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-codamol tablets

Product-based VMP prescription which is fully coded but there is an alternative way of modelling this dosage instruction, see second example below.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="c1ea9b0b-f157-4ee2-9771-84c6cbae5cad" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
</meta>
<status value="active" />
<intent value="order" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
<code value="inpatient" />
<display value="inpatient" />
</coding>
</category>
<priority value="routine" />
<medicationCodeableConcept>
<coding>
<system value="https://dmd.nhs.uk" />
<code value="322307006" />
<display value="Co-codamol 8mg/500mg tablets" />
</coding>
</medicationCodeableConcept>
<subject>
<identifier>
<system value="https://fhir.nhs.uk/Id/nhs-number" />
<value value="9999999999" />
</identifier>
</subject>
<authoredOn value="2020-05-15T15:00:00Z" />
<requester>
<reference value="urn:staff-1112" />
<display value="Dr Maikeu Well" />
</requester>
<recorder>
<reference value="urn:staff-1112" />
<display value="Dr Maikeu Well" />
</recorder>
<dosageInstruction>
<sequence value="1" />
<text value="2 tablet - as required for Migraine - take once" />
<timing>
<repeat>
<count value="1" />
</repeat>
</timing>
<asNeededCodeableConcept>
<coding>
<system value="http://snomed.info/sct" />
<code value="37796009" />
<display value="Migraine" />
</coding>
</asNeededCodeableConcept>
<doseAndRate>
<doseQuantity>
<value value="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
</doseAndRate>
</dosageInstruction>
<dosageInstruction>
<sequence value="2" />
<text value="2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs" />
<patientInstruction value="when migraine recurs" />
<timing>
<repeat>
<frequency value="1" />
<period value="4" />
<periodUnit value="h" />
</repeat>
</timing>
<doseAndRate>
<doseQuantity>
<value value="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
</doseAndRate>
<maxDosePerPeriod>
<numerator>
<value value="6" />
<unit value="dose" />
<system value="http://snomed.info/sct" />
<code value="3317411000001100" />
</numerator>
<denominator>
<value value="24" />
<unit value="hour" />
<system value="http://unitsofmeasure.org/" />
<code value="h" />
</denominator>
</maxDosePerPeriod>
</dosageInstruction>
<substitution>
<allowedBoolean value="false" />
</substitution>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "c1ea9b0b-f157-4ee2-9771-84c6cbae5cad",
"meta": {
"profile": [
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "inpatient"
}
]
}
],
"priority": "routine",
"medicationCodeableConcept": {
"coding": [
{
"system": "https://dmd.nhs.uk",
"code": "322307006",
"display": "Co-codamol 8mg/500mg tablets"
}
]
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"authoredOn": "2020-05-15T15:00:00Z",
"requester": {
"reference": "urn:staff-1112",
"display": "Dr Maikeu Well"
},
"recorder": {
"reference": "urn:staff-1112",
"display": "Dr Maikeu Well"
},
"dosageInstruction": [
{
"text": "2 tablet - as required for Migraine - take once",
"sequence": 1,
"timing": {
"repeat": {
"count": 1
}
},
"asNeededCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "37796009",
"display": "Migraine"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
]
},
{
"text": "2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs",
"sequence": 2,
"patientInstruction": "when migraine recurs",
"timing": {
"repeat": {
"frequency": 1,
"period": 4,
"periodUnit": "h"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
],
"maxDosePerPeriod": {
"numerator": {
"value": 6,
"unit": "dose",
"system": "http://snomed.info/sct",
"code": "3317411000001100"
},
"denominator": {
"value": 24,
"unit": "hour",
"system": "http://unitsofmeasure.org/",
"code": "h"
}
}
}
],
"substitution": {
"allowedBoolean": false
}
}
MedicationRequest.id[0]c1ea9b0b-f157-4ee2-9771-84c6cbae5cad
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.category[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/medicationrequest-category
MedicationRequest.category[0].coding[0].code[0]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322307006
MedicationRequest.medication[0].coding[0].display[0]Co-codamol 8mg/500mg tablets
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.authoredOn[0]2020-05-15T15:00:00Z
MedicationRequest.requester[0].reference[0]urn:staff-1112
MedicationRequest.requester[0].display[0]Dr Maikeu Well
MedicationRequest.recorder[0].reference[0]urn:staff-1112
MedicationRequest.recorder[0].display[0]Dr Maikeu Well
MedicationRequest.dosageInstruction[0].sequence[0]1
MedicationRequest.dosageInstruction[0].text[0]2 tablet - as required for Migraine - take once
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].text[0]2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs
MedicationRequest.dosageInstruction[1].patientInstruction[0]when migraine recurs
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Co-codamol 8mg/500mg tablets
2 tablet - as required for Migraine - take once, then 2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs

Alternative Representation

Product-based VMP prescription using a simpler Dosage but where further instructions are text-based.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="b31fcf06-b515-4468-92cd-ce7b13b0c256" />
<meta>
<profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
</meta>
<status value="active" />
<intent value="order" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
<code value="inpatient" />
<display value="inpatient" />
</coding>
</category>
<priority value="routine" />
<medicationCodeableConcept>
<coding>
<system value="https://dmd.nhs.uk" />
<code value="322307006" />
<display value="Co-codamol 8mg/500mg tablets" />
</coding>
</medicationCodeableConcept>
<subject>
<identifier>
<system value="https://fhir.nhs.uk/Id/nhs-number" />
<value value="9999999999" />
</identifier>
</subject>
<authoredOn value="2020-05-15T15:00:00Z" />
<requester>
<reference value="urn:staff-1112" />
<display value="Dr Maikeu Well" />
</requester>
<recorder>
<reference value="urn:staff-1112" />
<display value="Dr Maikeu Well" />
</recorder>
<dosageInstruction>
<text value="2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence" />
<patientInstruction value="Additional doses only to be taken after migraine recurrence" />
<timing>
<repeat>
<frequency value="1" />
<period value="4" />
<periodUnit value="h" />
</repeat>
</timing>
<asNeededCodeableConcept>
<coding>
<system value="http://snomed.info/sct" />
<code value="37796009" />
<display value="Migraine" />
</coding>
</asNeededCodeableConcept>
<doseAndRate>
<doseQuantity>
<value value="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
</doseAndRate>
<maxDosePerPeriod>
<numerator>
<value value="8" />
<unit value="dose" />
<system value="http://snomed.info/sct" />
<code value="3317411000001100" />
</numerator>
<denominator>
<value value="24" />
<unit value="hour" />
<system value="http://unitsofmeasure.org/" />
<code value="h" />
</denominator>
</maxDosePerPeriod>
</dosageInstruction>
<substitution>
<allowedBoolean value="false" />
</substitution>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "b31fcf06-b515-4468-92cd-ce7b13b0c256",
"meta": {
"profile": [
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
]
},
"status": "active",
"intent": "order",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
"code": "inpatient",
"display": "inpatient"
}
]
}
],
"priority": "routine",
"medicationCodeableConcept": {
"coding": [
{
"system": "https://dmd.nhs.uk",
"code": "322307006",
"display": "Co-codamol 8mg/500mg tablets"
}
]
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"authoredOn": "2020-05-15T15:00:00Z",
"requester": {
"reference": "urn:staff-1112",
"display": "Dr Maikeu Well"
},
"recorder": {
"reference": "urn:staff-1112",
"display": "Dr Maikeu Well"
},
"dosageInstruction": [
{
"text": "2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence",
"patientInstruction": "Additional doses only to be taken after migraine recurrence",
"timing": {
"repeat": {
"frequency": 1,
"period": 4,
"periodUnit": "h"
}
},
"asNeededCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "37796009",
"display": "Migraine"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
],
"maxDosePerPeriod": {
"numerator": {
"value": 8,
"unit": "dose",
"system": "http://snomed.info/sct",
"code": "3317411000001100"
},
"denominator": {
"value": 24,
"unit": "hour",
"system": "http://unitsofmeasure.org/",
"code": "h"
}
}
}
],
"substitution": {
"allowedBoolean": false
}
}
MedicationRequest.id[0]b31fcf06-b515-4468-92cd-ce7b13b0c256
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.category[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/medicationrequest-category
MedicationRequest.category[0].coding[0].code[0]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322307006
MedicationRequest.medication[0].coding[0].display[0]Co-codamol 8mg/500mg tablets
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.authoredOn[0]2020-05-15T15:00:00Z
MedicationRequest.requester[0].reference[0]urn:staff-1112
MedicationRequest.requester[0].display[0]Dr Maikeu Well
MedicationRequest.recorder[0].reference[0]urn:staff-1112
MedicationRequest.recorder[0].display[0]Dr Maikeu Well
MedicationRequest.dosageInstruction[0].text[0]2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].patientInstruction[0]Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]8
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Co-codamol 8mg/500mg tablets
2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence
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