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.

Use Case: Supply of Medication using ADCs

An automated dispensing cabinet (ADC) is a secure, computer-controlled storage unit used in hospitals and healthcare settings to store, track, and dispense medications at the point of care.

adc-context-diagram

Use Case 1: Set-up / Configuration of patient mediciations within the ADC

Sending the ADC details of a patient's current medication. An ADC will typically categorise medication as one of three types; routine, PRN/As Required and STAT (take once, immediately). The display console on an ADC will typically group a patient's medication into these three categories.

Any new, changed or stopped medication recorded within the EPMA system will trigger this interaction to be resent to the ADC.

The FHIR MedicationStatement resource could be used for this use case. This can share the medication and dosage. However the business data is more aligned with the FHIR MedicationRequest resource for the following reasons.

  • STAT doses can be identified using MedicationRequest.priority = stat. If using a MedicationStatement the identification of a STAT dose could be identified in two ways. The first is via date logic; if the date/time expressed within the dosage is before or close to the current time. The second is by adding stat to the dosage.timing.code value set, but note the HL7 community removed stat from the equivilant HL7v2 value set for the FHIR standard.
  • Sometimes an ADC is instructed with a quantity of medication to dispense, e.g. "28 tablets". The MedicationStatement does not directly support this so would need to be extended.
  • The element intent provides a logical separation between the use of the MedicationRequest resource for configuration / set-up (intent=plan) and for orders (intent=order). The FHIR standard states the intent element is labeled as a modifier because the intent alters when and how the resource is applicable.

See Profile: MedicationRequest.

Use Case 2: Order for "Click and Collect" medication from the ADC

A user-initiated order for "Click and Collect" medication using the FHIR MedicationRequest resource. Typically an ADC will assign the medication for the requesting clinical user, i.e. when the user next accesses the ADC the order will be visible on the ADC console.

See Profile: MedicationRequest.

Use Case 3: Configuration of patient allergies within the ADC

Using the FHIR AllergyIntolerance resource for sharing patient allergy records with the ADC. These records may come from either the Trust EPMA or PAS systems.

See Profile: AllergyIntolerance.

Use Case 4: Sharing formulary information from the pharmacy system to the ADC

Guidance to be discussed with the working group using the FHIR MedicationKnowledge resource.

Use Case 5: ADC refill request/response interactions between the pharmacy stock control system and the ADC

Guidance to be discussed with the working group using the FHIR SupplyRequest and SupplyDelivery resources.

Examples

See Supply of Medication using ADCs.

Currently OUT OF SCOPE Use Cases

The following integration use cases with an ADC are out of scope for this version of this guidance.

  • ADC configuration of patient encounter and demographic data from the PAS
  • Using ADCs to support virtual wards
  • Integration with automated dispensing trolleys
  • Self-Administration
    • Instructions that a patient will be self-administrating medication is out of scope. This a separate workflow characteristic describing who administers the medicine, i.e. the patient themselves. It does not on its own define a separate ADC set-up request. The medicine may be supplied in unit doses or whole packs. There is no need to flag or indicate self-administration to the ADC. The EMPA system would indicate to the clinical user that the medication is for patient self-administration.
  • One-Stop Supply
    • The provision of an original or whole pack to a patient during their admission, for use while admitted and continuation after discharge. It aims to reduce the need to dispense again at discharge. Some EPMA systems have a one-stop flag. Today, ADCs do not display a one-stop indicator but could do in the future. Using One-stop is a decision at the point of admission so applicable to ADC set-up. Typically, one-stop medication will be dispensed by pharmacy, not the ADC, therefore one-stop does not need to be a flag or indicator within the interactions with an ADC.
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