Supported Hospital Discharge to Social Care

A notification to Social Care that patient has self-discharged is a specialised instance of cancelling the referral. The trigger will be where the patient had been discharged in the health systems with a Discharge Method of “PATIENT discharged him/herself or was discharged by a relative or advocate” (or similar).

Timely visibility by social care teams that a patient has self-discharged, ensures that time is not spent setting up services no longer required, more importantly it ensures that they do no contact the patient to discuss the their needs, unaware of the situation.

HTTPS Request

Method:

PUT

Request URL:

The request URL will consist of 'https://'+'{Host}'+'{BaseURL}'+'?'+'{QueryString}'

Host Environments:

The Host URLs will determined by the service provider, for example the host URLs for the Nottinghamshire County Council Social Care Data Service are:

Environment	Host
Test	health-interoperability-test.nottscc.gov.uk
Live	health-interoperability.nottscc.gov.uk

Base URL:

/ReferralService/v3/Encounter

Query String /Parameters:

Name	Value
identifier	The identifier as per Encounter the asscoiated ReferralRequest, in the format {identifier.system \|identifier.value}

Example Request Url:

https://health-interoperability-test.nottscc.gov.uk/ReferralService/v3/Encounter?identifier=http://fhir.nottinghamshire.gov.uk/encounter/identifier|6521ea68-e87e-4c80-9ea4-510892d7025f

Request Body:

The Request body should be in either json or xml format

The primary base FHIR resource is a CareConnect-SHD-Encounter-1 with references to other resources as per the Entity Relationship Model below: UpdateEncounterUseCaseDiagram

See Examples for an illustration of the Request body of a typical Referral to Social Care for a Supported Hospital Discharge.

Response

Success

SHALL return a HTTP status code 200 OK on successful execution of the request

Error

An Error SHALL return one of the following HTTP Status Codes and an OperationOutcome with details of the issue:

HTTP Code	Display	Description
`400`	Bad Request	Poor Syntax or breaks a core FHIR constraint
`401`	Unauthorized	User is not authorised to perform the request.
`403`	Forbidden	The request is forbidden, authorization will not help.
`409`	Conflict	User has requested to create a resource that already exists.
`422`	Unprocessable Entity	The syntax is valid, but cannot be processed, e.g. breaks a business rule.
`500`	Internal Error	The server encountered an unexpected condition which prevented it from fulfilling the request.

JSON example of an OperationOutcome for a Unprocessable Entity

{
    "resourceType": "OperationOutcome",
    "issue":  [
        {
            "severity": "error",
            "code": "processing",
            "diagnostics": "Encounter statusHistory must contain a single element if status is 'cancelled'",
            "location":  [
                "(Encounter.status = 'cancelled') and (Encounter.statusHistory.count() != 1)"
            ]
        }
    ]
}

XML example of an OperationOutcome for a 422 Unprocessable Entity

<OperationOutcome xmlns="http://hl7.org/fhir">
    <issue>
        <severity value="error" />
        <code value="processing" />
        <diagnostics value="Encounter statusHistory must contain a single element if status is &#39;cancelled&#39;" />
        <location value="(Encounter.status = &#39;cancelled&#39;) and (Encounter.statusHistory.count() != 1)" />
    </issue>
</OperationOutcome>

Profiles

The Refer Patient (to Social Care for Supported Hospital Discharge) Use Care is supported by the following profiles

StructureDefinition	Version
CareConnect-SHD-Encounter-1	0.0.1
CareConnect-SHD-Location-1	0.0.1
CareConnect-SHD-Organization-1	0.0.1
CareConnect-SHD-Practitioner-1	0.0.1

Extensions	Version
Extension-SHD-MedicallyFitDetails	0.0.1
Extension-SHD-EncounterStatusChangeReason	0.0.1

ValueSets	Version
Supported Hospital Discharge Medically Fit Status	0.0.1
Supported Hospital Discharge Referral Cancellation Reason	0.0.1

CodeSystems	Version
Supported Hospital Discharge Medically Fit Status	0.0.1
Supported Hospital Discharge Referral Cancellation Reason	0.0.1

ConceptMap	Version
ConceptMap-SHD-Cancellation Reason	0.0.1

Rules and Mappings

The generic business context data mappings for the 'Madatory' and 'Must Support' elements are detailed in the Profiles section, however the section below deatils any specific rules or contrains that apply to this use case.

