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.

Plan and requested actions

The Plan and requested actions section carries information about planned and requested actions such as planned investigations, procedures etc. PRSB Elements should be formatted as subheadings in any HTML sent.

Section Description Card. MRO* FHIR Target and Guidance
Plan and requested actions The details of planned investigations, procedures and treatment, and whether this plan has been agreed with the patient or their legitimate representative. 0 to 1 required Carried in the CodeableConcept of Composition.section.code FHIR element. ValueSet UKCoreCompositionSectionCode
PRSB Element Description Card. MRO* FHIR Target and Guidance
Actions for healthcare professionals Including planned investigations, procedures and treatment for a patient's identified conditions and priorities. For each action the following should be identified: outcome expectations, including patient's expectations 0 to many R A record of the planned and requested actions. May be structured HTML for example a table, with actions, names, dates, status, location, strategies, or free text
Actions for patient or their carer For each action the following should be identified: outcome expectations, including patient's expectations. 0 to many R A record of the planned and requested actions. May be structured HTML for example a table, with actions, names, dates, status, location, strategies, or free text.
Agreed with patient or legitimate patient representative. Indicates whether the patient or legitimate representative has agreed the entire plan or individual aspects of treatment, expected outcomes, risks and alternative treatments. 0 to 1 R A record of the agreement of the decisions made. Text only
Care planning arrangements Record if CPA (Care Programme Approach) documentation is available and how and where it can be accessed; care and treatment plan in Wales and Scotland. In Wales this is superseded by the Mental Health Measure 2010. 0 to many R The Care planning arrangements in text.
Investigations requested This includes a name or description of the investigation requested and the date requested. 0 to many O The investigations requested including the date requested in text.
Procedures requested These are the diagnostic or therapeutic procedures that have actually been requested (and the date requested). 0 to many O The procedures requested including the date requested in text.
* M=Mandatory R=Required O=Optional

Example Plan and Requested Actions 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": "Plan and requested actions",
            "code": {
                "coding":  [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                        "code": "plan-and-requested-actions",
                        "display": "Plan and requested actions"
                    }
                ]
            },
            "text": {
                "status": "additional",
                "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Actions for healthcare professionals</th><td>\n                      GP please continue secondary preventative medication. \n                                 \n                      <p>Status: Requested</p><p>Doses will be uptitrated by Cardiac Rehab team.</p><p>Status: Requested</p></td></tr></tbody></table></div>"
            }
        }
    ]
}
<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="Plan and requested actions" />
        <code>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                <code value="plan-and-requested-actions" />
                <display value="Plan and requested actions" />
            </coding>
        </code>
        <text>
            <status value="additional" />
            <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Actions for healthcare professionals</th><td>
                      GP please continue secondary preventative medication. 
                                 
                      <p>Status: Requested</p><p>Doses will be uptitrated by Cardiac Rehab team.</p><p>Status: Requested</p></td></tr></tbody></table></div>
        </text>
    </section>
    <!--   other sections removed for readability   -->
</Composition>

Example Coded Resources

TBC - potentially a UKCore-Careplan and Goal

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