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Any medication may be the subject of further instructions to the pharmacist, for example to indicate that it should be labeled in Spanish, et cetera.
This structure is included in the target substance administration or supply act using the <entryRelationship> element defined in the CDA Schema. The figure below is an example of recording an instruction for an <entry>, and is used as context for the following sections.
|Pharmacy||HL7 Pharmacy Domain (Normative)|
<entry> <supply classCode='SPLY' moodCode='EVN'> ∶ <entryRelationship typeCode='SUBJ' inversionInd='true'> <act classCode='ACT' moodCode='INT'> <templateId root='2.16.840.1.1138188.8.131.52.43'/> <templateId root='184.108.40.206.4.1.193220.127.116.11.18.104.22.168'/> <code code='FINSTRUCT' codeSystem='22.214.171.124.4.1.193126.96.36.199.2' codeSystemName='IHEActCode' /> <text><reference value='#comment-2'/></text> <statusCode code='completed' /> </act> </entryRelationship> ∶ </supply> </entry>
<entryRelationship typeCode='SUBJ' inversionInd='true'>
Again, a related statement is made about the medication or immunization. In CDA, this observation is recorded inside an <entryRelationship> element occurring at the end of the substance administration or supply entry. The containing <act> is the subject (typeCode='SUBJ') of this new observation, which is the inverse of the normal containment structure, thus inversionInd='true'. For HL7 Version 3 Messages, this relationship is represented with the <sourceOf> element however the semantics, typeCode, and inversionInd remain the same.
<act classCode='ACT' moodCode='INT'>
The related statement is the intent (moodCode='INT') on how the related entry is to be performed.
These <templateId> elements identify this <act> as a medication fulfillment instruction, allowing for validation of the content.
<code code='FINSTRUCT' codeSystem='188.8.131.52.4.1.193184.108.40.206.2' codeSystemName='IHEActCode' />
The <code> element indicates that this is a medication fulfillment instruction. This element shall be recorded exactly as specified above.
|Note:||These values will be sent to HL7 for harmonization with the HL7 Act Vocabulary.|
The <text> element contains a free text representation of the instruction. For CDA this SHALL contain a provides a <reference>element to thelink text of the comment in the narrative portion of the document. The comment itself is not the act being coded, so it appears in the <text> of the <observation>, not as part of the <code>. For HL7 Version 3 Messages, the full text SHALL be represented here.
<statusCode code='completed' />
The code attribute of <statusCode> for all comments must be completed.