CH EMED (R4)
5.0.0-ballot - ballot Switzerland flag

This page is part of the CH EMED (R4) (v5.0.0-ballot: STU 5 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Change Log

All significant changes to this FHIR implementation guide will be documented on this page.

STU 5 Sequence - v5.0.0-ballot (2024-05-16)

Added

  • #245: Include EDQM Administration Method
  • #262: Add extension to include the identifier of the last considered document (CARD)
  • #250: Add nmol ‘nanomole’ (UCUM) and 413568008 ‘Application - unit of product usage (qualifier value)’ (SCT) to VS UnitCode

Changed / Updated

  • #256: Move all terminology to CH Term
    • Update the canonical URLs in the VS binding in the profiles
    • Fix links from internal (CH EMED) to external (CH Term) artifacts
  • #258: CH Core base profiles as parent
  • #252: SCT code 246205007 ‘Quantity (attribute)’ instead of UCUM human annotation {Piece} ‘Stk.’
  • #263: Add additional constraints beside ch-dosage-1 to check, if the sequence number is present in split dosage elements
  • #269: Remove discriminator for slicing Practitioner.identifier (coming from CH Core parent profile)
  • #268: Relax max card for treatment reason from 1 to * (MedicationStatement, MedicationRequest, MedicationDispense, MedicationAdministration)

STU 4 Sequence - v4.0.1 (2023-12-28)

  • #270: 4.0.1 Technical correction for invalid package

Open Issues

During the ballot, the following comments came in, which will be taken into account in the further development of CH EMED:

  • #252: SCT code for {Piece} (UCUM)
  • #250: Split up units in ‘units of presentation’ and ‘units of administration’
  • #245: Include MOA (method of application)

See also open issues on GitHub.

Added

  • #248: Add SCT code 106181007 ‘Immunologic substance (substance)’ to ValueSet ActivePharmaceuticalIngredient

Changed / Updated

  • #234: Replacing UCUM codes with human readable annotations with SCT codes (ValueSet UnitCode)
    • {Dose} ‘Dose’ -> 408102007 ‘Unit dose (qualifier value)’
    • 10*6.{Unit} ‘(the number ten for arbitrary powers ^ 6) * Unit’ -> 396186001 ‘Million unit (qualifier value)’
    • {Package} ‘Package’ -> 1681000175101 ‘Package - unit of product usage (qualifier value)’
    • 10*3.{Unit} ‘Thousand Per * Unit’ -> 2011000175108 ‘Thousand unit (qualifier value)’
    • {Unit} ‘Unit’ -> 767525000 ‘Unit (qualifier value)’
    • {Piece} ‘Piece’ -> not done yet, see #252
  • #242: Add MedicationAdministration to Medication Dispense document (DIS)
  • #241: Add required author and timestamp elements on entry level, see details under ‘Guidance - Authorship’
  • #233: Remove the version (SCT Swiss extension) for SCT codings, where the code is from the international edition. (Only Composition.type DIS has a SCT code from the Swiss extension.)
  • #238: List the data type profiles under tab profile

Fixed

  • #231: Correct referenced identifier for Beloc Zok (in 2-7)
  • #228: Correct the SNOMED CT code for DIS
  • #234: Fix rules concerning collection (ch-obs-1 & ch-emed-comp-card/dis/list/pre/mtp/padv)

Issues resolved without amendment

  • #230: Concerning extension from CH Core not CH EMED
  • #236: Fix constraint for Composition.type
  • #246: Fix typo
  • #243: Document names
  • #244: CH EMED extensions

STU 4 Sequence - v4.0.0-ballot (2023-06-29)

Added

  • #176: Adding extensions to LIST entries for referencing the parent document.
  • #177: Adding an annotation section in the Medication List Composition, analogous to the other documents.
  • #210: Clarification of the handling of the changed entries in case of an Observation CHANGE:
    • Add aggregation type ‘referenced/bundled’ to the references for the changed MedicationStatement/MedicationRequest.
    • Introducing of separate profiles for changed MedicationStatement/MedicationRequest (based on those used before) with the additional required reference back to the Observation.
  • #224: Add SNOMED CT Swiss extension version.

