Domain: Pharmacy

Orders & Observations Co-Chair Hans Buitendijk

Siemens Medical Solutions Health Services
Vocabulary Facilitator James Case, DVM, PhD.
University of California, Davis
Medication SIG Co-Chair Peter Johnson
Primary Care Development Ctr
Orders & Observations Co-Chair Clem McDonald, M.D.
Regenstrief Institute for Health Care
Medication SIG Co-Chair Lloyd McKenzie
IBM Canada & CIHI - HL7 Canada & Alberta Wellnet
Medication SIG Co-Chair Alan Rector, M.D.
University of Manchester
Medication SIG Co-Chair Scott Robertson
Kaiser Permanente
Orders & Observations Co-Chair Gunther Schadow, M.D., PhD.
Regenstrief Institute for Health Care
Orders & Observations Co-Chair Helen Stevens
McKesson Information Solutions

Last Published: Thu 07/24/2003 1:13 PM

HL7® Version 3 Standard, © 2003 Health Level Seven®, Inc. All Rights Reserved.

HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off

Table of Contents
1. Overview
1.1. Introduction & Scope
1.2. Message Design Element Navigation
1.3. Domain Message Information Models
1.4. Storyboards
2. Message Definitions
2.1. Storyboards
2.2. Application Roles
2.3. Trigger Events
2.4. Refined Message Information Models
2.5. Hierarchical Message Descriptions
2.6. Interactions
3. Query Definitions
4. Master File Definitions
5. Indicies
5.1. CMETs Derived From this Domain
5.2. CMETs Used in this Domain
5.3. Interaction Indexes
5.3.1. By Application Role
 5.3.2. By Trigger Event
5.3.3. By Message Type

1 Overview

1.1 Introduction & Scope

This domain deals with the order, promise (or intent) to perform and events that
cover the dispensing and administration of pharmaceutical and therapeutic
products and dispensed devices. It also includes the communication flows that
facilitate the maintenance and appropriate use of these products. These concepts
can be applied, for example, to inpatient (unit dose and compound unit dose),
outpatient, IV's and hyperalimentation IV's (nutritional IV's). The messages in this
domain represent the communication and relationship between care providers and
pharmacies and treatment providers.

Here is a conceptual workflow of a subset of the supported events, which are

described in greater detail within this domain.

 When an order is initiated by a pharmacy order placer, the appropriate

information pertaining to that order request is transmitted to the pharmacy
order fulfiller. This can include dispense and administration information
requested by a care provider
 The pharmacy order filler then establishes its promise to perform and can
register the order request with an encoding message to the clinical system,
which includes any additional or revised information from the pharmacy
order filler. Additionally, when the order is initiated directly into the
pharmacy system, the encoded message can be sent to the clinical system,
notifying it about the existence of a new order and the pharmacy's promise
to execute that order.

 Each instance of dispensing a drug or treatment to fill an existing order or

orders may result in a dispense message to the clinical application when
such information is required. This dispense message may describe a single
dose, a half-day dose, a daily dose, a refill of a prescription, start of an IV,
an IV adjustment, etc. It is not intended to be a complete record of an
order, rather, it is documentation from the pharmacy order filler to the
clinical application with drug/treatment dispense data. Once a dispensed
product has been received by a patient, financial information associated
with the dispense can also be transmitted.

 A pharmacy order fulfiller can issue a message to the care provider when
give instructions need to be transmitted for the purpose of allowing the care
provider to accurately administer the drug or treatment. The message
contains drug or treatment administration instructions for one or more
scheduled administrations.

 For each administration of an existing drug or treatment, a message can be

issued from the care provider's application. It contains the administration
record with all pertinent information such as who performed the service,
 what was given and when the service was done.

 When an existing order is revised or maintained on either the pharmacy

order filler or the clinical application, updated order information can be
transmitted. Updates may include dosage information, quantity and timing,
number of refills, discontinue (i.e., end date), etc.

Storyboard Introduction

Organization

Storyboards in the Pharmacy Domain are organized by practice settings. Primary,

comprehensive storyboards exist for Institutional (PORX_ST003500), and
Community ( PORX_ST000800) practice settings. Additional storyboards in each
practice setting illustrate variations from the primary storyboards or alternate
scenarios. Additional practice settings and variations will be included as additional
scenarios are defined.

The primary distinction between Institutional and Community practice settings

relate to the potential complexity of the order(s) and who ultimately administers
the therapy to the patient:

 Institutional Practice In institutional settings (hospital inpatient, emergency

room, long term care facilities, some forms of home care, among others)
typically the therapeutic agent is supplied to an intermediary (typically a
nurse or a nurses aide) who subsequently administers the therapy to the
patient. In such situations, orders may be very complex or detailed as the
person administering the therapy has specific education or training to
understand and deal with the complexities. Specific information on the
administration of the therapy (e.g., the time) is very important in
institutional settings. Message content in institutional settings many include
supply, administration, or both (combined) and may relate to the overall
therapy or to individually scheduled events.
 Community Practice In community settings (ambulatory clinics, retail
pharmacy, some forms of home care, among others) the patient typically
administers the therapy to themselves. In these situations, orders are
typically less complex, both due to specific knowledge limitations of the
patient and the generally less-controlled environment. Specific information
on the administration of the therapy (e.g., the time) is usually not available
in the community setting. Message content in the community setting is
usually limited to supply information.

Structured Sort Name Convention

Structured sort names for storyboards in the Pharmacy Domain begin with the
practice setting (e.g., Institutional, Community). The second term is either
"Comprehensive" or describes the focal aspect where the storyboard departs from
or modifies the story-line of the comprehensive storyboard (e.g., Administration
Event). Additional sort name terms provide information on the setting or the focus
of activity of the storyboard (e.g., TPN with duration).
Application Role Introduction

All Application Roles defined in Practice and Operations make use of 6 common
stereotypes, and share a common hierarchical approach.

The hierarchy of application roles is based on the Act state-transitions. At present,

Practice and Observations deals with the following state transitions: Activate,
Suspend, Resume, Abort, Replace (a combination of 'Obsolete' and 'Activate'),
Complete and Re-activate. These states have been placed into a hierarchy
representing what an application is capable of. The hierarchy is as follows:

 Basic: This application role is only capable of dealing with the 'Complete'
state transition. It is only capable of sending messages when a particular
act is finished.
 Lifetime: This application builds on the Basic role, but adds the concept of
an Act having a period of existence, from the time it begins (or becomes
effective) and the time it ends. Applications supporting his role add the
transitions of Activate (meaning the act has begun/become active), and
Abort (meaning that the act has been prematurely terminated.) The
following Application Roles all build upon the lifetime Role. They each
require that the application have a concept of lifetime. A system may mix
and match more than one of these roles, depending on its capabilities.

 Revision: This application is capable of dealing with changes to an act that

do not require the assignment of a new identifier. (Different jurisdictions
may have different guidelines over what changes ay be made without
requiring the creation of a 'new' act.).

 Replacement: This application is capable of creating a new act that replaces

an existing act. This is similar to a revision, except that a new identifier is
assigned to the modified act.

 Suspension: This application role is capable of dealing with the temporary

de-activation of an act. (For example, temporarily stopping a test, placing a
prescription on hold). The application is also capable of dealing with the re-
activation of the act. This level does not deal with any transitions involving
the 'new' state (which represents an Act that is still being edited and is not
yet 'active').

 Nullification: This application role is capable of dealing with the idea that a
particular action may have happened in error and may need to be reversed.
This is supported by two state transitions - nullification which causes the act
to be treated as if it never really existed and Reactivation which allows an
Act that had been marked as completed to be re-transitioned to the Active
state.

Within the hierarchy, there are 6 stereotypes, defined as follows:

1. Informer: An application that is capable of notifying another application

about a significant event (the status change of a focal class), but does not
 expect any action on the part of the receiver. Paired with 'Tracker'.
2. Tracker: An application that is capable of receiving information about a
significant event (the status change of a focal class), but is not expected by
the receiver to perform any action. Paired with 'Informer'.

3. Placer: An application that is capable of requesting another application to

perform some action. Paired with 'Fulfiller'.

4. Fulfiller: An application that is capable of receiving a request from a Placer

application and responding with the action(s) that have been, or will be,
taken relative to the request.

5. Confirmer: An application that is capable of accepting a request from a

Placer application and responding with promise to perform the requested
action. This is a hidden application role, a specialization of 'Fulfiller', and
paired with 'Confirmation Receiver'.

6. Confirmation Receiver: An application that is capable of accepting

promise(es) to perform action(s). This is a hidden application role, a
specialization of 'Placer', and paired with 'Confirmer'.

1.2 Message Design Element Navigation

Pharmacy Supply PORX_RM000021
Pharmacy Institutional Order PORX_RM000011
Pharmacy Medication Administration Query Response PORX_RM000031
Pharmacy Community Dispense PORX_RM000002
Pharmacy Community Prescription PORX_RM000001

Domain Message Information Models

1.3 Domain Table of Contents

Pharmacy Domain Model (PORX_DM000000)

Description
Pharmacy Domain Message Information Model

Description

This is the global messaging model to support therapeutic "substance

administration" and "supply".

The real life processes being represented are, in essence, making a

prescription or medication order to actually give (administer) a medicine (in)to
a patient and organizing a supply of a medication to allow it to be
administered. Analysis of the way this real life process works in systems terms
requires some of the real life objects to be represented as more than one
class. We also have to recognize that each class will progress through a
number of distinct states before the process is complete.

