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.

Example 2: Inpatient MedicationRequest

Note: This example below is a draft and requires clinical verification.

Chris is started on new medication. 75mg of Pregabalin twice per day for three days, increased to 75mg three times per day thereafter.

Actors

Provider System = Ward EMPA system

Consumer System = Hospital pharamcy system

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="7d107ed2-70c6-43d9-9cbe-f19c319d1456" />
    <identifier>
        <system value="urn:[organisation_name]:[system_name]" />
        <value value="urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa" />
    </identifier>
    <type value="message" />
    <timestamp value="2021-05-07T16:15:32Z" />
    <!--    Message Header    -->
    <entry>
        <fullUrl value="urn:message-header-167434" />
        <resource>
            <MessageHeader>
                <id value="urn:message-header-167434" />
                <eventCoding>
                    <system value="https://fhir.hl7.org.uk//CodeSystem/message-event" />
                    <code value="prescription-order" />
                    <display value="Prescription Order" />
                </eventCoding>
                <source>
                    <name value="ACME Clinical Systems" />
                    <software value="ACME ePMA" />
                    <version value="3.5.68" />
                    <endpoint value="urn:nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="urn:med-req-01923" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--  // Patient associated with the encounter   -->
    <entry>
        <fullUrl value="urn:patient-01912" />
        <resource>
            <Patient>
                <id value="patient-01912" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="4857773456" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mr Chris Packet" />
                    <family value="Packet" />
                    <given value="Chris" />
                    <prefix value="Mr" />
                </name>
                <gender value="male" />
                <birthDate value="1995-11-12" />
            </Patient>
        </resource>
    </entry>
    <!--  // Prescribing clinician associated with the encounter.   -->
    <entry>
        <fullUrl value="urn:staff-1112" />
        <resource>
            <Practitioner>
                <id value="staff-1112" />
                <name>
                    <text value="Dr Maikeu Well" />
                    <family value="Well" />
                    <given value="Maikeu" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
                            <code value="2145879" />
                            <display value="General Medical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!--  // Medication prescribed   -->
    <entry>
        <fullUrl value="urn:medication-99101" />
        <resource>
            <Medication>
                <id value="medication-99101" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="415159003" />
                        <display value="Pregabalin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--   // Medication Request   -->
    <entry>
        <fullUrl value="urn:med-req-01923" />
        <resource>
            <MedicationRequest>
                <id value="med-req-01923" />
                <identifier>
                    <value value="6d2bfb69-656a-45ef-92d0-d4aae02bb438" />
                </identifier>
                <status value="active" />
                <intent value="order" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="inpatient" />
                        <display value="inpatient" />
                    </coding>
                </category>
                <priority value="routine" />
                <medicationReference>
                    <reference value="medication-99101" />
                    <display value="Pregabalin" />
                </medicationReference>
                <subject>
                    <reference value="patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-07T18:12:41+01:00" />
                <requester>
                    <reference value="staff-1112" />
                    <display value="Dr Maikeu Well" />
                </requester>
                <recorder>
                    <reference value="staff-1112" />
                    <display value="Dr Maikeu Well" />
                </recorder>
                <dosageInstruction>
                    <sequence value="1" />
                    <timing>
                        <repeat>
                            <boundsDuration>
                                <value value="3" />
                                <unit value="day" />
                                <system value="http://unitsofmeasure.org" />
                                <code value="d" />
                            </boundsDuration>
                            <frequency value="2" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="75" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <dosageInstruction>
                    <sequence value="2" />
                    <timing>
                        <repeat>
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="75" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "7d107ed2-70c6-43d9-9cbe-f19c319d1456",
    "identifier": {
        "system": "urn:[organisation_name]:[system_name]",
        "value": "urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa"
    },
    "type": "message",
    "timestamp": "2021-05-07T16:15:32+00:00",
    "entry":  [
        {
            "fullUrl": "urn:message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "urn:message-header-167434",
                "eventCoding": {
                    "system": "https://fhir.hl7.org.uk//CodeSystem/message-event",
                    "code": "prescription-order",
                    "display": "Prescription Order"
                },
                "source": {
                    "name": "ACME Clinical Systems",
                    "software": "ACME ePMA",
                    "version": "3.5.68",
                    "endpoint": "urn:nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "urn:med-req-01923"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-01912",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-01912",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "4857773456"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mr Chris Packet",
                        "family": "Packet",
                        "given":  [
                            "Chris"
                        ],
                        "prefix":  [
                            "Mr"
                        ]
                    }
                ],
                "gender": "male",
                "birthDate": "1995-11-12"
            }
        },
        {
            "fullUrl": "urn:staff-1112",
            "resource": {
                "resourceType": "Practitioner",
                "id": "staff-1112",
                "name":  [
                    {
                        "text": "Dr Maikeu Well",
                        "family": "Well",
                        "given":  [
                            "Maikeu"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gmc-number",
                                    "code": "2145879",
