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
  4. Data Transfer Mechanisms
  5. Assurance
  6. Help & Support

3.4.1 FHIR UK Core Bundle Profile

IMPORTANT – The UK Core Bundle profile is currently in draft status and has not undergone Clinical & Technical Assurance review, or 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.

The FHIR UK Core Bundle is used to group together the resources required for the Supplementary Remote Monitoring Data from a Virtual Ward Stay (Supplementary RM Data).

Structure Definition

This page provides specific guidance on using the Bundle resource for Supplementary RM Data. For the full structure definition, please see the FHIR UK Core Bundle Resource.

The UK Core resource inherits from the international HL7 FHIR R4 base resource definition.

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)

Element Optionality
Bundle.id mandatory
Bundle.meta mandatory
Bundle.identifer optional
Bundle.type mandatory
Bundle.entry mandatory

Further guidance on each element is outlined in the sections below.

Id

FHIR Attribute DataType Optionality Cardinality Usage Guidance
id id mandatory 1:1 A logical identifier generated for this bundle. 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 (XML)

<id value="9c9ab2af-6df4-4b63-9c8d-249a3dcb033f" />

Example (JSON)

{
    "id": "9c9ab2af-6df4-4b63-9c8d-249a3dcb033f"
}

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-Bundle"
meta.versionID id Optional (recommended) 0:1 Version specific identifier Changes each time the content of the bundle changes. Can be used to indicate if any corrections are required.
meta.lastUpdated instant Optional (recommended) 0:1 The date/time that the bundle was assembled or last updated - i.e. when the resources were placed in the bundle.

Example (XML)

<meta>
    <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle" />
    <version value="1" />
    <lastUpdated value="2023-01-02T12:48:23.413+00:00" />
</meta>

Example (JSON)

"meta": {
    "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle"
    ]
    "versionId": "1",
    "lastUpdated": "2023-01-02T12:48:23.413+00:00"
}

Identifier

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Identifier Identifier Optional 0:1 A persistent identifier for the bundle that won't change as a bundle is copied from server to server. The identifer should be defined using the `system` and `value` sub-elements. The system is a URI which defines the set of identifiers (i.e. how the value is unique). The value is a unique identifier value within that system.

Example (XML)

<identifier>
    <system value="https://tools.ietf.org/html/rfc4122" />
    <value value="73c52d0f-8584-43fe-b492-3a4d3017ac22" />
</identifier>

Example (JSON)

{
    "identifier": {
        "system: "https://tools.ietf.org/html/rfc4122",
        "value": "73c52d0f-8584-43fe-b492-3a4d3017ac2"
    }
}

Bundle Type

FHIR Attribute DataType Optionality Cardinality Usage Guidance
Type code mandatory 1:1 Indicates the purpose of this bundle - how it is intended to be used (i.e. a collection of resources containing Supplementary RM data). The code contains a fixed value of "collection", taken from the BundleType value set.

Example (XML)

<type value="collection" />

Example (JSON)

{
    "type": "collection"
}

Entry

This specification requires a minimum of 4 entry elements, which are outlined below.

FHIR Attribute DataType Optionality Cardinality Usage Guidance
entry (Patient) Backbone Element mandatory 1:1 A resource containing Patient details. Patient resource
entry (Organization) Backbone Element mandatory 1:* A resource containing organisation details. Organization resource
entry (Encounter) Backbone Element mandatory 1:1 A resource containing encounter details for the virtual ward stay. Encounter resource
entry (DocumentReference) Backbone Element mandatory 1:1 A resource containing the PDF document. DocumentReference resource
entry (Observation) Backbone Element optional 0:* Resources containing observations (e.g. NEWS2 scores). Observation resource
entry.fullUrl uri mandatory 1:1 The URI for the entry resource UUID. The `fullUrl` for each entry must match the `[resource].id` field for the individual resource within the entry. URI for resource (Absolute URL server address or URI for UUID/OID). Note that this is not required to be a functional URL for retrieving the resource via an API.

