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 6: Discharge MedicationStatement

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

Codeine has been stopped. Pregabalin has been started. The MedicationStatement resources here would be included within any Discharge Summary sent to the patient's registered GP practice.

Actors

Provider System = Ward EMPA system

Consumer System = Any system requiring a view of current medication, including a shared patient record

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="24e34f04-270d-446a-a8c2-0991c93e9b46" />
    <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="medication-statement" />
                    <display value="Medication Statement" />
                </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:medication-statement-1234" />
                    <reference value="urn:medication-statement-123456" />
                </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>
    <!--     // Clinician who stopped Codine     -->
    <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>
    <!--    // Pharmacist who verified and amended the Pregabalin discharge instructions    -->
    <entry>
        <fullUrl value="urn:staff-0009" />
        <resource>
            <Practitioner>
                <id value="urn:staff-0009" />
                <name>
                    <text value="Mrs Janet Wilson" />
                    <family value="Wilson" />
                    <given value="Janet" />
                    <prefix value="Mrs" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gphc-number" />
                            <code value="4563190" />
                            <display value="General Pharmaceutical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!--    // Medication    -->
    <entry>
        <fullUrl value="urn:medication-634523423" />
        <resource>
            <Medication>
                <id value="urn:medication-634523423" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="322503009" />
                        <display value="Codeine 30mg tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // MedicationStatement    -->
    <entry>
        <fullUrl value="urn:medication-statement-1234" />
        <resource>
            <MedicationStatement>
                <id value="urn:medication-statement-1234" />
                <status value="stopped" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="discharge" />
                        <display value="Discharge" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="urn:medication-634523423" />
                    <display value="Codeine 30mg tablets" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris PACKET" />
                </subject>
                <dateAsserted value="2021-05-07T16:15:32Z" />
                <informationSource>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Better" />
                </informationSource>
                <dosage>
                    <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="2" />
                            <unit value="tablet" />
                            <system value="http://snomed.info/sct" />
                            <code value="428673006" />
                        </doseQuantity>
                    </doseAndRate>
                </dosage>
            </MedicationStatement>
        </resource>
    </entry>
    <!--       // Medication       -->
    <entry>
        <fullUrl value="urn:medication-415159003" />
        <resource>
            <Medication>
                <id value="urn:medication-415159003" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="415159003" />
                        <display value="Pregabalin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--       // MedicationStatement       -->
    <entry>
        <fullUrl value="urn:medication-statement-123456" />
        <resource>
            <MedicationStatement>
                <id value="urn:medication-statement-123456" />
                <status value="active" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="discharge" />
                        <display value="Discharge" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="urn:medication-415159003" />
                    <display value="Pregabalin" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris PACKET" />
                </subject>
                <dateAsserted value="2021-05-09T10:12:42Z" />
                <informationSource>
                    <reference value="urn:staff-0009" />
                    <display value="Mrs Janet Wilson" />
                </informationSource>
                <dosage>
                    <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="100" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosage>
            </MedicationStatement>
