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Electronic Prescription Group

What an Electronic Prescription Group is

An electronic prescription (eP) is one prescribed medication: a MedicationRequest (ePrescription).

An Electronic Prescription Group (ePG) is a Bundle of one or more electronic prescriptions issued together as part of the same request, for example the three medicines a GP prescribes at one consultation. They share one prescription group identifier (each eP's groupIdentifier). The ePG also carries the eDispensations of those eP and their provenance (the prescriber's signature, who dispensed what and when). It is the IE MPD Electronic Prescription Group profile (cross-border: ePG, cross-border).

Entry	Profile	Cardinality	HIQA EP
Electronic prescriptions (eP)	MedicationRequest (ePrescription)	1..*	3.5, 4, 5
eDispensations of those eP	MedicationDispense (eDispensation)	0..*	6
Provenance	Provenance; the prescriber's signature is a signature Provenance	0..* (1..* cross-border)	2.13
Prescription group header	Prescription Group Header (RequestGroup)	1..1	3.1 to 3.4
Patient	Patient (ePrescription)	1..1	1
Allergy statement, allergies	Allergy statement, AllergyIntolerance	1..1, 0..*	1.6
Prescriber, pharmacist, facilities	Practitioner, PractitionerRole, Organization	0..*	2, 6.4
Medicinal products	Medication	0..*	4

Terms

HIQA's draft calls the group "the electronic prescription" and each eP a "prescription item". This IG uses:

IE MPD	HIQA EP	FHIR
Electronic Prescription Group (ePG)	Electronic prescription (Section 3)	Bundle (IEMpdElectronicPrescriptionGroup)
Prescription group identifier	3.1 Electronic prescription identifier	Bundle.identifier = header identifier = every eP's groupIdentifier
Date of issue	3.2 Date and time of issuing the prescription	header authoredOn = every eP's authoredOn
Prescription group status (+ reason)	3.3 Prescription status	header status (+ statusReason extension)
Presented form	3.4 Presented form	header presentedForm extension
Electronic prescription (eP)	3.5 Prescription item	MedicationRequest
eP identifier, eP status	3.5.1, 3.5.2 Prescription item identifier, status	MedicationRequest.identifier, .status
eDispensation	Section 6 Medication dispense	MedicationDispense

Structure

flowchart TB
    subgraph EPG["Electronic Prescription Group (ePG) · Bundle · identifier = prescription group identifier"]
        direction TB
        P1["eP 1 · MedicationRequest<br/>groupIdentifier"]
        P2["eP 2 · MedicationRequest<br/>groupIdentifier"]
        PN["eP n · MedicationRequest<br/>groupIdentifier"]
        D1["eDispensation of eP 1<br/>MedicationDispense"]
        D2["eDispensation of eP 2<br/>MedicationDispense"]
        S["Provenance: prescriber signature"]
        DP["Provenance: dispensing record"]
        H["Prescription Group Header · RequestGroup<br/>group identifier · date of issue · group status (+reason) · presented form"]
        O["Patient · allergy statement · prescriber · pharmacist · facilities · medicines"]
    end
    D1 -- "authorizingPrescription" --> P1
    D2 -- "authorizingPrescription" --> P2
    S -- "target" --> P1
    S -- "target" --> P2
    S -- "target" --> PN
    DP -- "target" --> D1
    H -- "action" --> P1
    H -- "action" --> P2
    H -- "action" --> PN

The ePG grows over its life: at issue it holds the eP, the header (and, cross-border, the signature); as eP are dispensed, their eDispensations and dispensing provenance are added; if the group is cancelled, the header becomes revoked with a reason and its eP are cancelled.

Why a header

The group-level data HIQA EP Section 3 defines (identifier type, date of issue, a Mandatory status with reason, a presented form) cannot go on a FHIR R4 Bundle: Bundle is a plain Resource, with no status and no extension. So it lives in the Prescription Group Header, a RequestGroup whose actions list the group's eP.

Rules

Invariant	Rule	HIQA
ie-bnd-rx-1	All eP in the ePG share one prescription group identifier	EP 3.1
ie-bnd-rx-8	Every eP's groupIdentifier is one of the header's identifiers	EP 3.1
ie-bnd-rx-9	Every eP has the group's patient, prescriber and date of issue	EP 3.2
ie-bnd-rx-7	The header lists every eP in the ePG as an action, and only those	EP 3.5
ie-bnd-rx-10 (warning)	The group status agrees with the eP: active → an active eP; revoked → only cancelled or stopped eP; completed → no active, on-hold or draft eP	EP 3.3
ie-grp-status-1	A group status reason is given unless the group is active, completed or draft	EP 3.3.2
ie-bnd-rx-11	The prescriber's facility has an address line, county, postcode and country	EP 2.9
ie-bnd-rx-12	Every eDispensation is authorised by an eP in the same ePG	EP 6.5
ie-bnd-rx-13	Every eDispensation is for the ePG's patient	patient safety
ie-bnd-rx-14 (warning)	Every Provenance targets resources in the same ePG	—
ie-bnd-xb-2	Cross-border: a signature Provenance covers every eP	EP 2.13

