FHIR API

Composition

The main resource type supporting implementation of the UGR will be the Genomics-Composition resource. This resource is used to align with existing Summary Care Record implementations and mirrors the EU Patient Summary guidance, whereby sections are defined for the data categories, which contain references to the data, e.g. Lab reports, Demographics etc.

It is expected the UGR could be represented as a section under a more general patient summary. When the UGR is integrated into a single patient record, the generation of the composition will follow the selected system's approach. The Composition MAY be generated and updated automatically by the UGR system following addition of resources referencing a patient. This avoids errors due to clients overwriting information or making incorrect edits to the UGR Composition itself. This means that the Composition endpoint MAY be read only, with write endpoints for clinical resources, Consent and RelatedPerson only (though this may be integrated with the OM and SPR APIs)

The sections included within the UGR are coded using https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings, as follows (Note: these may need to be aligned to IPS section headings depending on where the UGR sits within the wider Single Patient Record):

Section Title Code Entry Resource Type
Patient demographics patient-demographics Patient (may be NHS Identifier if registered on PDS)
Investigations and procedures requested investigations-and-procedures-requested ServiceRequest
Investigation results investigation-results DiagnosticReport (this resource will link off to the various Genomic Data Files and Observations, Note: a separate section for genomic data and observations irrespective of the report/request which generated this is currently being investigated, e.g. for on demand CDS)
Consent for information sharing consent-for-information-sharing Consent
Family history family-history RelatedPerson/FamilyMemberHistory
TBC Alerts/Allergies Alerts/allergies-and-adverse-reaction Likely AllergyIntollerance to record contraindications for treatments, e.g. drugs, based on genetic results

An example of a UGR record can be found at Composition-UGR-Example

Type and Category

To appropriately categorise the UGR alongside other Compositions and Documents, the type and category SHALL be fixed to the below.

"type": {
  "coding": [
    {
      "system": "http://snomed.info/sct",
      "code": "824321000000109",
      "display": "Summary record"
    }
  ]
},
"category": [
  {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "321401000000106",
        "display": "Genomics"
      }
    ]
  }
],

Author and Custodian

As the UGR is created and managed by NHS England, the author and custodian elements will be fixed to the X26 ODS code.

"author": [
  {
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/ods-organization-code",
      "value": "X26"
    }
  }
],
"custodian": {
  "identifier": {
    "system": "https://fhir.nhs.uk/Id/ods-organization-code",
    "value": "X26"
  }
},

Section

To better conform to the EU Patient Summary (EPS) Implementation Guide, section.text has been added to provide a human readable/HTML representation of the UGR sections. an example is provided below.

"section": [
  {
    "title": "Patient demographics",
    "code": {
      "coding": [
        {
          "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings",
          "code": "patient-demographics",
          "display": "Patient demographics"
        }
      ]
    },
    "text": {
      "status": "generated",
      "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Pheobe Smitham, Female, DOB: 2013-09-27</div>"
    },
    "entry": [
      {
        "identifier": {
          "system": "https://fhir.nhs.uk/Id/nhs-number",
          "value": "9449307539"
        }
      }
    ]
  },

Other Fixed Elements

  • status SHALL have a fixed value of final
  • title SHALL have a fixed value of Unified Genomic Record Summary
  • confidentiality SHALL have a fixed value of R due to the sensitivity of the data within the UGR