Changed / Updated

  • #175: Update Observation (PADV) for ‘CHANGE’
  • #194: Remove display values from patternCodeableConcepts, remove minimum cardinality = 1 for display values, using official display values in examples (valid with http://tx.fhir.org/r4).
  • #179: Change the author element for MedicationRequest from ‘performer’ to ‘requester’.
  • #206: Change required CodeableConcepts of Composition.type from SNOMED CT to LOINC (MTP/DIS/PRE/PADV/LIST) to be able to distinguish all document types.
  • #156: Set minimum cardinality of MedicationDispense.substitution.type back to 0 and define a ValueSet ActSubstanceAdminSubstitutionCode excluding ‘none’ to prevent contradictions.
  • #195: Add additional slice in Composition.author to reference a device (MTP/PRE/DIS/PADV).
  • #149: Add ATC-slice for Medication.code
  • #200: Relax minimum cardinality of timing in CH EMED Dosage (MedicationRequest)
  • #211: Remove element/entry custodian (was required because of CDA), analog to CH Core EPR
  • #214: Require dose/rate and frequency for split dosage
  • #215: Clarify usage of Dosage.patientInstruction: Use it for the patient instructions (e.g. ‘take with food’), incl. free text dosage instructions (e.g. for complex dosage). Don’t active support Dosage.text anymore.
  • #219: Update the examples to be conformant to CH-EMED-EPR.
  • #140: Add new SNOMED CT document type codes (Composition.type) and update the profiles to check the correctness of the second provided coding (LOINC):
    • CARD: SCT#736378000 ‘Medication management plan (record artifact)’
    • MTP: SCT#761931002 ‘Medication treatment plan report (record artifact)’
    • DIS: SCT#294121000195110 ‘Medication dispense document (record artifact)’
  • #226: Added values to examples (MedicationDispense.whenHandedOver, MedicationDispense.quantity.code/unit/system) and corrected identifier of the changed MedicationStatement (added a note to the Observation profile)

Fixed

  • #182: Don’t allow nested sections.
  • #196: No restriction of maximum cardinality of contained resources and adding aggregation type contained to element ‘medicationReference’.
  • #191: Typos
  • #209: Allow Patient and RelatedPerson as reference of MedicationStatement.informationSource (CARD)

STU 3 Sequence - v3.0.0 (2022-12-21)

Open Issues

During the ballot, the following comments came in, which will be taken into account in the further development of CH EMED:

  • #140: Adding a new code (SCT) for Medication Card document (Composition.type)

See also open issues on GitHub.

Added / Updated

  • Different authors:
    • #113: Mapping of the author of the medical decision and the author of the document for the Medication List document.
    • Add description/use cases for the use of the different authors at the different document levels (document/section/entry) under Guidance and update the profiles/examples according to the guidance (#113):
      • MTP/PRE/DIS/PADV:
        • Composition.author: Reference(CH EMED PractitionerRole | CH Core Patient EPR | RelatedPerson) (CH EMED Practitioner | CH Core Organization EPR | Device)
        • Composition.section.author: dito
      • CARD:
        • Composition.author: Reference(CH EMED PractitionerRole | Device | CH Core Patient EPR | RelatedPerson) (CH EMED Practitioner | CH Core Organization EPR)
        • Composition.section.author: remove this element from differential
        • Entries - Author document: use CH Core Extension (remove ch-emed-ext-documentauthor) (#146, #114)
        • Entries - Author medical decision: only allow PractitionerRole (remove ch-emed-ext-representedorganization) (#114)
      • LIST:
        • Composition.author: Reference(Device) (CH EMED Practitioner | CH EMED PractitionerRole | CH Core Patient EPR | RelatedPerson | CH Core Organization EPR)
        • Composition.section.author: remove this element from differential
        • Entries: add seperate list profiles as mentioned above
    • #132, #125: Practitioner and his/her organization (Composition.author) are mapped via PractitionerRole (updated profiles: all Compositions, PractitionerRole, Practitioner, Organization)
    • #151: Include various inputs on the topic
  • #161: Home: Include the new IG fragments (IP Statements/Cross Version Analysis/Dependency Table/Globals Table) and remove Copyright (new included in IP Statements)
  • #126: Set IG parameter ‘allow-extensible-warnings = true’ to show the warning when codes are not in extensible bindings
  • #141: Add CH EMED examples in the profiles for ‘identifier.value’ (Bundle, Composition, MedicationDispense, MedicationRequest, MedicationStatement, Observation)
  • #91: Allow Extension Substitution also in Medication Card document (incl. updating the description of the extension to clarify the usage)

