M2.1. Medication - Issue of Repeat Prescriptions

The following table describes the use of medication statements and related classes to convey information about an individual prescription issued in the practice which is one of a series of authorised repeats.

Multiple items on one prescription may be represented by including the MedicationStatement instances within an CompoundStatement. If this prescription is issued outside a consultation this instance of CompoundStatement will be the only component in an instance of EhrComposition specific to that repeat issue. However, if the repeat prescription is issued in a consultation the CompoundStatement representing the prescription should be part of the EhrComposition representing that consultation. Repeat and one-off prescription items should be included in the same CompoundStatement if they are issued together.

MedicationStatement

A statement that represents the a record of a prescription for a therapeutic substance or appliance.

[1..1] classCode (CS){ Fixed="SBADM " }

[1..1] moodCode (CS) {CNE:RQO}

[1..1] id (II)

An instance identifier of this statement represented using the Identifier Global flavour of the II data type.

[1..1] statusCode (CS) {CNE:EhrMedicationState}

If the prescription record is valid (i.e. believed to be accurate) the status is "complete".

The other possible values ("obsolete" and "nullified") are only used if the record was subsequently corrected or deleted due to an error.

[1..1] availabilityTime (TS)

The date and time of recording this prescribing action.

[1..1] code (CD) {CWE:EhrMedicinalProdCode}

The code representing the nature of the product as one of the following:

• virtual medicinal product
• virtual medicinal product pack
• actual medicinal product
• actual medicinal product pack.

If the native coding scheme for medicinal product is the Read Codes then the appropriate code is represented using the Coded with Original Text flavour of the data type CE. Otherwise the Coded Translated flavour should be used with the medicinal product represented in the coding system used  in the sending system with a translation to an appropriate (possibly more generalised) Read Code.

Note

• The source of these codes should eventually be an agreed UK medicinal product dictionary.

[0..1] pertinentInformation (MedicationStatement/pertinentInformation)

Relationship to the prescribed dosage.

[1..1] typeCode (CS){ Fixed="PERT " }

[1..1] MedicationDosage (MedicationDosage)

Details of the dosage.

[1..1] classCode (CS){ Fixed="SBADM " }

 Indicates that this is a substance administration action.

[1..1] moodCode (CS) {CNE:RMD}

Indicates whether this is a dosage instruction or recommendation..

[1..1] text (ED)

A textual description of the dosage instructions.

Note

• At present there is no provision for structured representation of dosage. This information is not available on the sending systems and is not included in current UK electronic prescribing. However, should structured data be required this could be supported by adding the doseQuantity and effectiveTime to represent the quantity and frequency of individual doses. If necessary routeCode could also be added.

[1..1] consumable (MedicationStatement/consumable)

Include this to identify the nature of the product.

[1..1] typeCode (CS){ Fixed="CSM " }

[1..1] manufacturedProduct (ManufacturedProduct)

Details of the medicinal product prescribed.

• May include, drugs, nutritional supplements, devices used to administer drugs, dressing, appliances, diagnostic reagents, etc.

[1..1] classCode (CS){ Fixed="MANU " }

Indicates that this is a manufactured product.

[1..1] manufacturedMaterial (Material)

Information about the material or substance that forms the medicinal product.

[1..1] Material

The details of a medicinal product.

[1..1] classCode (CS){ Fixed="MMAT " }

Indicates that this is an manufactured material.

[1..1] determinerCode (CS) {CNE:KIND}

Indicates that this represents a kind of material.

[1..1] code (CE)

The code representing the nature of the product as one of the following:

• virtual medicinal product
• virtual medicinal product pack
• actual medicinal product
• actual medicinal product pack.

If the native coding scheme for medicinal product is the Read Codes then the appropriate code is represented using the Coded with Original Text flavour of the data type CE. Otherwise the Coded Translated flavour should be used with the medicinal product represented in the coding system used  in the sending system with a translation to an appropriate (possibly more generalised) Read Code.

Note

• The source of these codes should eventually be an agreed UK medicinal product dictionary.

[0..1] quantity (PQ)

The quantity of the product.

• Express simple quantities such as "100 ml" or "3 grams" using Quantity in Standard Units.
• Express numbers of tablets, capsules, etc. where the item is explicit elsewhere using Quantity in Standard Units with the unit "1" (unity).
• Express quantities that cannot be represented adequately using standard units using Quantity in Arbitrary Units.

