Implementation Guide
ePA Medication Service
Version 1.2.0-ballot.2 - draft

## Operation API: eMP-Eintrag aktualisieren

Die auf dieser Seite dargestellten Inhalte geben den Stand der Version 1.2.0-ballot.1 wieder. Rückmeldungen aus dem laufenden Kommentierungsverfahren sowie daraus resultierende fachliche oder technische Anpassungen sind in dieser Fassung noch nicht oder nur teilweise berücksichtigt.

Die Operation eMP-Eintrag aktualisieren dient der gezielten Aktualisierung eines bestehenden Medikationseintrags im elektronischen Medikationsplan (eMP). Sie ermöglicht es, inhaltliche Änderungen an einer bereits dokumentierten Medikation vorzunehmen – beispielsweise um eine Notiz zu ergänzen, eine Dosierung zu verändern oder den Status des Eintrags zu aktualisieren.

### Nachricht

Die Nachricht zum Aktualisieren eines Medikationseintrags zum eMP wird als HTTP POST-Anfrage an den Medication Service gesendet. Als Eingabe werden eine MedicationRequest-Instanz mit dem Profil EMPMedicationRequest sowie ein eindeutiger Bezeichner (identifier[MedicationPlanIdentifier]) erwartet, über den der bestehende eMP-Eintrag im Medication Service identifiziert werden kann.

Die Medication-Instanz selbst wird ebenfalls geladen und ggf. aktualisiert – etwa wenn sich aus dem geänderten Status der MedicationRequest ergibt, dass die zugehörige Medikation nun ebenfalls als fehlerhaft (entered-in-error) oder inaktiv markiert werden muss.

Die Aktualisierung eines Eintrags kann auch dazu verwendet werden, den Eintrag aus dem aktuellen eMP zu entfernen. Dies geschieht nicht durch Löschen, sondern durch Setzen eines geeigneten Statuswertes wie beendet (completed), abgebrochen (stopped) oder fehlerhaft (entered-in-error). Nur Einträge mit den Statuswerten aktiv (active) oder pausiert (on-hold) werden bei der Erzeugung einer neuen eMP-Version berücksichtigt – Einträge mit anderen Statuswerten gelten als fachlich nicht mehr relevant für den aktuellen Plan.

#### Auslösung

Diese Operation des Medication Service dient dazu, bestehende eMP-Einträge gezielt zu aktualisieren oder aus dem elektronischen Medikationsplan (eMP) zu entfernen. Sie wird vom ePA-Client-System aufgerufen, wenn bereits dokumentierte Medikationseinträge angepasst oder aus dem eMP ausgeschlossen werden sollen – etwa durch Statusänderung auf stopped, completed oder entered-in-error.

#### Antwort

Die Operation gibt den erzeugten Medikationseintrag mit den Instanzen gemäß EMPMedicationRequest und EMPMedication als Ergebnis zurück.

#### FHIR Operation API

Das Primärsystem MUSS die Operation API: eMP-Eintrag aktualisieren implementieren, um einer Leistungserbringerinstitution das Aktualisieren eines Medikationseintrags zum eMP zu ermöglichen. Der Medication Service MUSS die Operation API: eMP-Eintrag aktualisieren gemäß der FHIR OperationDefinition eMP-Eintrag aktualisieren implementieren.

