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.

Sumatriptan

Product-based VMP prescription which is fully coded but there is an alternative way of modelling this dosage instruction, see second example below. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="c1ea9b0b-f157-4ee2-9771-84c6cbae5cad" />
    <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>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="322815004" />
            <display value="Sumatriptan 50mg 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>
        <sequence value="1" />
        <text value="1 tablet - take once - as required for Migraine" />
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="2" />
        <text value="1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="2" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org/" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "c1ea9b0b-f157-4ee2-9771-84c6cbae5cad",
    "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"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "322815004",
                "display": "Sumatriptan 50mg 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":  [
        {
            "sequence": 1,
            "text": "1 tablet - take once - as required for Migraine",
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        },
        {
            "sequence": 2,
            "text": "1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 2,
                    "periodUnit": "h"
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]c1ea9b0b-f157-4ee2-9771-84c6cbae5cad
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.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322815004
MedicationRequest.medication[0].coding[0].display[0]Sumatriptan 50mg 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].sequence[0]1
MedicationRequest.dosageInstruction[0].text[0]1 tablet - take once - as required for Migraine
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
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.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].text[0]1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]2
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Sumatriptan 50mg tablets
1 tablet - take once - as required for Migraine, then 1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours

Alternative Representation

Product-based VMP prescription using a simpler Dosage but where further instructions are text-based. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="b31fcf06-b515-4468-92cd-ce7b13b0c256" />
    <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>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="322815004" />
            <display value="Sumatriptan 50mg 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="1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence" />
        <patientInstruction value="Additional doses only to be taken after migraine recurrence" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="2" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org/" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "b31fcf06-b515-4468-92cd-ce7b13b0c256",
    "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"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "322815004",
                "display": "Sumatriptan 50mg 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": "1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence",
            "patientInstruction": "Additional doses only to be taken after migraine recurrence",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 2,
                    "periodUnit": "h"
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]b31fcf06-b515-4468-92cd-ce7b13b0c256
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.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322815004
MedicationRequest.medication[0].coding[0].display[0]Sumatriptan 50mg 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]1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].patientInstruction[0]Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]2
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
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.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Sumatriptan 50mg tablets
1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence
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