[1..2] component (MedicationStatement/component)

For repeat prescriptions there is always one instance of MedicationStatement/component containing the actual supply (Prescribe) as detailed here.

There may optionally be one additional instances of MedicationStatement/component containing details of the authorisation (Authorise) if authorisation and prescription issuing are recorded in the same EhrComposition.

First instance of MedicationStatement/component (mandatory for Prescriptions)

Relationship to details of the prescription.

[1..1] typeCode (CS){ Fixed="COMP " }

[1..1] EhrSupply (EhrSupply)

Prescribe

Represents an issued prescription.

[1..1] classCode (CS){ Fixed="SPLY " }

[1..1] moodCode (CS){ Fixed="RQO " }

[1..1] id (II)

An identifier of the prescription.

[1..1] code (CV) {CNE:EhrSupplyType}

A code representing the type of prescription.

[1..1] statusCode (CS) {CNE:EhrSupplyState}

If the prescription record is valid (i.e. believed to be accurate) the status is "complete".

The other possible values ("obsolete" and "nullified") are only used if the record was subsequently corrected or deleted due an error.

[1..1] availabilityTime (TS)

The date and time that the prescription was recorded.

[1..1] quantity (PQ)

The quantity to be supplied.

• Express simple quantities such as "100 ml" or "3 grams" using Quantity in Standard Units.
• Express numbers of doses, tablets, capsules, etc. where the size of the dose or item is explicit elsewhere in the prescribing data using Quantity in Standard Units with the unit "1" (unity).
• Express quantities that cannot be represented adequately using standard units using Quantity in Arbitrary Units (e.g. "3 packs each containing 21 tablets of substance A and 7 tablets of substance B".

[0..1] pertinentInformation (EhrSupply/pertinentInformation)

[1..1] typeCode (CS){ Fixed="PERT " }

[1..1] pertinentSupplyAnnotation (SupplyAnnotation)

Details of the annotation.

[1..1] classCode (CS){ Fixed="OBS " }

Indicates that this is an Observation.

[1..1] moodCode (CS){ Fixed="EVN " }

Indicates that this is an actual event.

[1..1] text (ED)

A textual note that was sent from the prescriber to the dispenser as part of the prescription.

Note

• This is not the place for recording dosage instructions.

[0..1] performer (EhrSupply/performer)

Include this only if the prescriber is not the the EhrComposition/author of the containing EhrComposition.

[1..1] typeCode (CS){ Fixed="PRF " }

[1..1] time (TS)

The date and time of prescribing.

[1..1] AgentRef (AgentRef)

Refers to the person (or other agent) responsible for this prescription.

[1..1] classCode (CS){ Fixed="AGNT " }

Indicates that this is a reference to a related agent.

[1..1] id (II)

The unique instance identifier of the referenced role as specified in the role directory.

• If a message contains several Folders, the referenced role directory is in the same Folder as the component that refers to it.

[0..1] inFulfillmentOf (Prescribe/inFulfillmentOf)

This is required for repeat prescriptions unless the authorisation is directly associated with the same MedicationStatement instance. This may occur if the authorisation and prescription are recorded at the same time (i.e. for the first of a series of repeat prescription issues).

Refers to  the authorisation against which this prescription was issued.

[1..1] typeCode (CS){ Fixed="FLFS" }

[1..1] MedicationRef (MedicationRef) 

A reference to a previously recorded MedicationStatement statement that authorised this repeat prescription issue.

[1..1] classCode (CS){ Fixed="SBADM" }

Indicates that the referenced class is based on the Substance Administration class.

[1..1] moodCode (CS){CNE:x_MedicationMood}

Indicates whether this is an intention (INT), recommendation (RMD), order (ORD) or an actual event (EVN). The value used here should be the same as the moodCode of the MedicationStatement being referenced.

[1..1] id (II)

Refers to the id of the referenced medication statement.

Optional second instance of MedicationStatement/component

MedicationStatement/component (MedicationStatement/component)

Relationship to details of the authorisation associated with a repeat prescription.

This is included only if the authorisation and prescribing actions are recorded together. Otherwise the authorisation is referenced from Prescribe by the Prescribe/inFulfillmentOf relationship.

[1..1] typeCode (CS){ Fixed="COMP " }

[1..1] Authorise (EhrSupply)

Details of the prescription see Supply - Authorise.