NHSE Design and Development Approach

This guidance is under active development by NHS Digital and content may be added or updated on a regular basis.

Profile Design

The HL7 FHIR® standard

The HL7 FHIR® standard creates a common foundation on which a variety of different solutions are implemented. The resources contained in the specification usually require further adaptation to particular health or social care use cases; this adaptation is referred to as "profiling" and the resulting artefacts as "profiles".

General profiling approach

The checklist below was adhered to when developing a draft NHSE profile suitable for progression to Clinical and Technical Assurance.

  • Use any corresponding CareConnect profile as a starting point For each profile, where a CareConnect STU3 profile exists, refer to it as a starting point for the UK Core FHIR R4 profiling exercise,
  • Consider the resource changes between FHIR STU3 and R4 versions Analyse the changes in the FHIR standard between FHIR STU3 version and FHIR R4,for example the addition or deletion of any elements and the introduction of new or updated terminology assets in the R4 version.

Approach to StructureDefinition elements

  • Identifiers - Where existing CareConnect STU3 profiles have applied slicing and profiling to identifiers, this will be recreated in the UK Core profiles, then evaluated during Clinical and Technical assurance.
  • Removal of elements - No elements will be removed from the FHIR assets for the UK Core profiles during initial profiling prior to Clinical and Technical Assurance.
  • Experimental element - The FHIR specification defines the 'StructureDefinition.experimental' element as the following, when set to ‘true’: 'This structure was authored for testing purposes (or education/evaluation/marketing), and is not intended for genuine usage.' (Source: HL7). Currently there is no requirement in the UK Core to set the experimental element as ‘true’ or ‘false’, so this field should remain in the default view (undefined).

Naming Convention

The NHSE profile name SHALL follow an agreed format. The name of a profile consists of a number of name segments, and will be in the form:-

[Base][FHIRAssetName][Specialism]


The segments are defined as follows:-

  • Base: (Mandatory) - The base for a profile this will always be ???.
  • FHIRAssetName: (Mandatory) - The name of the base FHIR Resource.
  • Specialism: (Required) - This is only used where there are multiple NHSE profiles for a given base resource type.

Note: "Mandatory" means that a segment SHALL be present. "Required" means that a segment SHOULD be present, in this case in the event of there being multiple profiles for one base resource.

The physical file name SHALL be in the format [Base]-[FHIRAssetName][Specialism] and SHALL be created in the file XML format.


Metadata Usage

The list below contains the element differences between the UKCore and HL7.

Base Resource Definitions

View further information about FHIR base resource definitions.

Element name Base Cardinality UK Core Cardinality Type Definition, Constraints and Notes
id 0..1 1..1 id In the NHSEngland the format in the following, with the FHIRAssetName and Specialism in PascalCase:

NHSEngland-[FHIRAssetName][Specialism].

StructureDefinition Content

View further information about FHIR Resource StructureDefinition - Content.

Element name Base Cardinality UK Core Cardinality Type Definition, Constraints and Notes
url 0..1 1..1 uri In the UK Core the format is the following, with the FHIRAssetName and Specialism in PascalCase:

https://fhir.hl7.org.uk/StructureDefinition/UKCore-[FHIRAssetName][Specialism].
identifier 0..* 0..0 Identifier identifier SHALL NOT be used within the UKCore
version 0..1 1..1 string This will follow the Semantic Versioning standard [major.minor.patch].
Further details about internal versioning for NHSEngland assets are available.
name 0..1 1..1 string In the NHSE the format is PascalCase:

NHSEngland[FHIRAssetName][Specialism] .
title 0..1 1..1 string In the NHSEngland the format is Proper Case:

UK Core [FHIRAssetName] [Specialism].
status 1..1 1..1 code For the NHSEngland these are defined as:
  • draft - Profiles in development
  • active - Profiles that have been approved via Clinical and Technical Assurance
  • retired - Profiles that are no longer required
date 0..1 1..1 dateTime Only the date, without time, is populated in NHSEngland.
publisher 0..1 1..1 string For all UK Core Profiles, where the base URL is https://fhir.hl7.org.uk, the name of the publisher will be HL7 UK.
contact 0..* 1..* ContactDetail See Publisher, Contact & Copyright for details of how this SHALL be populated for all UK Core Profiles, where the base URL is https://fhir.hl7.org.uk/.
description 0..1 1..1 markdown This SHALL be in the following format:

This profile defines the UK constraints and extensions on the International FHIR resource [FHIRAssetName]([link to HL7 Resource]).
purpose 0..1 1..1 markdown This provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is.
copyright 0..1 1..1 markdown All UK Core Profiles SHALL contain the the copyright as listed in Publisher, Contact & Copyright
fhirVersion 0..1 1..1 code The version of the FHIR specification on which this StructureDefinition is based - this is the formal version of the specification, without the revision number, e.g. [publication].[major].[minor].

The UKCore mandates the use of this element.
snapshot 0..1 0..0 BackboneElement Snapshots SHALL NOT be used within the UKCore
differential
.element
.defaultValue[x]
0..1 0..0 * Defining default values creates many difficulties in implementation (e.g. when is a value missing?). For these reasons, default values SHALL NOT be used within the UKCore.




Profile Illustration

Snapshot View

idΣ0..1id
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionC0..*Extension
modifierExtension?! C0..*Extension
id0..1string
extensionC0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ C0..1Period
assignerΣ C0..1Reference()
activeΣ ?!0..1boolean
serviceCategoryΣ0..*CodeableConcept
serviceTypeΣ0..*CodeableConcept
specialtyΣ0..*CodeableConceptBinding
id0..1string
extensionC0..*Extension
referenceΣ C0..1string
typeΣ0..1uriBinding
id0..1string
extensionC0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ C0..1Period
assignerΣ C0..1Reference()
displayΣ0..1string
planningHorizonΣ C0..1Period
comment0..1string

Differential View

idΣ0..1id
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionC0..*Extension
modifierExtension?! C0..*Extension
id0..1string
extensionC0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ C0..1Period
assignerΣ C0..1Reference()
activeΣ ?!0..1boolean
serviceCategoryΣ0..*CodeableConcept
serviceTypeΣ0..*CodeableConcept
specialtyΣ0..*CodeableConceptBinding
id0..1string
extensionC0..*Extension
referenceΣ C0..1string
typeΣ0..1uriBinding
id0..1string
extensionC0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ C0..1Period
assignerΣ C0..1Reference()
displayΣ0..1string
planningHorizonΣ C0..1Period
comment0..1string

Hybrid View

idΣ0..1id
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionC0..*Extension
modifierExtension?! C0..*Extension
id0..1string
extensionC0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ C0..1Period
assignerΣ C0..1Reference()
activeΣ ?!0..1boolean
serviceCategoryΣ0..*CodeableConcept
serviceTypeΣ0..*CodeableConcept
specialtyΣ0..*CodeableConceptBinding
id0..1string
extensionC0..*Extension
referenceΣ C0..1string
typeΣ0..1uriBinding
id0..1string
extensionC0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ C0..1Period
assignerΣ C0..1Reference()
displayΣ0..1string
planningHorizonΣ C0..1Period
comment0..1string

