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.

Inpatient Discharge / Paige Turner

Patient Journey: Paige Turner

  1. Paige is discharged from hospital following an admission where she was diagnosed as being diabetic. She was prescribed 4 weeks quantity of Metformin 500mg tablets by Dr Makieu Well, to take twice daily on an on-going basis. The MedicationRequest was recorded by pharmacist Bill Ding [Example 1].
  2. Pharmacy dispenses this medication as a MedicationDispense [Example 2] which is handed over to Paige before she leaves the hospital.
More information about this use-case can be found here

Example 1: MedicationRequest

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

Actors

Provider System = Ward EPMA system

Consumer System = Hospital pharmacy system

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="d0a503d2-6809-4055-be82-308183e64734" />
    <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="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-1023938" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--   Patient associated with the encounter.   -->
    <entry>
        <fullUrl value="urn:patient-013298920" />
        <resource>
            <Patient>
                <id value="urn:patient-013298920" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="2377954310" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Miss Paige Turner" />
                    <family value="Turner" />
                    <given value="Paige" />
                    <prefix value="Miss" />
                </name>
                <gender value="female" />
                <birthDate value="1990-08-04" />
            </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    -->
    <entry>
        <fullUrl value="urn:medication-109081006" />
        <resource>
            <Medication>
                <id value="urn:medication-109081006" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="325278007" />
                        <display value="Metformin 500mg tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    Medication Request    -->
    <entry>
        <fullUrl value="urn:med-req-1023938" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-1023938" />
                <status value="active" />
                <intent value="order" />
                <category>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
                        <code value="discharge" />
                        <display value="discharge" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="urn:medication-325278007" />
                    <display value="Metformin 500mg tablets" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-013298920" />
                    <display value="Miss Paige Turner" />
                </subject>
                <authoredOn value="2020-05-15T15:00:00Z" />
                <requester>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Well" />
                </requester>
                <recorder>
                    <reference value="urn:staff-4532" />
                    <display value="Bill Ding" />
                </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="1" />
                            <unit value="tablet" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="428673006" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "d0a503d2-6809-4055-be82-308183e64734",
    "type": "message",
    "timestamp": "2021-05-07T16:15:32+00:00",
    "entry":  [
        {
            "fullUrl": "urn:message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "urn:message-header-167434",
                "eventCoding": {
                    "system": "https://fhir.hl7.org.uk//CodeSystem/message-event",
                    "code": "prescription-order",
                    "display": "Prescription Order"
                },
                "source": {
                    "name": "ACME Clinical Systems",
                    "software": "ACME ePMA",
                    "version": "3.5.68",
                    "endpoint": "urn:nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "urn:med-req-1023938"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-013298920",
            "resource": {
                "resourceType": "Patient",
                "id": "urn:patient-013298920",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "2377954310"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Miss Paige Turner",
                        "family": "Turner",
                        "given":  [
                            "Paige"
                        ],
                        "prefix":  [
                            "Miss"
                        ]
                    }
                ],
                "gender": "female",
                "birthDate": "1990-08-04"
            }
        },
        {
            "fullUrl": "urn:staff-1112",
            "resource": {
                "resourceType": "Practitioner",
                "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"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-109081006",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-109081006",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "325278007",
                            "display": "Metformin 500mg tablets"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-1023938",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "urn:med-req-1023938",
                "status": "active",
                "intent": "order",
                "category":  [
                    {
                        "coding":  [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                                "code": "discharge",
                                "display": "discharge"
                            }
                        ]
                    }
                ],
                "medicationReference": {
                    "reference": "urn:medication-325278007",
                    "display": "Metformin 500mg tablets"
                },
                "subject": {
                    "reference": "urn:patient-013298920",
                    "display": "Miss Paige Turner"
                },
                "authoredOn": "2020-05-15T15:00:00Z",
                "requester": {
                    "reference": "urn:staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "recorder": {
                    "reference": "urn:staff-4532",
                    "display": "Bill Ding"
                },
                "dosageInstruction":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 2,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 1,
                                    "unit": "tablet",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "428673006"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        }
    ]
}
Bundle.id[0]d0a503d2-6809-4055-be82-308183e64734
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]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-1023938
Bundle.entry[1].fullUrl[0]urn:patient-013298920
Bundle.entry[1].resource[0].id[0]urn:patient-013298920
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]2377954310
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Miss Paige Turner
Bundle.entry[1].resource[0].name[0].family[0]Turner
Bundle.entry[1].resource[0].name[0].given[0]Paige
Bundle.entry[1].resource[0].name[0].prefix[0]Miss
Bundle.entry[1].resource[0].gender[0]female
Bundle.entry[1].resource[0].birthDate[0]1990-08-04
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-109081006
Bundle.entry[3].resource[0].id[0]urn:medication-109081006
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]325278007
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Metformin 500mg tablets
Bundle.entry[4].fullUrl[0]urn:med-req-1023938
Bundle.entry[4].resource[0].id[0]urn:med-req-1023938
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://terminology.hl7.org/CodeSystem/medicationrequest-category
Bundle.entry[4].resource[0].category[0].coding[0].code[0]discharge
Bundle.entry[4].resource[0].category[0].coding[0].display[0]discharge
Bundle.entry[4].resource[0].medication[0].reference[0]urn:medication-325278007
Bundle.entry[4].resource[0].medication[0].display[0]Metformin 500mg tablets
Bundle.entry[4].resource[0].subject[0].reference[0]urn:patient-013298920
Bundle.entry[4].resource[0].subject[0].display[0]Miss Paige Turner
Bundle.entry[4].resource[0].authoredOn[0]2020-05-15T15:00:00Z
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-4532
Bundle.entry[4].resource[0].recorder[0].display[0]Bill Ding
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]2
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]tablet
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]428673006
Bundle.entry[4].resource[0].substitution[0].allowed[0]False
Bundle

