Kenya ePrescription FHIR Implementation Guide
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Use Cases

Use Cases

This page describes the primary clinical and operational use cases supported by the Kenya ePrescription Implementation Guide (IG). Each use case is mapped to the FHIR profiles defined in this IG.

Actors

Actor Description
Prescriber A registered medical practitioner (physician, clinical officer, nurse prescriber) licensed by KMPDC
Dispenser A registered pharmacist or pharmacy technician operating a licensed pharmacy
Patient The individual for whom the prescription is issued
Pharmacy System A dispensing management system connected to the national HIE
EMR / CPOE System An electronic medical record or computerised prescribing system used at the facility
National HIE The Kenya Health Information Exchange operated by DHA
NHIF / SHA National Health Insurance Fund / Social Health Authority — the national insurer

UC-01 – Outpatient Electronic Prescription

Trigger: A clinician completes a patient consultation and decides to prescribe medication.

Actors: Prescriber, Patient, EMR System, National HIE

Preconditions:

  • The patient has been registered and verified against the MPI.
  • The prescriber holds a valid KMPDC medical licence.
  • The EMR is connected to the national HIE.

Main Flow:

  1. The prescriber selects the patient and opens a new prescription.
  2. The EMR checks the patient's allergy record (AllergyIntolerance) against the selected drug.
  3. If no contraindication, the prescriber completes the MedicationRequest with dose, route, frequency, and duration.
  4. The EMR sends the MedicationRequest to the national HIE.
  5. The patient receives a prescription reference number (QR code / SMS).
  6. The prescription is accessible at any dispensing point linked to the HIE.

FHIR Resources Used:

  • KenyaEncounter — consultation encounter
  • KenyaEPrescriptionMedicationRequest — the prescription
  • KEAllergyIntolerance — allergy check
  • KenyaEPrescriptionMedication — medication catalogue lookup

UC-02 – Pharmacy Dispensing

Trigger: A patient presents a prescription reference at a pharmacy.

Actors: Dispenser, Patient, Pharmacy System, National HIE

Preconditions:

  • A valid MedicationRequest with status active exists on the HIE.
  • The pharmacy is a licensed dispensing facility with an MFL code.

Main Flow:

  1. The pharmacist retrieves the prescription from the HIE using the reference number.
  2. The pharmacy system validates the prescription (status, validity period, refill count).
  3. The pharmacist verifies the patient's identity against the national ID.
  4. The pharmacist dispenses the medication and records a MedicationDispense resource.
  5. The HIE updates the MedicationRequest status to completed (if no refills remain).
  6. An optional dispense notification is sent to the prescriber via the HIE.

FHIR Resources Used:

  • KenyaEPrescriptionMedicationRequest — prescription retrieval and status update
  • KenyaMedicationDispense — dispense record
  • DispenseNotificationExtension — optional notification

UC-03 – Inpatient Medication Administration

Trigger: A nurse or clinician administers a prescribed medication to an admitted patient.

Actors: Prescriber/Nurse, Patient, EMR System

Preconditions:

  • The patient is admitted (inpatient encounter exists).
  • A MedicationRequest with status active has been issued during the admission.

Main Flow:

  1. The nurse opens the Medication Administration Record (MAR) for the patient.
  2. The system retrieves pending administrations from the MedicationRequest.
  3. The nurse confirms the five rights (patient, drug, dose, route, time) and administers the medication.
  4. The nurse records the event as a MedicationAdministration resource.
  5. The MAR is updated and the administration is linked to the prescription.

FHIR Resources Used:

  • KenyaEncounter — inpatient admission encounter
  • KenyaEPrescriptionMedicationRequest — source prescription
  • KEMedicationAdministration — administration record

UC-04 – Medication History / Reconciliation

Trigger: A clinician or pharmacist needs to review a patient's current and past medications.

Actors: Prescriber, Pharmacist, EMR/Pharmacy System

Main Flow:

  1. The clinician queries the HIE for all MedicationStatement records for the patient.
  2. The system returns current and historical medication records.
  3. The clinician reconciles current medications with the new prescription to check for interactions or duplicates.
  4. The reconciled list is updated in the patient's longitudinal record.

FHIR Resources Used:

  • KenyaMedicationStatement — medication history record
  • KEAllergyIntolerance — cross-check for drug allergies

UC-05 – Oncology Care Plan and Chemotherapy Prescription

Trigger: An oncology MDT approves a chemotherapy protocol for a cancer patient.

