Implementation Guide
ePA Medication Service
Version 1.3.3 - release

## Operation API: Entfernen einer eML-eMP-Verknüpfung

Die Operation Entfernen einer eML-eMP-Verknüpfung dient dazu, die Verknüpfung zwischen einem bestehenden eML-Eintrag (MedicationStatement) und einem dokumentierten eMP-Eintrag (MedicationRequest) gezielt aufzuheben.

Als Ergebnis wird eine neue Version des elektronischen Medikationsplans (eMP) erstellt. Die Rückgabe der Operation enthält die folgenden Elemente:

- den aktualisierten MedicationStatement (nun ohne Verknüpfung),
- den betroffenen MedicationRequest (eMP-Eintrag),
- eine Provenance-Ressource zur Beschreibung der Aktivität (z. B. wer die Entknüpfung vorgenommen hat),
- sowie eine Provenance-Ressource zur Beschreibung der neuen eMP-Version (Chronologieeintrag).

Diese Informationen ermöglichen die vollständige Nachvollziehbarkeit der Änderung und sichern die Konsistenz zwischen eML und eMP.

### Nachricht

Die Nachricht zur Entfernung einer Verknüpfung zwischen einem eML-Eintrag und einem eMP-Eintrag wird als HTTP POST-Anfrage an den Medication Service auf die betreffende MedicationStatement-Instanz gesendet.

#### Verwendung des HTTP Header X-Requesting-Organization

Bei der Ausführung dieser Operation ist der HTTP Header X-Requesting-Organization mitzugeben. Er enthält eine FHIR Organization-Ressource im Format FHIR+JSON, die Base64-kodiert übermittelt wird.

Die übermittelte Organisation dient zur Identifikation der anfragenden Leistungserbringerinstitution (LEI). Sie wird vom Service validiert, in jedem Änderungseintrag (Provenance nach dem Profil EPA Activity Provenance) der betroffenen Instanz referenziert und zusätzlich im Medication Service als Organization-Ressource dedupliziert gespeichert. Dadurch ist sichergestellt, dass alle Änderungen eindeutig einer LEI zugeordnet und auch über die Query API nachvollzogen werden können

#### Auslösung

Diese Operation des Medication Service dient dazu, eine Verknüpfung zwischen einem bestehenden eML-Eintrag (MedicationStatement) und einem dokumentierten eMP-Eintrag (MedicationRequest) aufzuheben. Die Nachricht wird vom ePA-Client-System gesendet, wenn erkannt wird, dass die Verknüpfung nicht korrekt war und rückgängig gemacht werden muss.

#### Antwort

Die Operation gibt den aktualisierten eML-Eintrag (MedicationStatement) ohne Verknüpfung, den betroffenen eMP-Eintrag (MedicationRequest) sowie die zugehörigen Provenance-Ressourcen zur Beschreibung der Aktion und der neuen eMP-Version zurück.

#### FHIR Operation API

Das Primärsystem MUSS die Operation Entfernen einer eML-eMP-Verknüpfung implementieren, um eine eML-eMP-Verknüpfung zu entfernen. Das Primärsystem MUSS für die Ausführung der Operation Entfernen einer eML-eMP-Verknüpfung den HTTP Header X-Requesting-Organization übermitteln. Der Medication Service MUSS für die Operation Entfernen einer eML-eMP-Verknüpfung die im HTTP Header X-Requesting-Organization enthaltene Organization-Ressource validieren, im Änderungseintrag (</i>Provenance</i> nach dem Profil EPAActivityProvenance) referenzieren und als Organization-Instanz dedupliziert speichern. Der Medication Service MUSS die Operation Entfernen einer eML-eMP-Verknüpfung gemäß der FHIR OperationDefinition eMP-Verknüpfung entfernen ausführen.

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###

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      "id" : "example-epa-op-unlink-emp-entry-parameters-1",
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          "name" : "medicationPlanIdentifier",
          "valueIdentifier" : {
            "system" : "https://gematik.de/fhir/sid/emp-identifier",
            "value" : "266620a9-2c26-41c1-b0cb-a10947b867f5"
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      <id value="example-epa-op-unlink-emp-entry-parameters-1"/>
      <meta>
        <profile
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      </meta>
      <parameter>
        <name value="acknowledgedChronologyId"/>
        <valueId value="0b383501-f078-464b-b984-9fdb6751601b"/>
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      <parameter>
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    </Parameters>

