UKCore Hackathon Supporting Guide

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

Patient Care Records

Use Cases

Vanessa Jenkins (Welsh patient) is a diabetic and is being treated by her Welsh GP, as a result of this condition she has a laboratory test performed by an English laboratory

Neil Smith is a diabetic and is being treated by his local GP, Hospital and Social Services. The care for the Hospital episode is being provided at the patients home

Aim

Clinicians and health care professionals want to be able to view the observations taken by the patients, pathology reports and summary care reports.

UK Core Profiles

Observation Messages

Pattern

The document and document metadata is sent directly to the recipient.

send-message

Pros

  • Is well supported in HL7 v2 ORU_R01 Unsolicited Observation messages.

Cons

  • Concurrency Issues (document is correct at point of creation, corrections or updates can make interaction complex)
  • Suited for point to point sharing only

FHIR Technical Framework Options

This pattern may be sent in several ways in FHIR. They overlap especially around the content of the FHIR resources. They should have low technical overhead with only minor amendments required.

RESTful API

The document metadata and document are individually to the recipient. This would involve the following interactions.

  • POST /Observation to store the individual observations.
  • POST /DiagnosticReport to store the report

It is likely this would need to be complemented with patient demographic interactions, such as searching for an existing patient record or adding a new record.

Transactions

This contains the same interactions listed in the previous section and is sent in a single interaction using the FHIR Bundle resource.

  • POST / to send a collection of the RESTful interactions. See demonstration examples 'Bundle-transaction-physicalActivity' and 'Bundle-transaction-ClinicalObservations' POST /

Messaging

This has a defined set of resources and for Observation Messages, this is likely to include FHIR DiagnosticReport and Observations. In FHIR this is defined in a FHIR MessageDefinition i.e. unsolicited-observations

It is sent via the following interaction.

Shared Observation Records

Pattern

qedm

Pros

  • Patient Observations data can be consistently shared across the Health and Social Care Enterprise.

Cons

  • Possible questions on the detail of the Observations shared, FHIR Observation share a detailed summary. This may be enough for most care purposes?

FHIR Technical Framework Options

The extra interactions added by this option are all RESTful API based.

They are likely follow all of the following: UKCore FHIR Access, and IHE-QEDM.

The interactions are:

Observations Data Capture

Pattern

retrieve-form

Overview

Unless Observations are recorded via a device, it is possible Observations do not get entered as FHIR Observations. It is quite easy to find applications which use forms or form based applications to capture the data. For examples:

NHS UK has a blood pressure form.

https://www.nhs.uk/conditions/blood-pressure-test

Form-Blood-Pressure

It is quite common in virtual wards (and during the COVID 19 pandemic) for patients to be asked to enter a series of clinical relevant observation values daily. This often resembled NEWS2/Vital Signs forms used within hospitals. (Screenshot below is taken from NLM LHC Forms Demo application

vital-signs-form

This data capture is part of a clinical process. If data is entered by a patient then it is likely to have:

For Virtual Wards, it is possible the following process will occur:

  1. Patient manually completes a form. See Questionnaires and Structured Data Capture for more details.
  2. The captured data has a clinical review and where applicable data is entered as Observations in the patients EHR. See
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Which data is stored as FHIR Observations depends on the (wider) clinical need for sharing. For example, it is not anticipated a Patients Heart rate is shared as a form/FHIR QuestionnaireResponse, it would be shared as a FHIR Observation.

Observation Data Capture Reminders

Pattern

alert-communication

Overview

Alongside the Observations Data Capture it will be normal for providers to send out reminders to patient or practitioners. These will normally be in SMS, application notifications, letters, email, etc.

For an example API using FHIR to enable this interaction see [NHS App](NHS App). For general handling of notifications, without focusing on specific technology, see IHE-mACM

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