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 4: Discharge MedicationRequest

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

Discharge TTO medication requests for Paracetamol , Ibuprofen and Pregabalin.

Actors

Provider System = Ward EMPA system

Consumer System = Hospital pharamcy system

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="acd1d58c-4abd-415b-a5a3-88f5dac71ec0" />
    <type value="message" />
    <timestamp value="2021-05-07T16:15:32Z" />
    <!--    Message Header    -->
    <entry>
        <fullUrl value="urn:message-header-9920192" />
        <resource>
            <MessageHeader>
                <id value="urn:message-header-9920192" />
                <eventCoding>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <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-76462" />
                </focus>
                <focus>
                    <reference value="urn:med-req-987765745" />
                </focus>
                <focus>
                    <reference value="urn:med-req-11adfw53446" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--   // Patient associated with the encounter    -->
    <entry>
        <fullUrl value="urn:patient-01912" />
        <resource>
            <Patient>
                <id value="urn: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="urn: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 #1: Paracetamol   -->
    <entry>
        <fullUrl value="urn:medication-90332006" />
        <resource>
            <Medication>
                <id value="urn:medication-90332006" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="90332006" />
                        <display value="Paracetamol" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // Medication Request #1: Paracetamol 1g four times a day    -->
    <entry>
        <fullUrl value="urn:med-req-76462" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-76462" />
                <identifier>
                    <value value="35873655-0d53-469a-9428-04df65f5cbb4" />
                </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="urn:medication-90332006" />
                    <display value="Paracetamol" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-14T11:34:12+01:00" />
                <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>
                    <timing>
                        <repeat>
                            <frequency value="4" />
                            <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="1" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
    <!--   // Medication #2: Ibuprofen 800mg modified-release tablets   -->
    <entry>
        <fullUrl value="urn:medication-39110311000001101" />
        <resource>
            <Medication>
                <id value="urn:medication-39110311000001101" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="39110311000001101" />
                        <display value="Ibuprofen 800mg modified-release tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // Medication Request #2: Ibuprofen 800mg modified-release tablets   -->
    <entry>
        <fullUrl value="urn:med-req-987765745" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-987765745" />
                <identifier>
                    <value value="63a40946-c387-4810-9458-c573f873d7b4" />
                </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="urn:medication-39110311000001101" />
                    <display value="Ibuprofen 800mg modified-release tablets" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-14T11:34:12Z" />
                <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>
                    <timing>
                        <repeat>
                            <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="800" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
    <!--   // Medication #3: Pregabalin   -->
    <entry>
        <fullUrl value="urn:medication-234567321" />
        <resource>
            <Medication>
                <id value="urn:medication-234567321" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="415160008" />
                        <display value="Pregabalin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // Medication Request #3: Pregabalin    -->
    <entry>
        <fullUrl value="urn:med-req-11adfw53446" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-11adfw53446" />
                <identifier>
                    <value value="63a40946-c387-4810-9458-c573f873d7b4" />
                </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="urn:medication-234567321" />
                    <display value="Pregabalin" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-14T11:34:12Z" />
                <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>
                    <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>