Example 2: MedicationDispense

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

Actors

Provider System = Hospital pharmacy system

Consumer System = Ward EPMA system

Example

<!--     This xml example is for illustrative purposes only and has not been clinically verified.     -->
<Bundle xmlns="http://hl7.org/fhir">
    <id value="830a2a41-cca8-46a3-a35c-3237cb9828e4" />
    <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="http://hl7.org/fhir/message-events" />
                    <code value="dispense-notification" />
                    <display value="Dispense Notification" />
                </eventCoding>
                <source>
                    <name value="ACME Clinical Systems" />
                    <software value="ACME Pharmacy" />
                    <version value="4.1.15" />
                    <endpoint value="urn:nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="urn:med-disp-324234234" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--    Patient associated with the encounter.    -->
    <entry>
        <fullUrl value="urn:patient-113582401" />
        <resource>
            <Patient>
                <id value="urn:patient-113582401" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="113582401" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Ms Paige Turner" />
                    <family value="Turner" />
                    <given value="Paige" />
                    <prefix value="Ms" />
                </name>
                <gender value="female" />
                <birthDate value="1982-11-20" />
            </Patient>
        </resource>
    </entry>
    <!--      Performer associated with the encounter.      -->
    <entry>
        <fullUrl value="urn:staff-0002" />
        <resource>
            <Practitioner>
                <id value="urn:staff-0002" />
                <name>
                    <text value="Dr Allo Kate" />
                    <family value="Kate" />
                    <given value="Allo" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gpc-number" />
                            <code value="123543" />
                            <display value="General Pharmaceutical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!--    Medication   -->
    <entry>
        <fullUrl value="urn:medication-22349811000001106" />
        <resource>
            <Medication>
                <id value="urn:medication-22349811000001106" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="22349811000001106" />
                        <display value="Metformin 500mg tablets (Milpharm Ltd)" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--      Medication Dispense      -->
    <entry>
        <fullUrl value="urn:med-disp-324234234" />
        <resource>
            <MedicationDispense>
                <id value="urn:med-disp-324234234" />
                <identifier>
                    <system value="urn:[organisation_name]:[system_name]" />
                    <value value="urn:55b65ae3-c4f3-4da3-8d8a-7a4af42122d47" />
                </identifier>
                <status value="in-progress" />
                <medicationReference>
                    <reference value="urn:medication-22349811000001106" />
                    <display value="Metformin 500mg tablets (Milpharm Ltd)" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-113582401" />
                    <display value="Ms Paige Turner" />
                </subject>
                <performer>
                    <actor>
                        <reference value="urn:staff-0002" />
                        <display value="Dr Allo Kate" />
                    </actor>
                </performer>
                <authorizingPrescription>
                    <reference value="urn:med-req-1023938" />
                </authorizingPrescription>
                <quantity>
                    <value value="56" />
                    <unit value="tablet" />
                    <system value="http://snomed.info/sct" />
                    <code value="428673006" />
                </quantity>
                <daysSupply>
                    <value value="28" />
                    <unit value="Day" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="d" />
                </daysSupply>
                <whenPrepared value="2021-05-07T16:15:32Z" />