                                    "display": "General Medical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-99101",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-99101",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "415159003",
                            "display": "Pregabalin"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-01923",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "med-req-01923",
                "identifier":  [
                    {
                        "value": "6d2bfb69-656a-45ef-92d0-d4aae02bb438"
                    }
                ],
                "status": "active",
                "intent": "order",
                "category":  [
                    {
                        "coding":  [
                            {
                                "system": "http://hl7.org/fhir/medication-request-category",
                                "code": "inpatient",
                                "display": "inpatient"
                            }
                        ]
                    }
                ],
                "priority": "routine",
                "medicationReference": {
                    "reference": "medication-99101",
                    "display": "Pregabalin"
                },
                "subject": {
                    "reference": "patient-01912",
                    "display": "Mr Chris Packet"
                },
                "authoredOn": "2021-05-07T18:12:41+01:00",
                "requester": {
                    "reference": "staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "recorder": {
                    "reference": "staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "dosageInstruction":  [
                    {
                        "sequence": 1,
                        "timing": {
                            "repeat": {
                                "boundsDuration": {
                                    "value": 3,
                                    "unit": "day",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "d"
                                },
                                "frequency": 2,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 75,
                                    "unit": "milligram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "mg"
                                }
                            }
                        ]
                    },
                    {
                        "sequence": 2,
                        "timing": {
                            "repeat": {
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 75,
                                    "unit": "milligram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "mg"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        }
    ]
}
Bundle.id[0]7d107ed2-70c6-43d9-9cbe-f19c319d1456
Bundle.identifier[0].system[0]urn:[organisation_name]:[system_name]
Bundle.identifier[0].value[0]urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa
Bundle.type[0]message
Bundle.timestamp[0]2021-05-07T16:15:32+00:00
Bundle.entry[0].fullUrl[0]urn:message-header-167434
Bundle.entry[0].resource[0].id[0]urn:message-header-167434
Bundle.entry[0].resource[0].event[0].system[0]https://fhir.hl7.org.uk//CodeSystem/message-event
Bundle.entry[0].resource[0].event[0].code[0]prescription-order
Bundle.entry[0].resource[0].event[0].display[0]Prescription Order
Bundle.entry[0].resource[0].source[0].name[0]ACME Clinical Systems
Bundle.entry[0].resource[0].source[0].software[0]ACME ePMA
Bundle.entry[0].resource[0].source[0].version[0]3.5.68
Bundle.entry[0].resource[0].source[0].endpoint[0]urn:nhs-uk:addressing:ods:T48NT
Bundle.entry[0].resource[0].focus[0].reference[0]urn:med-req-01923
Bundle.entry[1].fullUrl[0]urn:patient-01912
Bundle.entry[1].resource[0].id[0]patient-01912
Bundle.entry[1].resource[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
Bundle.entry[1].resource[0].identifier[0].value[0]4857773456
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Mr Chris Packet
Bundle.entry[1].resource[0].name[0].family[0]Packet
Bundle.entry[1].resource[0].name[0].given[0]Chris
Bundle.entry[1].resource[0].name[0].prefix[0]Mr
Bundle.entry[1].resource[0].gender[0]male
Bundle.entry[1].resource[0].birthDate[0]1995-11-12
Bundle.entry[2].fullUrl[0]urn:staff-1112
Bundle.entry[2].resource[0].id[0]staff-1112
Bundle.entry[2].resource[0].name[0].text[0]Dr Maikeu Well
Bundle.entry[2].resource[0].name[0].family[0]Well
Bundle.entry[2].resource[0].name[0].given[0]Maikeu
Bundle.entry[2].resource[0].name[0].prefix[0]Dr
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/gmc-number
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].code[0]2145879
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].display[0]General Medical Council
Bundle.entry[3].fullUrl[0]urn:medication-99101
Bundle.entry[3].resource[0].id[0]medication-99101
Bundle.entry[3].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].code[0].coding[0].code[0]415159003
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Pregabalin
Bundle.entry[4].fullUrl[0]urn:med-req-01923
Bundle.entry[4].resource[0].id[0]med-req-01923
Bundle.entry[4].resource[0].identifier[0].value[0]6d2bfb69-656a-45ef-92d0-d4aae02bb438
Bundle.entry[4].resource[0].status[0]active
Bundle.entry[4].resource[0].intent[0]order
Bundle.entry[4].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[4].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[4].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[4].resource[0].priority[0]routine
Bundle.entry[4].resource[0].medication[0].reference[0]medication-99101
Bundle.entry[4].resource[0].medication[0].display[0]Pregabalin
Bundle.entry[4].resource[0].subject[0].reference[0]patient-01912
Bundle.entry[4].resource[0].subject[0].display[0]Mr Chris Packet
Bundle.entry[4].resource[0].authoredOn[0]2021-05-07T18:12:41+01:00
Bundle.entry[4].resource[0].requester[0].reference[0]staff-1112
Bundle.entry[4].resource[0].requester[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].recorder[0].reference[0]staff-1112
Bundle.entry[4].resource[0].recorder[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].dosageInstruction[0].sequence[0]1
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]3
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]2
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].code[0]26643006
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].display[0]oral
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]75
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]milligram
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]mg
Bundle.entry[4].resource[0].dosageInstruction[1].sequence[0]2
Bundle.entry[4].resource[0].dosageInstruction[1].timing[0].repeat[0].frequency[0]3
Bundle.entry[4].resource[0].dosageInstruction[1].timing[0].repeat[0].period[0]1
Bundle.entry[4].resource[0].dosageInstruction[1].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[4].resource[0].dosageInstruction[1].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[1].route[0].coding[0].code[0]26643006
Bundle.entry[4].resource[0].dosageInstruction[1].route[0].coding[0].display[0]oral
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].dose[0].value[0]75
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].dose[0].unit[0]milligram
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].dose[0].code[0]mg
Bundle.entry[4].resource[0].substitution[0].allowed[0]False
Bundle
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