Pre-requisites

The patient MUST have an Active Referral Request
The patient MUST have been diacharge in the Health System (i.e. with a Discharge Method of “PATIENT discharged him/herself or was discharged by a relative or advocate”).

Data Mappings

CareConnect-SHD-Encounter-1

FHIR Element	Card.	Type	Description/Business Context
Encounter.status	1..1	code	Encounter.status SHALL be "cancelled"
Encounter.statusHistory	1..*	BackboneElement	Status History is SHALL be provided for the previous "in-progress" state on update where Encounter.status="cancelled", where Encounter.statusHistory.period.end = Actual Discharge Date
Encounter.statusHistory.extension[encounterStatusChangeReason]	1..1	Extension	SHALL be provided where Encounter.status="cancelled".
Encounter.statusHistory.extension[encounterStatusChangeReason].valueCodeableConcept.coding.system	1..1	uri	Fixed Value: "http://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-CancellationReason"
Encounter.statusHistory.extension[encounterStatusChangeReason].valueCodeableConcept.coding.code	1..1	code	Fixed Value: "10"
Encounter.statusHistory.extension[encounterStatusChangeReason].valueCodeableConcept.coding.display	1..1	string	Fixed Value: "Patient has self-discharged"
Encounter.period.end	1..1	dateTime	SHALL be provided where Encounter.status="cancelled", and in which case the Encounter.period.end will relate to the Cancellation Date. In cases where the Patient has self discharged, the cancellation date will also be the actual discharge date.

Examples

Request Body

JSON example of a CareConnect-SHD-Encounter-1

{
    "resourceType": "Encounter",
    "meta": {
        "profile":  [
            "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Encounter-1"
        ]
    },
    "text": {
        "status": "additional",
        --- We have skipped the narrative for better readability of the resource ---
    },
    "contained":  [
        {
            "resourceType": "Practitioner",
            "id": "shd-lead-clinician",
            "meta": {
                "profile":  [
                    "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Practitioner-1"
                ]
            },
            "name":  [
                {
                    "use": "official",
                    "text": "Ms Laura Clarke"
                }
            ]
        },
        {
            "resourceType": "Location",
            "id": "shd-location",
            "meta": {
                "profile":  [
                    "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Location-1"
                ]
            },
            "name": "Ward 22",
            "managingOrganization": {
                "reference": "#shd-hospital"
            }
        },
        {
            "resourceType": "Organization",
            "id": "shd-hospital",
            "meta": {
                "profile":  [
                    "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Organization-1"
                ]
            },
            "identifier":  [
                {
                    "system": "https://fhir.nhs.uk/Id/ods-site-code",
                    "value": "RK5BC"
                }
            ],
            "name": "King's Mill Hospital"
        }
    ],
    "extension":  [
        {
            "extension":  [
                {
                    "url": "medicallyFitStatus",
                    "valueCoding": {
                        "system": "https://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-MedicallyFitStatus",
                        "code": "01",
                        "display": "Medically Fit"
                    }
                },
                {
                    "url": "dateDeemedMedicallyFit",
                    "valueDateTime": "01/30/2019 10:56:00"
                }
            ],
            "url": "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/Extension-SHD-MedicallyFitDetails"
        }
    ],
    "identifier":  [
        {
            "system": "http://fhir.sfht.nhs.uk/encounter/identifier",
            "value": "11a2d937-39d5-439e-bc6a-d5e586eSteve"
        }
    ],
    "status": "cancelled",
    "statusHistory":  [
        {
            "extension":  [
                {
                    "url": "https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/Extension-SHD-EncounterStatusChangeReason",
                    "valueCodeableConcept": {
                        "coding":  [
                            {
                                "system": "https://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-CancellationReason",
                                "code": "10",
                                "display": "Patient has self-discharged"
                            }
                        ],
                        "text": "Patient has self-discharged"
                    }
                }
            ],
            "status": "in-progress",
            "period": {
                "start": "01/25/2019 00:00:00",
                "end": "02/01/2019 00:00:00"
            }
        }
    ],
    "type":  [
        {
            "coding":  [
                {
                    "system": "https://fhir.nottinghamshire.gov.uk/encounter/type",
                    "code": "supported-discharge"
                }
            ]
        }
    ],
    "participant":  [
        {
            "individual": {
                "reference": "#shd-lead-clinician"
            }
        }
    ],
    "period": {
        "start": "01/25/2019 00:00:00",
        "end": "02/03/2019 00:00:00"
    },
    "reason":  [
        {
            "text": "Description of the reason why the patient was admitted to hospital"
        }
    ],
    "location":  [
        {
            "location": {
                "reference": "#shd-location"
            }
        }
    ]
}