Changed / Updated

  • Update dependency to the current version of CH Core -> STU3 (v3.0.0)
  • #123: Update of the introduction according to the current status
  • #120: Change mapping for patient instruction from ‘Entry.note’ to ‘Dosage.patientInstruction’ to be able to map the annotation comment in the Medication Card document to ‘MedicationStatemtent.note’
  • Simplification/enhancement of dosing
    • #120: Add element ‘patientInstruction’ -> because the mapping from element ‘.note’ has changed to ‘Dosage.patientInstruction’
    • #117, #72: Add mapping for reserve medication as ‘Dosage.asNeededBoolean’
    • #130, #127: Allow more different cases of dosages
  • #150: Due to the decision that the CDA format will no longer be supported, CDA specific elements have been removed/adapted:
    • Remove extensions from differential (since they are defined in the underlying CH Core EPR profiles, they can theoretically still be used):
      • time-extension (http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-epr-time) in author elements (profiles/examples)
      • sectionId-extension (http://fhir.ch/ig/ch-core/StructureDefinition/ch-ext-epr-sectionid) in Composition.section (profiles/examples) (#155)
      • dataEnterer-extension in Composition (profiles)
      • versionNumber-extension in Composition (profiles)
      • informationRecipient in Composition (profiles) (note: is still a required element from CH Core EPR)
    • Remove mapping between CDA and FHIR in profiles (#157)
    • Remove the links to the CDA-CH-EMED documents (in the document tabs)
  • #118: Adaptation of the use case title (de/fr) for PADV document to avoid confusion
  • #131: Optimization of the descriptions of the extensions which represent the references to other documents
  • #129: Remove additional FHIR validation rules on ‘Composition.title’ and ‘Composition.section.title’
  • #24 CDA: Update description of CARD and LIST
  • #139: Update description of CARD

Fixed

  • #128: Remove requirement ‘fixedValue’ for ‘MedicationStatement.status’ and ‘MedicationRequest.status’, fixed wrong codes (completed) in examples
  • #144: Typo
  • #135: Broken link
  • #160: Add missing elements ‘experimental=false’ and ‘description’ to CodeSystems

Issues resolved without amendment

  • #119: Update the mapping to CDA for the Observation is no longer necessary
  • #134: Issue was withdrawn
  • #124: Due to the simplification of dosing, this request for stricter validation is no longer necessary
  • #142: Representation GTIN remains in Medication.code (not identifier)
  • #143: Currently no representation of the product code
  • #136: No update for MTP necessary
  • #137: No update for PRE necessary
  • #138: Solved with other issue

STU 3 Sequence - v2.1.0-ballot (2022-07-07)

Changed / Updated

  • #95: Update description of Composition/Bundle.identifier
  • #86: Update minimum cardinality of Composition.custodian (due to relaxation in the underlying CH Core profile)
  • #101: Update profiles -> Composition.author.extension:time (according to update in CH Core)
  • #103: Dosage - Do not allow unstructured dosage text when normal/split dosing issue90-dosage
  • #90: Dosage in Medication Prescription document - Relax minimum cardinality of Dosage.timing.repeat.boundsPeriod to 0
  • #106: Improve slicing that info entry[x] warnings are not shown
  • #110: Update title of the profiles for a better readability of the references
  • Update value sets
    • #89: ActivePharmaceuticalIngredient -> fix typo (Nicotine)
    • #94: EDQM - RouteOfAdministration -> add EDQM code ‘20087000’ (Extrapleural use)
    • #93: UnitCode -> add UCUM code ‘a’ (year)
    • UnitCode -> update the fr-CH display value for ‘732982009’ from ‘poche’ to ‘sac’
    • #111: UnitCode -> add UCUM code ‘mo’ (month)

Fixed

  • #97, #92: Typos
  • #164: Fix id of the element ‘medicationReference’ in the differential (profile)

STU 2 Sequence - v2.0.0 (2022-02-11)

Open Issues

During the ballot, the following comments came in, which will be taken into account in the further development of CH EMED:

  • #72 Representation of status “in reserve” (InRes) for a medication is missing.

See also open issues on GitHub.

Added

Changed / Updated

Fixed

Issues resolved without amendment

  • #70 Remove language requirements of titles
  • #68 MedicationDispense: languageCode fr-CH not accepted
  • #65 CH EMED Extension Substitution - ValueSets not equal to CDA