Transfer of Care R4 Hackathon Implementation Guide

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Distribution list

The Distribution list section carries a list of recipients of the document. PRSB Elements should be formatted as subheadings in any HTML sent.

The document may be sent to any number of recipients, however all recipients should be included in the distribution list to allow individual recipients to know who else has received a copy.

Section	Description	Card.	MRO*	FHIR Target and Guidance
Distribution list	A list of other individuals to receive a copy of this communication.	0 to 1	R	Carried in the CodeableConcept of Composition.section.code FHIR element. ValueSet UKCoreCompositionSectionCode
PRSB Element	Description	Card.	MRO*	FHIR Target and Guidance
Name	If the communication is being sent to a named individual, then this is the name of the recipient, preferably in a structured format. An identifier for the individual, for example GMC code (for a GP), or an SDS identifier, a NHS Number (for a patient) will be sent alongside the name.	0 to 1	R	Names may be entered as the communication is being created or sourced from the hospital system. Patient names may be from the Patient Demographic Service. Text and carried in the FHIR element Practitioner.name or Patient.name. The identifier will be carried in the FHIR element Practitioner.identifier or Patient.identifier.
Role	If the communication is being sent to either a named individual, or to a non-named person with a specific role, then this is the role of the recipient.	0 to 1	R	Role may be entered as the communication is being created or sourced from the hospital system. This may be a role defined in the National Workforce data set (see the NHS Data Dictionary Job Role Code). Text and carried in the PractitionerRole.code
Grade	The recipient's grade.	0 to 1	O	The grade of the recipient, if known by the sending institution, otherwise omitted. Text only
Organisation name	The name of the organisation the recipient is representing or the organisation named as the receiving organisation. An identifier for the organisation will be sent alongside the name.	0 to 1	R	Organisation name in text and carried in the FHIR element Organization.name and identifier (which MUST NOT be in carried in the text), taken from the Organisation Data Service (ODS)) and carried in the FHIR element Organization.identifier
Team	Team that the recipient belongs to in the context of receiving this message, or the team acting as the recipient.	0 to 1	O	There are no national codes for teams, so this value would have to be agreed locally, and entered as free text only.
Relationship to subject	The relationship of the receiver to the patient, where the receiver has a personal relationship to the patient, for example, carer or parent	0 to 1	O	Personal relationships as documented in the NHS Data Dictionary Person Relationship Type (This value set is now retired carried as text and where possible mapped to the FHIR ValueSet relatedperson-relationshiptype and carried a code in the FHIR element RelatedPerson.relationship
* M=Mandatory R=Required O=Optional

Example Distribution List 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:2c0bca60-1873-46f7-a462-5733feaf32c9"
    },
    "encounter": {
        "reference": "urn:uuid:5a9f67fa-9343-40cc-8fde-0dd91822b7fd"
    },
    "date": "2023-01-28T10:00:00+00:00",
    "author":  [
        {
            "reference": "urn:uuid:2a32666e-84a2-4f90-a6a6-d5451ae2e32f"
        }
    ],
    "title": "Cardiology Service Discharge Summary",
    "section":  [
        {
            "title": "Distribution list",
            "code": {
                "coding":  [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                        "code": "distribution-list",
                        "display": "Distribution list"
                    }
                ]
            },
            "text": {
                "status": "generated",
                "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Mrs</p><p>Given Name: Angela</p><p>Family Name: Jones</p></td></tr><tr><th>Role</th><td>Community Nurse</td></tr><tr><th>Organisation name</th><td>Leeds Community Healthcare NHS Trust</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>Role</th><td>General Medical Practitioner</td></tr><tr><th>Organisation name</th><td>MGP Medical Centre</td></tr></tbody></table></div>"
            },
            "entry":  [
                {
                    "reference": "urn:uuid:339b9af6-5f90-4067-b300-98176900d693"
                },
                {
                    "reference": "urn:uuid:a0b25b87-6278-4b18-9ae7-ce0ac36baab6"
                }
            ]
        }
    ]
}

<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:2c0bca60-1873-46f7-a462-5733feaf32c9" />
    </subject>
    <encounter>
        <reference value="urn:uuid:5a9f67fa-9343-40cc-8fde-0dd91822b7fd" />
    </encounter>
    <date value="2023-01-28T10:00:00+00:00" />
    <author>
        <reference value="urn:uuid:2a32666e-84a2-4f90-a6a6-d5451ae2e32f" />
    </author>
    <title value="Cardiology Service Discharge Summary" />
    <section>
        <title value="Distribution list" />
        <code>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                <code value="distribution-list" />
                <display value="Distribution list" />
            </coding>
        </code>
        <text>
            <status value="generated" />
            <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Mrs</p><p>Given Name: Angela</p><p>Family Name: Jones</p></td></tr><tr><th>Role</th><td>Community Nurse</td></tr><tr><th>Organisation name</th><td>Leeds Community Healthcare NHS Trust</td></tr></tbody></table><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>Role</th><td>General Medical Practitioner</td></tr><tr><th>Organisation name</th><td>MGP Medical Centre</td></tr></tbody></table></div>
        </text>
        <entry>
            <reference value="urn:uuid:339b9af6-5f90-4067-b300-98176900d693" />
        </entry>
        <entry>
            <reference value="urn:uuid:a0b25b87-6278-4b18-9ae7-ce0ac36baab6" />
        </entry>
    </section>
    <!--   other sections removed for readability   -->
</Composition>

Example Coded Resources

This text section may be linked to a UKCore-Practitioner profiled resource. E.g.

{
    "resourceType": "Practitioner",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner"
        ]
    },
    "identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/sds-user-id",
            "value": "033345750517"
        }
    ],
    "name":  [
        {
            "family": "Jones",
            "given":  [
                "Angela"
            ],
            "prefix":  [
                "Mrs"
            ]
        }
    ]
}

<Practitioner xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" />
    </meta>
    <identifier>
        <system value="https://fhir.nhs.uk/Id/sds-user-id" />
        <value value="033345750517" />
    </identifier>
    <name>
        <family value="Jones" />
        <given value="Angela" />
        <prefix value="Mrs" />
    </name>
</Practitioner>

A UKCore-Practitioner would have associaled roles (UKCore-PractitionerRole profiled resource.)

{
    "resourceType": "PractitionerRole",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole"
        ]
    },
    "practitioner": {
        "reference": "urn:uuid:339b9af6-5f90-4067-b300-98176900d693"
    },
    "organization": {
        "reference": "urn:uuid:4ba94ff2-8ebc-4afa-ba0c-0bbd4813154e"
    },
    "code":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "224540001",
                    "display": "Community nurse"
                }
            ]
        }
    ]
}

<PractitionerRole xmlns="http://hl7.org/fhir">
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole" />
    </meta>
    <practitioner>
        <reference value="urn:uuid:339b9af6-5f90-4067-b300-98176900d693" />
    </practitioner>
    <organization>
        <reference value="urn:uuid:4ba94ff2-8ebc-4afa-ba0c-0bbd4813154e" />
    </organization>
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="224540001" />
            <display value="Community nurse" />
        </coding>
    </code>
</PractitionerRole>