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.

Phenoxymethylpenicillin tablets

Product-based VMP prescription using free text additional instruction because 'on an empty stomach' is neither SNOMED coded nor in a FHIR valueset.

It was decided that modelling only as 'an hour before food' would not be sufficient.

<timing>
    <repeat>
        <when value="C"/>
        <offset value="60" />
    </repeat>
</timing>

Therefore a free-text instruction needs to be added.

<additionalInstruction>
    <text value="or on an empty stomach" />
</additionalInstruction>
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="5dcc8ffd-9838-45ed-8d31-fd20026fde4b" />
<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="https://dmd.nhs.uk" />
<code value="323416001" />
<display value="Phenoxymethylpenicillin 250mg tablets" />
</coding>
</medicationCodeableConcept>
<subject>
<identifier>
<system value="https://fhir.nhs.uk/Id/nhs-number" />
<value value="9999999999" />
</identifier>
</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-1112" />
<display value="Dr Maikeu Well" />
</recorder>
<dosageInstruction>
<text value="2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach" />
<additionalInstruction>
<text value="or on an empty stomach" />
</additionalInstruction>
<timing>
<repeat>
<frequency value="1" />
<period value="6" />
<periodUnit value="h" />
<when value="AC" />
<offset value="60" />
</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>
</dosageInstruction>
<substitution>
<allowedBoolean value="false" />
</substitution>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "5dcc8ffd-9838-45ed-8d31-fd20026fde4b",
"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": "https://dmd.nhs.uk",
"code": "323416001",
"display": "Phenoxymethylpenicillin 250mg tablets"
}
]
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"authoredOn": "2020-05-15T15:00:00Z",
"requester": {
"reference": "urn:staff-1112",
"display": "Dr Maikeu Well"
},
"recorder": {
"reference": "urn:staff-1112",
"display": "Dr Maikeu Well"
},
"dosageInstruction": [
{
"text": "2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach",
"additionalInstruction": [
{
"text": "or on an empty stomach"
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 6,
"periodUnit": "h",
"when": [
"AC"
],
"offset": 60
}
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "26643006",
"display": "oral"
}
]
},
"doseAndRate": [
{
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
]
}
],
"substitution": {
"allowedBoolean": false
}
}
MedicationRequest.id[0]5dcc8ffd-9838-45ed-8d31-fd20026fde4b
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]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]323416001
MedicationRequest.medication[0].coding[0].display[0]Phenoxymethylpenicillin 250mg tablets
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]2020-05-15T15:00:00Z
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]2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]or on an empty stomach
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]6
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].when[0]AC
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].offset[0]60
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]26643006
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]oral
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Phenoxymethylpenicillin 250mg tablets
2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach
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