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.

Outpatient / Scott Chegg

Patient Journey: Scott Chegg

  1. Scott is prescribed a Goserelin 3.6mg implant by Dr Justin Thyme to be administered by IM injection in the Outpatients department on 1st May 2020. The medication request is written and sent to pharmacy by ward nurse Levy Tate based on Dr Thyme's instructions as a MedicationRequest [Example 1].
  2. Pharmacy dispenses this medication as a MedicationDispense [Example 2].

Example 1: MedicationRequest

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

Actors

Provider System = Outpatient EPMA system

Consumer System = Hospital pharmacy system

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="d3f6aa00-24a3-45fe-87fd-877820f5f0e8" />
    <identifier>
        <system value="urn:[organisation_name]:[system_name]" />
        <value value="urn:39920ce3-e585-4ef2-921b-9128fcfd307f" />
    </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="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-342355475687898" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!-- Patient associated with the encounter. -->
    <entry>
        <fullUrl value="urn:patient-3204221854" />
        <resource>
            <Patient>
                <id value="urn:patient-3204221854" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="3204221854" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mr Scott Chegg" />
                    <family value="Chegg" />
                    <given value="Scott" />
                    <prefix value="Mr" />
                </name>
                <gender value="male" />
                <birthDate value="1960-04-02" />
            </Patient>
        </resource>
    </entry>
    <!-- Prescribing clinician associated with the encounter.  -->
    <entry>
        <fullUrl value="urn:staff-0001" />
        <resource>
            <Practitioner>
                <id value="urn:staff-0001" />
                <name>
                    <text value="Dr Justin Thyme" />
                    <family value="Thyme" />
                    <given value="Justin" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
                            <code value="1234567" />
                            <display value="General Medical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!-- Ward nurse associated with the encounter.  -->
    <entry>
        <fullUrl value="urn:staff-0003" />
        <resource>
            <Practitioner>
                <id value="urn:staff-0003" />
                <name>
                    <text value="Levy Tate" />
                    <family value="Tate" />
                    <given value="Levy" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/nmc-number" />
                            <code value="71A2998E" />
                            <display value="Nurse Midwifery Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!-- Medication prescribed  -->
    <entry>
        <fullUrl value="urn:medication-327337009" />
        <resource>
            <Medication>
                <id value="urn:medication-327337009" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="327337009" />
                        <display value="Goserelin 3.6mg implant pre-filled syringes" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  Medication Request  -->
    <entry>
        <fullUrl value="urn:med-req-342355475687898" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-342355475687898" />
                <identifier>
                    <system value="urn:[organisation_name]:[system_name]" />
                    <value value="urn:39920ce3-e585-4ef2-921b-9128fcfd307f" />
                </identifier>
                <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>
                <priority value="routine" />
                <medicationReference>
                    <reference value="urn:medication-327337009" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-3204221854" />
                    <display value="Mr Scott Chegg" />
                </subject>
                <authoredOn value="2020-04-30T17:00:00Z" />
                <requester>
                    <reference value="urn:staff-0001" />
                    <display value="Dr Justin Thyme" />
                </requester>
                <recorder>
                    <reference value="urn:staff-0003" />
                    <display value="Levy Tate" />
                </recorder>
                <dosageInstruction>
                    <timing>
                        <event value="2020-05-01" />
                        <repeat>
                            <count value="1" />
                        </repeat>
                    </timing>
                    <site>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="59380008" />
                            <display value="Anterior abdominal wall structure" />
                        </coding>
                    </site>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="78421000" />
                            <display value="intramuscular route" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="422145002" />
                            <display value="inject" />
                        </coding>
                    </method>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "d3f6aa00-24a3-45fe-87fd-877820f5f0e8",
    "identifier": {
        "system": "urn:[organisation_name]:[system_name]",
        "value": "urn:39920ce3-e585-4ef2-921b-9128fcfd307f"
    },
    "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-342355475687898"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-3204221854",
            "resource": {
                "resourceType": "Patient",
                "id": "urn:patient-3204221854",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "3204221854"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mr Scott Chegg",
                        "family": "Chegg",
                        "given":  [
                            "Scott"
                        ],
                        "prefix":  [
                            "Mr"
                        ]
                    }
