ePMA Implementation Guidance for FHIR STU3

This guidance is under active development by NHS Digital and content may be added or updated on a regular basis.
Please note: This guidance has been superseded by the Implementation guide for digitial medicines, which contains up-to-date information.

Element: category

It is expected that any implementation will need to distinguish between medication orders for processes for dispensing and / or administration so this element is business required.

The STU3 suggested value-set is defined as:

  • inpatient
  • outpatient
  • community

The R4 suggested value-set is extended with discharge.

For a UK implementation based on STU3, it is recommended to extend this value-set with both discharge and leave.

Category FHIR Definition / Description
inpatient Includes requests for medications to be administered or consumed in an inpatient or acute care setting.
outpatient Includes requests for medications to be administered or consumed in an outpatient setting (for example, Emergency Department, Outpatient Clinic, Outpatient Surgery, Doctor’s office).
community Includes requests for medications to be administered or consumed by the patient in their home (this would include long term care or nursing homes, hospices, etc.).
discharge Includes requests for medications created when the patient is being released from a facility.
leave Note: Not included within the FHIR standard. Requests for medications that the patient will take away with them during any short break from inpatient care. Typically requests would be dispensed by the hospital pharmacy to be self-administered at home with or without the assistance of community based nursing staff.

Category values mapped to target use-cases

The in-scope use-cases for this version of the implementation guidance are as follows:

Category Use-case Scenario
inpatient Inpatient medication requests, for a named patient, to be dispensed by the hospital pharmacy and intended for administration on a hospital ward. Patient Anne Teak is admitted as an inpatient is prescribed Amoxicillin 500mg orally three times daily for a suspected chest infection.
inpatient Medication requests, for a named patient who is on short-term leave from an inpatient stay (but is not discharged), to be dispensed by the hospital pharmacy and intended for administration at home. Current inpatient Jackie Taitor is going home for weekend leave and is prescribed 3 days supply of Citalopram 20mg tablets one to be taken in the morning.
inpatient Discharge medications requests, for a named patient, to be dispensed by the hospital pharmacy and issued on discharge for administration at home. Patient Bill Ding is discharged from hospital following an admission where they were diagnosed as being diabetic. They were prescribed 4 weeks quantity of Metformin 500mg tablets to take twice daily on an on-going basis. Their GP will be instructed to continue this course of medication within a discharge note.
outpatient Outpatient medication requests, for a named patient, to be dispensed by the hospital pharmacy and intended for administration in the Outpatients department, Accident and Emergency department, or Day unit. Patient Moe DeGrasse is prescribed a Goserelin 3.6mg implant to be administered by IM injection in the Outpatients department on 1st May 2020.
outpatient Outpatient medication requests, for a named patient, to be dispensed by the hospital pharmacy for administration at home. Patient Lorna Mower has attended the dermatology outpatients clinic and is prescribed Betamethasone 0.1% cream to be applied sparingly twice daily for 2 weeks.
Note: A `community` medication request would trigger the printing and signing of a paper `FP10HNC` prescription, or (when implemented by the Trust) an electronic prescription sent to the NHS Electronic Prescription Service.
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