Online Consultation to Community Pharmacy - Pilot Specification

This version is in draft and is currently being migrated from the GP Connect Access Record: Structured specification

Capability requirements

The items below outline the requirements for the Online Consultation capability.


Payload requirements

Composition

GPCM-SD-OC-001 a Composition resource profiled to CareConnect-Composition-1 resource MUST be present in the payload

The following requirements describe how the Composition resource is populated:

GPCM-SD-OC-002 Composition.status MUST contain fixed value final
GPCM-SD-OC-003 Composition.type MUST contain the SNOMED code 149951000000107 (Patient information received using general practice online consultation system (finding))
GPCM-SD-OC-004 Composition.date MUST contain the date/time the message was created
GPCM-SD-OC-005 Composition.confidentiality MUST contain the fixed value N (Normal), or R (Restricted) if the consultation is classed as confidential
GPCM-SD-OC-006 Composition.title MUST contain the fixed value Online consultation report
GPCM-SD-OC-007 Composition.text MUST contain a summary of request in the following format:
Online consultation report for {Patient Name}, NHS Number {NHS Number}, Version {Version Number}
GPCM-SD-OC-008 Composition.subject MUST contain a reference to Patient resource profiled to CareConnect-Patient-1
GPCM-SD-OC-009 Composition.author MUST contain a reference to one or more of the following resources:
GPCM-SD-OC-010 Composition.custodian MUST contain a reference to the sender Organization resource profiled to CareConnect-Organization-1
GPCM-SD-OC-011 Composition.relatesTo MUST contain the UUID of the previous message if a replacement document is being sent
GPCM-SD-OC-012 Composition.section.entry MUST reference a binary document which provides a report of the full online consultation in PDF format profiled to ITK-Attachment-Binary-1

Additional input elements

Message senders MAY include additional binary documents in the payload as each expressed as an additional instance of the composition.section as described.

GPCM-SD-OC-013 where binary documents are included in the payload in addition to the Online Consultation Report, the message receiver MUST process these according ensuring all attachments remain in the context of the encounter information delivered to downstream systems
GPCM-SD-OC-014 when displaying the Online Consultation Report in the practice workflow/task list, the message receiver MUST display Online consultation report for {Patient Name}, NHS Number {NHS Number}, Version {Version Number}
GPCM-SD-OC-015 the message receiver MUST make any attachments included with the Consultation Report available to the end user

Patient resource

GPCM-SD-OC-016 the payload MUST contain a patient resource describing the patient

The CareConnect-Patient-1 in the payload is populated as follows:

GPCM-SD-OC-017 the NHS Number of the patient MUST be specified in the nhsNumber slice of the identifier element
GPCM-SD-OC-018 the name of the patient MUST be present in the single instance of the name element where name.use is set to official
GPCM-SD-OC-019 the date of birth of the patient MUST be specified in YYYY-MM-DD format in the birthDate element. Birth time is not required
GPCM-SD-OC-020 values specified in the patient resource for surname, date of birth and NHS Number MUST match those specified in MESH metadata Mex_To (for the MESH API) or To_DTS field (for the MESH client) as described in MESH message configuration

Organization resource

GPCM-SD-OC-021 the payload MUST contain an organization resource describing the sender organisation (the originating organisation)

The CareConnect-Organization-1 resource present in the payload is populated as follows:

GPCM-SD-OC-021 the payload MUST contain an organization resource describing the sender organisation (the originating organisation)
GPCM-SD-OC-022 the odsOrganisationCode slice of the identifier element MUST contain the ODS code
GPCM-SD-OC-023 the name element MUST contain the name of the organisation
GPCM-SD-OC-024 the telecom element MUST contain the telephone number of that organization. i.e. where telecom.system is set to a fixed value of phone, and telecom.value contains the telephone number

Practitioner resource

The CareConnect-Practitioner-1 resource present in the payload is populated as follows:

GPCM-SD-OC-025 the SDS User ID of the practitioner MUST be present in the sdsUserID slice of the identifier element
GPCM-SD-OC-026 the name of the practitioner MUST be present in the single instance of the name element where name.use is set to official
GPCM-SD-OC-027 telephone contact details MUST be present if available in the telecom element. i.e. telecom.system is set to a fixed value of phone, and telecom.value contains the telephone number

