This page is part of the CH EMED (R4) (v4.0.0-ballot: STU 4 Ballot 1) based on FHIR 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 4 Ballot - v3.1.0 (2023)
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 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 - 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 - Different Authors 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 Ballot - v2.1.0 (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 - 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
- #73: Add warning if non-recommended timing-event codes are used in the structured dosage.
- #76: Elaboration of the repeated dispense.
Changed / Updated
- #64: Dosage.timing.repeat.bounds[x] restricted to Period (start/end) instead of Duration, Range, Period to be equivalent to CDA.
- #75: Set mustSupport = true for patient (Composition.subject) and author (Composition.author) of the Medication Card document, because they belong to the minimal data set of IPAG.
- #74: Change the description of the identifiers of MedicationStatement, MedicationRequest, MedicationDispense and Observation (clear naming without relation to the naming of the equivalent CDA element).
- #62: Provide a separate paragraph on the flag mustSupport on the front page of the IG.
- #76: Set minimum cardinality for element
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed (and MedicationRequest.dispenseRequest) back to 0, according to changes in CDA.
- #80: Update references for the document author (Composition.author)
- Change references for Composition.author from ‘CH Core Practitioner Profile EPR’ to ‘CH EMED Practitioner Profile’ and from ‘CH Core Practitioner Role Profile’ to ‘CH EMED PractitionerRole Profile’.
- Add profiles (derived from CH Core EPR profiles)
Fixed
- #63: Typo in constraint “ch-emed-sect-annot”
- #66: Removed element Organization.telecom with the value ‘nullFlavor’ (extension), if no value is set, the element will not be represented.
- #71: Typo in constraint “ch-emed-sect-padv”
- #69: Wrong data in example 2-6 Medication Prescription document (base64 pdf, MedicationRequest.dispenseRequest)
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