Example (XML)

<entry>
    <fullUrl value="urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546">
    <resource>
        <Patient>
            <id value="dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546">
            <!-- Patient resource -->
        </Patient>
    </resource>
</entry>
<entry>
    <fullUrl value="urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71">
    <resource>
        <Organization>
            <id value="9b9dfe0d-1747-424f-a739-35f7be8e8d71">
            <!-- Organization resource -->
        </Organization>
    </resource>
</entry>
<entry>
    <fullUrl value="urn:uuid:4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e">
    <resource>
        <Encounter>
            <id value="4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e">
            <!-- Encounter resource -->
        </Encounter>
    </resource>
</entry>
<entry>
    <fullUrl value="urn:uuid:eeef5be5-30c5-4d0a-aecc-91b5648e9c9f">
    <resource>
        <DocumentReference>
            <id value="eeef5be5-30c5-4d0a-aecc-91b5648e9c9f">
            <!-- DocumentReference resource -->
        </DocumentReference>
    </resource>
</entry>
<entry>
    <resource>
        <fullUrl value="urn:uuid:c29b0ed6-0a6b-4606-a8b6-99a6b1736c7a">
        <Observation>
            <id value="c29b0ed6-0a6b-4606-a8b6-99a6b1736c7a">
            <!-- Observation resource -->
        </Observation>
    </resource>
</entry>

Example (JSON)

{
    "entry": [
        {
            "fullUrl": "urn:uuid:"dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"
            "resource" : {
                "resourceType": "Patient",
                "id": ""dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546",
                // Patient resource
            }
        },
        {
            "fullUrl": "urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"
            "resource" : {
                "resourceType": "Organization",
                "id": "9b9dfe0d-1747-424f-a739-35f7be8e8d71",
                // Organization resource
            }
        },
        {
            "fullUrl": "urn:uuid:4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e"
            "resource" : {
                "resourceType": "Encounter",
                "id": "4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e",
                // Encounter resource
            }
        },
        {
            "fullUrl": "urn:uuid:eeef5be5-30c5-4d0a-aecc-91b5648e9c9f",
            "resource" :{
                "resourceType": "DocumentReference",
                "id": "eeef5be5-30c5-4d0a-aecc-91b5648e9c9f",
                // DocumentReference resource
            } 
        },
        {
            "fullUrl": "urn:uuid:c29b0ed6-0a6b-4606-a8b6-99a6b1736c7a",
            "resource" :{
                "resourceType": "Observation",
                "id": "c29b0ed6-0a6b-4606-a8b6-99a6b1736c7a",
                // Observation resource
            }
        }
    ]
}

For full Patient, DocumentReference and Observation resource examples, please see the individual profile pages.

Full Bundle Example (XML)