RelatedPerson resource

The CareConnect-RelatedPerson-1 in the payload is populated as follows:

GPCM-SD-OC-028 the name of the related person MUST be present in the single instance of the name element
GPCM-SD-OC-029 the date of birth of the related person MUST be specified in YYYY-MM-DD format in the birthDate element. Birth time is not required
GPCM-SD-OC-030 telephone contact details MUST be present if available in the telecom element

Device resource

The ITK-Device-1 resource present in the payload is populated as follows:

GPCM-SD-OC-031 a SNOMED code describing the type of device MUST be present in the type element
GPCM-SD-OC-032 the manufacturer of the device MUST be present in the manufacturer element

Encounter resource

The CareConnect-Encounter-1 in the payload is populated as follows:

GPCM-SD-OC-033 the status element MUST contain a fixed value of finished
GPCM-SD-OC-034 the type element MUST contain a valid SNOMED code for the type encounter being sent, for example 149971000000103 (Encounter using general practice online consultation system (procedure))
GPCM-SD-OC-035 the subject element MUST reference the Patient profile representing the Patient who is the subject of the encounter
GPCM-SD-OC-036 the participant element SHOULD reference the Practitioner profile or the RelatedPerson profile if applicable
GPCM-SD-OC-037 the priority element SHOULD reference a priority code, by default this value should be R meaning routine
GPCM-SD-OC-038 the period element SHOULD be populated with the start and end time of the encounter captured in the source system
GPCM-SD-OC-039 the serviceProvider element SHOULD contain a reference to the organisation responsible for the encounter

List resource

The CareConnect-List-1 in the payload is populated as follows:

GPCM-SD-OC-040 a List containing references to all Observation resources that are captured MUST be populated if coded Observations are being sent. The List resource in FHIR is used to manage collections of resources.
GPCM-SD-OC-041 the status element MUST contain a fixed value of current
GPCM-SD-OC-042 the mode element MUST contain a fixed value of snapshot
GPCM-SD-OC-043 the title element MUST contain the display element from the code field
GPCM-SD-OC-044 the code element MUST contain 826501000000100 - Miscellaneous record
GPCM-SD-OC-045 the subject element MUST reference the Patient profile representing the Patient against whom the data was recorded
GPCM-SD-OC-046 the entry.item element MUST be populated to reference each Observation in the message

Observation resource

Each CareConnect-Observation-1 in the payload is populated as follows:

GPCM-SD-OC-047 the status element MUST contain a fixed value of preliminary if unchecked by a clinician, or final
GPCM-SD-OC-048 the category element SHOULD contain high level category that represents the data in the Observation
GPCM-SD-OC-049 the code element MUST contain a clinical code that represents the data in the Observation
GPCM-SD-OC-050 the subject element MUST reference the Patient profile representing the Patient against whom the data was recorded
GPCM-SD-OC-051 the issued element MUST contain an audit trail timestamp representing when the data was recorded
GPCM-SD-OC-052 to ensure the Observation can be identified as patient entered data, the performer element MUST contain a reference to patient resource of the patient completing the Online Consultation
GPCM-SD-OC-053 the value[x] element SHOULD contain the value of the Observation
GPCM-SD-OC-054 the component element SHOULD be populated if recording a pair of results

Questionnaire resource

The CareConnect-Questionnaire-1 in the payload is populated as follows:

GPCM-SD-OC-055 the status element MUST contain a fixed value of active
GPCM-SD-OC-056 the version element SHOULD contain the business version of the questionnaire
GPCM-SD-OC-057 the name element SHOULD contain the name of the questionnaire
GPCM-SD-OC-058 the title element SHOULD contain the title of the questionnaire
GPCM-SD-OC-059 the date element SHOULD contain the date the questionnaire was last updated
GPCM-SD-OC-060 the description element SHOULD contain a human readable description of the questionnaire
GPCM-SD-OC-061 the effectivePeriod element SHOULD contain the period when the questionnaire is expected to be used
GPCM-SD-OC-062 the item elements MUST be completed to contain the questions and sections of the questionnaire