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known"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MSG_RESOURCE_ID_FAIL"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Invalid dosage structure or content"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_DOSAGE_INVALID"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Invalid Data Structure in Medication Service"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDICATIONSVC_NO_VALID_STRUCTURE"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Parameter with wrong status"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_STATUS_INVALID"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"409"},{"url":"description","valueString":"Mismatch between acknowledged and current eMP chronology ID"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_EMP_CHRONOLOGY_ID_MISMATCH"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"}],"name":"update-emp-entry","definition":"https://gematik.de/fhir/epa-medication/OperationDefinition/update-emp-entry-op"},{"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation","valueCode":"SHALL"},{"extension":[{"url":"name","valueString":"X-Requesting-Organization"},{"url":"type","valueString":"string"},{"url":"description","valueString":"Base64 encoded FHIR Organization resource in JSON format used to identify the originator of the request"},{"url":"format","valueString":"base64(fhir+json:Organization)"},{"url":"required","valueBoolean":true}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-header"},{"extension":[{"url":"statusCode","valueString":"200"},{"url":"description","valueString":"Successful operation"},{"url":"responseType","valueString":"Bundle"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Invalid request"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MSG_BAD_FORMAT"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"409"},{"url":"description","valueString":"Mismatch between acknowledged and current eMP chronology ID"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_EMP_CHRONOLOGY_ID_MISMATCH"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Invalid dosage structure or content"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_DOSAGE_INVALID"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Invalid Data Structure in Medication Service"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDICATIONSVC_NO_VALID_STRUCTURE"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"400"},{"url":"description","valueString":"Parameter with wrong status"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_STATUS_INVALID"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"409"},{"url":"description","valueString":"Update Conflict (server current version = %s, client version referenced = %s)"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MSG_VERSION_AWARE_CONFLICT"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"404"},{"url":"description","valueString":"Resource is not known"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MSG_RESOURCE_ID_FAIL"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"}],"name":"batch-emp","definition":"https://gematik.de/fhir/epa-medication/OperationDefinition/batch-emp-entries-op"},{"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation","valueCode":"SHALL"},{"extension":[{"url":"name","valueString":"X-Requesting-Organization"},{"url":"type","valueString":"string"},{"url":"description","valueString":"Base64 encoded FHIR Organization resource in JSON format used to identify the originator of the request"},{"url":"format","valueString":"base64(fhir+json:Organization)"},{"url":"required","valueBoolean":true}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-header"},{"extension":[{"url":"statusCode","valueString":"200"},{"url":"description","valueString":"Successful operation"},{"url":"responseType","valueString":"Parameters"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"405"},{"url":"description","valueString":"The operation can only be executed within a batch context"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_OPERATION_OUTSIDE_BATCH"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"},{"extension":[{"url":"statusCode","valueString":"409"},{"url":"description","valueString":"Mismatch between acknowledged and current eMP chronology ID"},{"url":"responseType","valueString":"EPAMSOperationOutcome"},{"url":"errorCode","valueString":"MEDSVC_EMP_CHRONOLOGY_ID_MISMATCH"}],"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-response-info"}],"name":"emp-commit","definition":"https://gematik.de/fhir/epa-medication/OperationDefinition/emp-commit-op"}]}]}

###

          {"resourceType":"OperationDefinition","id":"update-emp-entry-op","meta":{"profile":["https://gematik.de/fhir/ti/StructureDefinition/ti-operationdefinition"]},"text":{"status":"generated","div":"<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\">Generated Narrative: OperationDefinition update-emp-entry-op</p><a name=\"update-emp-entry-op\"> </a><a name=\"hcupdate-emp-entry-op\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"https://gematik.de/fhir/ti/1.1.1-ballot.1/StructureDefinition-ti-operationdefinition.html\">OperationDefinition Profil für TI FHIR Data Service</a></p></div>URL: [base]/$$update-emp-entryInput parameters Profile:<a href=\"StructureDefinition-epa-op-update-emp-entry-input-parameters.html\">EPA Operation UpdateEMPEntry Input-Parameters</a>Output parameters Profile:<a href=\"StructureDefinition-epa-op-emp-entry-output-parameters.html\">EPA Operation EMPEntry Output-Parameters</a>Parameters<table class=\"grid\">UseNameScopeCardinalityTypeBindingDocumentation</table></div>"},"extension":[{"url":"https://gematik.de/fhir/ti/StructureDefinition/extension-http-method","valueCode":"POST"}],"url":"https://gematik.de/fhir/epa-medication/OperationDefinition/update-emp-entry-op","version":"1.2.0-ballot.2","name":"updateEMPEntry_MedicationSvc","title":"eMP-Eintrag aktualisieren","status":"draft","kind":"operation","date":"2025-09-02","publisher":"gematik GmbH","contact":[{"name":"gematik GmbH","telecom":[{"system":"url","value":"https://www.gematik.de"},{"system":"email","value":"patientteam [ at ] gematik.de"}]}],"description":"Diese Operation dient der gezielten Aktualisierung eines bestehenden Medikations-Eintrags im elektronischen Medikationsplan (eMP).","jurisdiction":[{"coding":[{"system":"urn:iso:std:iso:3166","code":"DE"}]}],"affectsState":true,"code":"update-emp-entry","system":true,"type":false,"instance":false,"inputProfile":"https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-update-emp-entry-input-parameters","outputProfile":"https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-emp-entry-output-parameters"}