Actors: Oncologist (Prescriber), MDT Team, Patient, EMR System

Preconditions:

  • A confirmed oncology diagnosis (KenyaOncologyDiagnosisCondition) exists.
  • Histopathology results (KenyaMorphologyObservation) are available.

Main Flow:

  1. The MDT reviews the morphology report and staging.
  2. The oncologist creates an EpisodeOfCare to group all oncology encounters.
  3. The MDT records a KenyaOncologyCarePlan with chemotherapy activities and supportive care.
  4. For each chemotherapy cycle, a MedicationRequest is issued (flagged with ControlledSubstanceScheduleExtension if applicable).
  5. The nurse records each administration as KEMedicationAdministration.
  6. Follow-up observations are recorded against the care plan.

FHIR Resources Used:

  • KenyaOncologyDiagnosisCondition — cancer diagnosis
  • KenyaMorphologyObservation — histopathology result
  • KenyaEpisodeOfCare — oncology episode
  • KenyaOncologyCarePlan — treatment plan
  • KenyaEPrescriptionMedicationRequest — chemotherapy prescription
  • KEMedicationAdministration — cycle administration record

UC-06 – Controlled Substance Prescription

Trigger: A prescriber issues a prescription for a Schedule II–IV controlled substance (e.g. morphine, tramadol).

Actors: Prescriber, Patient, Pharmacy System, Kenya Pharmacy and Poisons Board (PPB)

Preconditions:

  • The prescriber has the authority to prescribe controlled substances.
  • The dispensing pharmacy holds a controlled-substance licence.

Main Flow:

  1. The prescriber creates a MedicationRequest and attaches the ControlledSubstanceScheduleExtension indicating the schedule.
  2. If required, the prescriber attaches a PrescriptionDigitalSignatureExtension.
  3. For high-cost controlled substances, an InsurancePreAuthorizationExtension is added.
  4. The prescription is transmitted to the HIE with enhanced audit logging.
  5. The pharmacy verifies the prescriber's authority, dispenses, and records a MedicationDispense.
  6. The transaction is flagged for PPB pharmacovigilance reporting.

FHIR Resources Used:

  • KenyaEPrescriptionMedicationRequest — prescription
  • ControlledSubstanceScheduleExtension — controlled substance flag
  • PrescriptionDigitalSignatureExtension — e-signature
  • InsurancePreAuthorizationExtension — pre-auth (if applicable)
  • KenyaMedicationDispense — dispense record

UC-07 – Allergy Documentation and Drug Safety Alert

Trigger: A patient discloses an allergy, or a clinician identifies a new allergy during consultation.

Actors: Prescriber / Clinical Staff, Patient, EMR System, CDS System

Main Flow:

  1. The clinician records the allergy as a KEAllergyIntolerance resource with substance, severity, and reaction details.
  2. The allergy is transmitted to the HIE and flagged in the patient's record.
  3. On the next prescription, the CDS system queries the patient's allergies and checks for contraindicated substances.
  4. If a contraindication is detected, a safety alert is raised and the prescriber must override with a documented reason.

FHIR Resources Used:

  • KEAllergyIntolerance — allergy record
  • KenyaEPrescriptionMedicationRequest — prescription with detectedIssue reference

UC-08 – Prescription Audit Trail

Trigger: A regulator, pharmacovigilance officer, or facility manager needs to determine who created, amended, or verified a medication record and when.

Actors: Prescriber, Pharmacist, EMR System, National HIE, Kenya Pharmacy and Poisons Board (PPB)

Preconditions:

  • The medication workflow resources (MedicationRequest, MedicationDispense, or MedicationAdministration) already exist on the HIE.
  • The acting system is authorised to write provenance records.

Main Flow:

  1. Whenever a medication workflow resource is created or updated, the EMR or pharmacy system generates a KEProvenance resource pointing to that resource as target.
  2. The activity element records the nature of the operation (CREATE, UPDATE, DELETE) using the HL7 v3 DataOperation vocabulary.
  3. The agent element identifies the responsible person (prescriber, pharmacist) and the organisation on whose behalf they acted.
  4. The entity element optionally links to the prior version of the resource or the originating prescription to preserve the full chain of custody.
  5. When an audit query is received, the HIE returns all Provenance records matching the queried target resource or date range.
  6. The regulator or auditor can reconstruct the complete lifecycle: prescription created → prescription updated → dispense recorded → administration documented.

FHIR Resources Used:

  • KEProvenance — audit record linking actor, activity, and target
  • KenyaEPrescriptionMedicationRequest — target: prescription creation / amendment
  • KenyaMedicationDispense — target: dispense verification
  • KEMedicationAdministration — target: administration recording