Introduction

A medication scheme is a kmehrmessage that consists of

• 1 transaction MS (medicationscheme), 
• 0 or more transactions MSE (medicationschemeelement) and 
• 0 or more transactions TS (treatmentsuspension)

The next paragrahs describe the kmehrmessage as used for Vitalink. Please refer to the Kmehr standard specification for the basic explanation, see External Links#kmehr_message-overview.

If no Vitalink meaning is specified, the Kmehr meaning is applicable.

Kmehrmessage element <header>

Vitalink does not require more elements than the ones that are mandatory by the Kmehr standard.

When writing to Vitalink, all the elements are generated by the eHealth technical connector, based on the used properties.

Kmehrmessage element <folder>

Folder element <patient>

Vitalink does not require more elements than the ones that are mandatory by the Kmehr standard.

When writing to Vitalink, all the elements are generated by the eHealth technical connector, based on the patient information given by the application.

Folder element <transaction> "medicationscheme" (MS)

The Vitalink transaction MS contains the general information of the medication scheme.

Kmehr parent transaction

Vitalink child transaction MS

Folder element <transaction> "medicationschemeelement" (MSE)

Kmehr parent transaction

Vitalink child transaction MSE

Transaction element <item>

Each Kmehr element <item> consists of the next elements:

Transaction element <item> "medication"

The item medication has of the following additional elements, for which the meaning is explained in the corresponding paragraph:

Medication elements for medication information 

Information with regard to the medication can be included in four different ways. The method that is used depends on whether:

• the medication is prescribed on product name
• the medication is prescribed on substance name (‘Prescription On Substance' or POS)
• the medication needs to be identified via an EAN code
• the medication is a pharmaceutical compound

Medication information via <medicinalproduct>

The medication is defined with the help of exactly 1 tag <medicinalproduct> in <content>.

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.11">medication</cd>
	<content>
		<medicinalproduct>
			<intendedcd S="CD-DRUG-CNK" SV="2010-07">0018614</intendedcd>
			<intendedname>Alkeran filmomh. tabl. 25 x 2 mg</intendedname>
		</medicinalproduct>
	</content>
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.11">medication</cd>
	<content>
		<medicinalproduct>
			<intendedcd S="CD-DRUG-CNK" SV="1.0">0044545</intendedcd>
			<intendedname>DAFALGAN FORTE AGR BRUIS 500MG TABL 32</intendedname>
			<deliveredcd S="CD-DRUG-CNK" SV="1.0">1449842</deliveredcd>
			<deliveredname>DAFALGAN FORTE AGR BRUIS 1G TABL 32</deliveredname>
		</medicinalproduct>
	</content>
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...

Medication information via <substanceproduct>

The medication is defined with the help of exactly 1 tag <substanceproduct> in <content>.

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.11">medication</cd>
	<content>
		<substanceproduct>
			<intendedcd S="CD-INNCLUSTER" SV="2018-08">01569</intendedcd>
			<intendedname>rosuvastatine</intendedname>
		</substanceproduct>
	</content>
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.11">medication</cd>
	<content>
		<substanceproduct>
			<intendedcd S="CD-INNCLUSTER" SV="2018-08">01569</intendedcd>
			<intendedname>rosuvastatine</intendedname>
			<deliveredcd S="CD-DRUG-CNK" SV="2018-08">3641081</deliveredcd>
			<deliveredname>Rosuvastatine Mylan filmomh. tabl. 98 x 40 mg</deliveredname>
		</substanceproduct>
	</content>
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...

Medication information via CD-EAN and <text>

The medication is defined with a CD-EAN code as <content> and a tag <text> in <item>.

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.4">medication</cd>
	<content>
		<cd SV="external" S="CD-EAN">8426420004947</cd>
	</content>
	<text L="nl">DAFALGAN FORTE DROOG 1G TABL 50</text>
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...

Note that the version of the CD-EAN table is externally defined, since it is not a proprietary Kmehr table. No Vitalink validation is done regarding that version or value passed for CD-EAN.

Medication information via <compoundprescription> and <text>

In the current kmehr standard it is only possible to enter a pharmaceutical compound in textual form. However steps have been taken to do this in a more structured manner in a future version. When these modifications are included in kmehr Vitalink will possibly be aligned. As a placeholder for this future change, the tag <compoundprescription> is already defined. This structure is the again accompanied by another tag <text>.

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.4">medication</cd>
	<content>
		<compoundprescription L="nl">
			<magistraltext L="nl">R/ Aluminiumchloride hexahydraat 15 g + Isopropylalcohol 78 g + Gezuiverd water q.s. ad 100 g T</magistraltext>
        </compoundprescription>
	</content>
	<text L="nl">Aluminiumchloride transpiratieremmende hydroalcoholische oplossing 15 % TMF</text>
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...

