GP Connect - Update Record (ITK3)

Part of the GP Connect product family

Mapping PRSB headings to FHIR

The Community Pharmacy Standard General Implementation Guidance v3.01 (section 4.2 page 22) highlights the data items required for each use case.

PRSB CP Implementation Guidance (external link, opens in a new tab)

This ITK3 specification currently focuses on the CPCS Minor Illnesses, Contraception, and Blood Pressure Check services.

How are PRSB headings represented within FHIR?

In previous ITK3 specifications, the NHS has asked providers to send this as HTML within the Composition.section.text element, along with a SNOMED code within Composition.section.code.

GP Connect does not follow this pattern, and prefers that uncategorised data be sent within the following FHIR profiles:

A value from the following code system should be used within meta.tag to articulate which headings the data item being represented aligns to. A link to the code system can be found below.

Code system: RecordStandardHeadings

In the event of multiple values for the same heading being sent, additional profiles will be sent.

Note: Only the main headings within PRSB standards are represented within this code-system. Sub-headings are not to be used, and can instead be inferred by the data being expressed in the profile.

More information about this can be found within the Tagging payloads with meta.tag section of this specification.

Heading: History

The record of the person’s significant medical, surgical and mental health history. Including relevant previous diagnoses, problems and issues, procedures, investigations, specific anaesthesia issues, etc. (will include dental and obstetric history).

This is a required data item in the Community Pharmacy Standard, which means that Pharmacy Suppliers are obliged to provide this information if it is present within their clinical system.


Recorded as a free-text string within the ClinicalImpression.summary element.

Note: The PRSB suggest a member from the 1127581000000103 | Health issues simple reference set (foundation metadata concept) reference set which has over 125,000 members.

It is very unlikely that the entire reference set will be searched to store this information coded, and as such, free text is preferred to record the history in this version of the specification.

Example

<ClinicalImpression xmlns="http://hl7.org/fhir">
    <id value="4ab82e30-64a6-45df-a171-89102ee02e98" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1" />
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="history" />
            <display value="History" />
        </tag>
    </meta>
    <status value="completed" />
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <summary value="Patient has history of panic attacks" />
</ClinicalImpression>
ClinicalImpression.id[0]4ab82e30-64a6-45df-a171-89102ee02e98
ClinicalImpression.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1
ClinicalImpression.meta[0].tag[0].system[0]https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings
ClinicalImpression.meta[0].tag[0].code[0]history
ClinicalImpression.meta[0].tag[0].display[0]History
ClinicalImpression.status[0]completed
ClinicalImpression.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
ClinicalImpression.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
ClinicalImpression.summary[0]Patient has history of panic attacks

Heading: Clinical Summary

A description detailing a patient’s reason for attendance, results from the diagnostic and treatment process.

This is a mandatory data item in the Community Pharmacy Standard, which means that Pharmacy Suppliers are obliged to provide this information if it is present within their clinical system.


Recorded as a free-text string within the ClinicalImpression.summary element.


Example

<ClinicalImpression xmlns="http://hl7.org/fhir">
    <id value="e461896a-b0c8-457d-9397-b276c9aec312" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1" />
        <tag>
            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
            <code value="clinical-summary" />
            <display value="Clinical summary" />
        </tag>
    </meta>
    <status value="completed" />
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <summary value="A description detailing a patient’s reason for attendance, any red flags, results from the diagnostic and treatment process." />
</ClinicalImpression>
ClinicalImpression.id[0]e461896a-b0c8-457d-9397-b276c9aec312
ClinicalImpression.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1
ClinicalImpression.meta[0].tag[0].system[0]https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings
ClinicalImpression.meta[0].tag[0].code[0]clinical-summary
ClinicalImpression.meta[0].tag[0].display[0]Clinical summary
ClinicalImpression.status[0]completed
ClinicalImpression.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
ClinicalImpression.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
ClinicalImpression.summary[0]A description detailing a patient’s reason for attendance, any red flags, results from the diagnostic and treatment process.

Heading: Signpost details

These are the details of any services that the person has been signposted too. Signposting is in the form of providing the person with the name of an organisation and their contact details - for example, telephone number, website (it is not a referral).