<Bundle xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir fhir-all-xsd/schema14.xsd" resourceType="Bundle">
   <id value="9c9ab2af-6df4-4b63-9c8d-249a3dcb033f"/>
   <meta>
      <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle"/>
      <versionId value="1"/>
      <lastUpdated value="2023-01-02T12:48:23.413+00:00"/>
   </meta>
   <identifier>
      <system value="https://tools.ietf.org/html/rfc4122"/>
      <value value="73c52d0f-8584-43fe-b492-3a4d3017ac2"/>
   </identifier>
   <type value="collection"/>
   <entry>
      <fullUrl value="urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"/>
      <resource>
          <resourceType value="Patient"/>
            <id value="dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"/>
            <meta>
               <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient"/>
            </meta>
            <identifier>
               <extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus">
                  <valueCodeableConcept>
                     <coding>
                        <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-NHSNumberVerificationStatus"/>
                        <code value="number-present-and-verified"/>
                        <display value="Number present and verified"/>
                     </coding>
                  </valueCodeableConcept>
               </extension>
               <system value="https://fhir.nhs.uk/Id/nhs-number"/>
               <value value="9912003890"/>
            </identifier>
            <name>
               <use value="official"/>
               <family value="SMITH"/>
               <given value="Richard"/>
            </name>
            <telecom>
               <use value="home"/>
               <value value="01131231266"/>
            </telecom>
            <gender value="female"/>
            <birthDate value="2021-02-11"/>
            <deceasedBoolean value="true"/>
            <deceasedDateTime value="2010-10-22T00:00:00+00:00"/>
            <address>
               <use value="home"/>
               <type value="both"/>
               <line value="22 Brightside Crescent"/>
               <city value="Overtown"/>
               <district value="West Yorkshire"/>
               <postalCode value="LS10 4YU"/>
            </address>
            <contact>
               <relationship>
                  <coding>
                     <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-AdditionalPersonRelationshipRole"/>
                     <code value="Personal"/>
                     <display value="Personal relationship with the patient"/>
                  </coding>
               </relationship>
               <name>
                  <use value="official"/>
                  <text value="JACKSON Jane (Miss)"/>
                  <family value="Jackson"/>
                    <given value="Jane"/>
        <prefix value="Miss"/>
      </name>
      <telecom>
        <system value="phone"/>
        <value value="07777123123"/>
        <use value="mobile"/>
      </telecom>
      <address>
        <use value="home"/>
        <type value="physical"/>
        <line value="5 Alwoodley Road"/>
        <line value="LEEDS"/>
        <postalCode value="LS17 6EH"/>
      </address>
      <gender value="female"/>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"/>
    <resource>
      <resourceType value="Organization"/>
      <id value="9b9dfe0d-1747-424f-a739-35f7be8e8d71"/>
      <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"/>
      </meta>
      <identifier>
        <system value="https://fhir.nhs.uk/Id/ods-organization-code"/>
        <value value="X26"/>
      </identifier>
      <name value="NHS England"/>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e"/>
    <resource>
      <resourceType value="Encounter"/>
      <id value="4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e"/>
      <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"/>
      </meta>
      <identifier>
        <system value="https://tools.ietf.org/html/rfc4122"/>
        <value value="3b1670c3-cad9-4202-9445-872030cec058"/>
      </identifier>
      <status value="final"/>
      <class>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="HH"/>
        <display value="home health"/>
      </class>
      <type>
        <coding>
          <system value="http://snomed.info/sct"/>
           <code value="270420001"/>
          <display value="Seen in own home"/>
        </coding>
      </type>
      <subject>
        <reference value="urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"/>
      </subject>
      <period>
        <start value="2023-01-07T13:34:00+01:00"/>
        <end value="2023-01-15T15:21:00+01:00"/>
      </period>
      <serviceProvider>
        <reference value="urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"/>
      </serviceProvider>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:eeef5be5-30c5-4d0a-aecc-91b5648e9c9f"/>
    <resource>
      <resourceType value="DocumentReference"/>
      <id value="eeef5be5-30c5-4d0a-aecc-91b5648e9c9f"/>
      <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-DocumentReference"/>
      </meta>
      <masterIdentifier>
        <system value="http://example.com/identifiers"/>
        <value value="12345"/>
      </masterIdentifier>
      <status value="current"/>
      <docStatus value="final"/>
      <type>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="371534008"/>
          <display value="Summary report (record artifact)"/>
        </coding>
      </type>
      <subject>
        <reference value="urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"/>
      </subject>
      <author>
        <reference value="urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"/>
      </author>
      <custodian>
        <reference value="urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"/>
      </custodian>
      <content>
        <attachment>
          <contentType value="application/pdf"/>
          <data value="//base64encoded PDF"/>
          <title value="Care Plan Report"/>
          <creation value="2016-03-08T15:26:00+01:00"/>
        </attachment>
      </content>
        <context>
    <encounter>
        <reference value="urn:uuid:4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e"/>
    </encounter>
</context>
  </resource>
  </entry>
  <entry>
  <fullUrl value="urn:uuid:c29b0ed6-0a6b-4606-a8b6-99a6b1736c7a" />
  <resource>
    <resourceType value="Observation" />
    <id value="c29b0ed6-0a6b-4606-a8b6-99a6b1736c7a" />
    <meta>
      <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
    </meta>
    <identifier>
      <system value="https://tools.ietf.org/html/rfc4122" />
      <value value="3b1670c3-cad9-4202-9445-872030cec058" />
    </identifier>
    <status value="final" />
    <category>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/observation-category" />
        <code value="survey" />
        <display value="Survey" />
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://snomed.info/sct" />
        <code value="1104051000000101" />
        <display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) total score" />
      </coding>
    </code>
    <subject>
      <reference value="urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546" />
    </subject>
    <effectiveDateTime value="2018-10-04T14:17:59+01:00" />
    <performer>
      <reference value="urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71" />
    </performer>
    <valueInteger value="12" />
    <note value="Patient presents with..." />
  </resource>
</entry>
</Bundle>

Full Bundle Example (JSON)

