Implementation guide for interoperable medicines

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

</identifier>

<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>

<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>

<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>

<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>

<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>

<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>

<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>

<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 not found for 'subject=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

id : 24e34f04-270d-446a-a8c2-0991c93e9b46

identifier

system : urn:[organisation_name]:[system_name]

value : urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa

type : message

timestamp : 2021-05-07T16:15:32Z

entry

fullUrl : urn:message-header-167434

resource

id : urn:message-header-167434

event

system : https://fhir.hl7.org.uk//CodeSystem/message-event

code : medication-statement

display : Medication Statement

source

name : ACME Clinical Systems

software : ACME ePMA

version : 3.5.68

endpoint : urn:nhs-uk:addressing:ods:T48NT

focus

reference : urn:medication-statement-1234

reference : urn:medication-statement-123456

entry

fullUrl : urn:patient-01912

resource

id : urn: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

entry

fullUrl : urn:staff-1112

resource

id : urn: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

entry

fullUrl : urn:staff-0009

resource

id : urn:staff-0009

name

text : Mrs Janet Wilson

family : Wilson

given : Janet

prefix : Mrs

qualification

code

coding

system : https://fhir.hl7.org.uk/Id/gphc-number

code : 4563190

display : General Pharmaceutical Council

entry

fullUrl : urn:medication-634523423

resource

id : urn:medication-634523423

code

coding

system : http://snomed.info/sct

code : 322503009

display : Codeine 30mg tablets

entry

fullUrl : urn:medication-statement-1234

resource

id : urn:medication-statement-1234

status : stopped

category

coding

system : http://hl7.org/fhir/medication-request-category

code : discharge

display : Discharge

medication

reference : urn:medication-634523423

display : Codeine 30mg tablets

subject

reference : urn:patient-01912

display : Mr Chris PACKET

dateAsserted : 2021-05-07T16:15:32Z

informationSource

reference : urn:staff-1112

display : Dr Maikeu Better

dosage

timing

repeat

frequency : 4

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 2

unit : tablet

system : http://snomed.info/sct

code : 428673006

entry

fullUrl : urn:medication-415159003

resource

id : urn:medication-415159003

code

coding

system : http://snomed.info/sct

code : 415159003

display : Pregabalin

entry

fullUrl : urn:medication-statement-123456

resource

id : urn:medication-statement-123456

status : active

category

coding

system : http://hl7.org/fhir/medication-request-category

code : discharge

display : Discharge

medication

reference : urn:medication-415159003

display : Pregabalin

subject

reference : urn:patient-01912

display : Mr Chris PACKET

dateAsserted : 2021-05-09T10:12:42Z

informationSource

reference : urn:staff-0009

display : Mrs Janet Wilson

dosage

timing

repeat

frequency : 2

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 100

unit : milligram

system : http://unitsofmeasure.org

code : mg