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Please note: This guidance has been superseded by the Implementation guide for digitial medicines, which contains up-to-date information.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: medication[x]

This is a mandatory element and is recommended to be used to represent the medication that was supplied - even if it differs to the original MedicationRequest.

Where the requested medication is contained within the NHS dm+d then it must be recorded using the dm+d standard

Recommendation: implementation via a referenced Medication resource.

The Referencing FHIR Resources page has guidance regarding the usage FHIR References.

Note: At the time of writing an alpha implementation of a dm+d FHIR Medication Resource Server is available from the North East CSU as a demonstrator and associated API.

It is recommended that the medicationReference.display is populated with the medication description as selected by the clinician. This may be slightly different to the medication described as returned by a SNOMED/dm+d terminology FHIR server if the ePMA system has not fully implemented dm+d into their medication picking list.

Requested medication with no dm+d code

Medication not published within the dm+d may be requested in the Acute care setting.

In this scenario it is recommended to use the CodeableConcept variant for this element. Software logic can then clearly distinguish this from nationally coded dm+d medication.

If the ePMA system has both a locally assigned code and description for the medication then;

  • The medicationCodeableConcept.text should be the description for the medication.
  • The medicationCodeableConcept.coding.code should be the code for the medication.
  • The medicationCodeableConcept.coding.display should be the description for the medication, i.e. the same value as medicationCodeableConcept.text.

If the ePMA system only has a description for the medication then;

  • The medicationCodeableConcept.text should be the locally assigned description for the medication.

Multiple dispense requests for a single medication request

In the event that multiple dispense requests are required to fulfil a MedicationRequest, the same requesting identifier should be used with the appropriate status.

An example of this could be the Cosopt medication where one medication request would be received; however, two dispense messages would be returned for Dorzolamide and Timolol.

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