NHSDigital-Task

Conformance url FHIR Module Maturity Level
https://fhir.nhs.uk/StructureDefinition/NHSDigital-Task trial-use




agentS0..1Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))
prescriptionS0..1Extension(Complex)
repeatInformationS0..1Extension(Complex)
identifierS
groupIdentifierS
statusS
statusReason
intentS
codeS1..Binding
focusS IReference(NHSDigitalAppointment | NHSDigitalServiceRequest | NHSDigitalBundleFHIRMessage | NHSDigitalMedicationRequest | https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient)
system1..Fixed Value
value1..
authoredOnS
system1..
value1..
system1..
value1..
system1..
code1..
display1..
systemFixed Value
noteS
endS
inputS

agentS0..1Extension(Reference(NHSDigitalPractitionerRole | NHSDigitalPractitioner | NHSDigitalHealthcareService))
prescriptionS0..1Extension(Complex)
repeatInformationS0..1Extension(Complex)
identifierS
groupIdentifierS
statusS
statusReason
intentS
codeS1..Binding
focusS IReference(NHSDigitalAppointment | NHSDigitalServiceRequest | NHSDigitalBundleFHIRMessage | NHSDigitalMedicationRequest | https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient)
system1..Fixed Value
value1..
authoredOnS
system1..
value1..
system1..
value1..
system1..
code1..
display1..
systemFixed Value
noteS
endS
inputS

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Definition

FHIR Task usage and scope is defined as

A task resource describes an activity that can be performed and tracks the state of completion of that activity. It is a representation that an activity should be or has been initiated, and eventually, represents the successful or unsuccessful completion of that activity. Note that there are a variety of processes associated with making and processing orders. Some orders may be handled immediately by automated systems but most require real world actions by one or more humans. Some orders can only be processed when other real world actions happen, such as a patient presenting themselves so that the action to be performed can actually be performed. Often these real world dependencies are only implicit in the order details.

A Task resource often exists in parallel with clinical resources.

For example, a Task could request fulfillment of a ServiceRequest ordering a Procedure that would result in a Procedure, Observation, DiagnosticReport, ImagingStudy or similar resource. Another example would be a Task that requests fulfillment of a CommunicationRequest to be performed between various actors.

Comment

Task has three main uses:

  • basic delivery of an order resource (e.g. MedicationRequest or ServiceRequest)
  • minor workflow requests (e.g. phone patient, complete form or validate a referral)
  • workflow support (centred around complex workflow support and may involves a workflow engine)
Order Fulfilment

Centres on the fulfilment of the order. It does not contain the order details which are held in a referenced request resource. In the diagram below the recipient or fulfiller of the order uses FHIR Task to accept or reject the order, it also uses Task to send event updates. Note the fulfiller will use other resources to record the details of the fulfilment such as MedicationDispense for a MedicationRequest.

Examples:

Task.code Task.status Task.focus Task.requester Meaning
fulfill rejected MedicationRequest dispenser The dispenser is rejecting the fulfilment/deliver of a referenced MedicationRequest. The MedicationRequest is not cancelled
fullfill cancelled MedicationRequest any The requested fulfilment of the MedicationRequest is cancelled. The referenced MedicationRequest is not cancelled
fullfill accepted MedicationRequest dispenser The dispenser is taking responsibility of fulfilling the referenced MedicationRequest.
fullfill completed MedicationRequest dispenser The requested fulfilment of the MedicationRequest is completed. The referenced MedicationRequest can now be changed to completed.

See the section on status for more details.


Minor Workflow Requests

This is used to implement additional around an order or to record specific workflow requests. These may not have a focused resource reference. It is anticipated they are coded using SNOMED CT.

