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In IHE PCC TF2 (revision 11.0), p.187, the dose (doseQuantity) and rate (rateQuantity) are defined by their low and high bounds that are different if a range is given, or equal otherwise (<doseQuantity><low value='' unit=''/><high value='' unit=''/></doseQuantity). In IHE PHARM PRE (revision 1.9), pp.47-48, they are only defined by their value and unit (<doseQuantity value='' unit=''/>).In IHE PCC CDA (revision 2.6), p.141 and p.144, low+high is given in the definition and @value + @unit is shown in the example.The two standards disagree on the correct structure, Stéphane is investigating why PHARM is not following PCC here.In any case, the rateQuantity and doseQuantity IVL_PQ structure should be restrained to either @value + @unit or low + high. The examples that show a doseQuantity with a center are wrong for both PHARM and PCC.I guess the same correction should be applied to the template Dosage Instructions Dosage Change.-
Wait for IHE guidance on this, then constrain both rateQuantity and doseQuantity to the chosen structure.-
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The following elements part of the Dosage Instructions:• Prescription Item Entry Additional Template ID• Effective Time (Duration of Treatment)• Medication Frequency • Route of Administration• Approach Site Code • Dose Quantity • Rate Quantity• Related Components
If that's right, 'repeatNumber' would also be missing from the Medication Treatment Plan Item Entry Content Module example.
Set the 'repeatNumber' cardinality to 1...1 and add the following attributes: @value (0...1) and @nullFlavor="NI" (0...1), at least in Medication Treatment Plan Item Entry Content Module, Prescription Item Entry Content Module and Pharmaceutical Advice Item Entry Content Module.
As per IHE PCC TF-2 §6.3.4.18.7 and IHE PHARM PRE §6.3.4.2.3.9, the repeatNumber is constrained to have either the attribute value or the attribute nullFlavor='NI'.
OR (1…1): - @value (1…1) - @nullFlavor="UNK" (1…1)
IHE Pharm PRE 6.3.4.6.3.8: In case the (structured) dosage instructions include a dose regime using “Normal Dosing”, this element SHALL be present and SHALL NOT be null flavor.
Proposition for a Schematron error: hl7:templateId[@root='1.3.6.1.4.1.19376.1.5.3.1.4.7.1'] and not(hl7:doseQuantity)
IHE Pharm PRE 6.3.4.6.3.9: In case the (structured) dosage instructions include a dose regime using “Normal Dosing”, this element SHALL be present and SHALL NOT be null flavor.=> Not sure why, this is a bit weird.
IHE Pharm PRE 6.3.4.6.3.4: In case the (structured) dosage instructions include a dose regime [For the scope of this Content Module, “dose regime” groups the data elements Medication Frequency, Dose Quantity and Rate Quantity, provided in a certain type of dosing (“Normal dosing”, “Split dosing”, etc.)] this element SHALL be present and specify the entire duration of the medication treatment.
IHE Pharm PRE 6.3.4.6.3.5: In case the (structured) dosage instructions include a dose regime using “Normal Dosing”, this element SHALL be present and SHALL NOT be null flavor.
Proposition for a Schematron error: hl7:templateId[@root='1.3.6.1.4.1.19376.1.5.3.1.4.7.1'] and not(hl7:effectiveTime[@xsi:type='EIVL_TS']) and not(hl7:effectiveTime[@xsi:type='SXPR_TS'])