    {
      "resourceType" : "Parameters",
      "id" : "example-epa-op-update-emp-entry-input-parameters-1",
      "meta" : {
        "profile" : [
          🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-update-emp-entry-input-parameters"
        ]
      },
      "parameter" : [
        {
          "name" : "acknowledgedChronologyId",
          "valueId" : "b467ce05-e0e5-4d71-9a0b-d824dbb492ef"
        },
        {
          "name" : "medicationPlanIdentifier",
          "valueIdentifier" : {
            "system" : "https://gematik.de/fhir/sid/emp-identifier",
            "value" : "3dfe8327-dd4c-4e53-a695-cd2e0b21e699"
          }
        },
        {
          "name" : "empEntry",
          "resource" : {
            "resourceType" : "MedicationRequest",
            "id" : "3dfe8327-dd4c-4e53-a695-cd2e0b21e699",
            "meta" : {
              "versionId" : "1",
              "lastUpdated" : "2026-12-01T14:00:00.400Z",
              "profile" : [
                🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication-request"
              ]
            },
            "extension" : [
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension",
                "valueCode" : "EMP"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/reason-patient-instruction-extension",
                "valueString" : "Bluthochdruck"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/patient-note-extension",
                "valueAnnotation" : {
                  "text" : "Benazepril kann anfangs Schwindel verursachen - daher zuerst in Ruhe einnehmen und Autofahren vermeiden."
                }
              },
              {
                "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.effectiveDosePeriod",
                "valuePeriod" : {
                  "start" : "2026-12-01"
                }
              }
            ],
            "identifier" : [
              {
                "system" : "https://gematik.de/fhir/sid/emp-identifier",
                "value" : "3dfe8327-dd4c-4e53-a695-cd2e0b21e699"
              }
            ],
            "status" : "active",
            "intent" : "plan",
            "medicationReference" : {
              🔗 "reference" : "Medication/13c66845-d0ce-43e1-9b0b-884cbbe8df7f"
            },
            "subject" : {
              "identifier" : {
                "system" : "http://fhir.de/sid/gkv/kvid-10",
                "value" : "X110411319"
              }
            },
            "authoredOn" : "2026-12-01",
            "note" : [
              {
                "text" : "Hinweis für den LE"
              }
            ],
            "dosageInstruction" : [
              {
                "extension" : [
                  {
                    "extension" : [
                      {
                        "url" : "algorithm",
                        "valueCoding" : {
                          "system" : "http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithm",
                          "version" : "1.0.0",
                          "code" : "GematikDosageTextGenerator"
                        }
                      },
                      {
                        "url" : "algorithmVersion",
                        "valueString" : "1.0.0"
                      },
                      {
                        "url" : "language",
                        "valueCode" : "de-DE"
                      },
                      {
                        "url" : "text",
                        "valueString" : "2 x täglich: morgens und abends — je 1 Stück"
                      }
                    ],
                    "url" : "http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructions"
                  }
                ],
                "timing" : {
                  "repeat" : {
                    "frequency" : 2,
                    "period" : 1,
                    "periodUnit" : "d",
                    "when" : [
                      "MORN",
                      "EVE"
                    ]
                  }
                },
                "doseAndRate" : [
                  {
                    "doseQuantity" : {
                      "value" : 1,
                      "unit" : "Stück",
                      "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_BMP_DOSIEREINHEIT",
                      "code" : "1"
                    }
                  }
                ]
              }
            ]
          }
        }
      ]
    }

