In the Swiss prescription workflow, only two substitution permissions are usually used: authorized (by default in absence of other indication) and forbidden.
If the value is missing from the emed entry, no default value is currently defined by the specifications. Multiple values are currently authorized, with no instructions on how to process them (e.g. “None” + “Equivalent”). This should be enhanced and clarified.
Consequences of a status quo are additional difficulties for integrator, risk of mismatch with how the value set is used across clinical systems hindering the overall system quality, as well as cognitive burden on end-users.
Propositions:
1.
Value set
ActSubstanceAdminSubstitutionCode
: only keep the values “None (N)” and “Equivalent (E)”. The need for other values has not emerged from decennaries of paper prescription.
2.
Templates
Medication Treatment Plan Item Entry Content Module
,
Prescription Item Entry Content Module
: the entryRelationship element dedicated to substitution permissions get 0..1 cardinality instead of 0..*. If no value is given, the default is “Equivalent (E)”.
3.
Template
Dispense Item Entry Content Module
: the entryRelationship element dedicated to substitution act is marked as not supported. Healthcare professionals will most probably don't look at this value but only at the prescribed and dispensed products. The information value is therefore low.
4.
We foresee no reason to revert these changes in the future, as they are not used now in the Swiss prescription/dispense workflow.
Drafted by HUG and CARA.