Examples:
Task.code Task.focus Task.requester Task.owner Task.reasonCode Meaning
413292001 Assessment for referral ServiceRequest referrer clinician 3457005 Patient Referral Check the referenced referral is valid.
182836005 Review of medication clinician GP 151715009 Emergency admission, asthma Request to review medication following an emergency admission.
103742009 Renewal of prescription MedicationRequest patient GP Request for a reissue/refill of a medication
324861000000109 Review of patient laboratory test report DiagnosticReport consultant Request for a lab report to be reviewed. See also UHS Lab Reports

The Task.status can be used to indicate fulfilment/delivery status.


Workflow Support

More advanced workflow is supported, this adds in the use of Task.input and Task.output. This allows the passage of inputs and outputs which may be found in automated workflow activities.

The diagram below is from an acute trusts handling of a received eRS referral request. Each process communicates via the FHIR Task, the first process takes the eRS referral and gets the referral letter from eRS, these are then passed to the clinician for triage. Once triaged, the clinician creates a book appointment Task which the admin's action.

Constraints

extension:agent
Element Id Task.extension:agent
Cardinality 0..1
Slice Name agent
type Extension(ExtensionProvenanceAgent)

Definition

Is used as the author on request resources.

extension:prescription
Element Id Task.extension:prescription
Cardinality 0..1
Slice Name prescription
type Extension(ExtensionEPSPrescription)

Definition

"extension":  [
       {
           "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-Prescription",
           "extension":  [
               {
                   "url": "courseOfTherapyType",
                   "valueCoding": {
                       "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-course-of-therapy",
                       "code": "acute",
                       "display": "Acute"
                   }
               }
           ]
       }
   ],

extension:repeatInformation
Element Id Task.extension:repeatInformation
Cardinality 0..1
Slice Name repeatInformation
type Extension(ExtensionEPSRepeatInformation)

Definition

"extension": [
       {
           "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation",
           "extension": [
               {
                   "url": "numberOfRepeatsAllowed",
                   "valueUnsignedInt": 6
               },
               {
                   "url": "numberOfRepeatsIssued",
                   "valueUnsignedInt": 2
               }
           ]
       },

identifier
Element Id Task.identifier
Cardinality 0..*
type Identifier

Definition

For EPS

A single identifier MUST be present and the value must be a UUID.

"identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "5AC84C11-DB8B-44DA-8FCF-8980B3D13596"
        }
    ],

groupIdentifier
Element Id Task.groupIdentifier
Cardinality 0..1
type Identifier

Definition

EPS Only

An identifier to the original prescription-order MUST be present. Only the short form identifier needs to be supplied.

"groupIdentifier": {
        "system": "https://fhir.nhs.uk/Id/prescription-order-number",
        "value": "88AF6C-C81007-00001C"
    },

Requirements

Billing and/or reporting can be linked to whether multiple requests were created as a single unit.

status
Element Id Task.status
Cardinality 1..1
Terminology Binding TaskStatus (Required)
The current status of the task.
type code

Definition

These workflow tasks have status which indicates the Task status.

The following diagram reflects the "typical" state machine for Task. Note that not all states will be supported by all workflows and that some workflows may support additional transitions, including transitions from terminal states (e.g. back to "in-progress" from "failed" or "completed").

For example:

A patient requesting a repeat prescription would ask for task with code fulfil used with 103742009 | Renewal of prescription and a status of requested.
Once reviewed (by a clinician), the task status would be changed to accepted. When the task is then picked up (in-progress) and the related MedicationRequest is sent, the status would change to completed.

Requirements

These states enable coordination of task status with off-the-shelf workflow solutions that support automation of tasks.

Comment

For EPS

Only in-progress is currently supported for reasonCode = 373784005 (Dispensing medication) and focus is a dispense-notification.

rejected / cancelled / failed are supported for reasonCode = 33633005 (Prescription of drug) and focus is a prescription-order.

intent
Element Id Task.intent
Cardinality 1..1
Terminology Binding TaskIntent (Required)
Distinguishes whether the task is a proposal, plan or full order.
type code

Definition

Indicates the "level" of actionability associated with the Task, i.e. i+R[9]Cs this a proposed task, a planned task, an actionable task, etc.