    <Parameters xmlns="http://hl7.org/fhir">
      <id value="example-epa-op-update-emp-entry-input-parameters-1"/>
      <meta>
        <profile
                 value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-update-emp-entry-input-parameters"/>
      </meta>
      <parameter>
        <name value="acknowledgedChronologyId"/>
        <valueId value="b467ce05-e0e5-4d71-9a0b-d824dbb492ef"/>
      </parameter>
      <parameter>
        <name value="medicationPlanIdentifier"/>
        <valueIdentifier>
          <system value="https://gematik.de/fhir/sid/emp-identifier"/>
          <value value="3dfe8327-dd4c-4e53-a695-cd2e0b21e699"/>
        </valueIdentifier>
      </parameter>
      <parameter>
        <name value="empEntry"/>
        <resource>
          <MedicationRequest>
            <id value="3dfe8327-dd4c-4e53-a695-cd2e0b21e699"/>
            <meta>
              <versionId value="1"/>
              <lastUpdated value="2026-12-01T14:00:00.400Z"/>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication-request"/>
            </meta>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension">
              <valueCode value="EMP"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/reason-patient-instruction-extension">
              <valueString value="Bluthochdruck"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/patient-note-extension">
              <valueAnnotation>
                <text
                      value="Benazepril kann anfangs Schwindel verursachen - daher zuerst in Ruhe einnehmen und Autofahren vermeiden."/>
              </valueAnnotation>
            </extension>
            <extension
                       url="http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.effectiveDosePeriod">
              <valuePeriod>
                <start value="2026-12-01"/>
              </valuePeriod>
            </extension>
            <identifier>
              <system value="https://gematik.de/fhir/sid/emp-identifier"/>
              <value value="3dfe8327-dd4c-4e53-a695-cd2e0b21e699"/>
            </identifier>
            <status value="active"/>
            <intent value="plan"/>
            <medicationReference>🔗
              <reference value="Medication/13c66845-d0ce-43e1-9b0b-884cbbe8df7f"/>
            </medicationReference>
            <subject>
              <identifier>
                <system value="http://fhir.de/sid/gkv/kvid-10"/>
                <value value="X110411319"/>
              </identifier>
            </subject>
            <authoredOn value="2026-12-01"/>
            <note>
              <text value="Hinweis für den LE"/>
            </note>
            <dosageInstruction>
              <extension
                         url="http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructions">
                <extension url="algorithm">
                  <valueCoding>
                    <system
                            value="http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithm"/>
                    <version value="1.0.0"/>
                    <code value="GematikDosageTextGenerator"/>
                  </valueCoding>
                </extension>
                <extension url="algorithmVersion">
                  <valueString value="1.0.0"/>
                </extension>
                <extension url="language">
                  <valueCode value="de-DE"/>
                </extension>
                <extension url="text">
                  <valueString
                               value="2 x täglich: morgens und abends — je 1 Stück"/>
                </extension>
              </extension>
              <timing>
                <repeat>
                  <frequency value="2"/>
                  <period value="1"/>
                  <periodUnit value="d"/>
                  <when value="MORN"/>
                  <when value="EVE"/>
                </repeat>
              </timing>
              <doseAndRate>
                <doseQuantity>
                  <value value="1"/>
                  <unit value="Stück"/>
                  <system
                          value="https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_BMP_DOSIEREINHEIT"/>
                  <code value="1"/>
                </doseQuantity>
              </doseAndRate>
            </dosageInstruction>
          </MedicationRequest>
        </resource>
      </parameter>
    </Parameters>