QuestionnaireResponse resource

The CareConnect-QuestionnaireResponse-1 in the payload is populated as follows:

GPCM-SD-OC-063 the status element MUST contain a fixed value of completed
GPCM-SD-OC-064 the subject element MUST reference the Patient profile representing the Patient against whom the data was recorded
GPCM-SD-OC-065 the authored element SHOULD contain an audit trail timestamp representing when the data was recorded
GPCM-SD-OC-066 a set of item elements MUST contain the full online consultation questionnaire details
GPCM-SD-OC-067 the item.linkId element MUST contain a pointer specific to the questionnaire
GPCM-SD-OC-068 the item.text element MUST contain the question being asked
GPCM-SD-OC-069 the item.answer.value[x] element MUST contain the answer being given by the patient
GPCM-SD-OC-070 the item.answer.value[x].valueReference element SHOULD contain a reference to a resource, if applicable

ReferralRequest resource

GPCM-SD-OC-071 the status element MUST contain a fixed value of unknown
GPCM-SD-OC-072 the intent element MUST contain a fixed value of order
GPCM-SD-OC-073 the priority element SHOULD reference a priority code. A mapping is applied to the priority codes to align it to the e-Referral Service priority types. This MUST be populated where the source system has a referral priority which matches the e-Referral Service priority codes or can be mapped to those priority codes. If there is a priority code for the referral but it is incompatible with the e-Referral Service priorities, this element MUST be excluded and the priority MUST be supplied in the note element.
GPCM-SD-OC-074 the subject element MUST reference the Patient profile representing the Patient who is the subject of the referral
GPCM-SD-OC-075 the context element SHOULD reference the Encounter within which the referral was recorded
GPCM-SD-OC-076 the requester element SHOULD reference the details of the person, practitioner or organisation responsible for the decision to refer the patient or, if is not attributed specifically, then populate with the recorder
GPCM-SD-OC-077 the requester.agent element MUST reference one of the following:
GPCM-SD-OC-078 the recipient element SHOULD be populated with the practitioner and/or organisation the patient has been referred to, if that is recorded in a suitable coded format
GPCM-SD-OC-079 the reasonCode element SHOULD be populated with the source system’s main coded entry for the referral
GPCM-SD-OC-080 the description element SHOULD be populated with a free text description associated with the referral
GPCM-SD-OC-081 the supportingInfo element SHOULD contain a reference to the referral letter(s) and any other supporting documents or resources which are not covered by other more specific elements, for instance this could include reference to linked observations

DocumentReference resource

The CareConnect-DocumentReference-1 in the payload is populated as follows:

GPCM-SD-OC-082 the status element MUST contain a fixed value of either current, superseded or entered-in-error
GPCM-SD-OC-083 the type element MUST contain a coded entry that references the type of document, this SHOULD be taken from SNOMED refset 1127551000000109. Other classifications should be sent as text.
GPCM-SD-OC-084 the subject element MUST reference the Patient profile representing the Patient who is the subject of the document
GPCM-SD-OC-085 the author element SHOULD reference one of the following:
GPCM-SD-OC-086 the content element MUST contain details about the document being referenced
GPCM-SD-OC-087 the context element SHOULD contain details about the clinical context of the document being referenced

AllergyIntolerance resource

The CareConnect-AllergyIntolerance-1 in the payload is populated as follows:

GPCM-SD-OC-088 the extension[encounter] element SHOULD contain a reference to an associated encounter
GPCM-SD-OC-089 the extension[allergyEnd] element MUST contain the date the allergy or intolerance was recorded as resolved, if the clinicalStatus is set to resolved.
GPCM-SD-OC-090 the extension[allergyEnd].endReason element MUST contain the reason why the allergy or intolerance has been resolved. In exceptional cases where for legacy data there is no endReason recorder in the system then this MUST be populated with the text ‘No information available’.
GPCM-SD-OC-091 the clinicalStatus element MUST be populated with active for all active allergies, or resolved for resolved allergies.
GPCM-SD-OC-092 the verificationStatus element MUST contain a fixed value of unconfirmed.
GPCM-SD-OC-093 the type element SHOULD be set to allergy for reactions which are allergenic in nature (immunological), a value of intolerance MAY be used to indicate adverse reactions (not immunologic in nature). Where the type is unknown the type element may be omitted.
GPCM-SD-OC-094 the category element MUST use medication for all drug allergy types, environment for all non-drug allergies. The other values in the ValueSet (food and biologic) MUST NOT be used.
GPCM-SD-OC-095 the criticality element SHOULD used to distinguish between life-threatening (high) and non-life-threatening (low) potential as well as unable-to-assess. It MAY be used in addition to severity within the reaction element to express severity - for example, systems that support a severity of life-threatening MAY set criticality to high.
GPCM-SD-OC-096 the criticality element SHOULD used to distinguish between life-threatening (high) and non-life-threatening (low) potential as well as unable-to-assess. It MAY be used in addition to severity within the reaction element to express severity - for example, systems that support a severity of life-threatening MAY set criticality to high.
GPCM-SD-OC-097 the code element MUST contain the causative agent such as food, drug or substances that has caused or may cause an allergy, intolerance or adverse reaction in this patient.
GPCM-SD-OC-098 the patient element MUST contain a reference to the Patient who has, or had, the allergy or intolerance specified.
GPCM-SD-OC-099 the onset.DateTime element SHOULD contain a date when allergy/intolerance first manifested. Currently restricted to values of dateTime for GP Connect.
GPCM-SD-OC-100 the assertedDate element MUST contain a the datetime the record was believed to be true.
GPCM-SD-OC-101 the recorder element MUST contain a reference to who recorded the allergy.
GPCM-SD-OC-102 the asserter element SHOULD contain a reference to the source of the information about the allergy.
GPCM-SD-OC-103 the lastOccurrence element SHOULD contain the date and/or time of the last known occurrence of a reaction event.
GPCM-SD-OC-104 the note element SHOULD contain all text associated with the AllergyIntolerance including user-entered notes and qualifiers is grouped together and expressed in this field, which ensures unmapped coded values or qualifiers are not lost. MUST be used to contain any textual data relevant to the allergy.
GPCM-SD-OC-105 the reaction.manifestation element SHOULD contain the reaction resulting from the allergy/intolerance as a code.
GPCM-SD-OC-106 the reaction.description element SHOULD contain the textual description of the manifestation where no code is available.
GPCM-SD-OC-107 the reaction.severity element SHOULD contain severities of Mild, Moderate, Severe are mapped directly to the ValueSet. Map life threatening to Severe and populate criticality with high.
GPCM-SD-OC-108 the reaction.exposureRoute element SHOULD contain the route by which exposure to the substance causing the reaction occurred. Utilise the dm+d route codes.

FamilyMemberHistory resource

The CareConnect-FamilyMemberHistory-1 in the payload is populated as follows:

GPCM-SD-OC-109 the status element MUST contain a fixed value of either partial, completed, entered-in-error, or health-unknown
GPCM-SD-OC-110 the patient element MUST contain a reference to the Patient that the history is about.
GPCM-SD-OC-111 the relationship element MUST contain a coded entry describing the nature of the relationship between the patient and the related person being described in the family history.
GPCM-SD-OC-112 the reasonReference element SHOULD reference one of the following:
GPCM-SD-OC-113 the note element SHOULD contain all text associated with the related person.
GPCM-SD-OC-114 the condition element SHOULD contain the details of the condition that the related person had.

Task resource

The CareConnect-Task-1 in the payload is populated as follows:

GPCM-SD-OC-115 the status element MUST contain a fixed value of requested.
GPCM-SD-OC-116 the statusReason element SHOULD contain a code to identify the reason for the current status.
GPCM-SD-OC-117 the intent element MUST contain a fixed value of either proposal, plan, or order, to distinguish whether the task is a proposal, plan or full order.
GPCM-SD-OC-118 the priority element SHOULD contain a fixed value of either normal, urgent, asap, or stat.
GPCM-SD-OC-119 the code element SHOULD contain codes to identify what the task involves. These will typically be specific to a particular workflow.
GPCM-SD-OC-120 the for element SHOULD contain a reference to the Patient.
GPCM-SD-OC-121 the context element SHOULD contain a reference to the Encounter which this task originated.
GPCM-SD-OC-122 the requester.agent element SHOULD reference one of the following:
GPCM-SD-OC-123 the owner element SHOULD contain a reference a resource responsible for the task execution.
GPCM-SD-OC-124 the reason element SHOULD contain details explaining why the task is needed.
GPCM-SD-OC-125 the note element SHOULD contain comments made about the task.
GPCM-SD-OC-126 the restriction element SHOULD be populated if there are any limitations on what parts of the referenced request should be actioned.
GPCM-SD-OC-127 the input element SHOULD contain additional information that may be needed in the execution of the task.
GPCM-SD-OC-128 the output element SHOULD contain any outputs produced by the task.

The CareConnect-Consent-1 in the payload is populated as follows:

GPCM-SD-OC-129 the status element MUST contain a fixed value of either proposed, active, or rejected.
GPCM-SD-OC-130 the category element SHOULD contain a classification of the type of consent found in the statement.
GPCM-SD-OC-131 the patient element MUST contain a reference to the Patient the consent applies to.
GPCM-SD-OC-132 the period element SHOULD contain a the period this consent applies to.
GPCM-SD-OC-133 the consentingParty element SHOULD contain a reference to who is agreeing to the policy and exceptions.
GPCM-SD-OC-134 the action element SHOULD contain any actions controlled by this consent.
GPCM-SD-OC-135 the source[x] element SHOULD reference the source from which the consent was taken.
GPCM-SD-OC-136 the policy element SHOULD contain any policies covered by this consent.
GPCM-SD-OC-137 the purpose element SHOULD contain the context of activities for which the agreement is made.
GPCM-SD-OC-138 the datePeriod element SHOULD contain timeframe for data controlled by this consent.
GPCM-SD-OC-139 the data element SHOULD contain the data controlled by this consent.
GPCM-SD-OC-140 the except element SHOULD contain any exceptions to the base policy of this consent. An exception can be an addition or removal of access permissions.

Location resource

The CareConnect-Location-1 in the payload is populated as follows:

GPCM-SD-OC-168 the identifier element MUST contain a Site ODS code to identify the organization at site level.
GPCM-SD-OC-169 the status element MUST contain a fixed value of active.
GPCM-SD-OC-170 the name element MUST contain the name of the location used by humans.
GPCM-SD-OC-171 the type element SHOULD contain the type of function being performed at this location.
GPCM-SD-OC-172 the telecom element MUST contain the telephone number of that location. i.e. where telecom.system is set to a fixed value of phone, and telecom.value contains the telephone number
GPCM-SD-OC-173 the address element SHOULD contain the physical address of the location

ITK3 header requirements

Please refer to Using ITK3 to support GP Connect Messaging for an overview of the use of ITK3 in this context.

Requirements are given below which define how the ITK3 Message Header is populated in all instances of messages generated by sending organisations for this use case:

GPCM-SD-OC-141 when sending to the primary recipient (the care provider expected to action the message) the RecipientType MUST be set to fixed value of FA ('For action') taken from FHIR ValueSet ITK-RecipientType-1

The meaning of RecipientType is applied in a common way across all ITK3 messaging. "For action" in this case indicates that the recipient is expected to take action.

This item is found in the ITKMessageHandling extension within the ITK3 Message Header.
GPCM-SD-OC-142 when sending a copy message to the patient's registered GP practice the RecipientType MUST be set to fixed value of FI ('For information') taken from FHIR ValueSet ITK-RecipientType-1

"For information" in this case indicates that the recipient is not expected to take action but should attach the payload contents to the patient record.

This item is found in the ITKMessageHandling extension within the ITK3 Message Header.
GPCM-SD-OC-143 BusAckRequested MUST be set to fixed value of true. This will request an ITK3 Response with a response code in the range 30001 to 30003.

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-144 InfAckRequested MUST be set to fixed value of true. This will request an ITK3 Response with a response code in the range 10001 to 20013.

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-145 SenderReference MUST be set to the unique identifier of the encounter which has taken place at the sender organisation.