{
    "resourceType": "Bundle",
    "id": "9c9ab2af-6df4-4b63-9c8d-249a3dcb033f",
    "meta": {
        "profile": [
        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle"
        ],
        "versionId": "1",
        "lastUpdated": "2023-01-02T12:48:23.413+00:00"
    },
    "identifier": {
        "system": "https://tools.ietf.org/html/rfc4122",
        "value": "73c52d0f-8584-43fe-b492-3a4d3017ac2"
    },
    "type": "collection",
    "entry": [
        {
            "fullUrl": "urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546",
            "resource" : {
                "resourceType": "Patient",
                "id": "dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546",
                "meta": {
                    "profile": [
                      "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient"
                    ]
                  },
                  "identifier": [
                    {
                      "extension": [
                        {
                          "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-NHSNumberVerificationStatus",
                                "code": "number-present-and-verified",
                                "display": "Number present and verified"
                              }
                            ]
                          }
                        }
                      ],
                      "system": "https://fhir.nhs.uk/Id/nhs-number",
                      "value": "9912003890"
                    }
                  ],
                  "name": [
                    {
                      "use": "official",
                      "family": "SMITH",
                      "given": [
                        "Richard"
                      ]
                    }
                  ],
                  "telecom": [
                    {
                      "use": "home",
                      "value": "01131231266"
                    }
                  ],
                  "gender": "female",
                  "birthDate": "2021-02-11",
                  "deceasedBoolean": true,
                  "deceasedDateTime": "2010-10-22T00:00:00+00:00",
                  "address": [
                    {
                      "use": "home",
                      "type": "both",
                      "line": [
                        "22 Brightside Crescent"
                      ],
                      "city": "Overtown",
                      "district": "West Yorkshire",
                      "postalCode": "LS10 4YU"
                    }
                  ],
                  "contact": [
                    {
                      "relationship": [
                        {
                          "coding": [
                            {
                              "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-AdditionalPersonRelationshipRole",
                              "code": "Personal",
                              "display": "Personal relationship with the patient"
                            }
                          ]
                        }
                      ],
                      "name": {
                        "use": "official",
                        "text": "JACKSON Jane (Miss)",
                        "family": "Jackson",
                        "given": [
                          "Jane"
                        ],
                        "prefix": [
                          "Miss"
                        ]
                      },
                      "telecom": [
                        {
                          "system": "phone",
                          "value": "07777123123",
                          "use": "mobile"
                        }
                      ],
                      "address": {
                        "use": "home",
                        "type": "physical",
                        "line": [
                          "5 Alwoodley Road",
                          "LEEDS"
                        ],
                        "postalCode": "LS17 6EH"
                      },
                      "gender": "female"
                    }
                  ]
            }
        },
        {
            "fullUrl": "urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71",
            "resource" : {
                "resourceType": "Organization",
                "id": "9b9dfe0d-1747-424f-a739-35f7be8e8d71",
                "meta": {
                    "profile": [
                      "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                    ]
                  },
                  "identifier": [
                    {
                      "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                      "value": "X26"
                    }
                  ],
                  "name": "NHS England"
            }
        },
        {
            "fullUrl": "urn:uuid:4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e",
            "resource" : {
                "resourceType": "Encounter",
                "id": "4f28e0c6-17d6-4f52-b0a6-3bb88b1f6c9e",
                "meta": {
                    "profile": [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"
                    ]
                },
                "identifier": [
                    {
                        "system": "https://tools.ietf.org/html/rfc4122",
                        "value": "3b1670c3-cad9-4202-9445-872030cec058"
                    }
                ],
                "status": "final",
                "class": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "HH",
                    "display": "home health"
                },
                "type": [
                    {
                        "coding": [
                            {
                                "system": "http://snomed.info/sct",
                                "code": "270420001",
                                "display": "Seen in own home"
                            }
                        ]
                    }
                ],
                "subject": {
                    "reference": "urn:uuid:dd9724d1-7b61-44e2-9023-b72e6b966018-76563212455590986546"
                },
                "period": {
                    "start": "2023-01-07T13:34:00+01:00",
                    "end": "2023-01-15T15:21:00+01:00"
                },
                "serviceProvider": [
                    {
                        "reference": "urn:uuid:9b9dfe0d-1747-424f-a739-35f7be8e8d71"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:uuid:eeef5be5-30c5-4d0a-aecc-91b5648e9c9f",
            "resource" :{
                "resourceType": "DocumentReference",
                "id": "eeef5be5-30c5-4d0a-aecc-91b5648e9c9f",
                "meta": {
                    "profile": [
                        "https://fhir.hl7.org.uk/StructureDefinition/UKCore-DocumentReference"
                    ]
                },
                "masterIdentifier": {
                    "system": "http://example.com/identifiers",
                    "value": "12345"
                },
                "status": "current",
                "docStatus": "final",
                "type": {
                    "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "371534008",
                            "display": "Summary report (record artifact)"
                        }
                    ]
                },
                "subject": {
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