    {
      "resourceType" : "Parameters",
      "id" : "example-epa-op-emp-entry-output-parameters-2",
      "meta" : {
        "profile" : [
          🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-emp-entry-output-parameters"
        ]
      },
      "parameter" : [
        {
          "name" : "empEntry",
          "resource" : {
            "resourceType" : "MedicationRequest",
            "id" : "3dfe8327-dd4c-4e53-a695-cd2e0b21e699",
            "meta" : {
              "versionId" : "2",
              "lastUpdated" : "2026-12-15T14:00:00.400Z",
              "profile" : [
                🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication-request"
              ]
            },
            "extension" : [
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension",
                "valueCode" : "EMP"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/reason-patient-instruction-extension",
                "valueString" : "Bluthochdruck"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/patient-note-extension",
                "valueAnnotation" : {
                  "text" : "Benazepril kann anfangs Schwindel verursachen - daher zuerst in Ruhe einnehmen und Autofahren vermeiden."
                }
              },
              {
                "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.effectiveDosePeriod",
                "valuePeriod" : {
                  "start" : "2026-12-01"
                }
              }
            ],
            "identifier" : [
              {
                "system" : "https://gematik.de/fhir/sid/emp-identifier",
                "value" : "3dfe8327-dd4c-4e53-a695-cd2e0b21e699"
              }
            ],
            "status" : "active",
            "intent" : "plan",
            "medicationReference" : {
              🔗 "reference" : "Medication/13c66845-d0ce-43e1-9b0b-884cbbe8df7f"
            },
            "subject" : {
              "identifier" : {
                "system" : "http://fhir.de/sid/gkv/kvid-10",
                "value" : "X110411319"
              }
            },
            "authoredOn" : "2026-12-01",
            "note" : [
              {
                "text" : "Hinweis für den LE"
              }
            ],
            "dosageInstruction" : [
              {
                "extension" : [
                  {
                    "extension" : [
                      {
                        "url" : "algorithm",
                        "valueCoding" : {
                          "system" : "http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithm",
                          "version" : "1.0.0",
                          "code" : "GematikDosageTextGenerator"
                        }
                      },
                      {
                        "url" : "algorithmVersion",
                        "valueString" : "1.0.0"
                      },
                      {
                        "url" : "language",
                        "valueCode" : "de-DE"
                      },
                      {
                        "url" : "text",
                        "valueString" : "2 x täglich: morgens und abends — je 1 Stück"
                      }
                    ],
                    "url" : "http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructions"
                  }
                ],
                "timing" : {
                  "repeat" : {
                    "frequency" : 2,
                    "period" : 1,
                    "periodUnit" : "d",
                    "when" : [
                      "MORN",
                      "EVE"
                    ]
                  }
                },
                "doseAndRate" : [
                  {
                    "doseQuantity" : {
                      "value" : 1,
                      "unit" : "Stück",
                      "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_BMP_DOSIEREINHEIT",
                      "code" : "1"
                    }
                  }
                ]
              }
            ]
          }
        },
        {
          "name" : "medication",
          "resource" : {
            "resourceType" : "Medication",
            "id" : "13c66845-d0ce-43e1-9b0b-884cbbe8df7f",
            "meta" : {
              "versionId" : "1",
              "lastUpdated" : "2026-12-01T14:00:00.200Z",
              "profile" : [
                🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication"
              ]
            },
            "extension" : [
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension",
                "valueCode" : "EMP"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-type-extension",
                "valueCoding" : {
                  "system" : "http://snomed.info/sct",
                  "code" : "763158003",
                  "display" : "Medicinal product (product)"
                }
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/drug-category-extension",
                "valueCoding" : {
                  "system" : "https://gematik.de/fhir/epa-medication/CodeSystem/epa-drug-category-cs",
                  "code" : "00"
                }
              },
              {
                "url" : "http://fhir.de/StructureDefinition/normgroesse",
                "valueCode" : "N3"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/medication-id-vaccine-extension",
                "valueBoolean" : false
              }
            ],
            "identifier" : [
              {
                "system" : "https://gematik.de/fhir/epa-medication/sid/epa-medication-unique-identifier",
                "value" : "D15E4956F59A13CD3BB365799857D6FA9757C62D36DBDB9578D018CA4B6D969F"
              }
            ],
            "code" : {
              "coding" : [
                {
                  "system" : "http://fhir.de/CodeSystem/ifa/pzn",
                  "code" : "04351736",
                  "display" : "Benazepril AL 20mg 98 Filmtabletten N3"
                }
              ],
              "text" : "Benazepril AL 20mg 98 Filmtabletten N3"
            },
            "status" : "active",
            "form" : {
              "coding" : [
                {
                  "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM",
                  "code" : "FTA"
                }
              ]
            },
            "amount" : {
              "numerator" : {
                "extension" : [
                  {
                    "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/medication-total-quantity-formulation-extension",
                    "valueString" : "98"
                  }
                ],
                "unit" : "Stück"
              },
              "denominator" : {
                "value" : 1
              }
            },
            "ingredient" : [
              {
                "itemCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "http://fhir.de/CodeSystem/ask",
                      "code" : "23413"
                    }
                  ],
                  "text" : "Benazepril hydrochlorid"
                },
                "strength" : {
                  "numerator" : {
                    "value" : 20,
                    "unit" : "mg"
                  },
                  "denominator" : {
                    "value" : 1,
                    "unit" : "Filmtbl."
                  }
                }
              }
            ]
          }
        },
        {
          "name" : "relatedActivity",
          "resource" : {
            "resourceType" : "Provenance",
            "id" : "d79a8998-0143-47df-9b07-d0d4d6e8c64b",
            "meta" : {
              "profile" : [
                🔗 "https://gematik.de/fhir/epa/StructureDefinition/epa-activity-provenance"
              ]
            },
            "target" : [
              {
                "reference" : "MedicationRequest/3dfe8327-dd4c-4e53-a695-cd2e0b21e699/_history/2"
              }
            ],
            "recorded" : "2026-12-15T14:00:00.100Z",
            "activity" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v3-DataOperation",
                  "code" : "UPDATE"
                }
              ]
            },
            "agent" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                      "code" : "author"
                    }
                  ]
                },
                "who" : {
                  🔗 "reference" : "Organization/450a9511-53e5-4af7-be36-a18444bb8dd2",
                  "identifier" : {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "PRN"
                        }
                      ]
                    },
                    "system" : "https://gematik.de/fhir/sid/telematik-id",
                    "value" : "9-2.58.00000089"
                  },
                  "display" : "Die Hausarztpraxis"
                }
              }
            ]
          }
        },
        {
          "name" : "relatedChronology",
          "resource" : {
            "resourceType" : "Provenance",
            "id" : "6c98e872-4247-4a54-aa7f-6967b099656a",
            "meta" : {
              "profile" : [
                🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/emp-chronology-provenance"
              ]
            },
            "extension" : [
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/is-emp-chronology-extension",
                "valueBoolean" : true
              }
            ],
            "target" : [
              {
                "reference" : "MedicationRequest/173439a1-40ee-4b61-bb8c-aab3f5a1af10/_history/2"
              },
              {
                "reference" : "MedicationRequest/e2da4372-accc-4a76-81da-83e43ef9b15a/_history/1"
              },
              {
                "reference" : "MedicationRequest/3dfe8327-dd4c-4e53-a695-cd2e0b21e699/_history/2"
              }
            ],
            "occurredDateTime" : "2026-12-15T14:00:00.100Z",
            "recorded" : "2026-12-15T14:00:00.100Z",
            "activity" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v3-DataOperation",
                  "code" : "UPDATE"
                }
              ]
            },
            "agent" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                      "code" : "author"
                    }
                  ]
                },
                "who" : {
                  🔗 "reference" : "Organization/450a9511-53e5-4af7-be36-a18444bb8dd2",
                  "identifier" : {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "PRN"
                        }
                      ]
                    },
                    "system" : "https://gematik.de/fhir/sid/telematik-id",
                    "value" : "9-2.58.00000089"
                  },
                  "display" : "Die Hausarztpraxis"
                }
              }
            ]
          }
        }
      ]
    }