Revision History

Notes: Version 8 release 3 - 14th July 2003

Changes:

1) Manufacturer, Medicine, MedicineSupplied, Ingredient and Supplier changed

froim using ID to code. The equivalents available in data type CE do what was
required from the ID field. Following emails between Hugh & Lloyd

2) Split RMIM - Community Supply into RMIM - Community Prescription and

RMIM - CommuntyDispense. Removed the recursion. Following MED-SIGg conf
call 19 June 2003

3) Removed shadowing because it is not allowed in that form. Following emails

between Hugh and Lloyd+Woody

4) Changed RMIMs to use medication CMETs to avoid endless repetition and

associated maintenance issues.

5) Corrected CMETs where MedicationAdministration and MedicationSupply

were incorrectly included.

6) Revised entry points

7) Split CMETs into Universal, Identified and Identified & Confirmable and
made use of them for the two MEDSig CMETs.

8) Removed A_Observation CMETs linked to both MedicationAdministration and

MedicationSupply. These were annotated as a link to patient notes but the
justification is not clear. A_Observation as a CMET has now been removed so
the model must be reviewed anyway.

9) Revised moods

10) Added in the AdministeredMedication CMET

To do:

1) Select appropriate flavours for all CMETs not from Pharmacy and check they
are still appropriate.

2) Review all the observation CMETs

 Diagram
Link to graphic (opens in a new window)

Storyboard Overview
1.4 Domain Table of Contents
Message Definition Storyboards

6 Message Definition Storyboards (Sorted by Title)

Combined Event Query ( PORX_ST100000 )
Community Pharmacy, Comprehensive #2 ( PORX_ST000810 )
Community Practice, Comprehensive #1 ( PORX_ST000800 )
Community Practice, UK Variation ( PORX_ST003000 )
Hospital Administration with Duration ( PORX_ST000700 )
Institutional Practice, Comprehensive ( PORX_ST003500 )
6 Message Definition Storyboards (Sorted by Structured Sort Name)
Community ( PORX_ST000800 )
Community ( PORX_ST000810 )
Community, UK Variation ( PORX_ST003000 )
Institutional ( PORX_ST003500 )
Institutional, Administration with Start/End ( PORX_ST000700 )
Pharmacy Combined Event Query ( PORX_ST100000 )

Message Definitions
2 Domain Table of Contents

2.1 Message Definition Storyboards

6 (Sorted by Title)
Combined Event Query ( PORX_ST100000 )
Community Pharmacy, Comprehensive #2 ( PORX_ST000810 )
Community Practice, Comprehensive #1 ( PORX_ST000800 )
Community Practice, UK Variation ( PORX_ST003000 )
Hospital Administration with Duration ( PORX_ST000700 )
Institutional Practice, Comprehensive ( PORX_ST003500 )
6 (Sorted by Structured Sort Name)
Community ( PORX_ST000800 )
Community ( PORX_ST000810 )
Community, UK Variation ( PORX_ST003000 )
Institutional ( PORX_ST003500 )
Institutional, Administration with Start/End ( PORX_ST000700 )
 Pharmacy Combined Event Query ( PORX_ST100000 )

Reference

For details on the interpretation of this section, see the storyboard discussion
in the Version 3 Guide.

Introduction

At the time of ballot, a limited number of Storyboards exist in the Pharmacy

Domain. This is not to imply the these are the only scenarios that will be
addressed in this domain. This initial set of Storyboards represent several
cases of broad interest and applicability. Additional Storyboards will be
developed to support additional, both general and specific, use cases. The
reader is encouraged to bring their experience and requirements to the
committee and to join in the development process.

2.1.
Combined Event Query (PORX_ST100000)

Purpose
There are a number of scenarios in which care providers need to have an
overview of the medication(s) of a patient. The various scenarios outlined
below are based upon a common set of assumptions:

 there is an information infrastructure available

 electronic patient records exist which serve as the source of
medication information

 the most reliable medication information is available at pharmacies

 those prescriptions that are not filled are eliminated from the overview

 over the counter medication is not considered to be available in the

overview

The parties who are potential clients of the medication overview include, but
are not limited to:

 General Practitioner
 Local Pharmacy

 Hospital Pharmacy

 Medical Specialist
  Home care

 Paramedical care

 Nursing Homes

 Emergency care

 Dental care

General Practitioner

1. Prescribing a new drug A GP who prescribes a new drug should

compare it with the current medication. Double-medication and
possible interactions must be avoided. By comparing the intended
drug with the current medication (either visually or automatically),
problems can be avoided before the prescription is actually made.
2. Repeating a medication Repeat prescribing is a recurring activity in
general practice. In many cases, the GP is the author of the
originating prescription, but in many instances a drug is originally
prescribed by a clinical specialist in an outpatient clinic.

1. A GP repeats a self-originating prescription A GP may decide

that a prescription should be repeated. In that case, the
number of repetitions can be given by a number. It is also
possible to give the medication the predicate 'chronic'. The
prescription that originates in the own practice is stored in the
practice system database. It is possible to repeat from this
prescription, and provide the pharmacy with the prescription in
the regular manner. An alternative is to base the repeat
prescription on the medication overview. Advantages are:

 Related to the real start-date (drug supply instead of

the prescription order); ? If the pharmacy that the
patient would visit was unknown at the original
prescription, it will be available in the overview, and can
be selected;

 It is known what has been dispensed. The manufactured

product can be repeated specifically

 If the patient visits more than one pharmacy, the

medication overview from all sources will help to
overcome this problem (at the overview-level) There
should be a coupling between the prescription that is
repeated and the new prescription. In the local system
this can be realized using e.g. an episode coupling. NB.
The repetition is often performed by the practice
assistant or practice nurse. The authorization should be
done afterwards by the responsible physician
 2. A GP repeats the prescription from a medical specialist Often a
specialist writes out a prescription in an outpatient clinic, which
will be continued by a GP. The same may happen after
discharge from a clinical period. Regulations are, that the first
time a drug is prescribed, it is allowed for a limited period of
time (15 days, to prevent waste in case the product causes
problems, does not have the wanted effect, or in case the
patient does not take the medication). So the specialist
prescribes for a limited period of time, and the patient sees the
GP for a repeat (for a prolonged period). In fact, it is not a
repetition, but a new prescription by the GP, related to the
treatment policy that was started by the specialist. The original
prescriber must be available, either in the prescription or in a
coupling to the original prescription (e.g. through an episode).
The medication can be retrieved from the medication overview.
The data can be taken from this, and transferred to a new
prescription.

3. Modify and Stop Modification and cancellation of prescriptions

may occur, for various reasons:

 There are problems during use (e.g. side-effects);

 The medication has been prescribed more than once;

 The drug does not have the desired effect, and is

replaced by another;

 The dosage is too strong, or the prescribed amount is

not effective.

In these circumstances, the original prescription can be

cancelled, and a new one written. The link must be retained. In
case the prescription originated from another physician, this
physician must be notified. This can be done directly, or it must
be made clear in the overview.

4. GP after hours services A physician who acts as a locum for

another physician must have access to relevant part of the
electronic patient record. The overview of the current
medication is part of that. The overview is not only relevant in
cases where no medication is being prescribed, because it
provides an insight in the patient's health status.

Clinical Specialist

1. Outpatient clinic The outpatient treatment is comparable to the

treatment in general practice. In most cases, a patient takes the
prescription to the community pharmacy.
2. Clinical period: admission During admission of a patient, the
responsible clinician needs an overview of the current medication. On
 the basis of this it is decided which medication is to be continued
during the treatment in the hospital, and which medication is put on
hold. The clinician makes a selection from the overview, possibly
makes modifications (dosage, hospital administration regimen) and
transfers this as a medication order to the hospital pharmacy. During
the clinical period, the hospital pharmacy is responsible for the total
medication of the patient, including the continued medication.

3. Clinical prescribing During the clinical period, prescribing is done

through the order communication facilities that exist in the hospital. In
general, the current medication overview is readily available, either
directly from the hospital pharmacy system, or through the hospital
information system.

4. Discharge from the clinic When a patient is discharged, the responsible

physician makes a decision which medication should be continued. The
medication that the patient was using at the time of admission must
also be considered. It is possible that the dosage is modified. The
overview from the hospital pharmacy must be used to make a
selection for medication to be continued. The information must be
translated into a medication order that can be handled by the
community pharmacy. There may be a problem with medication that is
given to the patient to continue at home. The hospital pharmacy may
have supplied this, but the information may only be available
indirectly, as the hospital pharmacy system is generally linked to the
hospitals communication engine.

Community Pharmacy

1. Dispensing The pharmacy is responsible for safe delivery of a drug.

The current medication overview is instrumental in a correct handling
of the medication surveillance. The overview is especially important in
case the patient uses drugs that were dispensed by another pharmacy,
either in the community or in the hospital.
2. Dispensing during locum services During the after hour services, a
pharmacy must be aware of the current medication of the patient. In
general, the medication that is provided during these hours will be
incidental, because chronically used medication will not be addressed
outside the normal business hours.

