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.

Sodium citrate / Micralax Micro-enema

Product-based AMP prescription. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="d62bbf77-c6b5-4bac-a66f-147a869eacc7" />
    <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="community" />
            <display value="community" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="3351711000001106" />
            <display value="Micralax Micro-enema 5ml (RPH Pharmaceuticals AB)" />
        </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="Insert 1 enema - Rectal - take once" />
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37161004" />
                <display value="Rectal" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="421257003" />
                <display value="Insert" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="enema" />
                <system value="http://snomed.info/sct" />
                <code value="13299601000001101" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "d62bbf77-c6b5-4bac-a66f-147a869eacc7",
    "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": "community",
                    "display": "community"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "3351711000001106",
                "display": "Micralax Micro-enema 5ml (RPH Pharmaceuticals AB)"
            }
        ]
    },
    "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": "Insert 1 enema - Rectal - take once",
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37161004",
                        "display": "Rectal"
                    }
                ]
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "421257003",
                        "display": "Insert"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "enema",
                        "system": "http://snomed.info/sct",
                        "code": "13299601000001101"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]d62bbf77-c6b5-4bac-a66f-147a869eacc7
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]community
MedicationRequest.category[0].coding[0].display[0]community
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]3351711000001106
MedicationRequest.medication[0].coding[0].display[0]Micralax Micro-enema 5ml (RPH Pharmaceuticals AB)
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]Insert 1 enema - Rectal - take once
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]37161004
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Rectal
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]421257003
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Insert
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]enema
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]13299601000001101
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Micralax Micro-enema 5ml (RPH Pharmaceuticals AB)
Insert 1 enema - Rectal - take once

Dose-based VTM prescription where the quantity of 'Sodium citrate' is defined together with the route. Such medication would typically be prescribed by product (VMP or AMP), as per the above example.
IMPORTANT: This example cannot use the simple medicationCodeableConcept element. The VTM medication needs to be qualified with a form. This example uses a contained resource which would be suitable for a RESTful implementation. When using a FHIR Messaging implementation the instance of the Medication resource as another resource within the Bundle. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="63df7dcc-fc54-4eb2-8907-b53b09115bb6" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <contained>
        <Medication>
            <id value="med1" />
            <code>
                <coding>
                    <system value="https://dmd.nhs.uk" />
                    <code value="412547001" />
                    <display value="Sodium citrate" />
                </coding>
            </code>
            <form>
                <coding>
                    <system value="http://snomed.info/sct" />
                    <code value="385186005" />
                    <display value="Enema" />
                </coding>
            </form>
        </Medication>
    </contained>
    <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>
    <medicationReference>
        <reference value="#med1" />
    </medicationReference>
    <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="Insert 450 milligram - Rectal - take once" />
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37161004" />
                <display value="Rectal" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="421257003" />
                <display value="Insert" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="450" />
                <unit value="milligram" />
                <system value="http://unitsofmeasure.org" />
                <code value="mg" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "63df7dcc-fc54-4eb2-8907-b53b09115bb6",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "https://dmd.nhs.uk",
                        "code": "412547001",
                        "display": "Sodium citrate"
                    }
                ]
            },
            "form": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "385186005",
                        "display": "Enema"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationReference": {
        "reference": "#med1"
    },
    "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": "Insert 450 milligram - Rectal - take once",
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37161004",
                        "display": "Rectal"
                    }
                ]
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "421257003",
                        "display": "Insert"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 450,
                        "unit": "milligram",
                        "system": "http://unitsofmeasure.org",
                        "code": "mg"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]63df7dcc-fc54-4eb2-8907-b53b09115bb6
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.contained[0].id[0]med1
MedicationRequest.contained[0].code[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.contained[0].code[0].coding[0].code[0]412547001
MedicationRequest.contained[0].code[0].coding[0].display[0]Sodium citrate
MedicationRequest.contained[0].form[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.contained[0].form[0].coding[0].code[0]385186005
MedicationRequest.contained[0].form[0].coding[0].display[0]Enema
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].reference[0]#med1
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]Insert 450 milligram - Rectal - take once
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]37161004
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Rectal
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]421257003
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Insert
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]450
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]milligram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]mg
MedicationRequest.substitution[0].allowed[0]False
Command 'tree' could not render: File was not found for example-dosage-simple5-vtm

Example on-screen presentation:

Sodium citrate
Enema - Insert 450 milligram - Rectal - take once
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