Patient Registration

This proposed process is based on

• FHIR Workflow also known as action lists, worklists, task list in GP Systems.
• FHIR Structured Data Capture also known as templates in GP Systems
• NHS England UKCore Hackathon This contains a walkthrough of structured data capture.
• UK Gov Family Services Registration

It is an high level overview which can be extended to other processes/pathways.

1. Patient Registration Form Definition

The patient registers on the Virtually Healthcare application using a screen based on a potentially commonly defined form.

An example of the form being rendered is shown below (this is not how this would look in the Virtually Healthcare application). This form is a based on the standard GMS1 form and as HL7 FHIR it's (incomplete) definition can be found here Patient Registration. This form definition is held in a FHIR Questionnaire

2. Capture Patient Registration Data

To view this form and see a demonstration of this in use, use this link US National Laboratory of Medicine SDC Questionnaire App

On completion, this generates a FHIR QuestionnaireResponse which can be shared with a GP Supplier (this can be generated from the demonstration app).

{
    "resourceType": "QuestionnaireResponse",
    "id": "f74260fc-f1cf-4725-a815-195ca7f16c41",
    "meta": {
        "versionId": "1",
        "lastUpdated": "2023-05-06T06:00:06.832Z",
        "profile":  [
            "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse|2.7"
        ],
        "tag":  [
            {
                "code": "lformsVersion: 33.3.2"
            }
        ]
    },
    "questionnaire": "Questionnaire/989e8073-6fea-4678-b788-a4c1f46b64be",
    "status": "completed",
    "subject": {
        "reference": "Patient/e750ae05-8b7f-4537-b138-a857d3124ecf",
        "display": "Emily Smith"
    },
    "authored": "2023-05-06T06:00:05.719Z",
    "item":  [
        {
            "linkId": "prefix",
            "text": "Title",
            "answer":  [
                {
                    "valueString": "Mr"
                }
            ]
        },
        {
            "linkId": "forename",
            "text": "First Name",
            "answer":  [
                {
                    "valueString": "Horatio"
                }
            ]
        },
        {
            "linkId": "surname",
            "text": "Last name",
            "answer":  [
                {
                    "valueString": "Smith"
                }
            ]
        },
        {
            "linkId": "date_of_birth",
            "text": "Date of Birth",
            "answer":  [
                {
                    "valueDate": "2020-05-29"
                }
            ]
        },
        {
            "linkId": "nhs_number",
            "text": "NHS Number (if known)",
            "answer":  [
                {
                    "valueString": "9876543210"
                }
            ]
        },
        {
            "linkId": "previous_postcode",
            "text": "Your postcode used when you last registered with a UK GP",
            "answer":  [
                {
                    "valueString": "NG10 1NP"
                }
            ]
        },
        {
            "linkId": "current_address",
            "text": "Your current address",
            "answer":  [
                {
                    "valueString": "Janet Brown Avenue, Austhorpe, Leeds"
                }
            ]
        },
        {
            "linkId": "contact_group",
            "text": "Contact Preference",
            "item":  [
                {
                    "linkId": "contact_type",
                    "text": "Contact Type",
                    "answer":  [
                        {
                            "valueCoding": {
                                "system": "http://hl7.org/fhir/contact-point-system",
                                "code": "email",
                                "display": "Email"
                            }
                        }
                    ]
                },
                {
                    "linkId": "contact_value",
                    "text": "Contact Number or email",
                    "answer":  [
                        {
                            "valueString": "horatio.smith@example.org"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "gender_birth",
            "text": "Gender assigned at Birth",
            "answer":  [
                {
                    "valueCoding": {
                        "system": "http://hl7.org/fhir/administrative-gender",
                        "code": "male",
                        "display": "Male"
                    }
                }
            ]
        },
        {
            "linkId": "ethnic",
            "text": "Ethnic Category",
            "answer":  [
                {
                    "valueCoding": {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-EthnicCategoryEngland",
                        "code": "A",
                        "display": "White - British"
                    }
                }
            ]
        },
        {
            "linkId": "armed_forces",
            "text": "Have you ever been a member of the UK Armed Forces or are a family member registered with the Defence Medical Services?",
            "answer":  [
                {
                    "valueBoolean": true
                }
            ]
        }
    ]
}

3. Ask for the registration form to be actioned.

This is a FHIR Task sent to the GP system which requests the patient is registered using data captured in step 2.

{
    "intent": "order",
    "identifier":  [
        {
            "system": "https://tools.ietf.org/html/rfc4122",
            "value": "249d7c3b-0fda-40d1-b89b-996022e7c632"
        }
    ],
    "resourceType": "Task",
    "status": "requested",
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "184047000",
                "display": "Patient registration"
            }
        ]
    },
    "owner": {
        "reference": "Organization/78369bce-1c10-40e7-af64-38bd654ccabf",
        "display": "Archway Medical Centre",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
            "value": "F83004"
        }
    },
    "priority": "routine",
    "for": {
        "reference": "Patient/e750ae05-8b7f-4537-b138-a857d3124ecf",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9876543210"
        }
    },
    "description": "Please register this patient",
    "focus": {
        "reference": "QuestionnaireResponse/58aa3751-f324-4d89-9fb9-cd8b6e5ac781",
        "display": "Patient Registration",
        "type": "QuestionnaireResponse"
    },
    "lastModified": "2023-05-06T06:18:29.627Z",
    "authoredOn": "2023-05-06T06:18:29.627Z"
}

4. Action completed (or failed)

Ideally the GP system would send updates back using a similar structure the FHIR Task in step 3. The main difference is the use of status to indicate progress and would roughly be:

• requested in the request from Virtualy to GP Systems
• in-progess in the initial reply back from the request
• completed once the patient is registered probably with a link to the Patient registration (id of the patient?)

The statuses of error and rejected would be used to communicate issues.