                ],
                "gender": "male",
                "birthDate": "1960-04-02"
            }
        },
        {
            "fullUrl": "urn:staff-0001",
            "resource": {
                "resourceType": "Practitioner",
                "id": "urn:staff-0001",
                "name":  [
                    {
                        "text": "Dr Justin Thyme",
                        "family": "Thyme",
                        "given":  [
                            "Justin"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gmc-number",
                                    "code": "1234567",
                                    "display": "General Medical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:staff-0003",
            "resource": {
                "resourceType": "Practitioner",
                "id": "urn:staff-0003",
                "name":  [
                    {
                        "text": "Levy Tate",
                        "family": "Tate",
                        "given":  [
                            "Levy"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/nmc-number",
                                    "code": "71A2998E",
                                    "display": "Nurse Midwifery Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-327337009",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-327337009",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "327337009",
                            "display": "Goserelin 3.6mg implant pre-filled syringes"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-342355475687898",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "urn:med-req-342355475687898",
                "identifier":  [
                    {
                        "system": "urn:[organisation_name]:[system_name]",
                        "value": "urn:39920ce3-e585-4ef2-921b-9128fcfd307f"
                    }
                ],
                "status": "active",
                "intent": "order",
                "category":  [
                    {
                        "coding":  [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                                "code": "inpatient",
                                "display": "inpatient"
                            }
                        ]
                    }
                ],
                "priority": "routine",
                "medicationReference": {
                    "reference": "urn:medication-327337009"
                },
                "subject": {
                    "reference": "urn:patient-3204221854",
                    "display": "Mr Scott Chegg"
                },
                "authoredOn": "2020-04-30T17:00:00Z",
                "requester": {
                    "reference": "urn:staff-0001",
                    "display": "Dr Justin Thyme"
                },
                "recorder": {
                    "reference": "urn:staff-0003",
                    "display": "Levy Tate"
                },
                "dosageInstruction":  [
                    {
                        "timing": {
                            "event":  [
                                "2020-05-01"
                            ],
                            "repeat": {
                                "count": 1
                            }
                        },
                        "site": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "59380008",
                                    "display": "Anterior abdominal wall structure"
                                }
                            ]
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "78421000",
                                    "display": "intramuscular route"
                                }
                            ]
                        },
                        "method": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "422145002",
                                    "display": "inject"
                                }
                            ]
                        }
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        }
    ]
}
Bundle.id[0]d3f6aa00-24a3-45fe-87fd-877820f5f0e8
Bundle.identifier[0].system[0]urn:[organisation_name]:[system_name]
Bundle.identifier[0].value[0]urn:39920ce3-e585-4ef2-921b-9128fcfd307f
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-342355475687898
Bundle.entry[1].fullUrl[0]urn:patient-3204221854
Bundle.entry[1].resource[0].id[0]urn:patient-3204221854
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]3204221854
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Mr Scott Chegg
Bundle.entry[1].resource[0].name[0].family[0]Chegg
Bundle.entry[1].resource[0].name[0].given[0]Scott
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]1960-04-02
Bundle.entry[2].fullUrl[0]urn:staff-0001
Bundle.entry[2].resource[0].id[0]urn:staff-0001
Bundle.entry[2].resource[0].name[0].text[0]Dr Justin Thyme
Bundle.entry[2].resource[0].name[0].family[0]Thyme
Bundle.entry[2].resource[0].name[0].given[0]Justin
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]1234567
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].display[0]General Medical Council
Bundle.entry[3].fullUrl[0]urn:staff-0003
Bundle.entry[3].resource[0].id[0]urn:staff-0003
Bundle.entry[3].resource[0].name[0].text[0]Levy Tate
Bundle.entry[3].resource[0].name[0].family[0]Tate
Bundle.entry[3].resource[0].name[0].given[0]Levy
Bundle.entry[3].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/nmc-number
Bundle.entry[3].resource[0].qualification[0].code[0].coding[0].code[0]71A2998E
Bundle.entry[3].resource[0].qualification[0].code[0].coding[0].display[0]Nurse Midwifery Council
Bundle.entry[4].fullUrl[0]urn:medication-327337009
Bundle.entry[4].resource[0].id[0]urn:medication-327337009
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]327337009
Bundle.entry[4].resource[0].code[0].coding[0].display[0]Goserelin 3.6mg implant pre-filled syringes
Bundle.entry[5].fullUrl[0]urn:med-req-342355475687898
Bundle.entry[5].resource[0].id[0]urn:med-req-342355475687898
Bundle.entry[5].resource[0].identifier[0].system[0]urn:[organisation_name]:[system_name]