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    "type": "message",
    "timestamp": "2021-05-07T16:15:32Z",
    "entry":  [
        {
            "fullUrl": "urn:message-header-9920192",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "urn:message-header-9920192",
                "eventCoding": {
                    "system": "https://fhir.nhs.uk/STU3/CodeSystem/EventType-1",
                    "code": "prescription-order",
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                },
                "source": {
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                    "software": "ACME ePMA",
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                "focus":  [
                    {
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            }
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            "resource": {
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                "status": "active",
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                "category":  [
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                "priority": "routine",
                "medicationReference": {
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                "recorder": {
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                "dosageInstruction":  [
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                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 1,
                                    "unit": "gram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "g"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        },
        {
            "fullUrl": "urn:medication-39110311000001101",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-39110311000001101",
                "code": {
                    "coding":  [
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            }
        },
        {
            "fullUrl": "urn:med-req-987765745",
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                "resourceType": "MedicationRequest",
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                "substitution": {
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        {
            "fullUrl": "urn:medication-234567321",
            "resource": {
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                                    "unit": "milligram",
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                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        }
    ]
}
Bundle.id[0]acd1d58c-4abd-415b-a5a3-88f5dac71ec0
Bundle.type[0]message
Bundle.timestamp[0]2021-05-07T16:15:32+00:00
Bundle.entry[0].fullUrl[0]urn:message-header-9920192
Bundle.entry[0].resource[0].id[0]urn:message-header-9920192
Bundle.entry[0].resource[0].event[0].system[0]https://fhir.nhs.uk/STU3/CodeSystem/EventType-1
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-76462
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Bundle.entry[0].resource[0].focus[2].reference[0]urn:med-req-11adfw53446
Bundle.entry[1].fullUrl[0]urn:patient-01912
Bundle.entry[1].resource[0].id[0]urn: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]urn: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-90332006
Bundle.entry[3].resource[0].id[0]urn:medication-90332006
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]90332006
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Paracetamol
Bundle.entry[4].fullUrl[0]urn:med-req-76462
Bundle.entry[4].resource[0].id[0]urn:med-req-76462
Bundle.entry[4].resource[0].identifier[0].value[0]35873655-0d53-469a-9428-04df65f5cbb4
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]urn:medication-90332006
Bundle.entry[4].resource[0].medication[0].display[0]Paracetamol
Bundle.entry[4].resource[0].subject[0].reference[0]urn:patient-01912
Bundle.entry[4].resource[0].subject[0].display[0]Mr Chris Packet
Bundle.entry[4].resource[0].authoredOn[0]2021-05-14T11:34:12+01:00
Bundle.entry[4].resource[0].requester[0].reference[0]urn:staff-1112
Bundle.entry[4].resource[0].requester[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].recorder[0].reference[0]urn:staff-1112
Bundle.entry[4].resource[0].recorder[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]4
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]1
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]gram
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]g
Bundle.entry[4].resource[0].substitution[0].allowed[0]False
Bundle.entry[5].fullUrl[0]urn:medication-39110311000001101
Bundle.entry[5].resource[0].id[0]urn:medication-39110311000001101
Bundle.entry[5].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[5].resource[0].code[0].coding[0].code[0]39110311000001101
Bundle.entry[5].resource[0].code[0].coding[0].display[0]Ibuprofen 800mg modified-release tablets
Bundle.entry[6].fullUrl[0]urn:med-req-987765745
Bundle.entry[6].resource[0].id[0]urn:med-req-987765745
Bundle.entry[6].resource[0].identifier[0].value[0]63a40946-c387-4810-9458-c573f873d7b4
Bundle.entry[6].resource[0].status[0]active
Bundle.entry[6].resource[0].intent[0]order
Bundle.entry[6].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[6].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[6].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[6].resource[0].priority[0]routine
Bundle.entry[6].resource[0].medication[0].reference[0]urn:medication-39110311000001101
Bundle.entry[6].resource[0].medication[0].display[0]Ibuprofen 800mg modified-release tablets
Bundle.entry[6].resource[0].subject[0].reference[0]urn:patient-01912
Bundle.entry[6].resource[0].subject[0].display[0]Mr Chris Packet
Bundle.entry[6].resource[0].authoredOn[0]2021-05-14T11:34:12Z
Bundle.entry[6].resource[0].requester[0].reference[0]urn:staff-1112
Bundle.entry[6].resource[0].requester[0].display[0]Dr Maikeu Well
Bundle.entry[6].resource[0].recorder[0].reference[0]urn:staff-1112
Bundle.entry[6].resource[0].recorder[0].display[0]Dr Maikeu Well
Bundle.entry[6].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]2
Bundle.entry[6].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[6].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[6].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[6].resource[0].dosageInstruction[0].route[0].coding[0].code[0]26643006
Bundle.entry[6].resource[0].dosageInstruction[0].route[0].coding[0].display[0]oral
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]800
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]milligram
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]mg
Bundle.entry[6].resource[0].substitution[0].allowed[0]False
Bundle.entry[7].fullUrl[0]urn:medication-234567321
Bundle.entry[7].resource[0].id[0]urn:medication-234567321
Bundle.entry[7].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[7].resource[0].code[0].coding[0].code[0]415160008
Bundle.entry[7].resource[0].code[0].coding[0].display[0]Pregabalin
Bundle.entry[8].fullUrl[0]urn:med-req-11adfw53446
Bundle.entry[8].resource[0].id[0]urn:med-req-11adfw53446
Bundle.entry[8].resource[0].identifier[0].value[0]63a40946-c387-4810-9458-c573f873d7b4
Bundle.entry[8].resource[0].status[0]active
Bundle.entry[8].resource[0].intent[0]order
Bundle.entry[8].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[8].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[8].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[8].resource[0].priority[0]routine
Bundle.entry[8].resource[0].medication[0].reference[0]urn:medication-234567321
Bundle.entry[8].resource[0].medication[0].display[0]Pregabalin
Bundle.entry[8].resource[0].subject[0].reference[0]urn:patient-01912
Bundle.entry[8].resource[0].subject[0].display[0]Mr Chris Packet
Bundle.entry[8].resource[0].authoredOn[0]2021-05-14T11:34:12Z
Bundle.entry[8].resource[0].requester[0].reference[0]urn:staff-1112
Bundle.entry[8].resource[0].requester[0].display[0]Dr Maikeu Well
Bundle.entry[8].resource[0].recorder[0].reference[0]urn:staff-1112
Bundle.entry[8].resource[0].recorder[0].display[0]Dr Maikeu Well
Bundle.entry[8].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[8].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[8].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[8].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[8].resource[0].dosageInstruction[0].route[0].coding[0].code[0]26643006
Bundle.entry[8].resource[0].dosageInstruction[0].route[0].coding[0].display[0]oral
Bundle.entry[8].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].value[0]75
Bundle.entry[8].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].unit[0]milligram
Bundle.entry[8].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[8].resource[0].dosageInstruction[0].doseAndRate[0].dose[0].code[0]mg
Bundle.entry[8].resource[0].substitution[0].allowed[0]False
Bundle
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