Comment

Is not processed by EPS and is included for FHIR compliance reasons. The value should always be order.

code
Element Id Task.code
Cardinality 1..1
Terminology Binding NHSDigitalTaskCode (Extensible)
type CodeableConcept

Definition

e-RS

A SNOMED CT procedure code to indicate the action

  "code": {
        "coding": [
            {
                "system": "http://snomed.info/sct",
                "code": "386053000",
                "display": "Evaluation procedure"
            }
        ]
    },

EPS

The SNOMED action codes are complemented with order delivery task-code which indicates the type of action to be performed against the focal resource.

For example:

The code fulfil used with 182836005 | Review of medication means a task to review medication. The code approve used with 103742009 | Renewal of prescription is a task for a clinician to approve the issue of a repeat medication.

 "code": {
        "coding":  [
            {
                "system": "http://hl7.org/fhir/CodeSystem/task-code",
                "code": "fulfill",
                "display": "Fulfill the focal request"
            }
        ]

Comment

The title (eg "My Tasks", "Outstanding Tasks for Patient X") should go into the code.

focus
Element Id Task.focus
Cardinality 0..1
type Reference(NHSDigitalAppointment NHSDigitalServiceRequest NHSDigitalBundleFHIRMessage NHSDigitalMedicationRequest UKCorePatient)

Definition

e-RS

Reference to the resource which is the focus of the action

 "focus": {
        "reference": "https://server.fire.ly/ServiceRequest/eb13327f-e990-4667-b37a-89eb93a94c47"
    },

** EPS Only**

This will be the Bundle.identifier of the message this Task is acting on. For Tasks with a reasonCode of 373784005 - Dispensing medication this will be a dispense-notification message. For Tasks with a reasonCode of 33633005 - Prescription of drug this will be the prescription-order message from the Task/$release operation.

"focus": {
        "type": "Bundle",
        "identifier": {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "334a3195-1f6c-497a-8efe-d272ca9c4e38"
        }
    },

Requirements

Used to identify the thing to be done.

Comment

Tasks are often generated as a consequence of other workflows or relate to FHIR Workflow resources. For example a repeat medication request will be related to a previous MedicationRequest or a medication reconciliation may relate to a hospital admissions Encounter/EpisodeOfCare. This is carried in the focus element.

focus can be omitted. For example if an ED generated a Medication Review as a result of COPD Emergency encounter they may chose to include a reference to the Encounter but they may decide instead to use a more specific reasonCode such as 394720003 | Asthma medication review.

Constraints

  • nhsd-taskfocus (ERROR) focus - An identifier reference or resource reference must be provided

for
Element Id Task.for
Cardinality 1..1
type Reference(Resource)

Definition

A reference to the patient the Task is for. This will always be an identifier reference using the Patients NHSNumber.

"for": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9446368138"
        }
    },

Requirements

Used to track tasks outstanding for a beneficiary. Do not use to track the task owner or creator (see owner and creator respectively). This can also affect access control.

Constraints

  • patient-reference (ERROR) An identifier reference or resource reference must be provided
  • patient-nhs (ERROR) NHS Number must be in the English and Welsh NHS Number range or length of the number is wrong.

for.identifier.system
Element Id Task.for.identifier.system
Cardinality 1..1
Fixed Value https://fhir.nhs.uk/Id/nhs-number
type uri

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comment

Identifier.system is always case sensitive.

authoredOn
Element Id Task.authoredOn
Cardinality 0..1
type dateTime

Definition

Date and time the task was created.

"authoredOn": "2020-12-21T17:03:20-00:00",

Requirements

Most often used along with lastUpdated to track duration of task to supporting monitoring and management.

requester
Element Id Task.requester
Cardinality 0..1
type Reference(NHSDigitalPractitionerRole)
Aggregation - contained

Definition

Who is created the Request or the Event. In NHSDigital API's this SHOULD always be a PractitionerRole role reference.