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      "id" : "example-epa-op-unlink-emp-entry-output-parameters-1",
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      },
      "parameter" : [
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          "name" : "medicationStatement",
          "resource" : {
            "resourceType" : "MedicationStatement",
            "id" : "3afe43bc-8b57-417f-9e84-a70ea5062a6c",
            "meta" : {
              "versionId" : "3",
              "lastUpdated" : "2026-11-25T14:00:00.000Z",
              "profile" : [
                🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-statement|1.3.0"
              ]
            },
            "extension" : [
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension",
                "valueCode" : "MANUAL"
              },
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                "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationStatement.renderedDosageInstruction",
                "valueMarkdown" : "1-0-0-0 Stück"
              },
              {
                "extension" : [
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                    "url" : "algorithmVersion",
                    "valueString" : "1.0.1"
                  },
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                    "url" : "language",
                    "valueCode" : "de-DE"
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                ],
                "url" : "http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructionsMeta"
              }
            ],
            "status" : "unknown",
            "medicationReference" : {
              "reference" : "Medication/b43cb3c2-552a-4da1-9eaa-605ac532a83d"
            },
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              "identifier" : {
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                    "period" : 1,
                    "periodUnit" : "d",
                    "when" : [
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                  }
                },
                "doseAndRate" : [
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                    "doseQuantity" : {
                      "value" : 1,
                      "unit" : "Stück",
                      "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_BMP_DOSIEREINHEIT",
                      "code" : "1"
                    }
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              }
            ]
          }
        },
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          "name" : "empEntry",
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            "resourceType" : "MedicationRequest",
            "id" : "266620a9-2c26-41c1-b0cb-a10947b867f5",
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              "lastUpdated" : "2026-11-25T14:00:00.000Z",
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            },
            "extension" : [
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                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension",
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                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/reason-patient-instruction-extension",
                "valueString" : "Kopfschmerzen"
              },
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/patient-note-extension",
                "valueAnnotation" : {
                  "text" : "Alkohol: das Risiko für Magen-Darm-Geschwüre und -Blutungen ist erhöht."
                }
              },
              {
                "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.effectiveDosePeriod",
                "valuePeriod" : {
                  "start" : "2026-11-02"
                }
              },
              {
                "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.renderedDosageInstruction",
                "valueMarkdown" : "1-0-0-0 Stück"
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              {
                "extension" : [
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                    "url" : "algorithmVersion",
                    "valueString" : "1.0.1"
                  },
                  {
                    "url" : "language",
                    "valueCode" : "de-DE"
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                ],
                "url" : "http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructionsMeta"
              }
            ],
            "identifier" : [
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                "system" : "https://gematik.de/fhir/sid/emp-identifier",
                "value" : "266620a9-2c26-41c1-b0cb-a10947b867f5"
              }
            ],
            "status" : "active",
            "intent" : "plan",
            "medicationReference" : {
              "reference" : "Medication/d6508f13-9314-4e54-a0c3-3eafe1f356ff"
            },
            "subject" : {
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                "value" : "X110411319"
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            },
            "authoredOn" : "2026-11-01",
            "note" : [
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            "dosageInstruction" : [
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                  "repeat" : {
                    "frequency" : 1,
                    "period" : 1,
                    "periodUnit" : "d",
                    "when" : [
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                },
                "doseAndRate" : [
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                    "doseQuantity" : {
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                      "unit" : "Stück",
                      "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_BMP_DOSIEREINHEIT",
                      "code" : "1"
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                  }
                ]
              }
            ]
          }
        },
        {
          "name" : "relatedActivity",
          "resource" : {
            "resourceType" : "Provenance",
            "id" : "6fbf6cb7-6425-49c5-a005-50aac83fd8cd",
            "meta" : {
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              {
                "reference" : "MedicationRequest/266620a9-2c26-41c1-b0cb-a10947b867f5/_history/3"
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            "recorded" : "2026-11-25T14:00:00.000Z",
            "activity" : {
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                  "code" : "UPDATE"
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            },
            "agent" : [
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                "type" : {
                  "coding" : [
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                      "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" : "005c1662-8f1c-49cb-a08c-dfdf08080032",
            "meta" : {
              "profile" : [
                🔗 "https://gematik.de/fhir/epa-medication/StructureDefinition/emp-chronology-provenance|1.3.0"
              ]
            },
            "extension" : [
              {
                "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/is-emp-chronology-extension",
                "valueBoolean" : true
              }
            ],
