Implementation guide for interoperable medicines

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

Co-amoxiclav continuous infusion

To highlight the difference in representing an infusion and an injection using the FHIR standard.

FHIR Data Item Infusion Injection
Medication.ingredient (for the diluent) Sodium chloride 0.9% infusion 100ml bags Water for injections 20ml ampoules
dosageInstruction.timing.duration over 30 minutes over 3-4 minutes
dosageInstruction.method Continous infusion Inject
dosageInstruction.doseAndRate 100 ml 20 ml

Prescribing Event - by Infusion

<Bundle xmlns="http://hl7.org/fhir">
<id value="co-amoxiclav-infusion-request" />
<type value="message" />
<entry>
<fullUrl value="urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b" />
<resource>
<MessageHeader>
<id value="682858a9-3942-412d-9ae5-71a2f17f7c5b" />
<eventCoding>
<system value="http://snomed.info/sct" />
<code value="33633005" />
<display value="Prescription of drug" />
</eventCoding>
<source>
<endpoint value="https://myendpoint.nhs.uk/" />
</source>
<focus>
<reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
<type value="MedicationRequest" />
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
<resource>
<Medication>
<id value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication" />
</meta>
<code>
<text value="Co-amoxiclav 1.2 gram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion" />
</code>
<form>
<coding>
<system value="http://snomed.info/sct" />
<code value="385229008" />
<display value="Solution for infusion" />
</coding>
</form>
<ingredient>
<itemCodeableConcept>
<coding>
<system value="https://dmd.nhs.uk" />
<code value="39463011000001107" />
<display value="Co-amoxiclav" />
</coding>
</itemCodeableConcept>
<strength>
<numerator>
<value value="1.2" />
<unit value="gram" />
<system value="http://unitsofmeasure.org" />
<code value="g" />
</numerator>
<denominator>
<value value="1" />
</denominator>
</strength>
</ingredient>
<ingredient>
<itemCodeableConcept>
<coding>
<system value="https://dmd.nhs.uk" />
<code value="4898311000001108" />
<display value="Sodium chloride 0.9% infusion 100ml bags" />
</coding>
</itemCodeableConcept>
</ingredient>
</Medication>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
<resource>
<MedicationRequest>
<id value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
</meta>
<medicationReference>
<reference value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
<type value="Medication" />
</medicationReference>
<subject>
<reference value="Patient/UKCore-Patient-RichardSmith-Example" />
</subject>
<reasonCode>
<coding>
<system value="http://snomed.info/sct" />
<code value="68566005" />
<display value="Urinary tract infection" />
</coding>
</reasonCode>
<dosageInstruction>
<text value="Continuous infusion 100 millilitre - over 30 minutes - 3 times a day - Intravenous" />
<timing>
<repeat>
<duration value="30" />
<durationUnit value="min" />
<frequency value="3" />
<period value="1" />
<periodUnit value="d" />
</repeat>
</timing>
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="47625008" />
<display value="Intravenous" />
</coding>
</route>
<method>
<coding>
<system value="http://snomed.info/sct" />
<code value="261754007" />
<display value="Continuous infusion" />
</coding>
</method>
<doseAndRate>
<doseQuantity>
<value value="100" />
<unit value="millilitre" />
<system value="http://unitsofmeasure.org" />
<code value="ml" />
</doseQuantity>
</doseAndRate>
</dosageInstruction>
</MedicationRequest>
</resource>
</entry>
</Bundle>
{
"resourceType": "Bundle",
"id": "co-amoxiclav-infusion-request",
"type": "message",
"entry": [
{
"fullUrl": "urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b",
"resource": {
"resourceType": "MessageHeader",
"id": "682858a9-3942-412d-9ae5-71a2f17f7c5b",
"eventCoding": {
"system": "http://snomed.info/sct",
"code": "33633005",
"display": "Prescription of drug"
},
"source": {
"endpoint": "https://myendpoint.nhs.uk/"
},
"focus": [
{
"reference": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
"type": "MedicationRequest"
}
]
}
},
{
"fullUrl": "urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc",
"resource": {
"resourceType": "Medication",
"id": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
"meta": {
"profile": [