Emergency care

1. If a patient is admitted on an acute care unit, the availability of

relevant information may be critical for decision making. The
medication overview is a very important part of the medical record. It
does not only tell which drug a patient is on, but also indicates
important health problems

Diagram
2.1.
Institutional Practice, Comprehensive (PORX_ST003500)

Purpose
This Storyboard employs an older design that exposes detailed (hidden)
application roles. Further development of this Storyboard will reduce the
design complexity by exposing only the general, or "good-practice"
Application Roles. However, while the visible complexity will be reduced, the
fundamental scenario described is not expected to be altered, except as
needed to accurately reflect the real-world scenario.

To provide a comprehensive example of Institutional Pharmacy Practice:

Medication orders, changes, discontinuation, suggested/requested changes,
and administration events. This scenario covers basic pharmacy-related
interactions from admission through discharge. All possible variations and
decision points are not included in this storyboard. Additional storyboards
examine variations by building on the context and structure of this
storyboard.

Interactions in this storyboard that fall outside of the Pharmacy Domain are
detailed in other sections. The reader is referred to the following:

 Patient Administration Domain (PRPA_DO000001)

 Laboratory Domain (PRPA_DO000001)

 Diagram
Link to graphic (opens in a new window)

2.1.2.
Institutional, Comprehensive (PORX_SN003500)
Presentation and Admission Eve Everywoman presents at Good Health
Hospital Emergency Room complaining of shortness of breath, cough and
dyspnea on exertion. Upon examination, Dr. Eric Emergency notes a blood
pressure of 170/95, jugular vein distention and bilateral basal rales. Ms.
Everywoman informs Dr Emergency that she is taking the following
medications for hypertension:

 verapamil sustained release 120mg qd

 hydrochlorothiazide 25mg qd

Dr Emergency has Ms Everywoman admitted with a diagnosis of

decompensated congestive heart failure, for observation, fluid management
and cardiology consult. Admission orders include: Admission

 Diagnosis: Decompensated CHF, Hypertension

 Cardiac Care Unit

 Cardiac Consult

 Chest X-ray

 ECG

 Strict I and O

 low sodium diet

Lab Tests

 Electolytes stat and q4h

 CPK

Medications

 D5W IV TKO
 furosemide 80mg ivp q8h

 KCl 20meq in D5W 250ml, ivpb, q8h

 metolozone 2.5mg po qd
  verapapmil sr 120mg qd

The orders are routed to multiple departments [refer to other domains for
non-pharmacy interactions: Admission, Lab, Radiology, and Dietary]. In
particular, GHH's Hospital Information system sends the medication orders to
the Pharmacy System [Pharmacy Combined Order Activate Fulfillment
Request, Institutional (PORX_IN002122)]. The Pharmacy System creates new
orders as requested (these objects, all in the New state, exist in the
Pharmacy System, but are not "visible" to external systems until they
becomes "Active"). The Pharmacy System performs relevent clinical
evaluation of the medication orders and, with no contradictory information,
acknowledges the orders as requested [Pharmacy Combined Intent Activate
Confirmation, Institutional (PORX_IN003112)]. The Pharmacy System
develops a specific administration schedule and communicates the schedule
to the Nursing System [Pharmacy Scheduled Administration Intent Activate
Fulfillment Request, Institutional (PORX_IN033122)]. The Nursing System
establishes the administration events on the Eve Everywoman's MAR and
acknowledges this action to the Pharmacy System [Pharmacy Scheduled
Administration Event Activate Confirmation, Institutional (PORX_IN034132)].
Recording an Scheduled Administration Event In the CCU, Nancy
Nightingale checks Eve Everywoman's MAR and sees that it is time for her
metolazone. She retrieves the unit-dose medication previously delivered by
the Pharmacy. In the patient's room, she scans her staff ID barcode to access
the charting system, scans the patient's ID bracelet barcode to bring the
correct patient profile onto the charting screen. She then scans the barcode
on the unit-dose metolazone to identify the product being administered. The
nursing system retrieves the administration information for this medication
administration (previously sent by the Pharmacy System) and displays the
order for metolazone on the screen. Having verified the correct medication,
dose, time and patient, she gives the medication to Ms Nightingale. The nurse
charts that she has administered the metolazone and saves the data. The
Nursing System sends a message to the Pharmacy System indicating that this
administration event has occurred [Pharmacy Scheduled Administration Event
Complete Notification, Institutional (PORX_IN034412)]. Suggestion for
medication change On one of the subsequent electrolyte analyses for Eve
Everywoman, the Lab System sends a result notification including a
potassium level of 5.3 mEq/L [see Laboratory Domain for interaction details].
The Pharmacy System, as a tracker of relevant lab results, receives and
records this lab result against Eve Everywoman's profile and notes that this
high result suggests that alteration of the KCl order may be warranted. The
Pharmacy System sends a suggestion to the Hospital Information System to
reduce or discontinue the KCl for Eve Everywoman [Pharmacy Combined
Intent Replace Fulfillment Request, Institutional (PORX_IN033322)]. The
Hospital Information System prompts the internist on duty, Dr Otto Osler,
regarding the pharmacy suggestion. On reviewing Ms Everywoman's case to
date, Dr Osler elects to discontinue the KCl pending the results of the
Cardiology Consult. Dr Osler enters the discontinuation into the Hospital
Information System, which communicates the discontinuation to the
Pharmacy System [Pharmacy Combined Order Abort Confirmation,
Institutional (PORX_IN002632)]. The Pharmacy System receives the
discontinuation message, discontinues the KCl order and acknowledges the
action to the Hospital Information System [Pharmacy Combined Intent Abort
Notification, Institutional (PORX_IN033612)]. The Pharmacy System informs
the Nursing System to discontinue the KCl administration [Pharmacy
Scheduled Administration Intent Abort Fulfillment Request, Institutional
(PORX_IN033622)]. The Nursing System updates Eve Everywoman's MAR
and acknowledges this action to the Pharmacy System [Pharmacy Scheduled
Administration Event Abort Confirmation, Institutional (PORX_IN034632)].
Medication Order Changes The Cardiologist, Dr Patrick Pump, completes
the cardiology consult. Dr Pump notes that Eve's fluid balance has been
normalized and that the immediate symptoms of decompensation have been
abated. Based upon the test results, Dr Pump initiates beta-blocker and ACE-I
therapy. Dr Pump enters the following medication orders into the Hospital
Information System:

 Discontinue verapamil
 Discontinue iv furosemide

 metoprolol 12.5mg po bid

 lisinopril 20mg po qd

 furosemide 20mg po bid

 increase metolazone to 2.5mg po bid

 KCl 10meq po bid

The Hospital Information System sends these orders to the Pharmacy System
as:

 For the verapamil and iv furosemide, the Hospital Information System

sends discontinue messages to the Pharmacy System [Pharmacy
Combined Order Abort Fulfillment Request, Institutional
(PORX_IN002722)]. The Pharmacy System discontinues the verapamil
and furosemide orders and sends acknowledgement back to the
Hospital Information System [Pharmacy Combined Intent Abort
Confirmation, Institutional (PORX_IN003632)]. The Pharmacy System
also communicates with the Nursing System to discontinue
administration of these orders [Pharmacy Scheduled Administration
Intent Abort Fulfillment Request, Institutional (PORX_IN033622)]. The
Nursing System updates Eve Everywoman's MAR and acknowledges
this action back to the Pharmacy Application [Pharmacy Scheduled
Administration Event Abort Confirmation, Institutional
(PORX_IN034632)].
 The Hospital Information System sends new order messages for the
metoprolol, lisinopril, oral furosemide and KCl to the Pharmacy System
[Pharmacy Combined Order Activate Fulfillment Request, Institutional
(PORX_IN002122)]. The Pharmacy System establishes the medication
orders (see note regarding new order object, above). The Pharmacy
System performed relevant clinical evaluation and, with no
contradictory information, acknowledges the orders to the Hospital
Information System [Pharmacy Combined Intent Activate
 Confirmation, Institutional (PORX_IN003112)]. The Pharmacy System
develops a specific administration schedule and communicates
schedule to the Nursing System [Pharmacy Scheduled Administration
Intent Activate Fulfillment Request, Institutional (PORX_IN033122)].
The Nursing System updates Eve Everywoman's MAR and
acknowledges this action back to the Pharmacy System [Pharmacy
Scheduled Administration Event Activate Confirmation, Institutional
(PORX_IN034132)].