    <Parameters xmlns="http://hl7.org/fhir">
      <id value="example-epa-op-emp-entry-output-parameters-2"/>
      <meta>
        <profile
                 value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-emp-entry-output-parameters"/>
      </meta>
      <parameter>
        <name value="empEntry"/>
        <resource>
          <MedicationRequest>
            <id value="3dfe8327-dd4c-4e53-a695-cd2e0b21e699"/>
            <meta>
              <versionId value="2"/>
              <lastUpdated value="2026-12-15T14:00:00.400Z"/>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication-request"/>
            </meta>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension">
              <valueCode value="EMP"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/reason-patient-instruction-extension">
              <valueString value="Bluthochdruck"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/patient-note-extension">
              <valueAnnotation>
                <text
                      value="Benazepril kann anfangs Schwindel verursachen - daher zuerst in Ruhe einnehmen und Autofahren vermeiden."/>
              </valueAnnotation>
            </extension>
            <extension
                       url="http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.effectiveDosePeriod">
              <valuePeriod>
                <start value="2026-12-01"/>
              </valuePeriod>
            </extension>
            <identifier>
              <system value="https://gematik.de/fhir/sid/emp-identifier"/>
              <value value="3dfe8327-dd4c-4e53-a695-cd2e0b21e699"/>
            </identifier>
            <status value="active"/>
            <intent value="plan"/>
            <medicationReference>🔗
              <reference value="Medication/13c66845-d0ce-43e1-9b0b-884cbbe8df7f"/>
            </medicationReference>
            <subject>
              <identifier>
                <system value="http://fhir.de/sid/gkv/kvid-10"/>
                <value value="X110411319"/>
              </identifier>
            </subject>
            <authoredOn value="2026-12-01"/>
            <note>
              <text value="Hinweis für den LE"/>
            </note>
            <dosageInstruction>
              <extension
                         url="http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructions">
                <extension url="algorithm">
                  <valueCoding>
                    <system
                            value="http://ig.fhir.de/igs/medication/CodeSystem/DosageTextAlgorithm"/>
                    <version value="1.0.0"/>
                    <code value="GematikDosageTextGenerator"/>
                  </valueCoding>
                </extension>
                <extension url="algorithmVersion">
                  <valueString value="1.0.0"/>
                </extension>
                <extension url="language">
                  <valueCode value="de-DE"/>
                </extension>
                <extension url="text">
                  <valueString
                               value="2 x täglich: morgens und abends — je 1 Stück"/>
                </extension>
              </extension>
              <timing>
                <repeat>
                  <frequency value="2"/>
                  <period value="1"/>
                  <periodUnit value="d"/>
                  <when value="MORN"/>
                  <when value="EVE"/>
                </repeat>
              </timing>
              <doseAndRate>
                <doseQuantity>
                  <value value="1"/>
                  <unit value="Stück"/>
                  <system
                          value="https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_BMP_DOSIEREINHEIT"/>
                  <code value="1"/>
                </doseQuantity>
              </doseAndRate>
            </dosageInstruction>
          </MedicationRequest>
        </resource>
      </parameter>
      <parameter>
        <name value="medication"/>
        <resource>
          <Medication>
            <id value="13c66845-d0ce-43e1-9b0b-884cbbe8df7f"/>
            <meta>
              <versionId value="1"/>
              <lastUpdated value="2026-12-01T14:00:00.200Z"/>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication"/>
            </meta>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension">
              <valueCode value="EMP"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-type-extension">
              <valueCoding>
                <system value="http://snomed.info/sct"/>
                <code value="763158003"/>
                <display value="Medicinal product (product)"/>
              </valueCoding>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/drug-category-extension">
              <valueCoding>
                <system
                        value="https://gematik.de/fhir/epa-medication/CodeSystem/epa-drug-category-cs"/>
                <code value="00"/>
              </valueCoding>
            </extension>
            <extension url="http://fhir.de/StructureDefinition/normgroesse">
              <valueCode value="N3"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/medication-id-vaccine-extension">
              <valueBoolean value="false"/>
            </extension>
            <identifier>
              <system
                      value="https://gematik.de/fhir/epa-medication/sid/epa-medication-unique-identifier"/>
              <value
                     value="D15E4956F59A13CD3BB365799857D6FA9757C62D36DBDB9578D018CA4B6D969F"/>
            </identifier>
            <code>
              <coding>
