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.

Insulin lispro subcutaneous injection

Product-based instruction using an AMP. Uses a doseQuantity expressed as a number of Unit. The SNOMED-CT definition of this product contains an attribute for Has unit of administration (attribute) linked to Unit (qualifier value). This relationship is not contained within dm+d data therefore the medicationCodeableConcept.coding.system is "http://snomed.info/sct" instead of "https://dmd.nhs.uk".

Note: This representation using a doseQuantity as a number Units should only be used where the consumer system(s) are known to support it. This is opposed to those systems that expect all units of measure to be based on dm+d data such a GP and community pharmacy systems. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="18a8ea33-dc5f-4fb7-985e-acc474bf97cd" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="35776411000001102" />
            <display value="Insulin lispro Sanofi 100units/ml solution for injection 10ml vials (Sanofi)" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9999999999" />
        </identifier>
    </subject>
    <authoredOn value="2019-01-15T15:00:00Z" />
    <requester>
        <reference value="urn:staff-1112" />
        <display value="Dr Maikeu Well" />
    </requester>
    <recorder>
        <reference value="urn:staff-1112" />
        <display value="Dr Maikeu Well" />
    </recorder>
    <dosageInstruction>
        <text value="Inject 8 Unit - 3 times a day - at a meal - Subcutaneous route" />
        <timing>
            <repeat>
                <frequency value="3" />
                <period value="1" />
                <periodUnit value="d" />
                <when value="C" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="34206005" />
                <display value="Subcutaneous route" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="422145002" />
                <display value="Inject" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="8" />
                <unit value="Unit" />
                <system value="http://snomed.info/sct" />
                <code value="767525000" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "18a8ea33-dc5f-4fb7-985e-acc474bf97cd",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "35776411000001102",
                "display": "Insulin lispro Sanofi 100units/ml solution for injection 10ml vials (Sanofi)"
            }
        ]
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "authoredOn": "2019-01-15T15:00:00Z",
    "requester": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "recorder": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "dosageInstruction":  [
        {
            "text": "Inject 8 Unit - 3 times a day - at a meal - Subcutaneous route",
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "422145002",
                        "display": "Inject"
                    }
                ]
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "34206005",
                        "display": "Subcutaneous route"
                    }
                ]
            },
            "timing": {
                "repeat": {
                    "frequency": 3,
                    "period": 1,
                    "periodUnit": "d",
                    "when":  [
                        "C"
                    ]
                }
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 8,
                        "unit": "Unit",
                        "system": "http://snomed.info/sct",
                        "code": "767525000"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]18a8ea33-dc5f-4fb7-985e-acc474bf97cd
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.category[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/medicationrequest-category
MedicationRequest.category[0].coding[0].code[0]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.medication[0].coding[0].code[0]35776411000001102
MedicationRequest.medication[0].coding[0].display[0]Insulin lispro Sanofi 100units/ml solution for injection 10ml vials (Sanofi)
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.authoredOn[0]2019-01-15T15:00:00Z
MedicationRequest.requester[0].reference[0]urn:staff-1112
MedicationRequest.requester[0].display[0]Dr Maikeu Well
MedicationRequest.recorder[0].reference[0]urn:staff-1112
MedicationRequest.recorder[0].display[0]Dr Maikeu Well
MedicationRequest.dosageInstruction[0].text[0]Inject 8 Unit - 3 times a day - at a meal - Subcutaneous route
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]3
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].when[0]C
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]34206005
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Subcutaneous route
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]422145002
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Inject
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]8
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]Unit
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]767525000
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Insulin lispro Sanofi 100units/ml solution for injection 10ml vials (Sanofi)
Inject 8 Unit - 3 times a day - at a meal - Subcutaneous route
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