Overview
This section details the design approach using FHIR Resources to support the PRSB heading model for Medications and medical devices.
Resources Used for Profile Design
The FHIR Resources are profiled to create the medication list as below:
- CareConnect-ITK-MedicationDispense-List-1 - An NHS Digital Profile for recording a snapshot of the list of Medications dispensed for the patient.
- CareConnect-ITK-MedicationDispense-1 - An NHS Digital Profile derived from the CareConnect MedicationDispense Profile. Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication.
- CareConnect-ITK-Medication-1 - An NHS Digital Profile for medication. The Medication Resource is primarily used for the identification and definition of a medication.
List
This Resource acts as a container for the medication dispense items. The following is an example of the elements which can be used:
- identifier - uniquely identifies this list of medication (UUID)
- code - the type of list (SNOMED CT concept)
- status - should only be “current”
- mode - should only be “snapshot”
- title - descriptive name for the list
- subject - a reference to the patient whose medication list this is
- encounter - a reference to the context in which the list was created (the pharmacy visit)
- date - when the list was prepared
- source - who or what defined the list
- entry - a reference to the MedicationDispense Resource entry or entries
MedicationDispense
The main purpose of the MedicationDispense resource is to record that a medication product is to be or has been dispensed for a named patient by a named Practitioner. The following elements are business required or optional but recommended for a successful implementation.
- identifier - REQUIRED - uniquely identifies this medication dispense (UUID)
- status - REQUIRED - should always be completed
- medicationReference - REQUIRED - a reference to the medication which was dispensed
- subject - REQUIRED - a reference to the patient
- context - OPTIONAL - reference to the encounter in which the medication was dispensed (the pharmacy visit)
- performer - REQUIRED - who / what dispensed the medication
- type - REQUIRED - the type dispense/supply (SNOMED CT concept)
- quantity - REQUIRED - amount dispensed expressed as it’s unit form dose, e.g. tablet, ml, gram
- daysSupply - REQUIRED - amount supplied expressed as a number of days
- whenHandedOver - REQUIRED - the date/time on which the medication was supplied to the patient
- dosageInstruction - OPTIONAL - how the medication is to be used by the patient or administered by the carer
Medication
The Medication Resource allows for medications to be characterized by the form of the drug and the ingredient (or ingredients), as well as how it is packaged. The medication will include the ingredient(s) and their strength(s) and the package can include the amount (for example, number of tablets, volume, etc.) that is contained in a particular container (for example, 100 capsules of Amoxicillin 500mg per bottle). The following is an example of the elements that can be used:
- code - a SNOMED CT Concept that identifies this medication
- form - powder, tablets, capsule etc SNOMED CT form concepts
How the Medication Dispense List is Constructed
The diagram below shows the Resources used and the relationship between the Resources.
MedicationDispense Resource
Provides details of medication that has been dispensed to the patient.
status
Should contain the value “completed”.
type
This should be a SNOMED CT Concept to identify the nature of the dispensing or supply event:
- 1218611000000102 Urgent supply of prescription items by community pharmacy
- 1321521000000101 Supply of medication for minor illness by community pharmacy
quantity
The FHIR element Extension-CareConnect-MedicationQuantityText-1 is used to carry the quantity dispensed as a text string. This should be a concatenation of the numeric quantity dispensed and the unit of measure, separated by a single whitespace, for example “14 tablet”.
The quantity should also be structured using the SimpleQuantity structure. By default use UCUM units of measure (system uri “http://unitsofmeasure.org”), for example “gram” or “milliliter”.
Where a UCUM unit of measure is not defined, use a SNOMED CT Concept unit of measure (system uri “http://snomed.info/sct”). Examples of when a SNOMED CT unit of measure would be required include “tablet”, “capsule” or “ampule”.
Units of measure, where UCUM is not available, are contained within the hierarchy as descendants of 767524001 Unit of measure.
All units of measure should be expressed in the singular, for example “tablet” and not “tablets”.
daysSupply
The quantity supplied expressed as a number of days using the SimpleQuantity structure.
The daysSupply.value
shall be the number of days.
The daysSupply.unit
of measure shall be day
.
The daysSupply.system
uri shall be http://unitsofmeasure.org
.
The daysSupply.code
shall be d
.
performer
Who dispensed the medication if available to the sender.
references
The references to the following must be carried:
- medicationReference
- subject (patient)
- context (encounter)
The reference “display” element should be included and populated as follows;
- for medicationReference.display, the description of the medication
- for subject.display, the full name of the patient
- for context, display should be omitted
Medication Resource
This section gives guidance of the use of the Medication Resource
medication.code
This FHIR element is mapped to the PRSB medication name.
Constraint: MedicationName. Any VTM/VMP/AMP/VMPP/AMPP subsets from the dm+d terminology.
VTM NHS dm+d virtual therapeutic moiety (DD4C) 999000581000001102 |
VMP NHS dm+d virtual medicinal product (DD4C) 999000561000001109 |
VMPP NHS dm+d virtual medicinal product pack (DD4C) 999000571000001104 |
AMP NHS dm+d actual medicinal product (DD4C) 999000541000001108 |
AMPP NHS dm+d actual medicinal product pack (DD4C) 999000551000001106 |
The above as a SNOMED CT expression.