            "target" : [
              {
                "reference" : "MedicationRequest/266620a9-2c26-41c1-b0cb-a10947b867f5/_history/3"
              }
            ],
            "occurredDateTime" : "2026-11-25T14:00:00.000Z",
            "recorded" : "2026-11-25T14:00:00.000Z",
            "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-unlink-emp-entry-output-parameters-1"/>
      <meta>
        <profile
                 value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-op-link-emp-entry-output-parameters|1.3.0"/>
      </meta>
      <parameter>
        <name value="medicationStatement"/>
        <resource>
          <MedicationStatement>
            <id value="3afe43bc-8b57-417f-9e84-a70ea5062a6c"/>
            <meta>
              <versionId value="3"/>
              <lastUpdated value="2026-11-25T14:00:00.000Z"/>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-statement|1.3.0"/>
            </meta>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/context-extension">
              <valueCode value="MANUAL"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationStatement.renderedDosageInstruction">
              <valueMarkdown value="1-0-0-0 Stück"/>
            </extension>
            <extension
                       url="http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructionsMeta">
              <extension url="algorithmVersion">
                <valueString value="1.0.1"/>
              </extension>
              <extension url="language">
                <valueCode value="de-DE"/>
              </extension>
            </extension>
            <status value="unknown"/>
            <medicationReference>
              <reference value="Medication/b43cb3c2-552a-4da1-9eaa-605ac532a83d"/>
            </medicationReference>
            <subject>
              <identifier>
                <system value="http://fhir.de/sid/gkv/kvid-10"/>
                <value value="X110411319"/>
              </identifier>
            </subject>
            <effectivePeriod>
              <start value="2026-11-01"/>
            </effectivePeriod>
            <dateAsserted value="2026-11-01"/>
            <dosage>
              <timing>
                <repeat>
                  <frequency value="1"/>
                  <period value="1"/>
                  <periodUnit value="d"/>
                  <when value="MORN"/>
                </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>
            </dosage>
          </MedicationStatement>
        </resource>
      </parameter>
      <parameter>
        <name value="empEntry"/>
        <resource>
          <MedicationRequest>
            <id value="266620a9-2c26-41c1-b0cb-a10947b867f5"/>
            <meta>
              <versionId value="3"/>
              <lastUpdated value="2026-11-25T14:00:00.000Z"/>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/emp-medication-request|1.3.1"/>
            </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="Kopfschmerzen"/>
            </extension>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/patient-note-extension">
              <valueAnnotation>
                <text
                      value="Alkohol: das Risiko für Magen-Darm-Geschwüre und -Blutungen ist erhöht."/>
              </valueAnnotation>
            </extension>
            <extension
                       url="http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.effectiveDosePeriod">
              <valuePeriod>
                <start value="2026-11-02"/>
              </valuePeriod>
            </extension>
            <extension
                       url="http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.renderedDosageInstruction">
              <valueMarkdown value="1-0-0-0 Stück"/>
            </extension>
            <extension
                       url="http://ig.fhir.de/igs/medication/StructureDefinition/GeneratedDosageInstructionsMeta">
              <extension url="algorithmVersion">
                <valueString value="1.0.1"/>
              </extension>
              <extension url="language">
                <valueCode value="de-DE"/>
              </extension>
            </extension>
            <identifier>
              <system value="https://gematik.de/fhir/sid/emp-identifier"/>
              <value value="266620a9-2c26-41c1-b0cb-a10947b867f5"/>
            </identifier>
            <status value="active"/>
            <intent value="plan"/>
            <medicationReference>
              <reference value="Medication/d6508f13-9314-4e54-a0c3-3eafe1f356ff"/>
            </medicationReference>
            <subject>
              <identifier>
                <system value="http://fhir.de/sid/gkv/kvid-10"/>
                <value value="X110411319"/>
              </identifier>
            </subject>
            <authoredOn value="2026-11-01"/>
            <note>
              <text value="Hinweis für den LE"/>
            </note>
            <dosageInstruction>
              <timing>
                <repeat>
                  <frequency value="1"/>
                  <period value="1"/>
                  <periodUnit value="d"/>
                  <when value="MORN"/>
                </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="relatedActivity"/>
        <resource>
          <Provenance>
            <id value="6fbf6cb7-6425-49c5-a005-50aac83fd8cd"/>
            <meta>
              <profile
                       value="https://gematik.de/fhir/epa/StructureDefinition/epa-activity-provenance|1.3.0"/>
            </meta>
            <target>
              <reference
                         value="MedicationStatement/3afe43bc-8b57-417f-9e84-a70ea5062a6c/_history/3"/>
            </target>
            <target>
              <reference
                         value="MedicationRequest/266620a9-2c26-41c1-b0cb-a10947b867f5/_history/3"/>
            </target>
            <recorded value="2026-11-25T14:00:00.000Z"/>
            <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="005c1662-8f1c-49cb-a08c-dfdf08080032"/>
            <meta>
              <profile
                       value="https://gematik.de/fhir/epa-medication/StructureDefinition/emp-chronology-provenance|1.3.0"/>
            </meta>
            <extension
                       url="https://gematik.de/fhir/epa-medication/StructureDefinition/is-emp-chronology-extension">
              <valueBoolean value="true"/>
            </extension>
            <target>
              <reference
                         value="MedicationRequest/266620a9-2c26-41c1-b0cb-a10947b867f5/_history/3"/>
            </target>
            <occurredDateTime value="2026-11-25T14:00:00.000Z"/>
            <recorded value="2026-11-25T14:00:00.000Z"/>
            <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

Der Medication Service MUSS die Geschäftlogik der Operation Entfernen einer eML-eMP-Verknüpfung gemäß dem Aktivitätsdiagramm mit der ID IG-MED-BL-UNLINK-EMP-ENTRY-V2 ausführen. Dabei sind alle mit transaction gekennzeichneten Abschnitte entsprechend den Transaktionssicherheitsregeln des ePA-Aktensystems umzusetzen, sodass diese Abschnitte mit ihren Verarbeitungsschritten atomar, konsistent und isoliert durchgeführt werden.

Das folgende Aktivitätsdiagramm illustriert die Geschäftslogik der Operation Entfernen einer eML-eMP-Verknüpfung im Medication Service.

Abbildung: Geschäftslogik für die Operation Entfernen einer eML-eMP-Verknüpfung

### Sicherheitsanforderungen

Generelle Sicherheitsanforderungen werden hier festgehalten.