 For the metolazone, the HIS send a revision messages to the

Pharmacy System [Pharmacy Combined Order Revise Fulfillment
Request, Institutional (PORX_IN002222)]. The Pharmacy System
revises the metolazone order as requested and acknowledges back to
the Hospital Information System [Pharmacy Combined Intent Revise
Confirmation, Institutional (PORX_IN003232)]. The Pharmacy System
re-evaluates the metolazone order and creates a new administration
schedule. The Pharmacy System informs the Nursing System that the
prior administration schedule for the metolazone order should be
discontinued [Pharmacy Scheduled Administration Intent Abort
Fulfillment Request, Institutional (PORX_IN033622)]. The new
administration schedule for the metolazone order is sent by the
Pharmacy System to the Nursing System [Pharmacy Scheduled
Administration Intent Activate Fulfillment Request, Institutional
(PORX_IN033122)]. The Nursing System updates Eve Everywoman's
MAR and sends acknowledgements for the deleted schedule [Pharmacy
Scheduled Administration Event Abort Confirmation, Institutional
(PORX_IN034632)] and the newly scheduled items [Pharmacy
Scheduled Administration Event Activate Confirmation, Institutional
(PORX_IN034132)]

Dr Pump also recommends that, after 24 hours of stable symptoms and labs,
Ms Everywoman can be discharged with prompt (one week) referral to the
CHF clinic for follow-up and medication titration. Discharge with
medications The resident following Ms Everywoman, Dr Rachel Resident,
evaluates her on rounds. The resident, and the team, note that Ms
Everywoman's symptoms have been under control for more than 24 hours,
that she is in good spirits and anxious to return home. Dr Resident, following
Dr Pump's suggestion, enters discharge orders into the Hospital Information
System:

 Discharge to home [see Patient Administration Domain]

 CHF Clinic referral within 1 week [see Scheduling Domain]

 Medications

o metoprolol 12.5mg po bid, 2 week supply

o lisinopril 20mg po qd, 2 week supply

o furosemide 20mg po bid, 2 week supply

 o increase metolazone to 2.5mg po bid, 2 week supply

o KCl 10meq po bid, 2 week supply

The Hospital Information System, as a component of a Discharge order,

informs the pharmacy to discontinue all medications for Eve Everywoman
[Pharmacy Combined Order Abort Fulfillment Request, Institutional
(PORX_IN002722)]. In addition, the discharge medication orders are also
sent to the Pharmacy System [Pharmacy Supply Order Activate Fulfillment
Request, Institutional (PORX_IN022124)]. The Pharmacy System receives the
discontinue of inpatient medications and the discharge medication orders. The
current inpatient medication orders are discontinued on the Pharmacy
System, with acknowledgement of same to the Hospital Information System
[Pharmacy Combined Intent Abort Confirmation, Institutional
(PORX_IN003632)]. The discharge medications orders are created in the
Pharmacy System. After appropriate clinical review, with no contradictory
information, they are acknowledged back to the Hospital Information System
[Pharmacy Supply Intent Activate Confirmation, Institutional
(PORX_IN023134)]. Additionally, the Pharmacy System informs the Nursing
System to discontinue all medications for Eve Everywoman [Pharmacy
Scheduled Administration Intent Abort Fulfillment Request, Institutional
(PORX_IN033622)]. The Nursing System updates Ms Everywoman's MAR and
acknowledges the action back to the Pharmacy System [Pharmacy Scheduled
Administration Event Abort Confirmation, Institutional (PORX_IN034632)]

The pharmacy prepares the discharge medication. The pharmacist, Susan

Script, takes the discharge medications to Ms Everywoman. Dr Script
counsels Ms Everywoman on the proper way to take the medications and
possible untoward effects. Dr Script notes in the Pharmacy System that the
medications were supplied to the patient with appropriate counseling. The
Pharmacy System notifies the Hospital Information System that the supply
events have occurred [Pharmacy Supply Event Complete Notification,
Institutional (PORX_IN024414)].

2.1.
Hospital Administration with Duration (PORX_ST000700)

Purpose
This Storyboard employs an older design that exposes detailed (hidden)
application roles. Further development of this Storyboard will reduce the
design complexity by exposing only the general, or "good-practice"
Application Roles". However, while the visible complexity will be reduced, the
fundamental scenario described is not expected to be altered, except as
needed to accurately reflect the real-world scenario.

In most circumstances reflected in the general inpatient storyboard

(PORX_ST003500), inpatient medication administrations are only recorded
when complete. However, some types of administrations occur over a period
 of time, and both the beginning and end are recorded. This storyboard
illustrates such an administration event, occurring over a period of time,
where the beginning and ending times are significant and reported.

Diagram
Link to graphic (opens in a new window)

2.1.3.
Institutional, Administration, Event, TPN with dur (PORX_SN000701)
Record Administration Start

On the ICU, Nancy Nightingale checks Adam Everyman's MAR and sees that it
is time to start a new TPN IV. She retrieves the next TPN bag for the patient
and notes that it is number 4. She scans her staff ID barcode to access the
charting system, scans the patient's ID bracelet barcode to bring the correct
patient profile onto the charting screen, and then scans the TPN barcode on
the IV label to identify the specific product being administered. The nursing
system retrieves the administration information for this TPN bag previously
sent by the pharmacy application. The nursing system displays the order for
TPN number 4 containing:

1. 500 ml of Amino Acids 8.5%

2. Dextrose 50% 500 ml

3. Potassium Chloride 40 mEq

4. MVI 10 ml

5. MTE 4 ml

6. Calcium Chloride 1 g

7. Magnesium Sulfate 4 mEq

8. Vitamin K 10 mg

and the appropriate bottle schedule (number 4) on the screen. The nurse
charts that she has started the IV, validating that the correct patient, IV,
bottle number (and that all ingredients are accurately identified on the bottle
information online) and the charted date and time are correct. The infusion
rate for the bag is 150 ml/hr. She saves the data. The Nursing sends a
message to the pharmacy system indicating that this administration event
has begun [Pharmacy Scheduled Administration Event Revise Notification,
Institutional (PORX_IN034212)].

Record Administration Intermediate Reading

 Several hours later the nurse needs to document how much of the IV has
been infused into the patient. Using the barcode functionality she again
identifies herself and the patient. She then manually selects the hanging IV
bag from the IV charting system. She checks the IV bag and confirms the
amount remaining in the bag. She enters the remaining volume and the
amount infused is automatically calculated and displayed. She validates that
the displayed data (infused amount, date, time, patient) is correct and saves
the data. The nursing system sends a message to the pharmacy system with
the infused volume information for this administration event [Pharmacy
Scheduled Administration Event Revise Notification, Institutional
(PORX_IN034212)].

Record Administration Completion

Nurse Nightingale returns to the Mr. Everyman's room at the anticipated

completion time for the TPN. She notes that the infusion has completee.
Using the barcode functionality she again identifies herself and the patient.
She then selects the hanging IV bag from the IV charting system. She enters
that the bag has been completely infused. She validates that the displayed
data (infused amount, date, time, patient) is correct and saves the data. The
nursing system sends a message to the pharmacy system that this specific
administration has completed [Pharmacy Scheduled Administration Event
Complete Notification, Institutional (PORX_IN034412)].

2.1. Community Practice, Comprehensive #1

(PORX_ST000800)

Purpose
This Storyboard employs an older design that exposes detailed (hidden)
application roles. Further development of this Storyboard will reduce the
design complexity by exposing only the general, or "good-practice"
Application Roles. However, while the visible complexity will be reduced, the
fundamental scenario described is not expected to be altered, except as
needed to accurately reflect the real-world scenario.

To provide a comprehensive example of Community Pharmacy Practice:

Prescribe and fill an outpatient retail or community pharmacy prescription
where drug authorization is required and the order is placed on hold until
authorization, history and insurance are available. All possible variations and
decision points are not included in this storyboard. Additional storyboards
examine variations by building on the context and structure of this
storyboard. Interactions in this storyboard that fall outside of the Pharmacy
Domain are detailed in other sections. The reader is referred to the following:

 Claims and Reimbursement Domain (FICR_DO000001), a pertinent

storyboard being "Pre-Determination, Pharmacy" (DOCR_ST400200)
  Patient Administration Domain (FICR_DO000001)

Diagram
Link to graphic (opens in a new window)

2.1.4.
Community, Comprehensive (PORX_SN000800)
Outpatient prescription requiring authorization

Dr. Harold Hippocrates performs an exam of Mr. Neville Nuclear at Good

Health Hospital Outpatient Clinic. A diagnosis of Amyotrophic Lateral Sclerosis
is made (ICD-9-CM 335.20).

Dr. Hippocrates enters a prescription for Rilutek 50 mg Oral Tablets (NDDF

Dispensable Drug ID 42585; generic ingredient "riluzole") #60, Sig: one
tablet every 12 hours before meals with 1 refill, into the Clinical Information
System at Good Health Hospital Outpatient Clinic. Mr. Nuclear indicates that
he would like to have the medication dispensed at Good Neighbor Pharmacy.

The Clinic System transmits the prescription to Good Neighbor Pharmacy

[Pharmacy Supply Order Activate Fulfillment Request, Community
(PORX_IN022122)]. Good Neighbor's Pharmacy System receives the
prescription and creates a corresponding order (this object, in the New state,
exists in the Pharmacy System, but is not "visible" to external systems until
becomes "Active"). Good Neighbor Pharmacy does not have Mr. Nuclear
enrolled as a patient and the prescription message did not contain all of the
information that the Pharmacy System tracks for patients. The prescription is
placed on hold (an internal state change in the Pharmacy System) until
patient information can be obtained from Good Health Hospital. The
Pharmacy System requests additional patient information from the Clinic
System, which responds with the requested information [see Patient
Administration Domain for details on patient information query and response
interactions]. With all required information now in place, the Pharmacy
System acknowledges the prescription order to the Clinic System [Pharmacy
Supply Intent Activate Confirmation, Community (PORX_IN023132)].

Good Neighbor Pharmacy attempts to fill the prescription (National Drug Code
00075-7700-60). While electronically submitting the prescription for
payment, reimbursement is denied by Bargain Prescription Benefits because
the drug requires prior authorization [see Claims & Reimbursement Domain
for details on the claim and response interactions]. The prescription is
suspended [Pharmacy Supply Intent Suspend Notification, Community
(PORX_IN023812)] and a suggested revision to include prior authorization
information is sent from the Pharmacy System to the Clinic System
[Pharmacy Supply Intent Revise Fulfillment Request, Community
(PORX_IN023222)].

