Background
The introduction of a structured and machine-readable Dose Syntax to create a fully interoperable, computable medication Dosage Information structure is critical to enable timely transfer of medication Dosage Information between care settings without manual transcription.
The benefits of sharing this information in a machine-readable way include:
Patient safety - up-to-date and complete view of medications being shared/made available between/across service providers
Patient experience - not having to repeat medication information to multiple Health or Care Professionals
Efficiency and safety - reduction in manual entry of medications information reducing time and risk of errors
Downstream benefits include improving the ability to analyse and report on medications information that is held in a structured way.
The Interoperable Medication Standards programme has developed FHIR-based Standards which, when combined with the dm+d medicines Standard, provides an unambiguous and safe representation of a Patient’s complete prescription details.
The Dose Syntax API standards are an integral component of core medicine standards. This Roadmap Item is looking to introduce these standards into Primary Care systems. To date, the four medicine standards below have been published. All of the standards listed reference the Dose Syntax:
These standards are included as a reference to provide a holistic view of how medicine information should be defined.
The published ISN (DAPB4013: Medicine and Allergy/Intolerance Data Transfer) defines that all medicine and allergy information transmitted between systems needs to comply with these latest standards. Examples of where medicine information sharing needs to comply with this ISN are listed below – this is not an exhaustive list:
Intra-hospital (e.g. ePMA to pharmacy dispensing systems)
Inter-hospital (i.e. hospital to hospital transfer)
Medications on admission to hospital (medicine information from GP Systems)
Medications on discharge (Transfer of Care)
Consolidated/Shared Medications Record (CMR)
Medicines on admission, medications on discharge and Consolidated Medication Record use cases are dependent on GP systems being able to send and /or receive medications using the structured medication format, defined by the Standards listed above. This may have profound implications for clinical processes and clinical systems, changing the way medication related information is captured, held and transmitted.
The objective of this two-phase delivery is to complete the introduction of Dose Syntax by Suppliers implementing changes to support the storage, transmission & consumption of medicines information in a format that adheres to the UK Core FHIR Assets | Element: Dosage, into their systems.
Outline Plan
The overall development and implementation of Dose Syntax will require two separate changes to be delivered by the Suppliers:
The delivery of the functionality to create and store medication Dosage Information using Dose Syntax format (this Roadmap Item).
Adoption within GP Practices and updating of Electronic Patient Records (EPR) with the new Dose Syntax capability
By implementing the change described in point 1 above, the data will be created and stored, ready for future consumption by Primary and Secondary Care systems via structured medication Dosage Information. The systems will be assured as defined in the Assurance section below, at this stage of the process and will be able to deploy this version of the system to the estate. Any new medication prescribed as a result of a new repeat regime being created, or the creation of a new acute item, will be created and stored such as to support the transmission of medicine information in a format that adheres to the UK Core FHIR Assets | Element: Dosage as introduced via the ISN. It is worth noting that it is not expected that legacy data will transformed during the implementation of this Epic.
Summary of Change
Prescribing: Additional Implementation details ‘Dosage’ bullet point updated |
E00096 - manage prescribed Acute and Repeat medication for PatientsAs a Health or Care Professional I want to manage prescribed Acute medication and Repeat medication for Patients So that Acute and Repeat medication can be prescribed to Patients Acceptance criterion 1: create a prescribed Acute medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to create a prescribed Acute medication for a Patient And they are authorised to prescribe the selected item according to their prescribing rights And they have selected a prescribable item Then the prescribed Acute medication is created in the Electronic Patient Record (EPR) Acceptance criterion 2: view a prescribed Acute medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to view a prescribed Acute medication Then the prescribed Acute medication is displayed Acceptance criterion 3: amend prescribed Acute medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to amend a prescribed Acute medication for a Patient Then the prescribed Acute medication is amended Acceptance criterion 4: remove prescribed Acute medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to remove a prescribed Acute medication for a Patient Then the prescribed Acute medication is removed from the Electronic Patient Record (EPR) Acceptance criterion 5: create prescribed Repeat medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to create a prescribed Repeat medication And they are authorised to prescribe the selected item according to their prescribing rights And they have selected a prescribable item Then a finite number of Repeat medication issues can be specified And a Repeat medication review date can be specified And the prescribed Repeat medication is created in the Patient Record Acceptance criterion 6: view a prescribed Repeat medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to view a prescribed Repeat medication Then the prescribed Repeat medication is displayed Acceptance criterion 7: create issue of prescribed Repeat medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to create an issue of a prescribed Repeat medication Then the issue of prescribed Repeat medication is created Acceptance criterion 8: amend prescribed Repeat medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to amend a prescribed Repeat medication Then the prescribed Repeat medication is amended Acceptance criterion 9: remove prescribed Repeat medicationGiven the Health or Care Professional is permitted to manage prescribed medication When the Health or Care Professional selects to remove a prescribed Repeat medication Then the prescribed Repeat medication is removed from the Patient Record E00096 - Additional Implementation DetailsSolutions MUST comply with the following when implementing this Epic:
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Full Specification
Assurance Approach
The assurance of Dose Syntax will follow an approach of the following stages:
Suppliers will be required to pass the capability assessment for the acceptance criteria as stated within the epic of this roadmap item. Also, the suppliers will have to go through risk based assurance using the Solution Assurance Risk log. This risk log with pre-identified risks will be provided to the suppliers in advance of the assurance commencement, so that the suppliers can prepare to provide the risk mitigations evidence through a combination of test evidence and online demonstrations of the implementation.
Additional clinical assurance will be required to mitigate any clinical risks associated with the implementation and clinical safety assurance process will have to be followed in addition to the above assurance for the clinical safety report and clinical hazard logs as per the DCB0129 standard.
Suppliers are accountable for the testing of their solution and are expected to have tested for the delivery of this roadmap item, as per their internal testing processes in addition to the NHS England's assurance process.