NHS Digital FHIR Medicines

This guidance is under active development by NHS Digital and content may be added or updated on a regular basis.

Prescription Orders Overview

1. Create the prescription-order message

Detailed instructions can be found Developing Prescription Order Message

2. Add the Digital Signature

The order message prescription-order is sent to the EPS $prepare endpoint to generate the digitial signature.

Example message Prescription Order Homecare Prepare

This is added to the prescription-order message in a FHIR NHSDigital-Provenance resource and the amended prescription-order is then sent to the $process-message endpoint.

3. Send the prescription-order message

The $process-message endpoint follows FHIR Messaging standards and the operation definition for this can be found here process-message. The response to this call will be a FHIR Bundle containing NHSDigital-OperationOutcome which indicate success or failure, this is also known as application-acknowledgement in existing EPS documentation.

Example message Prescription Order Homecare using Medication resource

4. Cancel the prescription-order (if required)

Changes such as a cancelling a prescription item (MedicationRequest) are sent within a prescription-order-update message to the same $process-message endpoint the intial order was sent to and will respond with an application-acknowledement. This does not indicate the prescription items have been cancelled just the request has been accepted. Conformation the prescription has been updated is returned via a prescription-order-response message.

Example update message Prescription Order Homecare Update

4a. Cancellation Response Messages

Example update response message Prescription Order Homecare Response

Multiple responses to the prescription-order-update may be received.

At present the delivery method for responses responses has not been defined.

Developing Prescription Order Message

Overview

The FHIR Message Bundle that is sent to EPS MUST following the rules in this MessageDefinition prescription-order

This Bundle consists of several resources and is designed to allow reuse of resources from other services.

  • Patient from PDS
  • Practitioner from SDS (not currently a FHIR enabled service)
  • PractitonerRole from SDS (not currently a FHIR enabled service)
  • Organization from SDS or ODS (STU3)
  • Signature from EPS Signing Services

MedicationRequest has to be constructed but this resource should be forward compatible with other UK Core based system, i.e. it can be reused.

The use of these services to source these resources is not necessary and any UK Core can be used. However the resources MUST also follow the rules within this ImplementationGuide. In other words the EPS will not accept FHIR resources that don't meet the data requirements of EPS.

Important
EPS will not not reject messages that exceed EPS requirements, it will not process them and these will NOT be pass onto downstream systems (e.g. pharmacists).



Use of Meta

The tolerant principle outlined above is a change in the use of the meta elements in FHIR resources. Previous UK Implementation Guides mandated/suggested profile conformance within the meta section, e.g.

{
 "resourceType": "MedicationRequest",
 "meta": {
   "profile": [
     "https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-MedicationRequest-1"
   ]
 }
}

This example states the resource conforms to the https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-MedicationRequest-1 profile. In EPS this is not necessary, the EPS API's will check all resources against EPS profiles. If you wish to include a meta section it SHOULD state the relevant UK-Core profile, e.g.

{
 "resourceType": "MedicationRequest",
 "meta": {
   "profile": [
     "https://fhir.nhs.uk/StructureDefinition/UKCore-MedicationRequest"
   ]
 }
}


Resource Validation
Unlike STU3 where profile complinace was stated in resources, R4 focuses on the receiving service checking compliance according to the rules it needs to follow

Prescription Cancellations

1. Prescriber - Send Prescription

This is sent to FHIR Operation process-message as a prescription-order Message.

The example outpatient prescription Prescription Order Outpatient Multiple Medications consists of four Medications and has nominated pharmacy FX478

Medication ID (SNOMED) Medication Name Prescribed Quantity Unit of Measure
321196004 Diazepam 2mg tablets 28 Tablet
322236009 Paracetamol 500mg tablets 100 Tablet
321152004 Temazepam 10mg tablets 14 Tablet
36126511000001106 Morphine 10mg modified-release tablets 28 Tablet

2. Dispenser - Release Prescription.

The Pharmacy releases the prescription by calling the FHIR Operation release

POST /Task/$release

Example of the payload NominatedPharmacyReleaseRequest


3. Prescriber - Prescription MedicationRequest Cancellation

An electronic prescription MedicationRequest can be cancelled after submission to EPS provided the prescription has not been downloaded or processed by a dispenser.

To cancel a prescription the prescribing system is required to send a prescription-order-update cancellation message to the FHIR Operation process-message. A cancellation is at individual item level. Cancellation is applicable to all types of electronic prescriptions (i.e. acute, continuous prescribing and continuous dispensing prescriptions).

Example cancellation message Prescription Order Outpatient Cancel which cancels the Morphine medication.

Medication ID (SNOMED) Medication Name Prescribed Quantity Unit of Measure
36126511000001106 Morphine 10mg modified-release tablets 28 Tablet

Note: this prescription is being cancelled by a clerical worker and the original prescriber is now down as the responsible party.


4. Prescriber - Prescription Cancellation Response

The immediate response to a cancellation messge is a prescription-order-response FHIR Message. Example message Prescription Order Outpatient Response


5 Prescriber - Contact Pharmacy

Prescriptions sent to a nominated pharmacy are likely to be collected before they have been cancelled. This has happened in the above example and the prescriber SHOULD contact the pharmacy to cancel the prescription.


6 Dispenser - Dispense Proposal Withdrawal

As no Medications have been dispensed, the pharmacy can return the entire prescription back to EPS. This is performed sending a FHIR Task to EPS Task endpoint. Note the full prescription must be returned to allow a single MedicationRequest to be cancelled.

PUT /Task

Example payload Task Return Prescription Order


7 Prescriber - Prescription Current Status

As the prescription has now been returned to EPS, the EPS Prescription Tracker will now show the current status.


8 Dispenser - Re-Release Prescription

The dispenser can now download the modified prescription for dispensing. This is similar to step 2.

back to top