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Currently, a PADV CHANGE can replace a single PRE entry to multiple new ones. When doing so, a single MTP item entry further leads to multiple prescriptions, what should be prohibited. It's not allowed to change an MTP entry by a combination of others.
The aggregator will forbid it, at least in the first iteration.
Consequences of status quo are confusion for integration, and risks of information discontinuities in clinical practice.
Propositions:
1. Template Pharmaceutical Advice Item Entry Content Module : the element entryRelationship/organizer/component has its description clarified to indicate the cardinality is 1..1 in a PADV CHANGE but the cardinality isn’t modified (in a PADV OK, we might still use it to recommend substituting this medication by a combination of others). A Schematron rule can be created to assert the cardinality.
2. When a single medication is to be substituted by multiple medications, a PADV CANCEL is issued and a MTP document is created for each new medication.
Drafted by HUG and CARA.