 "requester": {
        "reference": "#requester"
    },

This will reference a contained PractitionerRole (note: this resource only contains limited user metadata such as ODS Code, professional code and SDS User Profile Id). This resource should not hold data which is held in SDS, only enough information to identify the SDS Entry,

{
    "resourceType": "Task",
    "id": "bd1ca5c4-ff49-4f2a-9db4-f5dda0112084",
    "meta": {
        "lastUpdated": "2016-07-11T11:07:22+00:00"
    },
    "contained": [
        {
            "resourceType": "PractitionerRole",
            "id": "requester",
            "practitioner": {
                "identifier": {
                    "system": "https://fhir.hl7.org.uk/Id/gmp-number",
                    "value": "G8123456"
                },
                "display": "DR AA BHATIA"
            },
            "organization": {
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                    "value": "C81007"
                },
                "display": "VERNON STREET MEDICAL CTR"
            },
            "telecom": [
                {
                    "system": "phone",
                    "use": "work",
                    "value": "01234567890"
                }
            ]
        }
    ],

Requirements

Identifies who created this task. May be used by access control mechanisms (e.g., to ensure that only the creator can cancel a task).

owner
Element Id Task.owner
Cardinality 0..1
type Reference(NHSDigitalPractitionerRole NHSDigitalOrganization)

Definition

EPS

Who is responsible for actioning the request Task (e.g. for a prescription-order this will be the pharmacy).

"owner": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
            "value": "FB444"
        },
        "display": "Freds Pharmacy"
    },

e-RS

"owner": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ers-service",
            "value": "12444"
        }
    },

Requirements

Identifies who is expected to perform this task.

Comment

Tasks may be created with an owner not yet identified.

reasonCode
Element Id Task.reasonCode
Cardinality 0..1
type CodeableConcept

Definition

In FHIR Task these types of workflow would be represented via reasonCode and/or reasonReference

For medication this is probably SNOMED CT based using codes under the SNOMED CT 182832007 Medication management and includes codes such as:

SNOMED CT Display
33633005 Prescription of drug
373784005 Dispensing medication

For referral management

SNOMED CT Display
3457005 Patient Referral
185499000 Expedite appointment

Comment

This should only be included if there is no focus or if it differs from the reason indicated on the focus.

reasonCode.coding:SNOMED
Element Id Task.reasonCode.coding:SNOMED
Cardinality 0..*
Slice Name SNOMED
type Coding

Definition

A reference to a code defined by a terminology system.

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comment

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

reasonCode.coding:SNOMED.system
Element Id Task.reasonCode.coding:SNOMED.system
Cardinality 0..1
Fixed Value http://snomed.info/sct
type uri

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comment

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

note
Element Id Task.note
Cardinality 0..*
type Annotation

Definition

EPS Only

This may contain cancellation reason.

e-RS

Used to add notes to the worklist items

"note": [
    {
      "text": "Optional comments"
    }
  ]

restriction
Element Id Task.restriction
Cardinality 0..1
type BackboneElement

Definition

If the Task.focus is a request resource and the task is seeking fulfillment (i.e. is asking for the request to be actioned), this element identifies any limitations on what parts of the referenced request should be actioned.

Requirements

Sometimes when fulfillment is sought, you don't want full fulfillment.

restriction.period.end
Element Id Task.restriction.period.end
Cardinality 0..1
type dateTime

Definition

In e-RS this is also known as the review date due.

Comment

e-RS

  • If deferred to provider (because there were no appointments available for a directly bookable service) then this is the date by which the provide should resolve the appointment slot issue; or
  • If the referral was sent to a triage service then this is the date by which the provider should have reviewed the referral

input
Element Id Task.input
Cardinality 0..*
type BackboneElement

Definition

Additional information that may be needed in the execution of the task.

Requirements

Resources and data used to perform the task. This data is used in the business logic of task execution, and is stored separately because it varies between workflows.