Bundle.entry[5].resource[0].identifier[0].value[0]urn:39920ce3-e585-4ef2-921b-9128fcfd307f
Bundle.entry[5].resource[0].status[0]active
Bundle.entry[5].resource[0].intent[0]order
Bundle.entry[5].resource[0].category[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/medicationrequest-category
Bundle.entry[5].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[5].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[5].resource[0].priority[0]routine
Bundle.entry[5].resource[0].medication[0].reference[0]urn:medication-327337009
Bundle.entry[5].resource[0].subject[0].reference[0]urn:patient-3204221854
Bundle.entry[5].resource[0].subject[0].display[0]Mr Scott Chegg
Bundle.entry[5].resource[0].authoredOn[0]2020-04-30T17:00:00Z
Bundle.entry[5].resource[0].requester[0].reference[0]urn:staff-0001
Bundle.entry[5].resource[0].requester[0].display[0]Dr Justin Thyme
Bundle.entry[5].resource[0].recorder[0].reference[0]urn:staff-0003
Bundle.entry[5].resource[0].recorder[0].display[0]Levy Tate
Bundle.entry[5].resource[0].dosageInstruction[0].timing[0].event[0]2020-05-01
Bundle.entry[5].resource[0].dosageInstruction[0].timing[0].repeat[0].count[0]1
Bundle.entry[5].resource[0].dosageInstruction[0].site[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[5].resource[0].dosageInstruction[0].site[0].coding[0].code[0]59380008
Bundle.entry[5].resource[0].dosageInstruction[0].site[0].coding[0].display[0]Anterior abdominal wall structure
Bundle.entry[5].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[5].resource[0].dosageInstruction[0].route[0].coding[0].code[0]78421000
Bundle.entry[5].resource[0].dosageInstruction[0].route[0].coding[0].display[0]intramuscular route
Bundle.entry[5].resource[0].dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[5].resource[0].dosageInstruction[0].method[0].coding[0].code[0]422145002
Bundle.entry[5].resource[0].dosageInstruction[0].method[0].coding[0].display[0]inject
Bundle.entry[5].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 = Outpatient 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="f3374004-b796-4d0d-949d-3574b0103ec9" />
    <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="individual-requirements-1" />
                    <display value="Individual Requirements" />
                </eventCoding>
                <source>
                    <endpoint value="urn:nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="urn:medication-disp-56756345423" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--    Patient associated with the encounter.    -->
    <entry>
        <fullUrl value="urn:patient-3204221854" />
        <resource>
            <Patient>
                <id value="urn:patient-3204221854" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="3204221854" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mr Scott Chegg" />
                    <family value="Chegg" />
                    <given value="Scott" />
                    <prefix value="Mr" />
                </name>
                <gender value="male" />
                <birthDate value="1960-04-02" />
            </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-824211000001107" />
        <resource>
            <Medication>
                <id value="urn:medication-824211000001107" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="824211000001107" />
                        <display value="Zoladex 3.6mg implant SafeSystem pre-filled syringes (AstraZeneca UK Ltd)" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--      Medication Dispense      -->
    <entry>
        <fullUrl value="urn:medication-disp-56756345423" />
        <resource>
            <MedicationDispense>
                <id value="urn:medication-disp-56756345423" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="urn:2aa74d82-ae47-4783-8b7a-ff594bc2929f" />
                </identifier>
                <status value="in-progress" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="outpatient" />
                        <display value="outpatient" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="urn:medication-824211000001107" />
                    <display value="Zoladex 3.6mg implant SafeSystem pre-filled syringes (AstraZeneca UK Ltd)" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-3204221854" />
                    <display value="Mr Scott Chegg" />
                </subject>
                <performer>
                    <actor>
                        <reference value="urn:staff-0002" />
                        <display value="Dr Allo Kate" />
                    </actor>
                </performer>
                <authorizingPrescription>
                    <reference value="urn:med-req-342355475687898" />
                </authorizingPrescription>
                <quantity>
                    <value value="1" />
                    <unit value="pre-filled disposable injection" />
                    <system value="http://snomed.info/sct" />
                    <code value="3318611000001103" />
                </quantity>
                <whenPrepared value="2021-05-07T16:15:32Z" />
                <dosageInstruction>
                    <timing>
                        <event value="2020-05-01" />
                        <repeat>
                            <count value="1" />
                        </repeat>
                    </timing>
                    <site>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="59380008" />
                            <display value="Anterior abdominal wall structure" />
                        </coding>
                    </site>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="78421000" />
                            <display value="intramuscular route" />
                        </coding>
                    </route>
                    <method>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="422145002" />
                            <display value="inject" />
                        </coding>
                    </method>
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Bundle
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