Prescription Management
EPS is an implementation of FHIR Workflow Management and implements those patterns. These are focused on the FHIR Task resource which is used to represent the 'prescription' within EPS.
Fulfilment
Prescription fulfilment is modelled using the FHIR NHSDigital-Task resource. This Task has links to both the MedicationRequest and MedicationDispense resources from prescription-order and dispense-notification messages. Prescription Managment acts on the Task resource only.
A summary of FHIR Task is below:
| FHIR Task | Description |
|---|---|
| status | The current status of the prescription-order or dispense-notification, e.g. accepted, completed, in-progress, etc |
| code | The type of Task, either prescription-order or dispense-notification |
| for | The NHS Number of the Patient the Task is for |
| requester | Who is created the Request (prescription-order) or the Event (dispense-notification) |
| owner | Who is responsible for actioning the request (normally the pharmacy for prescription-order) |
| input | Pointers to the MedicationRequest which are accessed by EPS Query API |
| output | Pointers to the MedicationDispense which are accessed by EPS Query API |
This Task resource is becomes available on receipt of a Prescription Order and is then updated by the other workflow messages. the Task will be given a status of 'requested', this is item 1 in the diagram below:
When the prescription is released by a pharmacy (item 2) the status changes to 'accepted'. When EPS receives a Prescription Dispense (item 3) the status will change to 'in-progress'. If all items in the Presciption Dispense state they are completed, the Task status will change to 'completed'.
The current status of the prescription can be viewed via the Prescription Tracker API
In a similar manner dispense-notification workflow events and the EPS generated prescription-order for continuous-repeat-dispensing, are also represented as sub Tasks.
The Task (code = prescription-order) interactions are:
- prescription release Download Prescription from EPS
- dispense proposal return Returning Prescriptions to EPS
The Task (code = dispense-notification) interactions are:
- dispense withdraw Cancel a Dispense Notification
Prescription Token
The prescription token allows the patient to choose the pharmacy which will fulfill the prescription order.
The prescription token is used by the dispenser to retrieve a non-nominated prescription quickly and effectively without having to cross-reference different stand-alone systems.
The prescription may be in a variety of forms:
For EPS purposes they are both considered to be FHIR NHSDigital-Task
- The Prescription Release operation is used to retrieve the prescriptions using the prescription token id code as a parameter.
Nominated Pharmacy
For nominated or one off prescriptions EPS will assign the Task based on
- one-off nomination in the Prescription Order
- patients nomination recorded in PDS (the patient can change this via NHSApp)
- The Prescription Release operation is used to retrieve the prescriptions using the pharmacies ODS code as a parameter.
Fulfilment States
EPS has an internal state engine which is used to manage the processing of the prescription (FHIR Task).
Direct State Changes
The Task fulfilment state can be manipulated directly via
The updated Task received by EPS follows these rules:
| Task.status | Task.businessStatus | Description | Resulting Task.status |
|---|---|---|---|
| failed | 0004 | Expired | |
| cancelled | 0005 | Cancelled | |
| rejected | 0007 | Not Dispensed | ready |
On release the Task in EPS is changed to:
| Task.status | Task.businessStatus | |
|---|---|---|
| accepted | 0002 | With Dispenser |
Cancelling dispense-notifications can also result in a Task.status change.
| Condition | Task.status | Task.businessStatus | |
|---|---|---|---|
| If no dispensing activity recorded | accepted | 0002 | With Dispenser |
Indirect State Changes
It indirectly manipulatd by
MedicationRequest.status (Prescription Order)
| MedicationRequest.status | condition | Task.status | Notes |
|---|---|---|---|
| active | if nominated | requested | Task is created in EPS |
| active | if not nominated | ready | Task is created in EPS |
| cancelled | if not with a dispenser | cancelled | |
| cancelled | if with a dispenser (active or not) | failed | when the dispenser returns the prescription this will turn to cancelled |
MedicationDispense.status and MedicationDispense.prescriptionStatus
The Task status is linked to the prescription status held in Extension-EPS-TaskBusinessStatus
| MedicationDispense.prescriptionStatus | Description | Task.status | MedicationRequest.status |
|---|---|---|---|
| 0003 | With Dispenser - Active | in-progress | |
| 0006 | Dispensed | completed | completed |