        </resource>
    </entry>
</Bundle>
Command 'json' could not render: File was not found for chris-packet-example-x2
Bundle.id[0]24e34f04-270d-446a-a8c2-0991c93e9b46
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]medication-statement
Bundle.entry[0].resource[0].event[0].display[0]Medication Statement
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:medication-statement-123456
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:staff-0009
Bundle.entry[3].resource[0].id[0]urn:staff-0009
Bundle.entry[3].resource[0].name[0].text[0]Mrs Janet Wilson
Bundle.entry[3].resource[0].name[0].family[0]Wilson
Bundle.entry[3].resource[0].name[0].given[0]Janet
Bundle.entry[3].resource[0].name[0].prefix[0]Mrs
Bundle.entry[3].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/gphc-number
Bundle.entry[3].resource[0].qualification[0].code[0].coding[0].code[0]4563190
Bundle.entry[3].resource[0].qualification[0].code[0].coding[0].display[0]General Pharmaceutical Council
Bundle.entry[4].fullUrl[0]urn:medication-634523423
Bundle.entry[4].resource[0].id[0]urn:medication-634523423
Bundle.entry[4].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].code[0].coding[0].code[0]322503009
Bundle.entry[4].resource[0].code[0].coding[0].display[0]Codeine 30mg tablets
Bundle.entry[5].fullUrl[0]urn:medication-statement-1234
Bundle.entry[5].resource[0].id[0]urn:medication-statement-1234
Bundle.entry[5].resource[0].status[0]stopped
Bundle.entry[5].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[5].resource[0].category[0].coding[0].code[0]discharge
Bundle.entry[5].resource[0].category[0].coding[0].display[0]Discharge
Bundle.entry[5].resource[0].medication[0].reference[0]urn:medication-634523423
Bundle.entry[5].resource[0].medication[0].display[0]Codeine 30mg tablets
Bundle.entry[5].resource[0].subject[0].reference[0]urn:patient-01912
Bundle.entry[5].resource[0].subject[0].display[0]Mr Chris PACKET
Bundle.entry[5].resource[0].dateAsserted[0]2021-05-07T16:15:32Z
Bundle.entry[5].resource[0].informationSource[0].reference[0]urn:staff-1112
Bundle.entry[5].resource[0].informationSource[0].display[0]Dr Maikeu Better
Bundle.entry[5].resource[0].dosage[0].timing[0].repeat[0].frequency[0]4
Bundle.entry[5].resource[0].dosage[0].timing[0].repeat[0].period[0]1
Bundle.entry[5].resource[0].dosage[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[5].resource[0].dosage[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[5].resource[0].dosage[0].route[0].coding[0].code[0]26643006
Bundle.entry[5].resource[0].dosage[0].route[0].coding[0].display[0]oral
Bundle.entry[5].resource[0].dosage[0].doseAndRate[0].dose[0].value[0]2
Bundle.entry[5].resource[0].dosage[0].doseAndRate[0].dose[0].unit[0]tablet
Bundle.entry[5].resource[0].dosage[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
Bundle.entry[5].resource[0].dosage[0].doseAndRate[0].dose[0].code[0]428673006
Bundle.entry[6].fullUrl[0]urn:medication-415159003
Bundle.entry[6].resource[0].id[0]urn:medication-415159003
Bundle.entry[6].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[6].resource[0].code[0].coding[0].code[0]415159003
Bundle.entry[6].resource[0].code[0].coding[0].display[0]Pregabalin
Bundle.entry[7].fullUrl[0]urn:medication-statement-123456
Bundle.entry[7].resource[0].id[0]urn:medication-statement-123456
Bundle.entry[7].resource[0].status[0]active
Bundle.entry[7].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[7].resource[0].category[0].coding[0].code[0]discharge
Bundle.entry[7].resource[0].category[0].coding[0].display[0]Discharge
Bundle.entry[7].resource[0].medication[0].reference[0]urn:medication-415159003
Bundle.entry[7].resource[0].medication[0].display[0]Pregabalin
Bundle.entry[7].resource[0].subject[0].reference[0]urn:patient-01912
Bundle.entry[7].resource[0].subject[0].display[0]Mr Chris PACKET
Bundle.entry[7].resource[0].dateAsserted[0]2021-05-09T10:12:42Z
Bundle.entry[7].resource[0].informationSource[0].reference[0]urn:staff-0009
Bundle.entry[7].resource[0].informationSource[0].display[0]Mrs Janet Wilson
Bundle.entry[7].resource[0].dosage[0].timing[0].repeat[0].frequency[0]2
Bundle.entry[7].resource[0].dosage[0].timing[0].repeat[0].period[0]1
Bundle.entry[7].resource[0].dosage[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[7].resource[0].dosage[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[7].resource[0].dosage[0].route[0].coding[0].code[0]26643006
Bundle.entry[7].resource[0].dosage[0].route[0].coding[0].display[0]oral
Bundle.entry[7].resource[0].dosage[0].doseAndRate[0].dose[0].value[0]100
Bundle.entry[7].resource[0].dosage[0].doseAndRate[0].dose[0].unit[0]milligram
Bundle.entry[7].resource[0].dosage[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[7].resource[0].dosage[0].doseAndRate[0].dose[0].code[0]mg
Bundle
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