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-146 MessageDefinition MUST be set to fixed value of https://fhir.nhs.uk/STU3/MessageDefinition/ITK-GPConnectSendDocument-MessageDefinition-1

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-147 LocalExtension MUST be set to fixed value of SendDocument-OnlineConsultationReport

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-148 Sender MUST contain a reference to the CareConnect-ITK-Header-Organization-1 resource present in the FHIR message bundle
GPCM-SD-OC-149 Source MUST contain the MESH mailbox ID of the sender
GPCM-SD-OC-150 Event MUST contain a fixed value of ITK007C from code system ITK-MessageEvent-2
GPCM-SD-OC-151 Timestamp MUST contain the date/time when the message was generated. (A separate process such as the MESH client may be responsible for sending the message at a later date/time.)

ITK3 responses generated

GPCM-SD-OC-153 BusAckRequested MUST contain a fixed value of false

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-154 InfAckRequested MUST contain a fixed value of false

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-155 SenderReference MUST contain the same unique identifier generated by GPCM-SD-042.

This item is found in the ITKMessageHandling extension within the ITK3 Message Header
GPCM-SD-OC-156 Sender MUST contain a reference to an CareConnect-ITK-Header-Organization-1 resource present in the FHIR message bundle
GPCM-SD-OC-157 Event MUST contain a fixed value of ITK008M from code system ITK-MessageEvent-2
GPCM-SD-OC-158 Timestamp MUST contain the date/time when the response was generated.

MESH message configuration

Important: The preferred method for sending Online Consultation Reports is the MESH API, this is because the MESH API is more easily integrated into sending systems, and the MESH API Address Lookup function needs to used to identify MESH mailbox IDs for community pharmacies.

The MESH client can be used to send the message, but the MESH API Address Lookup is still required if sending to a community pharmacy.

The Message routing to registered practice can be used if only ever sending to the patient’s registered GP practice.

Please refer to Integration to MESH for an introduction to the use of MESH for GP Connect Messaging use cases.

MESH API Address Lookup

GPCM-SD-OC-159 all messages sent through this use case to non-GP practice care providers MUST use the MESH API Address Lookup function to lookup the MESH mailbox ID of the receiving care provider.

Details of how to use Address Lookup can be found on the MESH API page

Workflow groups and Workflow ID

GPCM-SD-OC-160 each instance of a Online Consultation Report message MUST include the following MESH Workflow ID in the MESH message metadata: GPFED_CONSULT_REPORT
GPCM-SD-OC-161 each instance of an acknowledgement message generated as a result of receipt of a Online Consultation Report message MUST include the following Workflow ID in the MESH message metadata: GPFED_CONSULT_REPORT_ACK

MESH API configuration

When using the MESH API the Send Message API call will be used by a sending organisation API client to send a message to the MESH server. MESH metadata items are defined in HTTP header fields as described below:

GPCM-SD-OC-162 Mex-From MUST contain the MESH mailbox ID of the sender of the message – in this case the originating organisation
GPCM-SD-OC-163 Mex-To MUST contain the MESH mailbox ID of the receiver of the message – in this case either the mailbox ID for the patient's registered GP practice, or chosen community pharmacy
GPCM-SD-OC-164 Mex-Subject MUST contain To text in the following format:

Online consultation report for {Patient Name}, NHS Number {NHS Number}, ODS Code {ODS Code}
GPCM-SD-OC-175 Mex-Localid MUST contain the ODS code of the sending organisation

MESH client configuration

When using the MESH client to send a message to the MESH server, the .CTL file will contain the following metadata about the message:

GPCM-SD-OC-165 From_DTS MUST contain the MESH mailbox ID of the sender of the message – in this case the originating organisation
GPCM-SD-OC-166 To_DTS MUST contain the NHS Number, DOB and Surname of the patient delimited by the underscore character ‘_'. This enables automatic routing of the message to the registered GP MESH mailbox
GPCM-SD-OC-167 Subject MUST contain To text in the following format:

Online consultation report for {Patient Name}, NHS Number {NHS Number}, ODS Code {ODS Code}
GPCM-SD-OC-174 LocalID MUST contain the ODS code of the sending organisation
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