Transfer of Care R4 Hackathon Implementation Guide

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

Admission details

The Admission details section carries information about the patient's admission. PRSB Elements should be formatted as subheadings in any HTML sent.

Section Description Card. MRO* FHIR Target and Guidance
Admission details Details of the patient's admission and reason for admission 0..1 R Carried in the CodeableConcept of Composition.section.code FHIR element. ValueSet UKCoreCompositionSectionCode
PRSB Element Description Card. MRO* FHIR Target and Guidance
Reason for admission The health problems and issues experienced by the patient that prompted the decision to admit to hospital e.g. chest pain, mental health crisis, blackout, fall, a specific procedure, intervention, investigation or treatment, non-compliance with treatment. 0 to 1 R Text and where supported a SNOMED CT concept carried in the CodeableConcept of the Encounter.reason FHIR element to indicate the reason the patient was admitted.
Admission method How the patient was admitted to hospital. For example: elective, emergency, maternity, transfer etc. 0 to 1 R Text and where supported a code and description from the ValueSet ValueSet UKCore-AdmissionMethod carried in the CodeableConcept of the Encounter.hospitalization.Extension-UKCore-AdmissionMethod FHIR element.
Legal Status on admission Record if the patient was admitted as Informal or formal/detained. 0 to 1 R Text only
Source of admission Where the patient was immediately prior to admission, e.g. usual place of residence, temporary place of residence, penal establishment. National code. 0 to 1 R Text and where supported a code and description from the ValueSet UKCore-SourceOfAdmission carried in the CodeableConcept of the Encounter.hospitalization.admitSource FHIR element.
Date/time of admission Date and time patient admitted to hospital. 0 to 1 R The date and time of admission as recorded on the Patient Administration System (PAS) as text and carried in the Encounter.period.start FHIR element.
* M=Mandatory R=Required O=Optional

Example Admission Details Section

{
    "resourceType": "Composition",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition"
        ]
    },
    "status": "final",
    "type": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "373942005",
                "display": "Discharge summary"
            }
        ]
    },
    "subject": {
        "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
    },
    "encounter": {
        "reference": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d"
    },
    "date": "2023-01-27T15:39:00+00:00",
    "title": "Cardiology Service Discharge Summary",
    "section":  [
        {
            "title": "Admission details",
            "code": {
                "coding":  [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                        "code": "admission-details",
                        "display": "Admission details"
                    }
                ]
            },
            "text": {
                "status": "extensions",
                "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Reason for admission</th><td>Severe asthma attack</td></tr><tr><th>Admission method</th><td>Accident and emergency or dental casualty department of the Health Care Provider</td></tr><tr><th>Source of admission</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr><tr><th>Date/time of admission</th><td>27-Jan-2023 15:39</td></tr></tbody></table></div>"
            },
            "entry":  [
                {
                    "reference": "urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d"
                }
            ]
        }
    ]
}
<Composition xmlns="http://hl7.org/fhir">
    <!--  optional elements removed for readability  -->
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition" />
    </meta>
    <status value="final" />
    <type>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="373942005" />
            <display value="Discharge summary" />
        </coding>
    </type>
    <subject>
        <reference value="urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6" />
    </subject>
    <encounter>
        <reference value="urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d" />
    </encounter>
    <date value="2023-01-27T15:39:00+00:00" />
    <title value="Cardiology Service Discharge Summary" />
    <section>
        <title value="Admission details" />
        <code>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                <code value="admission-details" />
                <display value="Admission details" />
            </coding>
        </code>
        <text>
            <status value="extensions" />
            <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Reason for admission</th><td>Severe asthma attack</td></tr><tr><th>Admission method</th><td>Accident and emergency or dental casualty department of the Health Care Provider</td></tr><tr><th>Source of admission</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr><tr><th>Date/time of admission</th><td>27-Jan-2023 15:39</td></tr></tbody></table></div>
        </text>
        <entry>
            <reference value="urn:uuid:7eafed78-3e81-4e15-85c6-23485fd2b19d" />
        </entry>
    </section>
    <!--  other sections removed for readability  -->
</Composition>

Example Coded Resources

This text section should be linked to a UKCore-Encounter profiled resource. E.g.

