, any diluents or mixture of ingredients., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.medication.v1 and specialisations or openEHR-EHR-CLUSTER.medication.v2 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0131], code=at0131, itemType=SLOT, level=2, text=Amount, description=Specific details about the amount of the medication item., comment=CLUSTER.dosage is intended to carry details of medication order changes or dose administrations, whilst CLUSTER.medication_supply_amount is intended for details of dispensing-related activity., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.medication_supply_amount.v0 and specialisations or openEHR-EHR-CLUSTER.medication_supply_amount.v1 and specialisations or openEHR-EHR-CLUSTER.dosage.v1 and specialisations or openEHR-EHR-CLUSTER.dosage.v2 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0156], code=at0156, itemType=ELEMENT, level=2, text=Clinical indication, description=The clinical reason for the medication activity., comment=For example: 'Angina' or 'Pain'. Coding of the indication with a terminology is preferred, where possible. This data element allows multiple occurrences. If only an ACTION is used to record a medication indication, this data element can be used without additional consideration. However, if a clinical indication is recorded for both the Medication order INSTRUCTION and this Medication management ACTION, be aware that these indications might not be consistent.", uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0132], code=at0132, itemType=ELEMENT, level=2, text=Substitution, description=Subsitution action taken by the person administering or dispensing the drug., comment=In many jurisdictions, substitution of an ordered item as a generic form or with a different brand name, which has been determined as bioequivalent, is allowed at the point of dispense or supply. In other cases substitution is assumed and the clinician has to explicitly request non-substitution., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0138::Substitution performed [A medication was substituted which is bioequivalent to that ordered.] at0139::Substitution not performed [Although allowed by the medication order a bioequvalent medication was not substituted.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0133], code=at0133, itemType=ELEMENT, level=2, text=Substitution reason, description=The reason or justification for the substitution action taken., comment=For example: "Generic alternative contains a substance that is not tolerated by the patient." May be coded with a terminology when clinically appropriate, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0043], code=at0043, itemType=ELEMENT, level=2, text=Original scheduled date/time, description=The datetime at which the medication action was scheduled to occur., comment=Used to compare variance from actual action time where this is not readily calculable from the original instruction., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0154], code=at0154, itemType=ELEMENT, level=2, text=Restart date/time, description=The date/time on which the medication course is set to restart, as per the "Administrations suspended" pathway step., comment=For example: 2017-10-29, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0155], code=at0155, itemType=ELEMENT, level=2, text=Restart criterion, description=The criterion which triggers the medication course to restart, as per the "Administrations suspended" pathway step., comment=For example: "On day 2 after surgery"., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0021], code=at0021, itemType=ELEMENT, level=2, text=Reason, description=Reason that the pathway step for the identified medication was carried out., comment=For example: 'Postponed - Patient not avalable at administration time', 'Cancelled - Adverse reaction'. Note: This is not the reason for the medication instruction, but rather the specific reason that a care step was carried out, and will often be used to document some variance from the original order., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0140], code=at0140, itemType=CLUSTER, level=2, text=Administration details, description=Details of body site and administration of the medication., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0140]/items[at0147], code=at0147, itemType=ELEMENT, level=3, text=Route, description=The route by which the ordered item was, or is to be, administered into the subject's body., comment=Comment: For example: 'oral', 'intravenous', or 'topical'. Coding of the route with a terminology is preferred, where possible. Multiple potential routes may be specified., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0140]/items[at0141], code=at0141, itemType=ELEMENT, level=3, text=Body site, description=Structured description of the site of administration of the ordered item., comment=For example: 'left upper arm', 'intravenous catheter right hand'. Coding of the body site with a terminology is preferred, where possible., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0140]/items[at0142], code=at0142, itemType=SLOT, level=3, text=Structured body site, description=Structured description of the site of administration of the medication, vaccine or therapeutic good., comment=For example: "On the medial skin surface of the left forearm, from 10 cm to 20 cm distally from the point of the elbow"., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* openEHR-EHR-CLUSTER.anatomical_location.v1 and specialisations or openEHR-EHR-CLUSTER.anatomical_location_circle.v1 and specialisations or openEHR-EHR-CLUSTER.anatomical_location_relative.v2 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0140]/items[at0143], code=at0143, itemType=ELEMENT, level=3, text=Administration method, description=The technique or device by which the ordered item was, or is to be, administered., comment=Comment: For example: ' via Z-track injection'; 'via nebuliser'. Coding of the method with a terminology is preferred, where possible., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0140]/items[at0144], code=at0144, itemType=SLOT, level=3, text=Administration device, description=Details of the medical device used to assist administration of the medication., comment=null, uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.device.