In order to expedite the situation, Good Neighbor Pharmacy calls Dr.

Hippocrates's office to alert them to the status and pending request on Mr.
Nuclear's prescription. Dr. Hippocrates locates the message from the
pharmacy, reviews the prescription and medical history and submits a prior
authorization request to HC Payor, Inc., Mr. Nuclear's Healthcare insurer. HC
Payor, Inc. responds with an authorization for the medication [refer to the
Claims & Reimbursement Domain for details on the prior authorization
request and approval interactions]. Dr. Hippocrates notes and saves the prior
authorization approval with the prescription order. The Clinic System informs
the Pharmacy System of the updated prescription order, now with prior
authorization included [Pharmacy Supply Order Revise Confirmation,
Community (PORX_IN022232)].

Good Neighbor Pharmacy submits the prescription for payment to Bargain

Prescription Benefits. Bargain Prescription Benefits approves payment and
transmits remittance advice to Good Neighbor Pharmacy [see Claims &
Reimbursement Domain for details on the claim and response interactions].

Good Neighbor Pharmacy completes the prescription. Mr. Nuclear picks up the
prescription and receives counseling advice from Susan Script, Registered
Pharmacist. Mr. Nuclear signs a form acknowledging receipt of the
prescription. The prescription is now officially dispensed. The Pharmacy
System notifies the Clinic System that the prescription has been dispensed
[Pharmacy Supply Event Complete Notification, Community
(PORX_IN024412)].

Refill request by non-patient family member when active refills

remain

55 days later, Mrs. Nelda Nuclear telephones Good Neighbor Pharmacy and
requests a refill of the Rilutek. Good Neighbor Pharmacy submits the
prescription for payment to Bargain Prescription Benefits. Bargain Prescription
Benefits approves payment and transmits remittance advice to Good
Neighbor Pharmacy [see Claims & Reimbursement Domain for details on the
claim and response interactions].

Good Neighbor Pharmacy completes the prescription. Mrs. Nuclear picks up

the prescription and signs a form acknowledging receipt of the prescription.
No additional counseling advice is requested or given. The prescription refill is
now officially dispensed. The Pharmacy System notifies the Clinic System that
the prescription has been dispensed [Pharmacy Supply Event Complete
Notification, Community (PORX_IN024412)].

Refill request by non-patient family member when active refills do

not remain

60 days later Mrs. Nuclear telephones Good Neighbor Pharmacy and requests
a refill of the Rilutek. Good Neighbor Pharmacy's system detects that no
refills remain. A refill authorization request is electronically sent to Dr.
Hippocrates' system [Pharmacy Supply Intent Reactivate Fulfillment Request,
 Community (PORX_IN023522)].

Dr. Hippocrates receives the refill authorization request. Dr. Hippocrates

contacts Bargain Prescription Benefits Pharmacy [see Claims &
Reimbursement Domain for details on the claim and response interactions]
and obtains authorization for six more refills. The Clinic System updates the
prescription order and notifies the Pharmacy System that additional refills
have been authorized by the prescriber [Pharmacy Supply Order Reactivate
Confirmation, Community (PORX_IN022532)]. Good Neighbor Pharmacy
updates the number of authorized refills and the prior authorization.

Good Neighbor Pharmacy completes the prescription. Mrs. Nuclear picks up

the prescription and signs a form acknowledging receipt of the prescription.
No additional counseling advice is requested or given. The prescription refill is
now officially dispensed. The Pharmacy System notifies the Clinic System that
the prescription has been dispensed [Pharmacy Supply Event Complete
Notification, Community (PORX_IN024412)].

2.1. Community Pharmacy, Comprehensive #2

(PORX_ST000810)

Purpose
This storyboard was developed at the Cleveland WGM. This may respresent
an alternative to PORX_ST000800 , or the two may be maintained as
separate scenarios.

This scenario covers a range of typical community or outpatient prescribing

where dispensing occurs in a community pharmacy. The interaction occurs
between the prescribing system and the pharmacy dispensing system.
Examples of a prescribing system include: GP System, Dentist System,
Outpatient/Polyclinic System. Pharmacy systems include: Community
Pharmacy, Outpatient Dispensing. Only the Prescriber-Pharmacy system
interactions have been modelled. Potential messages relating to
reimbursement and interaction between pharmacy and payment agency have
not been covered. Further messaging for reimbursement are out of scope.
Any intermediate links are also out of scope for this story.

Diagram
Link to graphic (opens in a new window)

Interaction List
Community Pharmacy Supply Event Complete, Notification PORX_IN000008

2.1.5.
Community (PORX_SN000810)
Dr. Harold Hippocrates is consulted by Mr Adam Everyman for hypertension
and sinusitis and a request for a medication prescribed by his neurologist. Dr.
Hippocrates prescribes three items on the one prescription form

1. Hydrochlorothiazide 25 mg Oral Tablets to be taken : one tablet daily.

Supply (50) with 1 refill
2. Doxycycline 100mg capsuls, 2 to be taken immediately and then one
daily. Supply (7) with no refill

3. Riluzole 50 mg Oral Tablets, one tablet every 12 hours before meals;

supply 60 with 1 refill

Dr. Hippocrates electronically transmits the prescription form containing the

three items to Good Neighbor Pharmacy. (Community Pharmacy Order
Activate, Fulfilment Request (PORX_?????7)

Good Neighbor Pharmacy receives the prescription and identifies Mr

Everyman as a patient registered on their pharmacy system. The prescription
is placed on hold while insurance authorisation is obtained. Good Neighbor
Pharmacy receives the necessary insurance information. They attempt to
fulfill the prescription, but note that a prior authorisation is required for the
Rilutek due to the cost of this drug.

Good Neighbor Pharmacy leaves a message for Dr. Hippocrates to inform him
that he needs to contact Bargain Prescription Benefits to obtain authorization.
This is done and Dr. Hippocrates's nurse, (Nancy Nightingale) telephones
Good Neighbor Pharmacy with notification of insurance authorization which is
added to the prescription details.

The pharmacy system performs a safety review of the prescription and

identifies a major contraindication for this patient.

A second call is made to Dr.Hippocrates to attempt to identify a suitable

alternative item being prescribed on a new prescription. A new item is
identified and fresh prescription is issued for this new item. The prescription
for the problem item is cancelled. (Pharmacy Combined Order Activate,
Rejection PORX_IN?????9)

Good Neighbor pharmacy dispenses the remaining two medications in this

order (as well as the new item which is separately processed through another
message).

Good Neighbor Pharmacy sends a notification of supply for two medications to

Dr. Hipprocates (Community Pharmacy Supply Event Complete, Notification
(PORX_IN?????8)

Diagram notes

Message No: 1
 Real World Event: Prescribe drug

Initiator: Dr

Receiver: Pharmacist

Name: Community Pharmacy Combined Order Activate, Fulfilment Request

(PORX_?????7)

Message No: 4 (This is repeated for each of the two drugs supplied)

Real World Event: Dispense drug

Initiator: Pharmacist

Receiver: Dr

Name: Community Pharmacy Supply Event Complete, Notification

(PORX_IN?????8

Message No: 6

Real World Event: Refuse supply

Initiator: Pharmacist

Receiver: Dr

Name: Community Pharmacy Combined Order Activate, Rejection

PORX_IN?????9

2.1.
Community Practice, UK Variation (PORX_ST003000)

Purpose
This Storyboard employs an older design that exposes detailed (hidden)
application roles. Further development of this Storyboard will reduce the
design complexity by exposing only the general, or "good-practice"
Application Roles. However, while the visible complexity will be reduced, the
fundamental scenario described is not expected to be altered, except as
needed to accurately reflect the real-world scenario.

Localization considerations result is some vairation in community pharmacy

terminology and practice. This storyboard illustrates some of the variations
from the generalized community practice storyboard (PORX_ST000800) that
 exist in the UK pharmacy practice model.

Diagram
Link to graphic (opens in a new window)

2.1.6. Community, UK Variation, Prescription with Multipl

(PORX_SN003000)
Prescription for multiple products

Dr. Fay Family sees Mr. Adam Everyman for a urine infection and repeat of
regular hypertension and cholesterol medications. A prescription is generated
by the computerised medication management system for a specific brand
name equivalent of the following 3 items:

 Amoxycillin 250mg caps (pack of 20), 1 tds, Supply 1, no repeats

 Metoprolol 100mg tabs (pack of 30), 1 mane, Supply 1, 5 repeats

 Simvastatin 20mg tabs (pack of 30), 1 mane, Supply 1, 5 repeats

The prescription is sent to a central script repository (CPR) which is held by

HC Payor, Inc, the pharmaceutical plan manager, via the Internet [Pharmacy
Supply Order Activate Fulfillment Request, Community (PORX_IN022122)]
(using agreed electronic signature and encryption protocols). The CPR verifies
the patient's eligibility for benefits by checking the patient's details and
membership number, that each item is on the formulary, and that no
dispensing rules have been breached (such as earlier than expected return for
a repeat). In the situation of an ineligible script, a message is returned
electronically to the prescriber [Pharmacy Supply Intent Activate Rejection,
Community (PORX_IN023142)]. In other cases, a unique prescription number
is allocated, transmitted to the prescriber [Pharmacy Supply Order Activate
Confirmation, Community (PORX_IN023134)] and printed on the prescription
(as a number and barcode) which contains the 3 items. The details of the
prescription and the 3 items nested in it are stored in the repository awaiting
a request from any pharmacy to supply this information.