                <system value="http://fhir.de/CodeSystem/ifa/pzn"/>
                <code value="04351736"/>
                <display value="Benazepril AL 20mg 98 Filmtabletten N3"/>
              </coding>
              <text value="Benazepril AL 20mg 98 Filmtabletten N3"/>
            </code>
            <status value="active"/>
            <form>
              <coding>
                <system
                        value="https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM"/>
                <code value="FTA"/>
              </coding>
            </form>
            <amount>
              <numerator>
                <extension
                           url="https://gematik.de/fhir/epa-medication/StructureDefinition/medication-total-quantity-formulation-extension">
                  <valueString value="98"/>
                </extension>
                <unit value="Stück"/>
              </numerator>
              <denominator>
                <value value="1"/>
              </denominator>
            </amount>
            <ingredient>
              <itemCodeableConcept>
                <coding>
                  <system value="http://fhir.de/CodeSystem/ask"/>
                  <code value="23413"/>
                </coding>
                <text value="Benazepril hydrochlorid"/>
              </itemCodeableConcept>
              <strength>
                <numerator>
                  <value value="20"/>
                  <unit value="mg"/>
                </numerator>
                <denominator>
                  <value value="1"/>
                  <unit value="Filmtbl."/>
                </denominator>
              </strength>
            </ingredient>
          </Medication>
        </resource>
      </parameter>
      <parameter>
        <name value="relatedActivity"/>
        <resource>
          <Provenance>
            <id value="d79a8998-0143-47df-9b07-d0d4d6e8c64b"/>
            <meta>
              <profile
                       value="https://gematik.de/fhir/epa/StructureDefinition/epa-activity-provenance"/>
            </meta>
            <target>
              <reference
                         value="MedicationRequest/3dfe8327-dd4c-4e53-a695-cd2e0b21e699/_history/2"/>
            </target>
            <recorded value="2026-12-15T14:00:00.100Z"/>
            <activity>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/v3-DataOperation"/>
                <code value="UPDATE"/>
              </coding>
            </activity>
            <agent>
              <type>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
                  <code value="author"/>
                </coding>
              </type>
              <who>🔗
                <reference
                           value="Organization/450a9511-53e5-4af7-be36-a18444bb8dd2"/>
                <identifier>
                  <type>
                    <coding>
                      <system
                              value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                      <code value="PRN"/>
                    </coding>
                  </type>
                  <system value="https://gematik.de/fhir/sid/telematik-id"/>
                  <value value="9-2.58.00000089"/>
                </identifier>
                <display value="Die Hausarztpraxis"/>
              </who>
            </agent>
          </Provenance>
        </resource>
      </parameter>
      <parameter>
        <name value="relatedChronology"/>
        <resource>
          <Provenance>
            <id value="6c98e872-4247-4a54-aa7f-6967b099656a"/>
            <meta>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/emp-chronology-provenance"/>
            </meta>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/is-emp-chronology-extension">
              <valueBoolean value="true"/>
            </extension>
            <target>
              <reference
                         value="MedicationRequest/173439a1-40ee-4b61-bb8c-aab3f5a1af10/_history/2"/>
            </target>
            <target>
              <reference
                         value="MedicationRequest/e2da4372-accc-4a76-81da-83e43ef9b15a/_history/1"/>
            </target>
            <target>
              <reference
                         value="MedicationRequest/3dfe8327-dd4c-4e53-a695-cd2e0b21e699/_history/2"/>
            </target>
            <occurredDateTime value="2026-12-15T14:00:00.100Z"/>
            <recorded value="2026-12-15T14:00:00.100Z"/>
            <activity>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/v3-DataOperation"/>
                <code value="UPDATE"/>
              </coding>
            </activity>
            <agent>
              <type>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
                  <code value="author"/>
                </coding>
              </type>
              <who>🔗
                <reference
                           value="Organization/450a9511-53e5-4af7-be36-a18444bb8dd2"/>
                <identifier>
                  <type>
                    <coding>
                      <system
                              value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                      <code value="PRN"/>
                    </coding>
                  </type>
                  <system value="https://gematik.de/fhir/sid/telematik-id"/>
                  <value value="9-2.58.00000089"/>
                </identifier>
                <display value="Die Hausarztpraxis"/>
              </who>
            </agent>
          </Provenance>
        </resource>
      </parameter>
    </Parameters>

