Recip-e for elderly care institutions

Recip-e is the Belgian electronic prescription format. As the use case for elderly care institutions is different from the one for ambulatory patients, a specific flow has been defined. See the diagram below for more explanation.

1. The elderly care institution sends the prescriptionrequests via eHealthbox to the medical doctor
2. If the doctor validates the prescription, he sends the request to Recip-e
3. Recip-e sends a RID (Recip-e ID) to the doctor
4. If the prescription has been validated, the doctor sends a prescription validation to the elderly care institution. If it is denied, the doctor sends a prescription denial (with a reason why).
5. The elderly care institution sends the Orderlink to the pharmacy via eHealthBox. For this reason the Orderlink has been modified. The RID has been added, among other things (see modification in version 1.6)
6. The pharmacy checks if the RID exists on Recip-e
7. The RID is marked as delivered
8. The medication is delivered (or added to the robot)

PS. The red arrows represent data sent via eHealthbox

Remarks and special usecases:

1. The description for the prescriptionrequest can be found here.
2. The description for the prescriptionacceptation can be found here.
3. The description for the prescriptiondenial can be found here.
4. The description for the prescriptionerror can be found here.
5. In this flow no paper is needed anymore, not even the "proof of electronic prescription". All parties just need the RID, which will be shared in the different files described this flow.
6. Officially the paper prescription isn't allowed anymore as of 1/1/2018. But in the case of elderly care institutions the paper flow will still be accepted for a short period in 2018, so all software vendors have enough time to integrate this digital flow. This period has not been defined yet. This means that when starting this project a mixed situation where some doctors will already be able to prescribe electronic and some won't to be foreseen.
7. When starting a new medication, the elderly care institution will have to add it in its software and send the prescription request to the doctor. It is not allowed to start the flow from the medical software. This is done so because the formulary from the elderly care institution and the pharmacy are aligned, which is not the case for the doctor.
8. The doctor can only accept or refuse the prescription. Modification is not allowed. If this is needed, he wil have to refuse it and mention that he wants a modification. A new request has then to be sent to the doctor, after the modification was treated in the elderly care institution.
9. When a prescription is refused the reason why is mandatory.
10. If there is an structural error with the request, a prescription error file has to be sent, where the reason why is also mandatory.
11. On a normal base an order without RID should not be allowed, only if urgent. In that case the RID has to be sent in the next Orderlink. See description Orderlink 1.6
12. If the medication schedules are managed in the pharmacy, the same flow has to be implemented starting from the pharmacy software and sending prescription requests directly to the doctors.
13. Preferably every prescription is for only one medication, however more are allowed.
14. Every prescription and their validation/refusal is sent as 1 attachment in 1 eHealthBox message. (ex. 5 prescriptions = 5 messages)
15. In order to provide a full view of the medication schedule for the doctor, a schedule in pdf has to be added to the prescription request.
16. Medical software vendors are asked to provide a mobile functionality to validate the prescription. But this will take some time to be the case for all software packages.