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This is the design and development approach used to produce the NHS England IG. It serves several purposes, for example:

  • It is to allow implementers of the NHS England Profiles to understand how and why the NHS England IG has been produced.
  • To act as a guide for anyone creating a derived IG to understand the process.
  • To allow interested parties to get involved in these processes.
  • To facilitate suggestions for improvement to these processes.

NHS England Approach to FHIR

Implementers of FHIR need to get consistent guidance from NHS England.

Why do we need to change our approach?

  • Too many profiles for same resource type due to programme level profiles
  • Implementers really want one common profile
  • Not as per STU3 – 7 profiles of patient
  • Inconsistent and multiple ways of representing the same data in FHIR
  • We should use common patterns
  • Inconsistent and multiple ways of coding the same data in FHIR
  • Need agreed coding for all use cases
  • Lack of an NHS England wide approach and collaboration between stakeholders across programmes
  • Need to have a collaborative approach across all programmes
  • Lack of proper quality control and release approaches
  • Need a roadmap of what is being released and when.
  • All the previous points add more complexity and cost for implementers plus make interoperability harder

Use cases

Programme/domain use cases

Each programme/domain SHALL NOT have seperate FHIR assets.

UseCaseDiagram1


Event/clinical concept level use cases

Use cases should be at event/clinical concept lebel. FHIR UK Core SHALL be used wherever possible.

UseCaseDiagram2


Using NHS England IG for use cases

FHIR UK Core SHALL be used wherever possuble however using NHS England IG for NHS England specific use cases is allowed only by exception.

UseCaseDiagram3


Scope

The NHS England implementation guide conforms to UK Core but provides an additional layer of conformance for NHS England National programmes and systems to aid implementation only where it is deemed appropriate by NHS England national requirements.

  • Applies to new R4 FHIR work
  • Currently being used for CP-IS and FGM
  • All Existing implementations to be evaluated
  • Move to new approach only if appropriate
  • It is a breaking change due to new FHIR assets using different URLs

How will NHS England IG be developed?

Curation Assurance Release
IOPS will manage the NHS England IG ensuring no duplication of profiles; normally maximum of 1 per resource type; and only allowing extensions to UK Core when deemed appropriate The contents of the NHS England IG will be assured by the NHS England SMEs from IOPS and programmes using a series of sprints as required C&TA - Teams calls and a 1-week review period Followed by release of the agreed assured content NHS England IG will follow UK Core (FHIR) statuses IG naming will be in sequences (following FHIR UK Core and FHIR approach) are named by status + sequence number

Content for Early Releases

The content for early releases of NHS England IG will primarily contain only FHIR assets and associated implementation guideance. However, future subsequent releases may also include common approaches, frameworks, patterns for exchange, as well as other content deemed appropriate in the future.

Process

  • Programme level IGs allowable but only for extra guidance, use cases etc
  • No programme specific FHIR assets
  • Strict C&TA process for NHS England IG and FHIR assets hosted by IOPS
  • C&TA to open to all NHS England stakeholders, programmes, boards etc
  • Strict quality control and release process of NHS England IG and FHIR Assets. Controlled release of the NHS England IG with an agreed schedule.

What does this mean to implementers?

  • Fewer profiles to build to
  • More consistency (less re-coding)
  • Potential faster implementation
  • More interoperability
  • Easier sharing of data
  • Potential cost savings

What does this mean to programmes?

  • Potential faster development
  • Less duplicate of effort
  • Potential cost savings
  • Programmes need to track UK Core development (C&TA sprints and ballots) and interact with the FHIR UK Core Technical Implementation Group

Important points

  • Vendors should be instructed to build to UK Core Profiles (with any NHS England extensions)
  • Validation if required, should be done using UK Core and NHS England profiles and extensions during testing, FoTs etc
  • Specific programme requirements can still be met

Alignment with government design principles

  • Do the hard work to make it simple - NHS England should be doing the work, not leaving it to external developers to resolve differences between API’s.
  • Be consistent, not uniform - We are not building tight profiles but profiling just enough to ensure consistency and aid interoperability.
  • Iterate. Then iterate again - The development processes and C&TA are iterative processes
  • Start with user needs - What do clinical users want - Quote from a clinical lead “a patient is a patient, why do we profile 7 times?”

Who does what?

Task IOPS Programme Team
Develop UK Core IG and FHIR assets Yes No
Track development of UK Core Yes Yes
Participate in UK Core C&TA Yes Yes*
Develop NHS England IG and FHIR assets Yes No
Track development of NHS England IG and FHIR assets Yes Yes
Participate in NHS England C&TA Yes Yes*
Create use case/programme level guidance Yes** Yes**


* If subject/scope is appropriate
** Optional – only if additional guidance is required and can be done by IOPS, the programme team or a joint development

How do we build use case specific implementation guides?

Please click here to view further guidance on this topic.

Maturity of standards vs need to deliver

  • Standards take time to mature
  • Delivery always seems to be needed yesterday
  • We all need to manage this and correctly communicate to implementers

ProfileMaturityAndStabilityDiagram

Evaluating the maturity

Teams are able to evaluate the maturity of profiles and other FHIR assets across both FHIR UK Core and NHS England IG to make appropriate decisions based on current maturity levels.

The maturity level scoring is based on the likelihood that the profile will subject to change in the future.

UK Core

Maturity Level Status Status Definitions
Mature Balloted - Active The FHIR assets have completed the C&TA process and the HL7 UK Ballot process, and all issues raised have been resolved and the FHIR assets updated as appropriate. These FHIR assets are now deemed stable and only minor changes are anticipated. No breaking changes are likely.
Intermediate Clinically & Technically Assured -Active The FHIR assets have completed the C&TA process, which means they have been assured by SMEs against example use cases and updated as required. The assets have been made active and are deemed stable and deemed low risk for changes to implementers. The HL7 UK Ballot may make changes to these assets, but although possible it is not likely to be major or breaking changes.
Initial Draft These FHIR assets have been created only to allow some initial development / implementation work. These have had some input from SMEs but no formal assurance and therefore are likely to have changes which may be breaking applied during C&TA and the HL7 UK Ballot. Implementations using these assets should feedback and participate in the assurance process. These FHIR assets are still implementable at risk.

NHS England

Maturity Level Status Status Definitions
Mature Clinically & Technically Assured -Active The FHIR assets have completed the C&TA process, which means they have been assured by SMEs against example use cases and updated as required. The assets have been made active and are deemed stable and deemed low risk for changes to implementers. Changes may be made to these assets, but although possible it is not likely to be major or breaking changes.
Initial Draft These FHIR assets have been created only to allow some initial development / implementation work. These have had some input from SMEs but no formal assurance and therefore are likely to have changes which may be breaking applied during C&TA. Implementations using these assets should feedback and participate in the C&TA process and which will move these to active status.