Note: The concept of signposting within the PRSB is relatively new and not yet fully understood well enough to be mapped to FHIR in a structured fashion.

As such, free text is preferred to record the signpost details in this version of the specification.

Example

<ClinicalImpression xmlns="http://hl7.org/fhir">
    <id value="4ab82e30-64a6-45df-a171-89102ee02e92" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1" />
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="signpost-details" />
            <display value="Signpost details" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/clinicalImpression" />
        <value value="urn:uuid:4ab82e30-64a6-45df-a171-89102ee02e92" />
    </identifier>
    <status value="completed" />
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <summary value="Signposted to John Brown, a Senior Mental Health Social Working in the Cambridge Medical Health team due to signs of depression were noted during the consultation." />
</ClinicalImpression>
ClinicalImpression.id[0]4ab82e30-64a6-45df-a171-89102ee02e92
ClinicalImpression.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1
ClinicalImpression.meta[0].tag[0].system[0]https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings
ClinicalImpression.meta[0].tag[0].code[0]signpost-details
ClinicalImpression.meta[0].tag[0].display[0]Signpost details
ClinicalImpression.identifier[0].system[0]https://identifiers.provider.test/clinicalImpression
ClinicalImpression.identifier[0].value[0]urn:uuid:4ab82e30-64a6-45df-a171-89102ee02e92
ClinicalImpression.status[0]completed
ClinicalImpression.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
ClinicalImpression.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
ClinicalImpression.summary[0]Signposted to John Brown, a Senior Mental Health Social Working in the Cambridge Medical Health team due to signs of depression were noted during the consultation.

Heading: Information and advice given

The information or advice given to the person, carer, other authorised representative, care professional or other third party. May include advice about actions related to medicines or other ongoing care activities on an ‘information prescription'. State here if there are concerns about the extent to which the person and/or carer understand the information provided about diagnosis, prognosis and treatment.


Recorded as a free-text string within the ClinicalImpression.summary element.


Example

<ClinicalImpression xmlns="http://hl7.org/fhir">
    <id value="17cbf68a-1b91-4b54-a253-3b4b79f42a30" />
    <meta>
        <tag>
            <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" />
            <code value="information-and-advice-given" />
            <display value="Information and advice given" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/clinicalImpression" />
        <value value="urn:uuid:17cbf68a-1b91-4b54-a253-3b4b79f42a30" />
    </identifier>
    <status value="completed" />
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <summary value="Relevant information and advice provided to the patient during the consultation" />
</ClinicalImpression>
ClinicalImpression.id[0]17cbf68a-1b91-4b54-a253-3b4b79f42a30
ClinicalImpression.meta[0].tag[0].system[0]https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings
ClinicalImpression.meta[0].tag[0].code[0]information-and-advice-given
ClinicalImpression.meta[0].tag[0].display[0]Information and advice given
ClinicalImpression.identifier[0].system[0]https://identifiers.provider.test/clinicalImpression
ClinicalImpression.identifier[0].value[0]urn:uuid:17cbf68a-1b91-4b54-a253-3b4b79f42a30
ClinicalImpression.status[0]completed
ClinicalImpression.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
ClinicalImpression.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
ClinicalImpression.summary[0]Relevant information and advice provided to the patient during the consultation

Heading: Planned and requested actions

The details of planned investigations, procedures and treatment, and whether this plan has been agreed with the person or their legitimate representative.


Recorded as a free-text string within the ClinicalImpression.summary element.

Important: The concept of tasking between healthcare systems within GP Connect has not yet been defined, thus, this heading cannot be used for creating tasks.

The sending practitioner MUST contact the receiving practitioner (GP) directly to request tasks.

