Structured Medications Change 1 - Create and Store Dose Syntax

Owned by Michael France
Last updated: 30-03-2023 by Chiara.Beckett (Unlicensed)Version comment
6 min read

ID

RM62

Version

1.0.5

Type

Roadmap Item

Frameworks

Title

Structured Medications Change 1 - Create and Store Dose Syntax

Description

The creation and storing of medication dosage instructions using Dose Syntax format

Date Added

Mar 23, 2023

Standards and Capabilities

Prescribing

Change Route

Managed Capacity - Other

Change Type

New

Status

Draft

Publication Date

TBC

Effective Date

TBC

Incentives / Funding

No

Incentive / Funding Dates

N/A

Background

The introduction of a structured and machine-readable Dose Syntax to create a fully interoperable, computable medication dosage instructions 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:

  1. Intra-hospital (e.g. ePMA to pharmacy dispensing systems)

  2. Inter-hospital (i.e. hospital to hospital transfer)

  3. Medications on admission to hospital (medicine information from GP Systems)

  4. Medications on discharge (Transfer of Care)

  5. 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 aligns with the UKCore R4 Dose Syntax Standard, into their systems.

Outline Plan

The overall development and implementation of Dose Syntax will require two separate changes to be delivered by the Suppliers:

  1. The delivery of the functionality to create and store medication dosage instructions using Dose Syntax format

  2. 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 instructions. The systems will receive DevMACs; 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 aligns with the UKCore R4 Dose syntax Standard, as introduced via the ISN.

Summary of Change

Prescribing: Additional Implementation details ‘Dosage’ bullet point updated

E00096 - manage prescribed Acute and Repeat medication for Patients

As 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 medication

Given 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 medication

Given 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 medication

Given 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 medication

Given 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 medication

Given 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 medication

Given 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 medication

Given 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 medication

Given 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 medication

Given 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 Details

Solutions MUST comply with the following when implementing this Epic:

  • The following information to be stored for each medication:

    • The dm+d name, or other name (if a dm+d code does not exist)

    • dm+d description or form, strength and quantity

    • Dosage instructions to be collected and stored in a format that aligns with the UKCore R4 Dose Syntax Standard, including free text representation that aligns with the Dosage.text element described within the same Standard

    • Medication Type (Acute medication, a Repeat medication, a further issue of a Repeat medication, a Repeatable batch issue or Repeat medication, or Private medication)

    • Date of authorisation

    • Date of issuing (e.g. printing, electronic message sent)

    • Prescriber authorising the Prescription

Full Specification

Prescribing - GP v2.0.0

Assurance Approach

The assurance of Dose Syntax will follow an approach of the following stages:

The Supplier will receive:

  1. A new DevMAC for the Dose Syntax capability after system testing

  2. Updated DevMACS for national services where appropriate to ensure the implementation of Dose Syntax has not affected existing service compliance

After DevMACs have been received, the system can be deployed to GP Practices as with any other significant change.