Community Pharmacy operation

Mr. Everyman takes the printed and signed script to Good Neighbor
Pharmacy, presents the script which is passed under a barcode scanner to
read the prescription identifier. A message is sent to the HC Payor, Inc.
[Pharmacy Supply Intent Query o in development] who returns the
prescription details to the Pharmacy System [Pharmacy Supply Intent Query
Response o in development]. The Pharmacy System populates the
prescriptions pending action area with the 3 items (these three objects, all in
the New state, exist in the Pharmacy System, but are not "visible" to external
systems until they become "Active").

Mr. Everyman is asked for direction on how to dispense the 3 items. He

 requests the Amoxycillin and Metoprolol, as these are needed now.

1. Amoxycillin. The patient is noted to be allergic to this medication. A

message is sent to both the plan manager and doctor canceling this
item and requesting another [Pharmacy Supply Intent Replace
Fulfillment Request, Community (PORX_IN023322)]. The pharmacist
phones Dr. Family to bring the matter to her immediate attention. Dr.
Family reviews Mr. Everyman's case and agrees to replace the
Amoxycillin with Triprim 300mg 1 daily for 3 days. This is entered in
the computerized medication management system, and a message is
sent to the CPR at HC Payor and to Good Neighbor Pharmacy
[Pharmacy Supply Order Replace Confirmation, Community
(PORX_IN022332)]. Good Neighbor Pharmacy completes the
replacement of the amoxycillin order and dispenses Triprim. A
notification of this dispense is sent to HC Payor, Inc. [refer to Claims
and Reimbursement Domain for details on reimbursement
interactions] and to the prescribing doctor [Pharmacy Supply Event
Complete Notification, Community (PORX_IN024412)].
2. Metoprolol. This is dispensed as requested except that a generic
equivalent brand is used. The Pharmacy System sends notification of
dispense, with the generic product specified, to HC Payor, Inc. (refer
to Claims and Reimbursement Domain for details on reimbursement
interactions) and to the prescribing doctor [Pharmacy Supply Event
Complete Notification, Community (PORX_IN024412)]. The record of
the number of dispenses available on this script is amended and an
authorisation for the remaining repeats is printed by the Pharmacy
System.

3. Simvastatin. The patient requests that this not be dispensed as he has

just started a new bottle. Since no dispense occurs for this medication,
no corresponding dispense message is sent to the CPR at HL Payor,
Inc. An authorisation for the original script and repeats is printed.

Message Definitions
2 Domain Table of Contents

2.2 Message Definition Application Roles

6Message Definition Application Roles (Sorted by Structured Sort Name)
Pharmacy Supply Order Global Placer PORX_AR022132
Pharmacy Supply Order Global Fulfiller PORX_AR022142
Pharmacy Supply Order Global Confirmer PORX_AR022152
[Elemental]
Pharmacy Supply Order Global Confirmation
Receiver PORX_AR022162 [Elemental]
Pharmacy Supply Event Global Informer PORX_AR024112
 Pharmacy Supply Event Global Tracker PORX_AR024122
Pharmacy Supply Promise Global Confirmer PORX_AR023152
[Elemental]
Pharmacy Supply Promise Global Confirmation
Receiver PORX_AR023162 [Elemental]
Pharmacy Combined Order Global Placer PORX_AR002132
Pharmacy Combined Order Global Fulfiller PORX_AR002142
Pharmacy Combined Order Global Confirmer PORX_AR002152
[Elemental]
Pharmacy Combined Order Global Confirmation
Receiver PORX_AR002162 [Elemental]
Pharmacy Combined Event Query Placer PORX_AR100010
Pharmacy Combined Event Query Fulfiller PORX_AR100020
Pharmacy Combined Promise Global Confirmer PORX_AR003152
[Elemental]
Pharmacy Combined Promise Global Confirmation
Receiver PORX_AR003162 [Elemental]
Pharmacy Scheduled Administration Event Global
Confirmer PORX_AR035125 [Elemental]
Pharmacy Scheduled Administration Event Global Confirmation
Receiver PORX_AR035162 [Elemental]
Pharmacy Scheduled Administration Event Global
Informer PORX_AR035112
Pharmacy Scheduled Administration Event Global
Tracker PORX_AR035122
Pharmacy Scheduled Administration Promise Global
Placer PORX_AR033132
Pharmacy Scheduled Administration Promise Global
Fulfiller PORX_AR033142

Reference

For details on the interpretation of this section, see the discussion of

application roles and their relationships in the Version 3 Guide.

Introduction

At time of ballot, the Application Roles described in the Pharmacy Domain

was limited to those necessary to support the other content in this domain.
Additional Roles have been identified but are not fully developed at this
time.

2.2.1 Pharmacy Supply Placer (PORX_AR022132)

 Description
Structured Name: Pharmacy Supply Order Global Placer

An application that is capable of completing the actions necessary to deal

with the issuing, completion and discontinuing of a service request for a
dispensing a drug or similar therapy.

2.2.2 Pharmacy Supply Fulfiller (PORX_AR022142)

Description
Structured Name: Pharmacy Supply Order Global Fulfiller

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a dispensing a drug or similar therapy.

2.2.3 Pharmacy Supply Confirmer (PORX_AR022152)

Description
Structured Name: Pharmacy Supply Order Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a dispensing a drug or similar therapy.

Pharmacy Supply Confirmation Receiver

2.2.4
(PORX_AR022162)
Description
Structured Name: Pharmacy Supply Order Global Confirmation Receiver

An application that is capable of accepting a confirmation from a system

that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a service request for a dispensing a drug or
similar therapy.

Pharmacy Supply Event Global Informer

2.2.5
(PORX_AR024112)
Description
Structured Name: Pharmacy Supply Event Global Informer

An application that performs or manages pharmacy supply events and

sends notifications of those events to one or more receiving applications.
 The informer has no expectation that any action or activity will result on the
receiving application(s).

Pharmacy Supply Event Global Tracker

2.2.6
(PORX_AR024122)
Description
Structured Name: Pharmacy Supply Event Global Tracker

An application that can receive pharmacy supply event information. While

the tracker will most likely store some or all of the event information, no
specific action or further interact will result from the receipt of the
pharmacy supply event informaiton.

2.2.7 Pharmacy Supply Confirmer (PORX_AR023152)

Description
Structured Name: Pharmacy Supply Promise Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a commitment for a dispensing a drug or similar therapy.

Pharmacy Supply Confirmation Receiver

2.2.8
(PORX_AR023162)
Description
Structured Name: Pharmacy Supply Promise Global Confirmation Receiver

An application that is capable of accepting a confirmation from a system

that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a commitment for a dispensing a drug or
similar therapy

2.2.9 Combined Pharmacy Placer (PORX_AR002132)

Description
Structured Name: Pharmacy Combined Order Global Placer

An application that is capable of completing the actions necessary to deal

with the issuing, completion and discontinuing of a service request for a
administration and dispensing of a drug or similar therapy.
2.2.10 Combined Pharmacy Fulfiller (PORX_AR002142)
Description
Structured Name: Pharmacy Combined Order Global Fulfiller

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a administration and dispensing of a drug or similar
therapy.

2.2.11 Combined Pharmacy Confirmer (PORX_AR002152)

Description
Structured Name: Pharmacy Combined Order Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a administration and dispensing of a drug or similar
therapy.

Combined Pharmacy Confirmation Receiver

2.2.12
(PORX_AR002162)
Description
Structured Name: Pharmacy Combined Order Global Confirmation Receiver

An application that is capable of accepting a confirmation from a system

that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a service request for a administration and
dispensing of a drug or similar therapy.

2.2.13 Combined Event Query Placer (PORX_AR100010)

Description
Structured Name: Pharmacy Combined Event Query Placer

An application that can send a request for pharmacy order supply and
administration event information.

2.2.14 Combined Event Query Fulfiller (PORX_AR100020)

Description
Structured Name: Pharmacy Combined Event Query Fulfiller
 An application than can respond to a request for pharmacy order supply
and administration event information.

2.2.15 Combined Pharmacy Confirmer (PORX_AR003152)

Description
Structured Name: Pharmacy Combined Promise Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a commitment for a administration and dispensing of a drug or similar
therapy.

Combined Pharmacy Confirmation Receiver

2.2.16
(PORX_AR003162)
Description
Pharmacy Combined Promise Global Confirmation
Structured Name:
Receiver

An application that is capable of accepting a confirmation from a system

that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a commitment for a administration and
dispensing of a drug or similar therapy.

Scheduled Administration Event Global Confirmer

2.2.17
(PORX_AR035125)
Description
Pharmacy Scheduled Administration Event Global
Structured Name:
Confirmer

TO BE WRITTEN

Scheduled Admin Event Global Confirmation Receiver

2.2.18
(PORX_AR035162)
Description
Pharmacy Scheduled Administration Event Global
Structured Name:
Confirmation Receiver

TO BE WRITTEN
 Scheduled Administration Event Global Informer
2.2.19
(PORX_AR035112)
Description
Pharmacy Scheduled Administration Event Global
Structured Name:
Informer

An application that performs or manages pharmacy administration events

and sends notifications of those events to one or more receiving
applications. The informer has no expectation that any action or activity will
result on the receiving application(s).

