Administrative Data
Administrative data are sometimes referred to as reference data. They are relatively static, usually centrally maintained and not typically updated as a result of patient health and care events. Administrative data can be linked to clinical data to provide better context and improve the quality of this information.
Data Model Overview
The diagram below illustrates some of the key interrelationships that can exist between the different types of administrative data resource. The scope is the following resources:
FHIR Resources
The involved FHIR resources are described in the tabs below. For each, the relationships with the other administrative data resources listed above are illustrated, together with potential scenarios for use in the clinicial record.
- Organization
- Location
- HealthcareService
- OrganizationAffiliation
- Practitioner
- PractitionerRole
The Organization resource contains information about health and care organisations. In Wales this may include health boards and NHS trusts, hospitals, dental practices, GP practices and primary care clusters, but could be any public, private or voluntary sector organisation whose activities encompass the funding or provision of health care services. To aid Organization recognition and retrieval, the Organization.type element carries structured information defining the sector, domain, classification and subclassification. Each alias can also be classified using an aliasTypeextension.
Example scenarios:
- An encounter record for an admission or outpatient consultation will refer to the organisation that provided the care.
- A patient demographic record may refer to the GP practice with which they are registered and the health board responsible for their care (based on their postcode of residence).
The Location resource contains information about a physical or virtual place where services are provided and resources and participants may be stored, found, contained, or accommodated. Typical examples include buildings, wards, corridors, rooms or beds, but may also include mobile clinics, a vehicle or lift, or a patient's home. Location resources can contain details about physical address and position, location form and type and times of operation.
Example scenarios:
- An encounter record for an admission or outpatient consultation will refer to the organisation that provided the care.
- A patient demographic record may refer to the GP practice to which they are registered and the health board responsible for their care (based on their postcode of residence).
The HealthcareService resource captures healthcare services that are provided by an organisation at specified physical or virtual locations.
NOTE that the HealthcareService resource does not yet feature in the use cases covered by this guidance. It is envisaged that guidance for use of this resource will be a future development.
Example scenarios:
- A referral may be represented as a service request for a specific healthcare service.
- The ward to which a patient is admitted by may be dedicated to delivery of a specific healthcare service
The OrganizationAffiliation resource supports formal and enduring one-to-many and many-to-many relationships between organisations, that fall outside of the strict organisation hierarchy. Each OrganizationAffiliation resource links a pair of organisations. One organisation can be considered to own the arrangement, while the other is a participating organisation. The relationship can optionally include details of the involved locations and healthcare services of the participating organisation.
Example scenarios:
- See the Primary Care Clusters use case below.
- See the Healthcare Regions use case below.
The Practitioner resource defines an individual member of a clinical or allied profession directly or indirectly involved in the delivery of health and care services. The resource contains detail about the person in their professional capacity, such as formal name, title, professional registration numbers and other identifiers e.g. health board locally assigned identifiers, NADEX etc.
Example scenarios:
- A request for diagnostics will refer to the requesting clinician.
- A document may be submitted (saved) by a specific health care practitioner, identified by their system username.
The PractitionerRole resource defines the role of a clinical or non-clinical professional within a specific health and care system context. This would typically represent an employment contract with a specified health and care organisation. The resource contains information about the staff member’s role within the organisation such as grade or specialty.
Example scenarios:
- An encounter record for an admission or outpatient consultation will refer to the clinician(s) that provided the care, in a specific role for their employing organisation.
- An allergy recorded against a patient’s record can be linked to the clinician who identified this, together with their grade and specialty.
Organization and Location Use Cases
The Organization resource supports a formal decomposition hierarchy via a partOf link to the parent organization. In the case of Location the partOf link describes a physical decomposition e.g. a room is part of the building it sits within. The two hierarchies are linked by the identification of the managingOrganization for each Location, and by use of the mainLocation extension on the Organization resource. The structural hierarchies are illustrated in the Secondary Care Hierarchies and General Practice Hierarchies use cases below.
For any organizational relationships that sit outside of the formal structural hierarchy, the OrganizationAffiliation resource is used. The two main use cases in Wales are covered by the Primary Care Clusters and Healthcare Regions tabs.
- Secondary Care Hierarchies
- General Practice Hierarchies
- Primary Care Clusters
- Healthcare Regions
The generic structural hierarchy for secondary care hospitals is illustrated below, with the specific example of a ward and outpatient department at Glangwili General Hospital. Note that the Hospital itself is represented as an Organization resource and as the hospital site that is the main location for delivery of health care by that organisation. It is the hospital site that is then decomposed into wards and departments etc.
Example resources to illustrate this use case:
The generic structural hierarchy for general practice organisations and locations is illustrated below. In this case the mainLocation extension link distinguishes the main surgery from any other locations such as branch surgeries or mobile surgeries. In the worked example, the Amman Tawe Partnership practice has a main surgery plus two branch surgeries.
Example resources to illustrate this use case:
The delivery of primary care to the population of Wales is organized via primary care clusters that cover the population of a defined geographical area. Some clusters just cover general practice, but others may include more comprehensive coverage of primary care organizations, as in the theoretical example below.
As illustrated, a separate OrganizationAffiliation resource is used for each member organization. Every cluster is managed as part of a specific health board.
In the worked example below for the Amman Gwendraeth cluster, the solid lines represent the instantiation of the cluster and the membership participation of the Amman Tawe Partnership GP practice. The dotted lines represent pre-existing links that define the formal organization hierarchy.
Example resources to illustrate this use case:
- Example Cluster Affiliation - Amman Gwendraeth and Amman Tawe Partnership
- Example Organization - Hywel Dda University Local Health Board
- Example Organization - Amman Gwendraeth Cluster
- Example Organization - Amman Tawe Partnership
- Example Location - Amman Tawe Partnership GP Surgery
- Example Location - Brynamman Community GP Surgery
- Example Location - Meddygfa Cwmamman GP Surgery
A region is an administrative grouping of health boards for the purpose of collaborative delivery of healthcare services to their combined populations, where appropriate. Health boards can participate in multiple regions. The membership model for the South Central Wales Region involves four OrganizationAffiliation resources, one for each participating health board.
Example resources to illustrate this use case:
Practitioner Use Cases
- Clinicians and their Roles
A clinician is a unique entity with potentially multiple identifiers and other attributes that relate to them as a person. These aspects are all captured by the Practitioner resource. When a clinician performs a role during a patient event, it is often important to know the capacity within which they act. This information relates to their employment by a healthcare organisation, including aspects such as role and speciality which are captured in a PractitionerRole resource.
This worked example illustrates a qualified dietitian who works for Hywel Dda University Health Board as a specialist diabetes dietitian, while also providing more general dietitian services in Swansea Bay University Health Board.
Example resources to illustrate this use case: