GP Connect - Update Record (ITK3)

Suppliers identified a couple of issues with examples which were resolved.

• Pharmacy First service Examples 1 and 2 had issues with IDs (copy and paste error)
• BP Example 1 example had an incorrect SNOMED code for O/E Blood Pressure
• Note: This changed was made to the same version on Tuesday, 14th November 2023, and the guidance republished

Fixed typo in Diastolic SNOMED code in "On examination - blood pressure reading"

• Changed from 1091811000000100 to 1091811000000102
• Note: This changed was made to the same version on Monday, 13th November 2023, and the guidance republished

Additional guidance around observations has been added including:

• Social history and vital signs
• Which vital signs observations are supported
• Expected units of measure
• Conventions
• Systolic and Diastolic reading pairs
• Reference ranges and interpretation

Requirements for the following data items have been removed:

• Heading: Pregnancy Status - Expected delivery date
• Heading: Pregnancy Status - Feeding status of the baby
• Heading: Social context - Smoking status
• Heading: Social context - Date stopped smoking

• Removed references to smoking status
• Updated blood pressure SNOMED codes to support a variety of valid combinations - e.g., average, sitting, lying, standing, and on examination

Renamed the Minor illness / Common conditions examples to Pharmacy First.

• Pointed to the incorrect clinical impression example - now resolved (2023/11/01)

• Added missing meta.profile to the Composition resource in the profile (2023/11/01).

• The flag for safguarding has been removed for iteration 1 as it further clinical guidance is required around how to flow the information digitally between pharmacy and GP systems.

• The wrong URL was shown in the examples for ParticipantType in the Encounter
  • Changed from https://fhir.nhs.uk/STU3/ValueSet/GPConnect-ParticipantType-1 to https://fhir.nhs.uk/STU3/CodeSystem/GPConnect-ParticipantType-1
• Updated Line 5 on all examples URL from https://fhir.nhs.uk/STU3/StructureDefinition/ITK-Document-Bundle-1 to https://fhir.nhs.uk/STU3/StructureDefinition/ITK-Message-Bundle-1

• The NOPAT code is ambigous since it is not clear as to whether it is clinician-led, or patient-led
• Further clinical guidance required before NHS England can provide appropriate guidance around how to appropriately handle patient requests for non-disclosure of information in patient-facing services
• This means that providers will not be sending the NOPAT code within the meta.security element, of the CareConnect-GPC-Encounter-1 profile

• Providers are recomended to populate this field with a code from the https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-MedicationSupplyType-1 code system

• Updated the pregnancy status example to use the correct code.
• Changed from pregnancy-state to pregnancy-status

• No longer required.

• Updated guidance to state that at least one Profile: CareConnect-GPC-ClinicalImpression-1 MUST be included as per PRSB Community Pharmacy Standard v3.01.

• Updated the example in Encounter.meta.security.system to http://hl7.org/fhir/v3/ActCode.

• Updated the examples to include profile url in meta.profile of each fhir profile

• Changed format of references within examples from resource/[ID] to URN:UUID:[ID]

• FHIR package has been uplifted to version 1.1.3 to include additional items added to SDS job role ID and ITK message event code systems. Link to the new version of the package can be found by clicking here: Usage of FHIR packages

• The initial version of the FHIR package was not based on the Access Record: Structured FHIR assets which were created around five years before the publication date of this specification.
• The FHIR package on Simplifier has been re-created, using gpconnect-fhir release/1.5.0 as a base.
• Additional assets to support Update Record ITK3 have been added in this release.
• This is the only change since previous published version of this specification, and the Usage of FHIR packages has been updated to reflect the change in package version number.
• A link to the new package on Simplifier can be found by clicking here.

• Conventions around how vital signs are to be carried using this specification, and displayed.

• Information and signposting to the GPC Update Record FHIR package.

• The following profiles have been created by the Interoperable Standards team within NHS England and added to this specification.
• Profile: CareConnect-GPC-MedicationDispense-1
• Profile: CareConnect-GPC-ClinicalImpression-1

• Clarification around usage over urn:uuid:[id] over resourceName/[identifier] for this specification.

• Blood pressure check service - Example 1
• Blood pressure check service - Example 2
• Contraception service - Example 1
• Contraception service - Example 2
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• A button to download an XML file has been added to each example.
• A button to allow a user to validate XML using Simplifier validation has been added to each example.

• Added reference to dm+d under codesystems.

• Guidance around usage of the MessageDefinition added.

• Guidance around usage of meta.lastUpdated as per HL7 documentation added.

• Previous guidance was incorrect and referenced the incorrect headers - this has been resolved a reference link to the MESH documentation has been added.
• Removed section around MESH and the use of version - while it can be populated, it cannot be reliably used to indicate the current version since the MESH API does not carry a concept of version.

• Guidance added around reasons messages will be rejected.
• Guidance added around understanding the intent of a message.

• Section added to indicate how non-disclosure to linked profiles (proxy) can be relayed between clinical systems using meta.security.

• Section added to indicate how tags can be used to provide additional context and information about a payload.

• Links to the GP Connect Data model, included for reference.

• Guidance on how medications will be represented.

• Reference to the Unified Code for Units of Measure value set.

• Reference to the UK Core Record standard headings code system.

• Changed cardinality of CareConnect-GPC-Observation-1 to 0..*.
• Changed cardinality of CareConnect-GPC-MedicationDispense-1 to 0..*
• Updated name of MedicationDispense to CareConnect-MedicationDispense-1.
• Added intended delivery iterations and clarifications of all data-types required for the GP Matrix within the PRSB Community Pharmacy Standard.

• Ingestion being all data items in the profiles section of this specification MUST BE auto-ingested - that is, the activity of mapping from the FHIR representation to the consumer (receivers) internal data model automatically (auto-ingest) without amendment, and appropriate elements shown within the same areas of the clinical system as they would be if they were created on the receiving system directly.
• Filing meaning that data is saved to the patient record in a "finalised" state. "Auto-filing" refers to the filing of clinical data without any engagement whatsoever.
• Workflow will be used initially for this capability as the auto-filing rules have not yet been established for the pharmacy services.
• More information can be found within the Workflow groups and ID section of this specification.

• Formerly "How to represent uncategorised data".
• Usage of the UK Core Record Standings Code system.
• The code for the above system to be represented within meta.tag.
• Safeguarding can be represented within CareConnect-Flag-1.
• History can be represented within ClinicalImpression.
• Clinical Summary can be represented within ClinicalImpression.
• Signpost details can be represented within ClinicalImpression.
• Information and advice given can be represented within ClinicalImpression.
• Pregnancy status - * can be represented within Careconnect-GPC-Observation-1.
• Social context - * can be represented within Careconnect-GPC-Observation-1.
• Red flags can be represented as ClinicalImpression.
• Procedures and therapies - Procedures (ABPM declined) can be represented as CareConnect-Observation-1.
• Procedures and therapies - Contraception type can be represented as CareConnect-GPC-Observation-1.

• Minor illnesses including common conditions
• Blood pressure
• Common conditions