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Please note: This guidance has been superseded by the Implementation guide for digitial medicines, which contains up-to-date information.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

When used it must be populated with a fixed valueset defined within the FHIR standard.

It is expected that most implementations will require the use of status to support workflow.

The scope of status may vary depending on the nature of the implementation. The FHIR standard defines the status of Completed as “All actions that are implied by the prescription have occurred”.

This allows for different design decisions for tracking a medication request status.

  • An implementation may track the status through to the receipt of the medication request at the pharmacy, after which the status is Completed

  • An implementation may track the status through to completion of dispensing events, after which the status is Completed

  • An implementation may track the status through to completion of administration events for the medication that has been dispensed, after which the status is Completed.

The following guidance is based on an implementation tracking the status through to completion of dispensing events.

Status FHIR Definition Recommendation
Draft The prescription is not yet "actionable", e.g. it is a work in progress, requires sign-off, verification or needs to be run through decision support process. The order is work in progress within the ePMA system and has not yet sent to the pharmacy.
Active The prescription is "actionable", but not all actions that are implied by it have occurred yet. The order has been sent and accepted by the pharmacy. Dispensing and administration activities may of started but are not yet `Complete`.
Completed All actions that are implied by the prescription have occurred yet. Dispensing activities have been completed for the medication defined within the order.
On-Hold Actions implied by the prescription are to be temporarily halted, but are expected to continue later. May also be called `Suspended`. Will prevent the order being sent to the pharmacy. If already sent, an update needs to be sent to the pharmacy to temporarily halt further dispensing.
Cancelled The prescription has been withdrawn before any administrations have occurred. Will prevent the order being sent to the pharmacy. If already sent, an update needs to be sent to the pharmacy so that no further medication is dispensed.
Stopped Actions implied by the prescription are to be permanently halted, before all of the administrations occurred. This should not be used if the original order was entered in error. The order needs to be stopped on clinical grounds. An update needs to be sent to the pharmacy so that no further medication is dispensed.
Entered in Error Some of the actions that are implied by the medication request may have occurred. For example, the medication may have been dispensed and the patient may have taken some of the medication. Clinical decision support systems should take this status into account. The order needs to be stopped due to human data entry error. An update needs to be sent to the pharmacy so that no further medication is dispensed.
Unknown The authoring/source system does not know which of the status values currently applies for this observation. Note: This concept is not to be used for ‘other’ - one of the listed statuses is presumed to apply, but the authoring/source system does not know which. Recommended not to be supported as the use case for this status value is unclear.

Logical medicationRequest status transitions

This state transition diagram is an enhancement over the generic State Machine defined within the FHIR specification. It includes the status values associated with a medication request with transitions applicable to a UK implementation.


medication-request-status-flow


Status transitions explained

Previous Future Interoperability Recommendation
Draft Active This transition will trigger the sending / sharing of the MedicationRequest from the ePMA system to the pharmacy system to start dispensing activities. Within a RESTful implementation this would be typically implemented as an HTTP POST.
Draft Cancelled Contained within the ePMA system.
Draft On-Hold Contained within the ePMA system.
Draft Entered-in-Error Contained within the ePMA system.
On-Hold Draft Contained within the ePMA system.
On-Hold Active This transition will trigger an update to the MedicationRequest from the ePMA system to the pharmacy system to restart dispensing activities. Within a RESTful implementation this would be typically implemented as either an HTTP PUT or HTTP PATCH.
On-Hold Active Contained within the ePMA system.
On-Hold Stopped Contained within the ePMA system.
On-Hold Entered-in-error Contained within the ePMA system.
Active Active Not a MedicationRequest status transition but the pharmacy system could send / share dispensing activities with the ePMA system, typically using a FHIR profile based on MedicationDispense. Within a RESTful implementation this would be typically implemented as an HTTP POST.
Active On-Hold This transition will trigger an update to the MedicationRequest from the ePMA system to the pharmacy system to suspend dispensing activities. Within a RESTful implementation this would be typically implemented as either an HTTP PUT or PATCH.

If dispensing has already occurred but meds have not been delivered to the ward then they can stay within the pharmacy until the request is re-activated. If meds have been delivered to the ward then there is no action required by the pharmacy system.
Active Entered-in-Error This transition will trigger an update to the MedicationRequest from the ePMA system to the pharmacy system to stop dispensing activities. Within a RESTful implementation this would be typically implemented as either an HTTP PUT or PATCH.
Active Stopped This transition will trigger an update to the MedicationRequest from the ePMA system to the pharmacy system to stop dispensing activities. Within a RESTful implementation this would be typically implemented as either an HTTP PUT or PATCH.
Active Completed Contained within the ePMA system. All requested medication has been received from pharmacy and has been recorded / confirmed within the ePMA system.
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