Medication element <temporality>

This element specifies the chronicity of the treatment. Please refer to M. Concept: Temporality "Ad hoc" for details of usage.

Medication element <frequency>

This element specifies the frequency of the treatment. Please refer to M. Combined use of frequency and day and M. Concept: Hourly frequency and posology for details of usage.

Medication element <beginmoment>

This is the date from when the medication can at the earliest taken.

In the next example, the medication can be taken at the earliest starting from the 1th of september 2030: 

...
<transaction>
	<id S="ID-KMEHR" SV="1.0">46</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">medicationschemeelement</cd>
	...
	<item>
		...
		<cd S="CD-ITEM" SV="1.11">medication</cd>
		...
		<beginmoment>
        	<date>2030-09-01</date>
        </beginmoment>
		...
	</item>
	...
</transaction>
...

Medication element <endmoment>

This is the date until which the medication can be taken.

In the next example, the medication should not be taken anymore starting from the 1th of november 2030: 

...
<transaction>
	<id S="ID-KMEHR" SV="1.0">46</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">medicationschemeelement</cd>
	...
	<item>
		...
		<cd S="CD-ITEM" SV="1.11">medication</cd>
		...
		<beginmoment>
        	<date>2000-01-01</date>
        </beginmoment>
		<endmoment>
        	<date>2030-10-31</date>
        </endmoment>
		...
	</item>
	...
</transaction>
...

Medication element <duration>

An implicit endmoment can be expressed by defining a duration. This duration defines the period, starting from the beginmoment, during which the medication can be taken.

In the next example, the medication should not be taken anymore starting from the 1th of november 2030: 

...
<item>
	...
	<beginmoment>
		<date>2030-10-01</date>
	</beginmoment>
	...
	<duration>
		<decimal>31</decimal>
		<unit>
			<cd S="CD-TIMEUNIT" SV="2.1">d</cd>
		</unit>
	</duration>
	...

Medication element <regimen>

This is the element that provides a structure to be able to express a posology in a structured way.

The element <regimen> is mutually exclusive with the element <posology>.

Medication element <posology>

Only when it is not possible to express the medication posology in a structured way with <regimen>, it can be passed to Vitalink as free text. 

The element <posology> is mutually exclusive with the element <regimen>.

The element <posology> contains exactly 1 element <text>.

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.11">medication</cd>
	...
	<posology>
		<text L="nl">Until 3 x 1 per day with meal, during max 3 days and minimally 4hours between 2 ingestions.</text>
	</posology>
	...
</item>
...

Medication element <route>

This element specifies the administration route.

Medication element <instructionforpatient>

This is the usage instruction for the patient.

Medication element <instructionforoverdosing> (deprecated)

This is the medical justification when the product is overdosed. 

Transaction element <item> "healthcareelement"

To include certain Vitalink specific information within the medication scheme data element, use must be made of separate item with value 'healthcareelement'.

In order to further define these healthcareelements, the list CD-ITEM-MS was created for Vitalink, with as permitted values:

Healthcareelement "adaptationflag"

This healthcareelement is not be used by Vitalink. The original intention was to indicate the changes compared to the previous version of the transaction.

However an application should compare the complete transaction with the old version to find the differences, and not rely upon this adaptationflag.

By using a value of the table CD-MS-ADAPTATION it can be indicated where in the kmehr message modifications have been made by the end user.

Permitted values for this list are:

• nochanges
• medication
• posology
• treatmentsuspension

If changes have taken place to several parts of the kmehr message, it is possible to enter multiple values. However if the value ‘nochanges’ is used, only this value is permitted.

...
<item>
	<id SV="1.0" S="ID-KMEHR">2</id>
	<cd SV="1.3" S="CD-ITEM">healthcareelement</cd>
	<content>
		<cd SV="1.0" S="CD-ITEM-MS">adaptationflag</cd>
		<cd SV="1.0" S="CD-MS-ADAPTATION">medication</cd>
		<cd SV="1.0" S="CD-MS-ADAPTATION">posology</cd>
	</content>
</item>
...

Healthcareelement "begincondition"

This is an element containing a textual description with the condition when the treatment should be started.

Healthcareelement "endcondition"

This is an element containing a textual description with the condition when the treatment should be ended.

Healthcareelement "medicationtype"

The type of the medication can be indicated via CD-MS-MEDICATIONTYPE.

Permitted values for this list are:

• onprescription
• otc
• other

Healthcareelement "medicationuse"

...
<item>
	<id SV="1.0" S="ID-KMEHR">2</id>
	<cd SV="1.11" S="CD-ITEM">healthcareelement</cd>
	<content>
		<cd SV="1.0" S="CD-ITEM-MS">medicationuse</cd>
	</content>
	<content>
		<text L="nl">For stomachache</text>
	</content>
</item>
...