Example

<ClinicalImpression xmlns="http://hl7.org/fhir">
    <id value="4ab82e30-64a6-45df-a171-89102ee02e09" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1" />
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="plan-and-requested-actions" />
            <display value="Plan and requested actions" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/clinicalImpression" />
        <value value="urn:uuid:4ab82e30-64a6-45df-a171-89102ee02e09" />
    </identifier>
    <status value="completed" />
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <summary value="Plan and requested actions discussed with the patient go here." />
</ClinicalImpression>
ClinicalImpression.id[0]4ab82e30-64a6-45df-a171-89102ee02e09
ClinicalImpression.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1
ClinicalImpression.meta[0].tag[0].system[0]https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings
ClinicalImpression.meta[0].tag[0].code[0]plan-and-requested-actions
ClinicalImpression.meta[0].tag[0].display[0]Plan and requested actions
ClinicalImpression.identifier[0].system[0]https://identifiers.provider.test/clinicalImpression
ClinicalImpression.identifier[0].value[0]urn:uuid:4ab82e30-64a6-45df-a171-89102ee02e09
ClinicalImpression.status[0]completed
ClinicalImpression.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
ClinicalImpression.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
ClinicalImpression.summary[0]Plan and requested actions discussed with the patient go here.

Heading: Pregnancy Status - Pregnancy State

The pregnancy status of the patient. If the patient is currently pregnant.


Recorded as a member from the SNOMED Health issues simple reference set within Observation.code.

77386006 | Patient currently pregnant |

OR

60001007 | Not pregnant (finding) |


Example

<Observation xmlns="http://hl7.org/fhir">
    <id value="fe03c9e2-1678-43e2-a684-ecec57f92fd2" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1" />
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="pregnancy-status" />
            <display value="Pregnancy status" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/observation" />
        <value value="urn:uuid:fe03c9e2-1678-43e2-a684-ecec57f92fd2" />
    </identifier>
    <status value="final" />
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="77386006" />
            <display value="Not pregnant" />
        </coding>
        <text value="Not pregnant (finding)" />
    </code>
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <issued value="2023-07-26T13:16:15.1516395+00:00" />
    <performer>
        <reference value="urn:uuid:39f59e67-d56b-446c-bca9-2c37e7b32c7c" />
    </performer>
</Observation>
Observation.id[0]fe03c9e2-1678-43e2-a684-ecec57f92fd2
Observation.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1
Observation.meta[0].tag[0].system[0]https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings
Observation.meta[0].tag[0].code[0]pregnancy-status
Observation.meta[0].tag[0].display[0]Pregnancy status
Observation.identifier[0].system[0]https://identifiers.provider.test/observation
Observation.identifier[0].value[0]urn:uuid:fe03c9e2-1678-43e2-a684-ecec57f92fd2
Observation.status[0]final
Observation.code[0].coding[0].system[0]http://snomed.info/sct
Observation.code[0].coding[0].code[0]77386006
Observation.code[0].coding[0].display[0]Not pregnant
Observation.code[0].text[0]Not pregnant (finding)
Observation.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
Observation.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
Observation.issued[0]2023-07-26T13:16:15.151+00:00
Observation.performer[0].reference[0]urn:uuid:39f59e67-d56b-446c-bca9-2c37e7b32c7c

Heading: Red Flags

Confirmation of whether any red flags (symptoms that suggest more serious illness) were identified. Details of red flag symptoms recorded if the 'Red flags' were identified as 'Yes'".

This is a mandatory data item in the Community Pharmacy Standard, which means that Pharmacy Suppliers are obliged to provide this information if it is present within their clinical system.


Recorded as a free-text string within the ClinicalImpression.summary element.


Example

<ClinicalImpression xmlns="http://hl7.org/fhir">
    <id value="db9e8c58-bbe7-4c52-b699-b4db78a6a88d" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1" />
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="red-flags" />
            <display value="Red flags" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/clinicalimpression" />
        <value value="urn:uuid:db9e8c58-bbe7-4c52-b699-b4db78a6a88d" />
    </identifier>
    <status value="completed" />
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <summary value="Details of red flag symptoms identified." />
</ClinicalImpression>
ClinicalImpression.id[0]db9e8c58-bbe7-4c52-b699-b4db78a6a88d
ClinicalImpression.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1
ClinicalImpression.meta[0].tag[0].system[0]https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings
ClinicalImpression.meta[0].tag[0].code[0]red-flags
ClinicalImpression.meta[0].tag[0].display[0]Red flags
ClinicalImpression.identifier[0].system[0]https://identifiers.provider.test/clinicalimpression
ClinicalImpression.identifier[0].value[0]urn:uuid:db9e8c58-bbe7-4c52-b699-b4db78a6a88d
ClinicalImpression.status[0]completed
ClinicalImpression.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
ClinicalImpression.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
ClinicalImpression.summary[0]Details of red flag symptoms identified.