{
    "resourceType": "Encounter",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"
        ]
    },
    "extension":  [
        {
            "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod",
            "valueCodeableConcept": {
                "coding":  [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-AdmissionMethodEngland",
                        "code": "21",
                        "display": "Accident and emergency or dental casualty department of the Health Care Provider"
                    }
                ]
            }
        }
    ],
    "identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "60c7df19-36a1-4cd3-916a-8fa29bb3dfbc"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "IMP",
        "display": "inpatient encounter"
    },
    "type":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "185212007",
                    "display": "Seen in hospital ward"
                }
            ]
        }
    ],
    "subject": {
        "reference": "urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6"
    },
    "participant":  [
        {
            "type":  [
                {
                    "coding":  [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "DIS",
                            "display": "discharger"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f"
            }
        }
    ],
    "period": {
        "start": "2015-02-12T09:00:00+00:00",
        "end": "2015-02-16T15:00:00+00:00"
    },
    "reasonCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "425419005",
                    "display": "ECG: inferior ischaemia"
                }
            ]
        }
    ],
    "hospitalization": {
        "admitSource": {
            "coding":  [
                {
                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-SourceOfAdmissionEngland",
                    "code": "51",
                    "display": "NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department"
                }
            ]
        },
        "dischargeDisposition": {
            "coding":  [
                {
                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-DischargeDestinationEngland",
                    "code": "19",
                    "display": "Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode."
                }
            ]
        }
    },
    "location":  [
        {
            "location": {
                "reference": "urn:uuid:f79fe55e-2a96-47a4-b673-dd06d36b0977"
            },
            "period": {
                "end": "2023-01-27T16:13:00+00:00"
            }
        }
    ]
}
<Encounter xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter" />
    </meta>
    <extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod">
        <valueCodeableConcept>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-AdmissionMethodEngland" />
                <code value="21" />
                <display value="Accident and emergency or dental casualty department of the Health Care Provider" />
            </coding>
        </valueCodeableConcept>
    </extension>
    <identifier>
        <system value="https://tools.ietf.org/html/rfc4122" />
        <value value="60c7df19-36a1-4cd3-916a-8fa29bb3dfbc" />
    </identifier>
    <status value="finished" />
    <class>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" />
        <code value="IMP" />
        <display value="inpatient encounter" />
    </class>
    <type>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="185212007" />
            <display value="Seen in hospital ward" />
        </coding>
    </type>
    <subject>
        <reference value="urn:uuid:d7e2489c-d494-4f94-894e-be64700deba6" />
    </subject>
    <participant>
        <type>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType" />
                <code value="DIS" />
                <display value="discharger" />
            </coding>
        </type>
        <individual>
            <reference value="urn:uuid:fb5cf63f-02c7-49f2-9090-831d4846840f" />
        </individual>
    </participant>
    <period>
        <start value="2015-02-12T09:00:00+00:00" />
        <end value="2015-02-16T15:00:00+00:00" />
    </period>
    <reasonCode>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="425419005" />
            <display value="ECG: inferior ischaemia" />
        </coding>
    </reasonCode>
    <hospitalization>
        <admitSource>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-SourceOfAdmissionEngland" />
                <code value="51" />
                <display value="NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department" />
            </coding>
        </admitSource>
        <dischargeDisposition>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-DischargeDestinationEngland" />
                <code value="19" />
                <display value="Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode." />
            </coding>
        </dischargeDisposition>
    </hospitalization>
    <location>
        <location>
            <reference value="urn:uuid:f79fe55e-2a96-47a4-b673-dd06d36b0977" />
        </location>
        <period>
            <end value="2023-01-27T16:13:00+00:00" />
        </period>
    </location>
</Encounter>
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