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0053], code=at0053, itemType=SLOT, level=2, text=Additional details, description=Further structured details of the action, possibly specific to a pathway step., comment=null, uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* openEHR-EHR-CLUSTER.medication_authorisation.v0 and specialisations or openEHR-EHR-CLUSTER.medication_authorisation.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0033], code=at0033, itemType=ELEMENT, level=2, text=Patient guidance, description=Any guidance, instructions or advice given to the subject of care or personal carer at the time of the pathway step., comment=For example: 'Avoid grapefruit' , 'Take at least 2 hours before bedtime', 'Take with food'. May be coded with a terminology when clinically appropriate., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0149], code=at0149, itemType=ELEMENT, level=2, text=Double-checked?, description=The pathway step has been checked by a separate individual., comment=Details of the individual performing the double-check can be carried in the Reference Model element "Participation"., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0025], code=at0025, itemType=ELEMENT, level=2, text=Sequence number, description=The sequence number specific to the pathway step being recorded., comment=For example: Vaccine sequence number., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/description[at0017]/items[at0024], code=at0024, itemType=ELEMENT, level=2, text=Comment, description=Additional narrative about the activity or pathway step not captured in other fields, including details of any variance between the intended action and the action actually performed., comment=For example: 'Patient was in radiology department', 'Accidental injection into blood vessel during IM administration'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0030]/items[at0103], code=at0103, itemType=ELEMENT, level=2, text=Order ID, description=Unique identifier for the medication order., comment=Comment: This data element allows for multiple occurrences to be defined more explicitly at run-time, if required., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of: Identifier Text , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0030]/items[at0085], code=at0085, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* All not explicitly excluded archetypes, extendedValues=null]], ism_transition=[ResourceSimplifiedHierarchyItem [path=/ism_transition[at0109]_526_at0109, code=at0109, itemType=ISM_TRANSITION, level=1, text=Medication recommended, description=The medication has been recommended but no steps have been taken to initiate prescribing., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: planned, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0145]_526_245_at0145, code=at0145, itemType=ISM_TRANSITION, level=1, text=Prescription awaiting authorisation, description=Draft prescription has been prepared and is awaiting confirmation from an authorised clinician. May be used where reauthorisations are performed as a batch. This careflow_step may have a status of 'planned' or 'active', reflecting the need to to handle new orders as well as re-authorised orders., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: planned, active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0013]_527_at0013, code=at0013, itemType=ISM_TRANSITION, level=1, text=Medication course postponed, description=The scheduled medication course has been postponed prior to any administration., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: postponed, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0012]_528_at0012, code=at0012, itemType=ISM_TRANSITION, level=1, text=Medication course cancelled, description=The planned course of medication has been cancelled prior to any administration., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: cancelled, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0150]_528_at0150, code=at0150, itemType=ISM_TRANSITION, level=1, text=Prescription cancelled, description=The prescription was cancelled prior to being issued., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: cancelled, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0016]_529_at0016, code=at0016, itemType=ISM_TRANSITION, level=1, text=Medication start date/condition set, description=The time to start the medication, or other starting condition, has been set., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: scheduled, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0153]_529_at0153, code=at0153, itemType=ISM_TRANSITION, level=1, text=Medication authorised, description=The medication has been formally authorised for use., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: scheduled, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0002]_245_at0002, code=at0002, itemType=ISM_TRANSITION, level=1, text=Prescription issued, description=A prescription has been issued for the medication., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0003]_245_at0003, code=at0003, itemType=ISM_TRANSITION, level=1, text=Prescription dispensed, description=The ordered medication has been dispensed, for example from a pharmacy to the patient., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0106]_245_at0106, code=at0106, itemType=ISM_TRANSITION, level=1, text=Prescription re-authorised, description=The original medication order has been re-authorised to allow repeat prescription or dispensing. In some jurisdictions an entirely new order must be issued in these circumstances., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0010]_245_at0010, code=at0010, itemType=ISM_TRANSITION, level=1, text=Prescription re-issued, description=A prescription has been re-issued for an existing medication order., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0148]_245_at0148, code=at0148, itemType=ISM_TRANSITION, level=1, text=Medication prepared, description=The medication has been physically prepared., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0157]_245_at0157, code=at0157, itemType=ISM_TRANSITION, level=1, text=Medication double checked, description=The