Scheduled Administration Event Global Tracker

2.2.20
(PORX_AR035122)
Description
Structured Name: Pharmacy Scheduled Administration Event Global Tracker

An application that can receive pharmacy administration event information.

While the tracker will most likely store some or all of the event information,
no specific action or further interact will result from the receipt of the
pharmacy administration event informaiton.

Scheduled Administration Promise Global Placer

2.2.21
(PORX_AR033132)
Description
Pharmacy Scheduled Administration Promise Global
Structured Name:
Placer

TO BE WRITTEN

Scheduled Administration Promise Global Fulfiller

2.2.22
(PORX_AR033142)
Description
Pharmacy Scheduled Administration Promise Global
Structured Name:
Fulfiller

TO BE WRITTEN
 Message Definitions
2 Domain Table of Contents

2.2 Message Definition Application Roles

6Message Definition Application Roles (Sorted by Structured Sort Name)
Pharmacy Supply Order Global Placer PORX_AR022132
Pharmacy Supply Order Global Fulfiller PORX_AR022142
Pharmacy Supply Order Global Confirmer PORX_AR022152
[Elemental]
Pharmacy Supply Order Global Confirmation
Receiver PORX_AR022162 [Elemental]
Pharmacy Supply Event Global Informer PORX_AR024112
Pharmacy Supply Event Global Tracker PORX_AR024122
Pharmacy Supply Promise Global Confirmer PORX_AR023152
[Elemental]
Pharmacy Supply Promise Global Confirmation
Receiver PORX_AR023162 [Elemental]
Pharmacy Combined Order Global Placer PORX_AR002132
Pharmacy Combined Order Global Fulfiller PORX_AR002142
Pharmacy Combined Order Global Confirmer PORX_AR002152
[Elemental]
Pharmacy Combined Order Global Confirmation
Receiver PORX_AR002162 [Elemental]
Pharmacy Combined Event Query Placer PORX_AR100010
Pharmacy Combined Event Query Fulfiller PORX_AR100020
Pharmacy Combined Promise Global Confirmer PORX_AR003152
[Elemental]
Pharmacy Combined Promise Global Confirmation
Receiver PORX_AR003162 [Elemental]
Pharmacy Scheduled Administration Event Global
Confirmer PORX_AR035125 [Elemental]
Pharmacy Scheduled Administration Event Global Confirmation
Receiver PORX_AR035162 [Elemental]
Pharmacy Scheduled Administration Event Global
Informer PORX_AR035112
Pharmacy Scheduled Administration Event Global
Tracker PORX_AR035122
Pharmacy Scheduled Administration Promise Global
Placer PORX_AR033132
Pharmacy Scheduled Administration Promise Global
Fulfiller PORX_AR033142
 Reference

For details on the interpretation of this section, see the discussion of

application roles and their relationships in the Version 3 Guide.

Introduction

At time of ballot, the Application Roles described in the Pharmacy Domain

was limited to those necessary to support the other content in this domain.
Additional Roles have been identified but are not fully developed at this
time.

2.2.1 Pharmacy Supply Placer (PORX_AR022132)

Description
Structured Name: Pharmacy Supply Order Global Placer

An application that is capable of completing the actions necessary to deal

with the issuing, completion and discontinuing of a service request for a
dispensing a drug or similar therapy.

2.2.2 Pharmacy Supply Fulfiller (PORX_AR022142)

Description
Structured Name: Pharmacy Supply Order Global Fulfiller

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a dispensing a drug or similar therapy.

2.2.3 Pharmacy Supply Confirmer (PORX_AR022152)

Description
Structured Name: Pharmacy Supply Order Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a dispensing a drug or similar therapy.

Pharmacy Supply Confirmation Receiver

2.2.4
(PORX_AR022162)
Description
Structured Name: Pharmacy Supply Order Global Confirmation Receiver
 An application that is capable of accepting a confirmation from a system
that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a service request for a dispensing a drug or
similar therapy.

Pharmacy Supply Event Global Informer

2.2.5
(PORX_AR024112)
Description
Structured Name: Pharmacy Supply Event Global Informer

An application that performs or manages pharmacy supply events and

sends notifications of those events to one or more receiving applications.
The informer has no expectation that any action or activity will result on the
receiving application(s).

Pharmacy Supply Event Global Tracker

2.2.6
(PORX_AR024122)
Description
Structured Name: Pharmacy Supply Event Global Tracker

An application that can receive pharmacy supply event information. While

the tracker will most likely store some or all of the event information, no
specific action or further interact will result from the receipt of the
pharmacy supply event informaiton.

2.2.7 Pharmacy Supply Confirmer (PORX_AR023152)

Description
Structured Name: Pharmacy Supply Promise Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a commitment for a dispensing a drug or similar therapy.

Pharmacy Supply Confirmation Receiver

2.2.8
(PORX_AR023162)
Description
Structured Name: Pharmacy Supply Promise Global Confirmation Receiver

An application that is capable of accepting a confirmation from a system

 that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a commitment for a dispensing a drug or
similar therapy

2.2.9 Combined Pharmacy Placer (PORX_AR002132)

Description
Structured Name: Pharmacy Combined Order Global Placer

An application that is capable of completing the actions necessary to deal

with the issuing, completion and discontinuing of a service request for a
administration and dispensing of a drug or similar therapy.

2.2.10 Combined Pharmacy Fulfiller (PORX_AR002142)

Description
Structured Name: Pharmacy Combined Order Global Fulfiller

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a administration and dispensing of a drug or similar
therapy.

2.2.11 Combined Pharmacy Confirmer (PORX_AR002152)

Description
Structured Name: Pharmacy Combined Order Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a service request for a administration and dispensing of a drug or similar
therapy.

Combined Pharmacy Confirmation Receiver

2.2.12
(PORX_AR002162)
Description
Structured Name: Pharmacy Combined Order Global Confirmation Receiver

An application that is capable of accepting a confirmation from a system

that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a service request for a administration and
dispensing of a drug or similar therapy.
2.2.13 Combined Event Query Placer (PORX_AR100010)
Description
Structured Name: Pharmacy Combined Event Query Placer

An application that can send a request for pharmacy order supply and
administration event information.

2.2.14 Combined Event Query Fulfiller (PORX_AR100020)

Description
Structured Name: Pharmacy Combined Event Query Fulfiller

An application than can respond to a request for pharmacy order supply

and administration event information.

2.2.15 Combined Pharmacy Confirmer (PORX_AR003152)

Description
Structured Name: Pharmacy Combined Promise Global Confirmer

An application that is capable of confirming agreement to perform the

actions necessary to deal with the issuing, completion and discontinuing of
a commitment for a administration and dispensing of a drug or similar
therapy.

Combined Pharmacy Confirmation Receiver

2.2.16
(PORX_AR003162)
Description
Pharmacy Combined Promise Global Confirmation
Structured Name:
Receiver

An application that is capable of accepting a confirmation from a system

that has agreed to perform the actions necessary to deal with the issuing,
completion and discontinuing of a commitment for a administration and
dispensing of a drug or similar therapy.

Scheduled Administration Event Global Confirmer

2.2.17
(PORX_AR035125)
Description
 Pharmacy Scheduled Administration Event Global
Structured Name:
Confirmer

TO BE WRITTEN

Scheduled Admin Event Global Confirmation Receiver

2.2.18
(PORX_AR035162)
Description
Pharmacy Scheduled Administration Event Global
Structured Name:
Confirmation Receiver

TO BE WRITTEN

Scheduled Administration Event Global Informer

2.2.19
(PORX_AR035112)
Description
Pharmacy Scheduled Administration Event Global
Structured Name:
Informer

An application that performs or manages pharmacy administration events

and sends notifications of those events to one or more receiving
applications. The informer has no expectation that any action or activity will
result on the receiving application(s).

Scheduled Administration Event Global Tracker

2.2.20
(PORX_AR035122)
Description
Structured Name: Pharmacy Scheduled Administration Event Global Tracker

An application that can receive pharmacy administration event information.

While the tracker will most likely store some or all of the event information,
no specific action or further interact will result from the receipt of the
pharmacy administration event informaiton.

Scheduled Administration Promise Global Placer

2.2.21
(PORX_AR033132)
Description
Pharmacy Scheduled Administration Promise Global
Structured Name:
Placer
 TO BE WRITTEN

Scheduled Administration Promise Global Fulfiller

2.2.22
(PORX_AR033142)
Description
Pharmacy Scheduled Administration Promise Global
Structured Name:
Fulfiller

TO BE WRITTEN

Message Definitions
2 Domain Table of Contents

2.4 Refined Message Information Models

Reference

For details on the interpretation of this section, see the description of RMIMs
in the Version 3 Guide.

Introduction
At time of ballot, the RMIM's described in the Pharmacy Domain was limited
to those necessary to support the other content in this domain. Additional
RMIM's have been identified but are not fully developed at this time. These
additional RMIM's are listed here in order to document the concepts for
further development.