XML example of a CareConnect-SHD-Encounter-1

<Encounter xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Encounter-1" />
    </meta>
    <text>
        <status value="additional" />
        --- We have skipped the narrative for better readability of the resource ---
    </text>
    <contained>
        <Practitioner>
            <id value="shd-lead-clinician" />
            <meta>
                <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Practitioner-1" />
            </meta>
            <name>
                <use value="official" />
                <text value="Ms Laura Clarke" />
            </name>
        </Practitioner>
    </contained>
    <contained>
        <Location>
            <id value="shd-location" />
            <meta>
                <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Location-1" />
            </meta>
            <name value="Ward 22" />
            <managingOrganization>
                <reference value="#shd-hospital" />
            </managingOrganization>
        </Location>
    </contained>
    <contained>
        <Organization>
            <id value="shd-hospital" />
            <meta>
                <profile value="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/CareConnect-SHD-Organization-1" />
            </meta>
            <identifier>
                <system value="https://fhir.nhs.uk/Id/ods-site-code" />
                <value value="RK5BC" />
            </identifier>
            <name value="King&#39;s Mill Hospital" />
        </Organization>
    </contained>
    <extension url="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/Extension-SHD-MedicallyFitDetails">
        <extension url="medicallyFitStatus">
            <valueCoding>
                <system value="https://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-MedicallyFitStatus" />
                <code value="01" />
                <display value="Medically Fit" />
            </valueCoding>
        </extension>
        <extension url="dateDeemedMedicallyFit">
            <valueDateTime value="2019-01-30T10:56:00+00:00" />
        </extension>
    </extension>
    <identifier>
        <system value="http://fhir.sfht.nhs.uk/encounter/identifier" />
        <value value="11a2d937-39d5-439e-bc6a-d5e586eSteve" />
    </identifier>
    <status value="cancelled" />
    <statusHistory>
        <extension url="https://fhir.nottinghamshire.gov.uk/STU3/StructureDefinition/Extension-SHD-EncounterStatusChangeReason">
            <valueCodeableConcept>
                <coding>
                    <system value="https://fhir.nottinghamshire.gov.uk/STU3/codesystem/SHD-CancellationReason" />
                    <code value="10" />
                    <display value="Patient has self-discharged" />
                </coding>
                <text value="Patient has self-discharged" />
            </valueCodeableConcept>
        </extension>
        <status value="in-progress" />
        <period>
            <start value="2019-01-25T00:00:00+00:00" />
            <end value="2019-02-01T00:00:00+00:00" />
        </period>
    </statusHistory>
    <type>
        <coding>
            <system value="https://fhir.nottinghamshire.gov.uk/encounter/type" />
            <code value="supported-discharge" />
        </coding>
    </type>
    <participant>
        <individual>
            <reference value="#shd-lead-clinician" />
        </individual>
    </participant>
    <period>
        <start value="2019-01-25T00:00:00+00:00" />
        <end value="2019-02-03T00:00:00+00:00" />
    </period>
    <reason>
        <text value="Description of the reason why the patient was admitted to hospital" />
    </reason>
    <location>
        <location>
            <reference value="#shd-location" />
        </location>
    </location>
</Encounter>

Notify Social Care that patient has self-discharged