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.

Social context

The Social context section carries information about the social context of the patient. PRSB Elements should be formatted as subheadings in any HTML sent.

Section Description Card. MRO* FHIR Target and Guidance
Social context The social setting in which the patient lives, such as their household, occupational history, and lifestyle factors. 0 to 1 O Carried in the CodeableConcept of Composition.section.code FHIR element. ValueSet UKCoreCompositionSectionCode
PRSB Element Description Card. MRO* FHIR Target and Guidance
Household composition E.g., lives alone, lives with family, lives with partner, etc. This may be free text. 0 to 1 R This is the record of the people living in the household with the patient (including where the patient lives alone) as given by the patient or their representative or carer. Free text.
Occupational history The current and/or previous relevant occupation(s) of the patient/individual. 0 to many O This is a record of the patient's current or previous occupations as volunteered by the patient. Text only.
Educational history The current and/or previous relevant educational history of the patient/individual 0 to 1 O This is a record of the patient's current or previous educational history as volunteered by the patient or their representative or carer. Text only.
Alcohol intake Latest or current alcohol consumption observation 0 to 1 R Text only.
Drug/substance use Latest or current drug/ substance use observation 0 to 1 R Text only.
* M=Mandatory R=Required O=Optional

Example Social Context 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:31686b67-9f20-4644-9a54-193d2f91de57"
    },
    "encounter": {
        "reference": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a"
    },
    "date": "02/17/2015 10:00:00",
    "author":  [
        {
            "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc"
        }
    ],
    "title": "Cardiology Service Discharge Summary",
    "section":  [
        {
            "title": "Social context",
            "code": {
                "coding":  [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
                        "code": "social-context",
                        "display": "Social context"
                    }
                ]
            },
            "text": {
                "status": "additional",
                "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Household composition</th><td>Lives with wife</td></tr><tr><th>Occupational history</th><td>Self employed electrician</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:31686b67-9f20-4644-9a54-193d2f91de57" />
    </subject>
    <encounter>
        <reference value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" />
    </encounter>
    <date value="2015-02-17T10:00:00+00:00" />
    <author>
        <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" />
    </author>
    <title value="Cardiology Service Discharge Summary" />
    <section>
        <title value="Social context" />
        <code>
            <coding>
                <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
                <code value="social-context" />
                <display value="Social context" />
            </coding>
        </code>
        <text>
            <status value="additional" />
            <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Household composition</th><td>Lives with wife</td></tr><tr><th>Occupational history</th><td>Self employed electrician</td></tr></tbody></table></div>
        </text>
    </section>
</Composition>

Example Coded Resources

TBC - potentially a UKCore-List of UKCore-Observation, UKCore-Communication

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