Implementation guide for digital medicines

This guidance is under active development by NHS Digital 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>
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