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication"
]
},
"form": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "385229008",
"display": "Solution for infusion"
}
]
},
"code": {
"text": "Co-amoxiclav 1.2 gram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion"
},
"ingredient": [
{
"itemCodeableConcept": {
"coding": [
{
"system": "https://dmd.nhs.uk",
"code": "39463011000001107",
"display": "Co-amoxiclav"
}
]
},
"strength": {
"numerator": {
"value": 1.2,
"unit": "gram",
"system": "http://unitsofmeasure.org",
"code": "g"
},
"denominator": {
"value": 1
}
}
},
{
"itemCodeableConcept": {
"coding": [
{
"system": "https://dmd.nhs.uk",
"code": "4898311000001108",
"display": "Sodium chloride 0.9% infusion 100ml bags"
}
]
}
}
]
}
},
{
"fullUrl": "urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b",
"resource": {
"resourceType": "MedicationRequest",
"id": "34eb3c92-76e6-48c2-9691-aa1f0b58369b",
"meta": {
"profile": [
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
]
},
"subject": {
"reference": "Patient/UKCore-Patient-RichardSmith-Example"
},
"medicationReference": {
"reference": "11dc9519-b6e8-41bb-bce5-f6f724b743bc",
"type": "Medication"
},
"reasonCode": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "68566005",
"display": "Urinary tract infection"
}
]
}
],
"dosageInstruction": [
{
"text": "Continuous infusion 100 millilitre - over 30 minutes - 3 times a day - Intravenous",
"timing": {
"repeat": {
"duration": 30,
"durationUnit": "min",
"frequency": 3,
"period": 1,
"periodUnit": "d"
}
},
"method": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "261754007",
"display": "Continuous infusion"
}
]
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "47625008",
"display": "Intravenous"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 100,
"unit": "millilitre",
"system": "http://unitsofmeasure.org",
"code": "ml"
}
}
]
}
]
}
}
]
}
Bundle.id[0]co-amoxiclav-infusion-request
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].id[0]682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].event[0].system[0]http://snomed.info/sct
Bundle.entry[0].resource[0].event[0].code[0]33633005
Bundle.entry[0].resource[0].event[0].display[0]Prescription of drug
Bundle.entry[0].resource[0].source[0].endpoint[0]https://myendpoint.nhs.uk/
Bundle.entry[0].resource[0].focus[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[0].resource[0].focus[0].type[0]MedicationRequest
Bundle.entry[1].fullUrl[0]urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].id[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[1].resource[0].code[0].text[0]Co-amoxiclav 1.2 gram in Sodium chloride 0.9% infusion 100ml bags - Solution for infusion
Bundle.entry[1].resource[0].form[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].form[0].coding[0].code[0]385229008
Bundle.entry[1].resource[0].form[0].coding[0].display[0]Solution for infusion
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]39463011000001107
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Co-amoxiclav
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]1.2
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]gram
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]g
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].code[0]4898311000001108
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].display[0]Sodium chloride 0.9% infusion 100ml bags
Bundle.entry[2].fullUrl[0]urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].id[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[2].resource[0].medication[0].reference[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[2].resource[0].medication[0].type[0]Medication
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[2].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].reasonCode[0].coding[0].code[0]68566005
Bundle.entry[2].resource[0].reasonCode[0].coding[0].display[0]Urinary tract infection
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Continuous infusion 100 millilitre - over 30 minutes - 3 times a day - Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]30
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]261754007
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Continuous infusion
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]100
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle

Prescribing Event - by Injection

<Bundle xmlns="http://hl7.org/fhir">
<id value="co-amoxiclav-injection-request" />
<type value="message" />
<entry>
<fullUrl value="urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b" />
<resource>
<MessageHeader>
<id value="682858a9-3942-412d-9ae5-71a2f17f7c5b" />
<focus>
<reference value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
<type value="MedicationRequest" />
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
<resource>
<Medication>
<id value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication" />
</meta>
<code>
<text value="Co-amoxiclav 1.2 gram in Water for injections 20ml ampoules - Solution for injection" />
</code>
<form>
<coding>
<system value="http://snomed.info/sct" />
<code value="385219001" />
<display value="Solution for injection" />
</coding>
</form>
<ingredient>
<itemCodeableConcept>
<coding>
<system value="https://dmd.nhs.uk" />
<code value="39463011000001107" />
<display value="Co-amoxiclav" />
</coding>
</itemCodeableConcept>
<strength>
<numerator>
<value value="1.2" />
<unit value="gram" />
<system value="http://unitsofmeasure.org" />
<code value="g" />
</numerator>
<denominator>
<value value="1" />
</denominator>
</strength>
</ingredient>
<ingredient>
<itemCodeableConcept>
<coding>
<system value="https://dmd.nhs.uk" />
<code value="39720011000001104" />
<display value="Water for injections 20ml ampoules" />
</coding>
</itemCodeableConcept>
<strength>
<numerator>
<value value="1" />
<unit value="ampoule" />
<system value="http://snomed.info/sct" />
<code value="413516001" />
</numerator>
<denominator>
<value value="1" />
</denominator>
</strength>
</ingredient>
</Medication>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
<resource>
<MedicationRequest>
<id value="34eb3c92-76e6-48c2-9691-aa1f0b58369b" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
</meta>
<medicationReference>
<reference value="11dc9519-b6e8-41bb-bce5-f6f724b743bc" />
<type value="Medication" />
</medicationReference>
<subject>
<reference value="Patient/UKCore-Patient-RichardSmith-Example" />
</subject>
<reasonCode>
<coding>
<system value="http://snomed.info/sct" />
<code value="68566005" />
<display value="Urinary tract infection" />
</coding>
</reasonCode>
<dosageInstruction>
<text value="Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous" />
<timing>
<repeat>
<duration value="3" />
<durationMax value="4" />
<durationUnit value="min" />
<frequency value="3" />
<period value="1" />
<periodUnit value="d" />
</repeat>
</timing>
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="47625008" />
<display value="Intravenous" />
</coding>
</route>
<method>
<coding>
<system value="http://snomed.info/sct" />
<code value="422145002" />
<display value="Inject" />
</coding>
</method>
<doseAndRate>
<doseQuantity>
<value value="20" />
<unit value="millilitre" />
<system value="http://unitsofmeasure.org" />
<code value="ml" />
</doseQuantity>
</doseAndRate>
</dosageInstruction>
</MedicationRequest>
</resource>
</entry>
</Bundle>
{
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"type": "message",
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"dosageInstruction": [
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"text": "Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous",
"timing": {
"repeat": {
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"durationMax": 4,
"durationUnit": "min",
"frequency": 3,
"period": 1,
"periodUnit": "d"
}
},
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"coding": [
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"system": "http://snomed.info/sct",
"code": "422145002",
"display": "Inject"
}
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},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "47625008",
"display": "Intravenous"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 20,
"unit": "millilitre",
"system": "http://unitsofmeasure.org",
"code": "ml"
}
}
]
}
]
}
}
]
}
Bundle.id[0]co-amoxiclav-injection-request
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].id[0]682858a9-3942-412d-9ae5-71a2f17f7c5b
Bundle.entry[0].resource[0].focus[0].reference[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[0].resource[0].focus[0].type[0]MedicationRequest
Bundle.entry[1].fullUrl[0]urn:uuid:11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].id[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[1].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-Medication
Bundle.entry[1].resource[0].code[0].text[0]Co-amoxiclav 1.2 gram in Water for injections 20ml ampoules - Solution for injection
Bundle.entry[1].resource[0].form[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].form[0].coding[0].code[0]385219001
Bundle.entry[1].resource[0].form[0].coding[0].display[0]Solution for injection
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].code[0]39463011000001107
Bundle.entry[1].resource[0].ingredient[0].item[0].coding[0].display[0]Co-amoxiclav
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].value[0]1.2
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].unit[0]gram
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].system[0]http://unitsofmeasure.org
Bundle.entry[1].resource[0].ingredient[0].strength[0].numerator[0].code[0]g
Bundle.entry[1].resource[0].ingredient[0].strength[0].denominator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].system[0]https://dmd.nhs.uk
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].code[0]39720011000001104
Bundle.entry[1].resource[0].ingredient[1].item[0].coding[0].display[0]Water for injections 20ml ampoules
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].value[0]1
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].unit[0]ampoule
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].system[0]http://snomed.info/sct
Bundle.entry[1].resource[0].ingredient[1].strength[0].numerator[0].code[0]413516001
Bundle.entry[1].resource[0].ingredient[1].strength[0].denominator[0].value[0]1
Bundle.entry[2].fullUrl[0]urn:uuid:34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].id[0]34eb3c92-76e6-48c2-9691-aa1f0b58369b
Bundle.entry[2].resource[0].meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
Bundle.entry[2].resource[0].medication[0].reference[0]11dc9519-b6e8-41bb-bce5-f6f724b743bc
Bundle.entry[2].resource[0].medication[0].type[0]Medication
Bundle.entry[2].resource[0].subject[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example
Bundle.entry[2].resource[0].reasonCode[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].reasonCode[0].coding[0].code[0]68566005
Bundle.entry[2].resource[0].reasonCode[0].coding[0].display[0]Urinary tract infection
Bundle.entry[2].resource[0].dosageInstruction[0].text[0]Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].duration[0]3
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationMax[0]4
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].durationUnit[0]min
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[2].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].code[0]47625008
Bundle.entry[2].resource[0].dosageInstruction[0].route[0].coding[0].display[0]Intravenous
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].code[0]422145002
Bundle.entry[2].resource[0].dosageInstruction[0].method[0].coding[0].display[0]Inject
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]20
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]millilitre
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle
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