Status

Prescription group (header)	Its eP	Example
active	at least one eP active	ePGs 1 to 6
revoked (cancelled) + reason	all eP cancelled or stopped	ePG 10
completed	no eP active, on-hold or draft	—
on-hold, entered-in-error, unknown + reason	—	—

A declined dispense (scenario 5) is an eDispensation in the ePG with status declined; the eP and the group stay active until the prescriber or the service changes them.

Examples by interaction

Like the NHS England EPS example catalogue, the ePGs are grouped by what they demonstrate and cross-referenced:

ePG	Scenario	Contents
1	Acute adult prescription, dispensed	header, 1 eP, eDispensation, dispensing provenance
2	Child under 12 (age and weight)	header, 1 eP
3	Repeat prescription: part fill, balance, first repeat	header, 1 eP, three eDispensations
4	Schedule 2 controlled drug, in instalments	header with presented form, 1 eP, first instalment
5	Not dispensed: declined for a recorded penicillin allergy	header, 1 eP, declined eDispensation
6	Cross-border (IE → EU): two medicines prescribed together	header, 2 eP (metformin, atorvastatin), prescriber signature over both
10	Cancelled before dispensing (compare EPS B1/C1)	header revoked with reason, 1 eP cancelled

More ePGs with several electronic prescriptions

Each eP is coded with an NMPC VMP (SNOMED CT Irish Edition) through its Medication, which also carries the SNOMED CT International product or substance and the ATC code (as a coding, or as the HIQA EP 4.2.1 classification); indications, routes and additional instructions are SNOMED CT codings declaring the Irish Edition; doses use SNOMED CT units of presentation (product-based) or UCUM (strength-based, liquids). See Terminology.

ePG	Group	eP (NMPC VMP)	Shows
11	Cardiovascular and diabetes review	amlodipine 5 mg (267451000220105), ramipril 5 mg (716371000220101), atorvastatin 20 mg (254311000220102), metformin 500 mg (718271000220105)	4 continuous eP with repeats; at night (HS); with food (311504000); 2 of 4 already dispensed
12	Basal-bolus insulin	insulin glargine pen (529881000220106), insulin aspart cartridge (525351000220105)	doses in UCUM [iU]; supply in Pen (733006000) and Cartridge (732988008); three concurrent dosages (ACM, ACD, ACV)
13	Depression and reflux (penicillin allergy recorded)	sertraline 50 mg (268301000220104), omeprazole 20 mg (313941000220100)	substitution not allowed with a reason; in the morning (MORN); before breakfast (ACM, 311501008); allergy listed in the statement
14	Atrial fibrillation and hypertension	warfarin 5 mg (718731000220101), lisinopril 10 mg (714701000220101)	consecutive dosage schemes (sequence 1 loading, sequence 2 maintenance)
15	Child under 12	amoxicillin 250 mg/5 mL suspension (462991000220107), salbutamol inhaler (363291000220101)	age at prescribing on each eP; liquid dose in mL; as-needed dose range 1 to 2 actuations with a maximum

Administration (scenarios 7, 8) and medication statements (scenario 9) are separate records that point back to an eP; see Administration and Statements.

Compared with NHS England EPS (reference)

Topic	NHS England EPS	IE MPD
The group	No container resource: MedicationRequests share groupIdentifier (short-form id; long-form UUID in an extension)	The same shared groupIdentifier; the ePG Bundle holds the eP with their eDispensations and provenance, and the header carries the group-level HIQA data
Exchange	FHIR messaging: the prescription-order MessageDefinition (MessageHeader, 1 to 4 MedicationRequests, Provenance with the signature); dispensing is a separate dispense-notification message	One collection Bundle per group; HIQA does not specify the national interface (OI-105)
Consistency	MedicationRequests must agree on status, intent, category, subject, requester, groupIdentifier, course of therapy and validity period	ie-bnd-rx-1, ie-bnd-rx-8, ie-bnd-rx-9
Cancellation	prescription-order-update; status history extension on each MedicationRequest	Header revoked with a reason; eP cancelled with a reason
Signature	Provenance (advanced electronic signature) targeting the MedicationRequests	Provenance targeting the eP (optionally the header)