 PORX_RM023000 Pharmacy Supply Promise

 PORX_RM003000 Pharmacy Combined Promise

 PORX_RM004000 Pharmacy Combined Event

 PORX_RM013000 Pharmacy Administration Promise

 PORX_RM012000 Pharmacy Administration Order

 PORX_RM042000 Pharmacy Scheduled Supply Order

 PORX_RM022000 Pharmacy Supply Order

 PORX_RM002000 Pharmacy Combined Order

  PORX_RM043000 Pharmacy Scheduled Supply Promise

 PORX_RM014000 Pharmacy Administration Event

 PORX_RM033000 Pharmacy Scheduled Administration Promise

 PORX_RM032000 Pharmacy Scheduled Administration Order

2.4.1 Pharmacy Supply (PORX_RM000021)

Description
Parent: Pharmacy Domain Model (PORX_DM000000)

Diagram
Link to graphic (opens in a new window)

2.4.2 Pharmacy Institutional Order (PORX_RM000011)

Description
Parent: Pharmacy Domain Model (PORX_DM000000)

Diagram
Link to graphic (opens in a new window)

Pharmacy Medication Administration Query Response

2.4.3
(PORX_RM000031)
Description
Parent: Pharmacy Domain Model (PORX_DM000000)

Diagram
Link to graphic (opens in a new window)

2.4.4 Pharmacy Community Dispense (PORX_RM000002)

Description
Parent: Pharmacy Domain Model (PORX_DM000000)
 Diagram
Link to graphic (opens in a new window)

2.4.5 Pharmacy Community Prescription (PORX_RM000001)

Description
Parent: Pharmacy Domain Model (PORX_DM000000)

Diagram
Link to graphic (opens in a new window)

Message Definitions
2 Domain Table of Contents

2.5 Hierarchical Message Descriptions

Reference

For details on the interpretation of this section, see the description of HMDs in
the Version 3 Guide.

Introduction
At time of ballot, the HMD's described in the Pharmacy Domain was limited to
those necessary to support the other content in this domain. Additional HMD's
have been identified but are not fully developed at this time. These additional
HMD's are listed here in order to document the concepts for further
development.

 PORX_HD033200 Pharmacy Scheduled Administration Promise Revise

 PORX_HD002200 Pharmacy Combined Order Revise

 PORX_HD042500 Pharmacy Scheduled Supply Order Reactivate

 PORX_HD042200 Pharmacy Scheduled Supply Order Revise

 PORX_HD003400 Pharmacy Combined Promise Complete

  PORX_HD042400 Pharmacy Scheduled Supply Order Complete

 PORX_HD042100 Pharmacy Scheduled Supply Order Activate

 PORX_HD003300 Pharmacy Combined Promise Replace

 PORX_HD033300 Pharmacy Scheduled Administration Promise Replace

 PORX_HD043300 Pharmacy Scheduled Supply Promise Replace

 PORX_HD032200 Pharmacy Scheduled Administration Order Revise

 PORX_HD014400 Pharmacy Administration Event Complete

 PORX_HD013300 Pharmacy Administration Promise Replace

 PORX_HD032100 Pharmacy Scheduled Administration Order Activate

 PORX_HD042300 Pharmacy Scheduled Supply Order Replace

Message Definitions
2 Domain Table of Contents

2.6 Interactions
6 List of Interactions (Sorted by Title)
TO BE SPECIFIED ( PORX_IN000009 )
TO BE SPECIFIED ( PORX_IN000007 )
TO BE SPECIFIED ( PORX_IN000008 )
6 List of Interactions (Sorted by Structured Sort Name)
Community Pharmacy Combined Order Activate, Fulfilment Request (
PORX_IN000007 )
Community Pharmacy Combined Order Activate, Rejection (
PORX_IN000009 )
Community Pharmacy Supply Event Complete, Notification (
PORX_IN000008 )

Reference

For details on the interpretation of this section, see the definition of

Interactions in the Version 3 Guide.

Introduction
 At time of ballot, the Interactions described in the Pharmacy Domain was
limited to those necessary to support the other content in this domain.
Additional Interactions have been identified but are not fully developed at
this time. These additional Interactions are listed here in order to document
the concepts for further development.

2.6.1 TO BE SPECIFIED (PORX_IN000009)

Description
Structured Name: Community Pharmacy Combined Order Activate, Rejection
Note: temporary id assigned for this interaction. Subject to change as
development continues and this interaction is further integrated into the
standard.

Note: Message Type not set (PORX_MT999999 Preface used as a place

holder for missing information)

Note: Interaction not set (PORX_IN999999 Preface used as a place holder for
missing information)

This interaction is used by a Pharmacy Dispensing application (combined

pharmacy order fulfiller) to notify the Medication Management/Order Entry
application that the fulfillment request cannot be honored.

Sending Role Pharmacy Combined Order Global Fulfiller PORX_AR002142

Receiving Role Pharmacy Combined Order Global Placer PORX_AR002132
Trigger Event Preface PORX_TE999999
Message Type Preface PORX_MT999999

2.6.2 TO BE SPECIFIED (PORX_IN000007)

Description
Community Pharmacy Combined Order Activate, Fulfilment
Structured Name:
Request
Note: temporary id assigned for this interaction. Subject to change as
development continues and this interaction is further integrated into the
standard.

Note: Message Type not set (PORX_MT999999 Preface used as a place

holder for missing information)

This interaction is used by a Medication Management/Order Entry application

(combined pharmacy order placer) to request that the participating pharmacy
dispensing application (combined pharmacy order fulfiller) dispense
medication(s) persuant to an order.
 Sending Role Pharmacy Combined Order Global Placer PORX_AR002132
Receiving
Pharmacy Combined Order Global Fulfiller PORX_AR002142
Role
Pharmacy Combined Order Activate,
Trigger Event PORX_TE002120
Fulfillment Request
Message Type Preface PORX_MT999999

2.6.3 TO BE SPECIFIED (PORX_IN000008)

Description
Structured Name: Community Pharmacy Supply Event Complete, Notification
Note: temporary id assigned for this interaction. Subject to change as
development continues and this interaction is further integrated into the
standard.

Note: Message Type not set (PORX_MT999999 Preface used as a place

holder for missing information)

This interaction is used by a Pharmacy Dispensing application (combined

pharmacy order fulfiller) to notify other participating applications that a
dispense event has occurred.

As a combined pharmacy event, either the supply and adminstration are

combined or the medication was supplied and no distinct message for the
adminstration will be sent.

As a notification, no actions are required or expected of other participating

applications.

Sending Role Pharmacy Combined Order Global Fulfiller PORX_AR002142

Receiving
Pharmacy Combined Order Global Placer PORX_AR002132
Role
Combined Pharmacy Event Complete,
Trigger Event PORX_TE004410
Notification
Message Type Preface PORX_MT999999

Query Definitions
3 Domain Table of Contents
No content
 Master File Definitions
4 Domain Table of Contents
No Content

5 Common Message Elements Indexes

5.1 Derived From this Domain
A_AdministeredMedication universal COCT_RM690000
A_AlertNoText universal COCT_RM260003
A_MedicationOrderedAndSupplied universal COCT_RM720000
R_MaterialMedProduct identified COCT_RM230001
R_MaterialMedProduct identified-confirmable COCT_RM230002
R_MaterialMedProductPackaged identified COCT_RM220001
R_MaterialMedProductPackaged identified-confirmabl COCT_RM220002
R_MaterialMedProductPackaged universal COCT_RM220000
R_MaterialMedProduct universal COCT_RM230000

5.2 Used In this Domain

Pharmacy Administration Event Complete (PORX_HD014400)
A_EncounterDetailed COCT_MT010101
A_ObservationAnnotationDetailed COCT_MT120401
A_ObservationSupportingUniversal COCT_MT120200
R_AssignedDeviceIdentified COCT_MT090302
R_AssignedPersonIdentified COCT_MT090102
R_MaterialMedProductUniversal COCT_MT230000
R_PatientUniversal COCT_MT050000

Dutch Med Review (PORX_HD100400)

A_CoverageUniversal COCT_MT180000
R_AssignedPersonUniversal COCT_MT090100
R_MaterialMedPackagedUniversal COCT_MT220000
R_MaterialMedProductUniversal COCT_MT230000
R_PatientUniversal COCT_MT050000
 Interaction Indexes
5.3 Domain Table of Contents

5.3.1 Interaction Index by Application Role

Pharmacy Combined Order Global Placer (PORX_AR002132)
Interactions in which this application role is the sender:
Community Pharmacy Combined Order Activate, Fulfilment
PORX_IN000007
Request
Interactions in which this application role is the receiver:
Community Pharmacy Supply Event Complete, Notification PORX_IN000008
Community Pharmacy Combined Order Activate, Rejection PORX_IN000009
Pharmacy Combined Order Global Fulfiller (PORX_AR002142)
Interactions in which this application role is the sender:
Community Pharmacy Supply Event Complete, Notification PORX_IN000008
Community Pharmacy Combined Order Activate, Rejection PORX_IN000009
Interactions in which this application role is the receiver:
Community Pharmacy Combined Order Activate, Fulfilment
PORX_IN000007
Request

5.3.2 Interaction Index by Trigger Event

Pharmacy Combined Order Activate, Fulfillment Request
(PORX_TE002120)
Community Pharmacy Combined Order Activate, Fulfilment
PORX_IN000007
Request
Combined Pharmacy Event Complete, Notification (PORX_TE004410)
Community Pharmacy Supply Event Complete, Notification PORX_IN000008

5.3.3 Interaction Index by Message Type

Preface (PORX_MT999999)
Preface PORX_IN999999
Community Pharmacy Combined Order Activate, Rejection PORX_IN000009
Community Pharmacy Combined Order Activate, Fulfilment
PORX_IN000007
Request
Community Pharmacy Supply Event Complete, Notification PORX_IN000008