Healthcareelement "origin"

With the help of the list CD-MS-ORIGIN it can be indicated via which path the medication is included in the medication scheme. Has this occurred by means of the ‘normal’ path by which the medicine is prescribed by the doctor and is delivered by the pharmacist (or in the case of OTC medication, is only delivered by the pharmacist)? This path will be indicated with the code ‘regularprocess’.

The other manner is that the patient or a care player indicates that he ingests certain medication. This medication can already be present at the patient's home; they have been obtained via friends or family or possibly purchased via the Internet or abroad. This medication can then still be included in the medication scheme and be indicated with the code ‘recorded’.

Permitted values for this list are:

• regularprocess
• recorded

Folder element <transaction> "treatmentsuspension" TS

The Vitalink transaction TS can be used to express a suspension of the treatment. A medication scheme can contain 0 or more suspensions.

Kmehr parent transaction

Vitalink child transaction TS

Transaction element <item>

Each Kmehr element <item> consists of the next elements:

Transaction element <item> "medication"

The item medication has of the following additional elements:

Medication elements for medication information

These elements should be exactly the same as the medication information elements of the corresponding transaction MSE. 

Medication element <beginmoment>

This is the date from when the treatment should be suspended.

In the next example, the medication should not be taken anymore, until further notice, starting from the 1th of august 2030: 

...
<transaction>
	<id S="ID-KMEHR" SV="1.0">46</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">medicationschemeelement</cd>
	...
</transaction>
...
<transaction>
	<id S="ID-KMEHR" SV="1.0">49</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">treatmentsuspension</cd>
	...
	<item>
		...
		<beginmoment>
        	<date>2030-08-01</date>
        </beginmoment>
		...
		<lnk TYPE="isplannedfor" URL="//kmehr:transaction[id[@S='ID-KMEHR']='46']"/>
	</item>
	...
</transaction>
...

Medication element <endmoment>

This is the date until which the treatment should be suspended.

In the next example, the medication can be taken again earliest starting from the 1th of july 2030: 

...
<transaction>
	<id S="ID-KMEHR" SV="1.0">46</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">medicationschemeelement</cd>
	...
</transaction>
...
<transaction>
	<id S="ID-KMEHR" SV="1.0">49</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">treatmentsuspension</cd>
	...
	<item>
		...
		<beginmoment>
        	<date>2000-01-01</date>
        </beginmoment>
		<endmoment>
        	<date>2030-06-30</date>
        </endmoment>
		...
		<lnk TYPE="isplannedfor" URL="//kmehr:transaction[id[@S='ID-KMEHR']='46']"/>
	</item>
	...
</transaction>
...

Medication element <duration>

An implicit endmoment can be expressed by defining a duration. This duration defines the period, starting from the beginmoment, during which the medication can not be taken.

In the next example, the medication can be taken again earliest starting from the 1th of december 2030: 

...
<transaction>
	<id S="ID-KMEHR" SV="1.0">46</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">medicationschemeelement</cd>
	...
</transaction>
...
<transaction>
	<id S="ID-KMEHR" SV="1.0">49</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">treatmentsuspension</cd>
	...
	<item>
		...
		<beginmoment>
        	<date>2030-11-01</date>
        </beginmoment>
		<duration>
			<decimal>30</decimal>
			<unit>
				<cd S="CD-TIMEUNIT" SV="2.1">d</cd>
			</unit>
		</duration>
		...
		<lnk TYPE="isplannedfor" URL="//kmehr:transaction[id[@S='ID-KMEHR']='46']"/>
	</item>
	...
</transaction>
...

Medication element <lifecycle>

This element specifies if the suspension is temporary ("suspended") or definite ("stopped"). This lifecycle is only indicative, i.e. an application should not use this to interpret or express that a treatment should be stopped permanently. In the latter case, the application should remove the treatment.

Medication element <lnk>

This element contains a link to the transaction MSE that is suspended. The content is an XPath link identifying the corresponding MSE by its ID-KMEHR id.

...
<transaction>
	<id S="ID-KMEHR" SV="1.0">46</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">medicationschemeelement</cd>
	...
</transaction>
...
<transaction>
	<id S="ID-KMEHR" SV="1.0">49</id>
	...
	<cd S="CD-TRANSACTION" SV="1.11">treatmentsuspension</cd>
	...
	<item>
		...
		<cd S="CD-ITEM" SV="1.4">medication</cd>
		...
		<lnk TYPE="isplannedfor" URL="//kmehr:transaction[id[@S='ID-KMEHR']='46']"/>
	</item>
	...
</transaction>
...

Transaction element <item> "transactionreason"

The item medication has of the following additional elements:

...
<item>
	<id S="ID-KMEHR" SV="1.0">2</id>
	<cd S="CD-ITEM" SV="1.11">transactionreason</cd>
	<content>
		<text L="nl">Replaced by Fraxiparine because of tooth extraction</text>
	</content>
</item>
...