(^999000581000001102 |
OR ^999000561000001109 |
OR ^999000571000001104 |
OR ^999000541000001108 |
OR ^999000551000001106) |
OR with preferred terms |
(^999000541000001108 |National Health Service dictionary of medicines and devices actual medicinal product simple reference set| |
OR ^999000551000001106 |National Health Service dictionary of medicines and devices actual medicinal product pack simple reference set| |
OR ^999000561000001109 |National Health Service dictionary of medicines and devices virtual medicinal product simple reference set| |
OR ^999000571000001104 |National Health Service dictionary of medicines and devices virtual medicinal product pack simple reference set| |
OR ^999000581000001102 |National Health Service dictionary of medicines and devices virtual therapeutic moiety simple reference set|) |
medication.form
The medication form is included on the Medication profile. Where medication is represented using a VTM concept and this is additionally qualified with a coded form then use this element.
VMP, AMP, VMPP and AMPP concepts are pre-coordinated and include a form so do not need to be repeated in this element.
Constraint: DrugDoseForm. SNOMED CT CfH DoseForm termset. Constraint binding: [SNOMED CT]subset=CfH DoseForm (refset 999000781000001107)
The above as a SNOMED CT expression
^999000781000001107 |NHS dm+d (dictionary of medicines and devices) dose form simple reference set| |
Medication Dispense List Examples
Medication Dispense List
Examples are illustrative only.
<!--<xml>-->
<List xmlns="http://hl7.org/fhir">
<id value="4bc7faea-5974-407a-b658-d6ed1d4c9187"/>
<meta>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-ITK-MedicationDispense-List-1"/>
</meta>
<identifier>
<system value="https://tools.ietf.org/html/rfc4122"/>
<value value="197987da-97a7-49c2-9657-dac1aea2a461"/>
</identifier>
<status value="current"/>
<mode value="snapshot"/>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="163541000000107"/>
<display value="Dispensed Medication"/>
</coding>
</code>
<subject>
<reference value="urn:uuid:1e2b5223-1cd8-43ff-8a67-55dec3edb9b0"/>
<display value="SMITH, William (Mr)"/>
</subject>
<encounter>
<reference value="urn:uuid:adb353f9-0953-4fb4-a4ab-f0ab04a44dbc"/>
</encounter>
<date value="2018-05-09"/>
<entry>
<item>
<reference value="urn:uuid:42ac049c-87ca-4e33-93ad-987167422b01"/>
</item>
</entry>
</List>
<!--</xml>-->
Medication Dispense
Examples are illustrative only.
<!--<xml>-->
<MedicationDispense xmlns="http://hl7.org/fhir">
<id value="42ac049c-87ca-4e33-93ad-987167422b01"/>
<meta>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-ITK-MedicationDispense-1"/>
</meta>
<status value="completed"/>
<medicationReference>
<reference value="urn:uuid:9c7e61c3-5b92-4828-9ebc-21e74bcdbc96"/>
<display value="BD Viva hypodermic insulin needles for pre-filled / reusable pen injectors screw on 5mm/31gauge (Becton, Dickinson UK Ltd)"/>
</medicationReference>
<subject>
<reference value="urn:uuid:1e2b5223-1cd8-43ff-8a67-55dec3edb9b0"/>
<display value="SMITH, William (Mr)"/>
</subject>
<context>
<reference value="urn:uuid:adb353f9-0953-4fb4-a4ab-f0ab04a44dbc"/>
</context>
<performer>
<actor>
<reference value="urn:uuid:0e4c13d4-e61f-48f2-89ee-7cf8f5f3dbb3"/>
</actor>
<onBehalfOf>
<reference value="urn:uuid:1226082b-315e-40be-83cf-5d21a964219e"/>
</onBehalfOf>
</performer>
<type>
<coding>
<systemvalue="http://snomed.info/sct"/>
<codevalue="1218611000000102"/>
<displayvalue="Urgent supply of prescription items by community pharmacy"/>
</coding>
</type>
<quantity>
<extension url="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-MedicationQuantityText-1">
<valueString value="90 needle"/>
</extension>
<value value="90"/>
<unit value="needle"/>
<system value="http://snomed.info/sct"/>
<code value="3318111000001106"/>
</quantity>
<daysSupply>
<value value="14"/>
<unit value="day"/>
<system value="http://unitsofmeasure.org"/>
<code value="d"/>
</daysSupply>
<whenPrepared value="2018-05-09"/>
<whenHandedOver value="2018-05-09"/>
<dosageInstruction>
<text value="As previously advised"/>
</dosageInstruction>
</MedicationDispense>
<!--</xml>-->
Medication
Examples are illustrative only.
<!--<xml>-->
<Medication xmlns="http://hl7.org/fhir">
<id value="9c7e61c3-5b92-4828-9ebc-21e74bcdbc96"/>
<meta>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-ITK-Medication-1"/>
</meta>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="31771611000001107"/>
<display value="BD Viva hypodermic insulin needles for pre-filled / reusable pen injectors screw on 5mm/31gauge (Becton, Dickinson UK Ltd)"/>
</coding>
</code>
<status value="active"/>
</Medication>
<!--</xml>-->