### Geschäftslogik

Wurde ein Eintrag erfolgreich geändert, wird automatisch eine neue Version des eMP erzeugt. Dabei wird eine Provenance-Instanz vom Profil EMPChronologyProvenance erstellt, die alle derzeit relevanten MedicationRequest-Instanzen im Kontext des eMP referenziert. Diese Version bildet den neuen Stand des Medikationsplans ab. Als Lesenachweis für diesen Stand dient die Resource.id der soeben erzeugten Provenance-Instanz mit isEMPChronology = true.

Zusätzlich wird auch eine Provenance-Instanz vom Profil EPAActivityProvenance erzeugt, um die durchgeführte Aktivität (UPDATE) zu dokumentieren. Diese verweist auf die aktualisierte MedicationRequest-Instanz und gibt die Organisation an, die die Änderung vorgenommen hat – abgeleitet aus dem HTTP-Header X-Requesting-Organization.

Das Ergebnis dieser Operation wird im Format eines Output-Parameters zurückgegeben, welcher die aktualisierten bzw. geladenen Ressourcen enthält (einschließlich beider Provenance-Instanzen).

Der Medication Service MUSS die Geschäftlogik der Operation eMP-Eintrag aktualisieren gemäß dem Aktivitätsdiagramm mit der ID IG-MED-BL-UPDATE-EMP-ENTRY-V1 ausführen. Dabei sind alle mit transaction gekennzeichneten Abschnitte entsprechend den Transaktionssicherheitsregeln der ePA umzusetzen, sodass diese Abschnitte mit ihren Verarbeitungsschritten atomar, konsistent und isoliert durchgeführt werden.
Abbildung: Geschäftslogik für die Operation eMP-Eintrag aktualisieren

### Sicherheitsanforderungen

Generelle Sicherheitsanforderungen werden hier festgehalten.