Notice
- Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
- This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.
Use of attachments
Use of attachments, either in test orders or referenced in diagnostic reports is still under discussion.
There are a number of elements, such as PDF test reports and RoD documents which the national strategy indicates should not be stored on a national service, but instead should be accessible directly from the originating/data controller system. For the alpha and beta phase, where suppliers would struggle to meet timescales, the documents will be stored in the national service to simplify integration, but with a clear roadmap for changing where the documents and data are stored and retrieved. This could use a service such as NRL, possibly proxied through the national service to remove the risk of consumers losing access to the data and to decouple the development and migration of providers from a central document store to distributed document storage and retrieval.
This section will be updated as requirements are elicited.
Examples of attachments which may be used are:
- PDF copies of patient history and diagnostic reports
- DICOM or other images included as part of the patient history
- Variants of Unknown Significance (VUS) files which may be attached to genomic reports
It is expected PDFs in messages will be sent within the body of the FHIR message as a base64 encoded string.
Images and VUS files may be quite large in size so a separate image/variant store may need to be used to host this data centrally. Alternatively, suppliers can ensure this data can be queried and retrieved by the Genomic Medicine Service, either via NRL or externally queryable APIs, allowing these attachments to be referenced by their URL as per Bundle referencing.