Table View

Schedule..
Schedule.identifier..
Schedule.identifier.assignerReference()..
Schedule.specialty..
Schedule.actorReference( | | | | | | )..
Schedule.actor.identifier..
Schedule.actor.identifier.assignerReference()..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
<id value="UKCore-Schedule" />
<url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Schedule" />
<version value="1.2.0" />
<name value="UKCoreSchedule" />
<title value="UK Core Schedule" />
<status value="active" />
<date value="2022-12-16" />
<publisher value="HL7 UK" />
<name value="HL7 UK" />
<system value="email" />
<value value="ukcore@hl7.org.uk" />
<use value="work" />
<rank value="1" />
</telecom>
</contact>
<description value="This profile defines the UK constraints and extensions on the International FHIR resource [Schedule](https://hl7.org/fhir/R4/Schedule.html)." />
<purpose value="Schedule resources provide a container for time-slots that can be booked using an appointment. It provides the window of time (period) that slots are defined for and what type of appointments can be booked.\n\nThe schedule does not provide any information about actual appointments. This separation greatly assists where access to the appointments would not be permitted for security or privacy reasons, while still being able to determine if an appointment might be available." />
<copyright value="Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the "License"); you may not use this file except in compliance with the License. You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at https://www.hl7.org/fhir/license.html." />
<fhirVersion value="4.0.1" />
<identity value="w5" />
<uri value="http://hl7.org/fhir/fivews" />
<name value="FiveWs Pattern Mapping" />
</mapping>
<identity value="rim" />
<uri value="http://hl7.org/v3" />
<name value="RIM Mapping" />
</mapping>
<identity value="ical" />
<uri value="http://ietf.org/rfc/2445" />
<name value="iCalendar" />
</mapping>
<kind value="resource" />
<abstract value="false" />
<type value="Schedule" />
<baseDefinition value="http://hl7.org/fhir/StructureDefinition/Schedule" />
<derivation value="constraint" />
<element id="Schedule.identifier.assigner">
<path value="Schedule.identifier.assigner" />
<code value="Reference" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
</type>
</element>
<element id="Schedule.specialty">
<path value="Schedule.specialty" />
<strength value="extensible" />
<valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode" />
</binding>
</element>
<element id="Schedule.actor">
<path value="Schedule.actor" />
<code value="Reference" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Device" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-HealthcareService" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Location" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson" />
</type>
</element>
<element id="Schedule.actor.identifier.assigner">
<path value="Schedule.actor.identifier.assigner" />
<code value="Reference" />
<targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
</type>
</element>
</differential>
</StructureDefinition>

JSON View

{
"resourceType": "StructureDefinition",
"id": "UKCore-Schedule",
"url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Schedule",
"version": "1.2.0",
"name": "UKCoreSchedule",
"title": "UK Core Schedule",
"status": "active",
"date": "2022-12-16",
"publisher": "HL7 UK",
"contact": [
{
"name": "HL7 UK",
"telecom": [
{
"system": "email",
"value": "ukcore@hl7.org.uk",
"use": "work",
"rank": 1
}
]
}
],
"description": "This profile defines the UK constraints and extensions on the International FHIR resource [Schedule](https://hl7.org/fhir/R4/Schedule.html).",
"purpose": "Schedule resources provide a container for time-slots that can be booked using an appointment. It provides the window of time (period) that slots are defined for and what type of appointments can be booked.\n\nThe schedule does not provide any information about actual appointments. This separation greatly assists where access to the appointments would not be permitted for security or privacy reasons, while still being able to determine if an appointment might be available.",
"copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at https://www.hl7.org/fhir/license.html.",
"fhirVersion": "4.0.1",
"mapping": [
{
"identity": "w5",
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern Mapping"
},
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
},
{
"identity": "ical",
"uri": "http://ietf.org/rfc/2445",
"name": "iCalendar"
}
],
"kind": "resource",
"abstract": false,
"type": "Schedule",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Schedule",
"derivation": "constraint",
"element": [
{
"id": "Schedule.identifier.assigner",
"path": "Schedule.identifier.assigner",
"type": [
{
"code": "Reference",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
]
}
]
},
{
"id": "Schedule.specialty",
"path": "Schedule.specialty",
"binding": {
"strength": "extensible",
"valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode"
}
},
{
"id": "Schedule.actor",
"path": "Schedule.actor",
"type": [
{
"code": "Reference",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Device",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-HealthcareService",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Location",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson"
]
}
]
},
{
"id": "Schedule.actor.identifier.assigner",
"path": "Schedule.actor.identifier.assigner",
"type": [
{
"code": "Reference",
"https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
]
}
]
}
]
}
}
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