InterweaveSocialCareAssessment

FHIR Profile

The Notts Care Record will use the following Interweave Profiles, as published in the Interweave Implementation Guide:

Definition: A record of an assessment to determine a person’s support needs. An assessment record may be in progress, has already taken place, or is planned to be performed in the future.

Notts Guidance

This profile sets minimum expectations for the Social Care Asessment resource which is modelled using the FHIR Task resource. The FHIR Task resource was chosen to model the Assessment as it was the most akin in terms of logic and structure. Many of the irrelevant health fields have been stripped from this resource to create a clear and concise model for population. We will simply refer to this resource as an Assessment throughout the remainder of the notes section.

We are primarily interested in recording that an assessment is being / has been performed and the high-level outcomes of that assessment – we are not attempting to capture the detailed content of the assessment at this stage. In particular we are not attempting to capture detailed coded information about the findings and plans – although this could be added via other FHIR Resources in future.

An InterweaveAssessment can also be used to share detals of tasks and events that have been / are being untertaken by the Local Authority

Coverage and references

The following are use cases are examples of types of assessment/event that could be shared:

  • Occupational Therapy Assessment / Review.

  • Full Care and Support Assessment (as required under the Health and Care Act).

  • Hospital Discharge Assessment - confirming that the LA has set up the required services for a supported discharge, and the date those services will commence

  • CP-IS (i.e. Child Protection Plans / Looked After Child / Child in Need)

Mandatory fields

The following fields are mandatory:

  • status A mandatory flag to indicate whether the assessment is active or not. We limit the valueset to accepted; in-progress; completed; entered-in-error.

  • intent Although this field is not relevant to Social Care, it is mandatory within FHIR, therefore we default its value to 'plan'.

  • code code is used to house the 'category' of assessment. This should always be known, and vital for meaningful display purposes.Currently social care providers have vast lists of assessment types, so here we aim to categorise the type and then use code.text for displaying the more granular local assessment type. code.text must always be populated, if there is no divergence between the local assessment name and the code.display, simply repeat the code.display here.

  • for A reference to the person (Patient FHIR resource) which is the subject of the assessment.

  • authoredOn The date that the assessment was first entered into the source system.

  • lastModified The date that the assessment record was last updated.

  • owner The Organisational Team which has overall responsibility for the assessment.
    A key use case for sharing that a social care assessment has taken / is taking place, is to enable heath practitioners to contact the team responsible and ask for more information. For example an Occupational Therapist in community health may wish to discuss the detailed findings of a recent OT Assessment undertaken by the Local Authority) - as such where possibe the contct details for the owner should also included.

Must Support fields

In addition, the following fields are "Must Support" - i.e. they must be populated if relevant and known:

  • basedOn This is a reference to either the Social Care Assessment (FHIR Task) or Contact (FHIR ReferralReference) which triggered this Assessment to be carried out.

  • execution.period.start The date/time that the assessment commenced (Or is due to commence should the assessment be in a planned status).

  • execution.period.end The date/time that the assessment completed.

  • outcome This is an extension required by social care to specify the outcome of the assessment. The list of available codes has been derived from the "Event Outcome" field of the "V5 Adult Social Care - Client Level Data" specification and has been made extensible as it is foreseen that this list will grow.