Heading: Procedures and therapies - Procedures

The details of any procedures performed. Includes both psychological and medical therapies and procedures (for example, cognitive behaviour therapy, hip replacement).


Note: At the time of writing, the only use case for this heading is for the Blood Pressure Check service.

Example

<Observation xmlns="http://hl7.org/fhir">
    <id value="57eacdfb-12eb-48f7-8ce6-25dbe378613" />
    <meta>
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="procedures-and-therapies" />
            <display value="Procedures and therapies" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/flag" />
        <value value="urn:uuid:57eacdfb-12eb-48f7-8ce6-25dbe378613c" />
    </identifier>
    <status value="final" />
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="861231000000105" />
            <display value="Ambulatory blood pressure recording declined" />
        </coding>
        <text value="The reason the patient declined the ABPM can be recorded here." />
    </code>
    <subject>
        <reference value="urn:uuid:f39b71e6-27d3-11ee-be56-0242ac120002" />
    </subject>
</Observation>
{{table:57eacdfb-12eb-48f7-8ce6-25dbe378613}

Heading: Procedures and therapies - Contraception type

Record entry relating to the patient's use of contraception.


Recorded within an Observation.code as a codeable concept. The code should be a child taken from the SNOMED concept 13197004 | Uses contraception (finding) |, along with the effective period (start and end date) if known.

Note: The review date does not currently have an element in which it can be recorded within the Observation profile - record within the code.text element instead.

Example

<Observation xmlns="http://hl7.org/fhir">
    <id value="e2360fe6-c866-47e7-b35b-7e263f8bc50e" />
    <meta>
        <profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1" />
        <tag>
            <system value="https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings" />
            <code value="procedures-and-therapies" />
            <display value="Procedures and therapies" />
        </tag>
    </meta>
    <identifier>
        <system value="https://identifiers.provider.test/observation" />
        <value value="urn:uuid:e2360fe6-c866-47e7-b35b-7e263f8bc50e" />
    </identifier>
    <status value="final" />
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="169531004" />
            <display value="Uses contraceptive sponge and spermicide" />
        </coding>
        <text value="Free text regarding contraception (including review date) can go here." />
    </code>
    <subject>
        <reference value="urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5" />
    </subject>
    <context>
        <reference value="urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0" />
    </context>
    <effectivePeriod>
        <start value="2023-07-04" />
        <end value="2023-10-31" />
    </effectivePeriod>
    <issued value="2023-07-04T13:23:00.1516395+00:00" />
    <performer>
        <reference value="urn:uuid:39f59e67-d56b-446c-bca9-2c37e7b32c7c" />
    </performer>
</Observation>
Observation.id[0]e2360fe6-c866-47e7-b35b-7e263f8bc50e
Observation.meta[0].profile[0]https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1
Observation.meta[0].tag[0].system[0]https://fhir.nhs.uk/CodeSystem/RecordStandardHeadings
Observation.meta[0].tag[0].code[0]procedures-and-therapies
Observation.meta[0].tag[0].display[0]Procedures and therapies
Observation.identifier[0].system[0]https://identifiers.provider.test/observation
Observation.identifier[0].value[0]urn:uuid:e2360fe6-c866-47e7-b35b-7e263f8bc50e
Observation.status[0]final
Observation.code[0].coding[0].system[0]http://snomed.info/sct
Observation.code[0].coding[0].code[0]169531004
Observation.code[0].coding[0].display[0]Uses contraceptive sponge and spermicide
Observation.code[0].text[0]Free text regarding contraception (including review date) can go here.
Observation.subject[0].reference[0]urn:uuid:42451c37-752d-4c8e-aa80-be8258a9a4e5
Observation.context[0].reference[0]urn:uuid:43b4530b-7e0d-4009-a006-6a8d99cbd4f0
Observation.effective[0].start[0]2023-07-04
Observation.effective[0].end[0]2023-10-31
Observation.issued[0]2023-07-04T13:23:00.151+00:00
Observation.performer[0].reference[0]urn:uuid:39f59e67-d56b-446c-bca9-2c37e7b32c7c
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