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>

{
    "resourceType": "Bundle",
    "id": "co-amoxiclav-injection-request",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "urn:uuid:682858a9-3942-412d-9ae5-71a2f17f7c5b",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "682858a9-3942-412d-9ae5-71a2f17f7c5b",
                "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": "385219001",
                            "display": "Solution for injection"
                        }
                    ]
                },
                "code": {
                    "text": "Co-amoxiclav 1.2 gram in Water for injections 20ml ampoules - Solution for injection"
                },
                "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": "39720011000001104",
                                    "display": "Water for injections 20ml ampoules"
                                }
                            ]
                        },
                        "strength": {
                            "numerator": {
                                "value": 1,
                                "unit": "ampoule",
                                "system": "http://snomed.info/sct",
                                "code": "413516001"
                            },
                            "denominator": {
                                "value": 1
                            }
                        }
                    }
                ]
            }
        },
        {
            "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": "Inject 20 millilitre - over 3-4 minutes - 3 times a day - Intravenous",
                        "timing": {
                            "repeat": {
                                "duration": 3,
                                "durationMax": 4,
                                "durationUnit": "min",
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "422145002",
                                    "display": "Inject"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "47625008",
                                    "display": "Intravenous"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 20,
                                    "unit": "millilitre",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "ml"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}
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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
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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
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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
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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
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Bundle.entry[2].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]ml
Bundle
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