prepared medication has been double checked., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0004]_245_at0004, code=at0004, itemType=ISM_TRANSITION, level=1, text=Medication course commenced, description=The medication has been taken by, or administered to, the patient for the first time. Although in some settings this significant date may be computable as the first of several administrations, in other settings, such as primary care, specific administration dates are not readily available., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0041]_245_at0041, code=at0041, itemType=ISM_TRANSITION, level=1, text=Minor change to order, description=The medication order has been changed in a manner which does not require a new instruction/order to be issued, according to local clinical rules., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0005]_245_at0005, code=at0005, itemType=ISM_TRANSITION, level=1, text=Medication reassessed, description=The individual medication has been reassessed, for example whether the medication should still be taken. This is not intended to capture review of the medication list., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0006]_245_at0006, code=at0006, itemType=ISM_TRANSITION, level=1, text=Dose administered, description=A single administration of the medication has taken place., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0018]_245_at0018, code=at0018, itemType=ISM_TRANSITION, level=1, text=Dose administration omitted, description=An administration of the medication has been withheld and not given. There is no expectation that it will be given later, though the next dose (if any) should be administered according to the original order., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0044]_245_at0044, code=at0044, itemType=ISM_TRANSITION, level=1, text=Dose administration deferred, description=An administration of a dose of the medication has been delayed but is expected to be given as soon as possible., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: active, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0008]_530_at0008, code=at0008, itemType=ISM_TRANSITION, level=1, text=Prescription supply delayed, description=The prescription has not been dispensed due to a technical or pharamaceutical supply issue., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: suspended, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0009]_530_at0009, code=at0009, itemType=ISM_TRANSITION, level=1, text=Administrations suspended, description=The administration of the medication has been suspended until further notice. No further doses should be given until the restart date or conditions have been met. When setting the date/conditions for restart after suspending, a step from ‘Administrations suspended’ and back to 'Medication start date/condition set' should be performed., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: suspended, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0011]_530_at0011, code=at0011, itemType=ISM_TRANSITION, level=1, text=Prescription re-authorisation pending, description=Issue of the prescription is awaiting re-authorisation by a clinician., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: suspended, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0015]_531_at0015, code=at0015, itemType=ISM_TRANSITION, level=1, text=Medication course stopped, description=Administration of the medication has been ceased during the period of the intended course., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: aborted, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0039]_531_at0039, code=at0039, itemType=ISM_TRANSITION, level=1, text=Major change to order, description=A major change to the order was required, resulting in this order being stopped and a replacement order being started., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: aborted, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0151]_531_at0151, code=at0151, itemType=ISM_TRANSITION, level=1, text=Prescription invalid or expired, description=Prescription has been invalidated or has expired without being fulfilled., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: aborted, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0007]_532_at0007, code=at0007, itemType=ISM_TRANSITION, level=1, text=Medication course completed, description=The medication course has been completed as planned., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: completed, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/ism_transition[at0152]_532_at0152, code=at0152, itemType=ISM_TRANSITION, level=1, text=Prescription fulfilled, description=The prescription has been fulfilled successfully., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=Current state: completed, extendedValues=null]], context=[], data=[], activities=[], relationships=[], credentials=[], target=[], source=[], state=[], content=[], contacts=[], capabilities=[]}, topLevelItems={protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0030], code=at0030, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=1.., subCardinalityText= (Cardinality: 1.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], ism_transition=ResourceSimplifiedHierarchyItem [path=ROOT_/ism_transition[at0109], code=at0109, itemType=ISM_TRANSITION, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=null, subCardinalityText=null, dataType=ISM_TRANSITION, bindings=null, values=null, extendedValues=null], description=ResourceSimplifiedHierarchyItem [path=ROOT_/description[at0017], code=at0017, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=protocol, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/protocol[at0030]/items[at0103], code=at0103, itemType=ELEMENT, level=2, text=Order ID, description=Unique identifier for the medication order., comment=Comment: This data element allows for multiple occurrences to be defined more explicitly at run-time, if required., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:* Identifier Text , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0030]/items[at0085], code=at0085, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* All not explicitly excluded archetypes, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null]