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
back to top