Project Overview

The Notts Care Record / Ecosystem Platform (ESP) approach to digital transformation offers the local Integrated Care System (ICS) an opportunity to improve Shared Care Records across Nottingham and Nottinghamshire. Shared Care Records allow primary and secondary care clinicians to see the same information about a patient, meaning that patients only need to tell their health and care history or story once instead of multiple times. This saves time, reduces inefficiencies and ensures that patients receive the right care and support first time.

The project is a high level priority delivered by the Data, Analytics, Information and Technology (DAIT) Board of the ICS. The project is driven by a statutory requirement to have a Shared Care Record across the ICS. At a local level, the ESP project board is responsible for reviewing and providing guidance on the individual priorities.

The ESP will deliver the Shared Care Records for the ICS over a two year period. The project is part of the ICS Interoperability Programme, which aligns closely to the Public-Facing Digital Services (PFDS) and Capacity and Flow (C&F) programmes.
  • The Notts Care Record is not a single physical application or database, but a virtual network of resources that enables users to view the right information, in the right place, at the right time. The Notts Care Record will replace the Nottinghamshire Health and Care Portal (a.k.a. CareCentric)
  • The Ecosystem Platform (ESP) is the technical architecture and associated governance that supports the Nottinghamshire Care Record.
  • The ESP can also support other data sharing objectives, such as multi-agency workflow, shared care planning, and increased involvement from patients/citizens.
  • Health and care organisations within Nottinghamshire could be Data Consumers, Data Providers, or both
  • The ESP is a tool that Data Consumers use as a one stop shop for all their data needs, they do not need to know who might hold that data.
  • Data Providers only have to make their data available once, so will not have to support multiple requests for the same information, each in a different format.
  • Both Data Consumers and Providers will need a common understanding of the syntax for requesting data and responding to requests (i.e. FHIR)

High Level Logic Model

The figure below provided a high level model of the components and parties within the Ecosystems:

esp-logic-model

Technical Architecture

The figure below details the technical architecture of the Interweave solution:

ESP Architecture

FHIR Profiling

The core FHIR specification enables two or more systems to share data seamlessly, however it doesn’t ensure that all users and processes can interpret meaning and operate seamlessly. FHIR includes a framework, called ‘Profiling’ for extending and adapting the existing resources for specific use cases.

  • Profiling supports:
    • Changing Cardinality
    • Must Support flags
    • Slicing elements
    • Bindings / Codings
    • Extensions
  • Profiles are Hierarchical
  • Child profiles cannot break the rules established in the parent (i.e. base specification)
  • The Notts Care Record / ESP Data Standards (i.e. Interweave Profiles) are specialisations of the HL7 UK CareConnect FHIR Profiles, which in turn are specialisations of the international HL7 FHIR Profiles
  • Interweave Profiles still being curated
FHIR Profiling