NHS Digital FHIR Medicines

Download Prescription from EPS

The prescription needs to be collected by the pharmacy, this is achieved by calling the FHIR Operation release with either to release all prescriptions for a pharmacy NominatedPharmacyReleaseRequest or to release a specified prescription PatientPrescriptionReleaseRequest

Example - Nominated Pharmacy

POST /Task/$release

Payload to download all uncollected prescriptions for pharmacy with ODS Code of VNE51.

{
    "resourceType": "Parameters",
    "parameter":  [
        {
            "name": "owner",
            "valueIdentifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "VNE51"
            }
        },
        {
            "name": "status",
            "valueCode": "accepted"
        }
    ]
}

Example - Patient Prescription Release Request

POST /Task/$release

Payload to download a Patients prescription with token 82D996-C81010-11DB12

{
    "resourceType": "Parameters",
    "parameter":  [
        {
            "name": "owner",
            "valueIdentifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "VNE51"
            }
        },
        {
            "name": "group-identifier",
            "valueIdentifier": {
                "system": "https://fhir.nhs.uk/Id/prescription-order-number",
                "value": "82D996-C81010-11DB12"
            }
        },
        {
            "name": "status",
            "valueCode": "accepted"
        }
    ]
}

Response Payload

The response from the $release will be a FHIR Bundle with a Http status code of 200 OK.

The total number of prescription-order messages returned will be in the total element. The identifier.value is the release reference number and is used for reference in dispense messages.

The prescription-order is carried in the entry[].resource array. If no prescription-orders are found total and the number of entries will be zero. The number of entries and the total will match, paging is not supported in this API.

The $release is not a stateless operation. The $release operation only returns prescriptions that have not been downloaded, when the operation $release is called, EPS marks the the prescriptions as downloaded. So when $release is called again, any remaining prescriptions not marked as downloaded will be returned. The downloaded status corresponds to a FHIR Task status of accepted and businessStatus of 0002 With Dispenser, prescriptions undownloaded are deemed to have status of requested and businessStatus of 0001 To be Dispensed.

prescription-order examples and documentation can be found here prescription-order

{
    "resourceType": "Bundle",
    "id": "E9DDBBC4-DA9A-C223-A2E3-909534332C69",
    "meta": {
        "lastUpdated": "2004-09-20T10:30:00.000+00:00"
    },
    "identifier": {
        "system": "https://tools.ietf.org/html/rfc4122",
        "value": "BBC4E9DD-DA9A-C223-A2E3-332C69909534"
    },
    "type": "searchset",
    "total": 0
}

Dispense - Owings and Partial Dispensing

dispense-notification

This message definition describes the rules for a Dispense Notification interactions used in a FHIR Messaging exchange.

<MessageDefinition xmlns="http://hl7.org/fhir">
    <id value="bf729ea8-280b-4109-b2f5-02ce8e51d870" />
    <url value="https://fhir.nhs.uk/MessageDefinition/dispense-notification" />
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122" />
        <value value="bf729ea8-280b-4109-b2f5-02ce8e51d870" />
    </identifier>
    <version value="1.0.0" />
    <name value="NHSDigitalDispenseNotification" />
    <title value="Pharmacy/Treatment Dispense" />
    <status value="active" />
    <date value="2020-10-02" />
    <description value="Notification of dispensed medication" />
    <eventCoding>
        <system value="https://fhir.nhs.uk/CodeSystem/message-event" />
        <code value="dispense-notification" />
        <display value="Dispense Notification" />
    </eventCoding>
    <category value="notification" />
    <focus>
        <code value="MedicationDispense" />
        <profile value="https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense-Message" />
        <min value="1" />
        <max value="*" />
    </focus>
</MessageDefinition>

{
    "resourceType": "MessageDefinition",
    "id": "bf729ea8-280b-4109-b2f5-02ce8e51d870",
    "url": "https://fhir.nhs.uk/MessageDefinition/dispense-notification",
    "identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "bf729ea8-280b-4109-b2f5-02ce8e51d870"
        }
    ],
    "version": "1.0.0",
    "name": "NHSDigitalDispenseNotification",
    "title": "Pharmacy/Treatment Dispense",
    "status": "active",
    "date": "2020-10-02",
    "description": "Notification of dispensed medication",
    "eventCoding": {
        "system": "https://fhir.nhs.uk/CodeSystem/message-event",
        "code": "dispense-notification",
        "display": "Dispense Notification"
    },
    "category": "notification",
    "focus":  [
        {
            "code": "MedicationDispense",
            "profile": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense-Message",
            "min": 1,
            "max": "*"
        }
    ]
}

1st Dispensing Event – Prescription Status: “With Dispenser – Active”

This is the first dispense notification sent by the dispenser using the FHIR Operation process-message (POST /$process-message)

1st dispense event - partial

2nd Dispensing Event – Prescription Status: “With Dispenser – Active”

This is the second dispense notification sent by the dispenser using the FHIR Operation process-message

The second drug has not been dispensed but it currently a requirement that empty MedicationDispense is included in the dispense-notification message. This empty uses the prescribed drug dm+d code and the following elements are not present

• performer
• quantity
• daysSupply
• whenPrepared
• dosageInstruction

2nd dispense event - partial

3rd Dispensing Event – Prescription Status: “Dispensed”

This is the final dispense notification sent by the dispenser using the FHIR Operation process-message

3rd dispense event - completed

Different Packs/Flavours

A dispenser may choose a mix of packs and flavours to satisfy a prescription and dispense them at the same time.

For example a prescriber may order.

The dispenser chooses to issue

A MedicationDispense resource will be created for each medication dispensed and they will both be sent within the same dispense-notification.

Returning Prescriptions to EPS

A prescription may be downloaded, but never dispensed by the pharmacy, for example if the pharmacy cannot supply the prescribed medication items.

To allow the patient to visit a different dispenser the prescription must be returned to the Spine using the PUT /Task interaction. Once returned, the prescription should be removed from the local System.

See Returning Prescriptions to EPS for examples and explanation of the payload.

Non Dispensed Items

Any medication item that cannot, and will not in the future, be dispensed must be set to the item status “Item not dispensed” (0002) with a reason code from the “Not Dispensed Reason” list defined within DM-MedicationDispense-Type. This includes prescribed items that have expired.

If all prescribed items on a prescription are not dispensed then the MedicationDispense resources still need to be populated to declare the non-dispensing reason for each item.

Note. Within the DM-MedicationDispense-status-reason, the reason code 0003 “Owings note issued to patient” must not be implemented.

When an owings note is issued to a patient and no medication has been dispensed for any of the prescribed medication items on the prescription then no EPS messaging is required as no dispensing event has occurred. If other prescribed items have been dispensed then a Dispense Notification message must be submitted. This will indicate the quantity of medication dispensed and an item status code of 0004 “Item not dispensed owing” for the owing item.

When an owings note is issued to a patient where a partial quantity of medication has been dispensed then a dispense-notification message must be submitted. This will indicate the quantity of medication dispensed and an item status code of 0003 “Item dispensed – partial”.