                <dosageInstruction>
                    <timing>
                        <repeat>
                            <frequency value="2" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="428673006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="1" />
                            <unit value="tablet" />
                            <system value="http://snomed.info/sct" />
                            <code value="428673006" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
            </MedicationDispense>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "830a2a41-cca8-46a3-a35c-3237cb9828e4",
    "type": "message",
    "timestamp": "2021-05-07T16:15:32+00:00",
    "entry":  [
        {
            "fullUrl": "urn:message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "urn:message-header-167434",
                "eventCoding": {
                    "system": "http://hl7.org/fhir/message-events",
                    "code": "dispense-notification",
                    "display": "Dispense Notification"
                },
                "source": {
                    "name": "ACME Clinical Systems",
                    "software": "ACME Pharmacy",
                    "version": "4.1.15",
                    "endpoint": "urn:nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "urn:med-disp-324234234"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-113582401",
            "resource": {
                "resourceType": "Patient",
                "id": "urn:patient-113582401",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "113582401"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Ms Paige Turner",
                        "family": "Turner",
                        "given":  [
                            "Paige"
                        ],
                        "prefix":  [
                            "Ms"
                        ]
                    }
                ],
                "gender": "female",
                "birthDate": "1982-11-20"
            }
        },
        {
            "fullUrl": "urn:staff-0002",
            "resource": {
                "resourceType": "Practitioner",
                "id": "urn:staff-0002",
                "name":  [
                    {
                        "text": "Dr Allo Kate",
                        "family": "Kate",
                        "given":  [
                            "Allo"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gpc-number",
                                    "code": "123543",
                                    "display": "General Pharmaceutical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-22349811000001106",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-22349811000001106",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "22349811000001106",
                            "display": "Metformin 500mg tablets (Milpharm Ltd)"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-disp-324234234",
            "resource": {
                "resourceType": "MedicationDispense",
                "id": "urn:med-disp-324234234",
                "identifier":  [
                    {
                        "system": "urn:[organisation_name]:[system_name]",
                        "value": "urn:55b65ae3-c4f3-4da3-8d8a-7a4af42122d47"
                    }
                ],
                "status": "in-progress",
                "medicationReference": {
                    "reference": "urn:medication-22349811000001106",
                    "display": "Metformin 500mg tablets (Milpharm Ltd)"
                },
                "subject": {
                    "reference": "urn:patient-113582401",
                    "display": "Ms Paige Turner"
                },
                "performer":  [
                    {
                        "actor": {
                            "reference": "urn:staff-0002",
                            "display": "Dr Allo Kate"
                        }
                    }
                ],
                "authorizingPrescription":  [
                    {
                        "reference": "urn:med-req-1023938"
                    }
                ],
                "quantity": {
                    "value": 56,
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Bundle
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