WARNING
This guidance is under active development by NHS England and content may be added or updated on a regular basis.Shared Clinical Documents
Standards for Cross Enterprise Document Sharing API's are:
| Standards | Put Document | Register Document | Get Document List | Get Document |
|---|---|---|---|---|
| NRL | Create new, or Supersede existing, document pointers | Retrieve document pointers | ||
| IHE XDS | Provide and Register Document Set-b [ITI-41] | Register Document Set-b [ITI-42] | Registry Stored Query [ITI-18] | Retrieve Document Set [ITI-43] |
| IHE MHD (FHIR R4) | Simplified Publish [ITI-105] Provide Document Bundle [ITI-65] |
Find Document References [ITI-67] | Retrieve Document [ITI-68] | |
| HL7 v2 | MDM_T02 - Original document notification and content | MDM_T01 - Original document notification | ||
| HL7 FHIR | HTTP POST (POST /Binary) POST /DocumentReference |
POST /DocumentReference | GET /DocumentReference | HTTP GET (GET /Binary) |
Document API
DocumentReference - Get Document List
UK Core Profile UK Core DocumentReference
GET [base]/DocumentReference?param1=value&...{&_format=[mime-type]}
Search Parameters DocumentReference
All searches shall use search combinations and include the following :
| Parameters | Type | Modifiers | Optionality | IHE MHD | NRL |
|---|---|---|---|---|---|
| patient | reference | SHALL | ✓ | ||
| patient.identifier | reference | SHALL | ✓ | ||
| subject:identifier | token | SHALL | ✓ |
All searches should use the following parameters:
| Parameters | Type | Modifiers | Optionality | IHE MHD | NRL |
|---|---|---|---|---|---|
| author.given | string | SHOULD | ✓ | ||
| author.family | string | SHOULD | ✓ | ||
| category | token | SHOULD | ✓ | ||
| creation | date | SHOULD | ✓ | ||
| date | date | SHOULD | ✓ | ||
| event | token | SHOULD | ✓ | ||
| facility | token | SHOULD | ✓ | ||
| format | token | SHOULD | ✓ | ||
| identifier | token | SHOULD | ✓ | ||
| period | date | SHOULD | ✓ | ||
| related | date | SHOULD | ✓ | ||
| security-label | token | SHOULD | ✓ | ||
| setting | token | SHOULD | ✓ | ||
| status | token | SHOULD | ✓ | ||
| type | token | SHOULD | ✓ | ✓ |
Federated Document API
(Get Document List)
IHE Cross-Community Access (XCA)
For FHIR & IHE see Federated Query API
Clinical Document Architecture (FHIR Documents)
Standards for FHIR Documents are:
- NHS England
- Transfer of Care FHIR STU3
- Digital Medicine FHIR STU3 depreceated
- HL7 International
- HL7 EU
Most documents use a mix of formats such as:
- html
- png
- img
Health and Care has an additional format called Clinical Document Architecture. This comes in two HL7 versions
- HL7 v3 CDA
- FHIR Documents - see below
These document formats are content standards and can be used with any of the interaction standards listed in the previous sections (i.e. IHE XDS, HL7 FHIR and V2).
FHIR Documents
FHIR Documents is a FHIR exchange standard for:
- exchanging resources
- exchanging a html representation of those resources and clinical narrative.
Example rendered FHIR Document:
This allows the recipient to either process the structured content and/or the html representation of the content.
The diagram below shows a generic content and is based on the HL7 International Patient Summary Implementation Guide
FHIR Documents also cater for different levels of supplier/provider maturity as it can be both:
- A method of exchanging structured data
- A method of exchanging html documents.
So a receiving system which can't process the structured data would use the html representation. Another system may process the structured data. A sending system would always include the html content and structured data which they support.
The use of both HL7 FHIR Documents and HL7 v3 CDA represent only a proportion of the documents used in health care.
Messages (FHIR Messages)
NHS England standards for FHIR Message API's are:
Events
- National Event Management System (FHIR Message STU3)
- Transfer of Care FHIR Message and Document STU3
- Digital Medicine FHIR Message and Document STU3 depreceated
Request
- Bookings and Referrals (BARS) (FHIR Message R4)
- Electronic Prescription Service (EPS) (HL7 FHIR Message R4)
Are not considered Documents but will often be used as Documents.
Request FHIR Messages
Request FHIR Messages will often contain similar data to FHIR Documents without the html representation. However, the recommended content is much less resulting in smaller exchanges of patient record information. FHIR Messages can be said to concentrate more on the transfer of pertinent or key information. Request Messages focus on the workflow request, this may be present on a FHIR Document but here this workflow request is implied.
Event FHIR Messages
The Event FHIR Messages gist's in the diagram below are based on conversions of HL7 v2 messages to FHIR (these are not NHS England FHIR Message standards).
Like Request FHIR Messages they only exchange structured data with no html representation.