This draft implementation guidance was developed between February and March 2023 as part of the NHS England Virtual Wards Interoperability Discovery. It is provided for information only and is not currently being updated.

If you are not participating in the Discovery, you are advised not to develop against this guidance until a formal announcement has been made. The team can be contacted by emailing england.virtualward.interoperability@nhs.net.

Contents

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  1. Background & Use Case
  2. Architecture
  3. Data Model
  1. Data Transfer Mechanisms
  2. Assurance
  3. Help & Support

3.4.4 FHIR UK Core Encounter Profile

IMPORTANT – The UK Core Encounter profile is currently in active status, having undergone Clinical & Technical Assurance review. It has not been part of the HL7 UK Ballot process. This profile may change in future releases of the UK Core.

IMPORTANT - this page is intended as guidance only, solutions must be clinically assured locally within organisations before deployment into a live environment.

Usage

An Encounter Resource is a record of an event that occurs when a patient interacts with the healthcare system, such as a visit to a doctor's office, a hospital stay, or a telehealth consultation. It includes information about the date, time, location, participants, reason for the encounter, and any relevant clinical or administrative data associated with the encounter. The Encounter Resource is a foundational component of the FHIR standard, as it provides a way to capture and exchange key healthcare data related to patient encounters in a standardized and interoperable format.

IMPORTANT - Only one Encounter Resource is required to represent the entire virtual ward stay (start/end date - this is specified in Encounter.period.start/end).

Structure Definition

https://simplifier.net/HL7FHIRUKCoreR4/UKCoreEncounter/~related

Optionality Guidance

The population guidance below uses the following definitions for data item optionality:

  1. Mandatory - the data item MUST be recorded in the resource every time it is produced
  2. Required - if the system that is providing the data item contains this piece of data, then it should include it in the resource
  3. Optional - the system has the option to include this data if it is available

Note that the population guidance for this profile does not include all data items available in the resource. As per FHIR guidance, all data items inherited from the base resource can be included and used as appropriate, however only those considered relevant to Supplementary RM Data are covered in this guidance.

Required Elements (for Supplementary RM Data)

A minimum viable content that all provider and consumer systems should support is the following elements.

Element Mandatory
Encounter.id Mandatory
Encounter.meta Mandatory
Encounter.identifier Optional
Encounter.status Mandatory
Encounter.class Mandatory
Encounter.type Required
Encounter.subject Mandatory
Encounter.period Mandatory
Encounter.serviceProvider Optional

Id

FHIR Attribute DataType Optionality Cardinality Usage Guidance
id id Mandatory 1:1 A logical identifier generated for this encounter resource. Additional Guidance: Any combination of upper- or lower-case ASCII letters ('A'..'Z', and 'a'..'z', numerals ('0'..'9'), '-' and '.', with a length limit of 64 characters. (This might be an integer, an un-prefixed OID, UUID or any other identifier pattern that meets these constraints.)

Example

{
     "id": "4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e"
}

Meta

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Meta Element Mandatory 1:1 Metadata about the resource
meta.profile Canonical Mandatory 1:1 To identify the FHIR profile the resource conforms to Fixed value: "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"

Example

"meta": {
    "profile": [
      "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"
    ]
}

Encounter.identifier

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.Identifier Identifier Optional 0:* Identifier(s) assigned to this observation. Allows observations to be distinguished and referenced.
Encounter.Identifier.System uri Required (if using) 0:1 Establishes namespace for the value A URL that describes a set values that are unique
Encounter.Identifier.Value String Required (if using) 0:1 The identifier value that is unique within the context of the system.

Example

    "identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "3b1670c3-cad9-4202-9445-872030cec058"
        }
    ]

Encounter.Status

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.Status Code Mandatory 1:1 Status of the encounter Value must be one of: planned | arrived | triaged | in-progress | onleave | finished | cancelled (EncounterStatus value set)

Example

 "status": "finished"

Encounter.Class

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.class Coding Mandatory 1:1 Classification of patient encounter, such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations. Extensible value set: v3.ActEncounterCode

Example

   "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "HH",
        "display": "home health"
      },

Encounter.type

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.type CodeableConcept Required 0:* Specific type of encounter (SNOMED CT if possible) Preferred value set: UKCoreEncounterType

Example

"type": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "270420001",
              "display": "Seen in own home"
            }
          ]

Encounter.subject

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.subject Reference(UK Core Patient) Mandatory 1:1 The subject of the encounter This must reference the patient resource included in the Bundle
Encounter.subject.reference string Mandatory 1:1 A reference to a location at which the Patient resource is found. A reference to Patient.id for the Patient resource in the Bundle.

Example

"subject" : {
    "reference": "urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"
}

Encounter.period

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.period Period Mandatory 1:1 The start and end time of the encounter
Encounter.period.start dateTime Mandatory 1:1 Start time of the encounter, with inclusive boundary.
Encounter.period.end dateTime Mandatory 1:1 End time of the encounter, with inclusive boundary.

Example

"period" : {
    "start": "2023-01-07T13:34:00+01:00",
    "end": "2023-01-15T15:21:00+01:00"
}

Encounter.serviceProvider

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Encounter.serviceProvider Backbone Element Optional 0:* The organisation responsible for the encounter
Encounter.serviceProvider.Reference String Required (if using) 0:1 A reference to a location at which the Organization resource is found. This should reference an Organization resource within the Bundle using the Organization.id field.

Example

"serviceProvider:":
    {
        "reference": "urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"
    }