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.

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 transaction generic

Vitalink transaction MS specific

Folder element <transaction> "medicationschemeelement" (MSE)

Kmehr transaction generic

Vitalink transaction MSE specific

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 

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>

...
<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>
	...

Medication information via <substanceproduct>

Medication information via CD-EAN

...
<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 validation is done regarding that version or value passed for CD-EAN.

Medication information via <compoundprescription>

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.

Medication element <temporality>

Medication element <frequency>

Medication element <beginmoment>

Medication element <endmoment>

Medication element <duration>

...
<item>
	...
	<beginmoment>
		<date>2025-01-15</date>
	</beginmoment>
	...
	<duration>
		<decimal>4</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>

Medication element <instructionforpatient>

Medication element <instructionforoverdose>

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"

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"

Healthcareelement  "endcondition"

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 ingestion of the medication. A medication scheme can contain 0 or more suspensions.

Kmehr transaction generic

Vitalink transaction TS specific

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>

Medication element <endmoment>

Medication element <duration>

Medication element <lifecycle>

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>
...