WARNING
This guidance is under active development by NHS England and content may be added or updated on a regular basis.It is NOT currently recommended to develop against this guidance.
Add Reasonable Adjustment Record
Overview
For high level requirements, see Home.
Use Case
After obtaining consent from a patient, a Reasonable Adjustment Record may be created. This consists of a Flag resource containing an adjustment and a Condition resource may also optionally be created to record the details of an impairment.
If a Reasonable Adjustment Record exists, a Flag resource designated as the patient flag must be created to indicate that there are reasonable adjustments recorded for the patient. There is a single instance of this type of resource per patient.
System Interactions
The practitioner decides to record a condition with the patients consent. This could be done with individual calls to the required endpoints, or can be done in a single transaction Bundle. A transaction Bundle can help with data integrity requirements and also help to reduce required http calls.
Examples
The following set of examples constitute the individual associated resources with the initial addition of a flag for Reasonable Adjustment. This includes a patient Flag resource, the adjustment Flag resource and the associated Condition resource. All resources have contained provenances.
A transaction Bundle is also given that allows these resources (plus the patient) to be entered in an atomic traction. It uses PUTs, where in the case of an initial update, it may be done as a conditional update
The following set of examples are for the same patient, and constitute an addition flag and condition. The transaction Bundle here illustrates an idempotent update by simply adding the new resources to the first transaction Bundle.
Retrieve Reasonable Adjustment Record
Overview
For high level requirements, see Home.
Use Case
A Reasonable Adjustment Record may be retrieved if it exists. It will be possible to determine that adjustment flags exist by searching for a England Flag Patient Flag with:
- the code
national-reasonable-adjustments-flag
(see England Flag Category Patient), - or England Flag Patient Flag with a category of
national-reasonable-adjustments-flag
(see England Flag Category Patient).
System Interaction
Queries
Using FHIR search capabilities, it is possible to retrieve the reasonable adjustment records in several ways.
Patient endpoint search
This section describes how to query from the Patient endpoint using FHIR search
This will return all associated flag resources for Reasonable Adjustments.
GET /Patient?identifier=9912003888&_has:Flag:patient:code=NRAF&_has:Flag:patient:category=NRAF&_revinclude=Flag:patient&_has:Condition:patient:category=NRAF&_revinclude=Condition:patient
This limits the search to patients that have the identifier 9912003888
identifier=9912003888
This limits the search to patients that have Flag resources linked via patient and have the code NRAF, and also includes the resource in the returned searchset Bundle.
&_has:Flag:patient:code=NRAF&_revinclude=Flag:patient
This limits the search to patients that have Flag resources linked via patient and have the category NRAF, and also includes the resource in the returned searchset Bundle.
&_has:Flag:patient:category=NRAF&_revinclude=Flag:patient
This limits the search to patients that have Condition resources linked via patient and have the category NRAF, and also includes the resource in the returned searchset Bundle.
&_has:Condition:patient:category=NRAF&_revinclude=Condition:patient
The following queries will return all or some of the resources constituting a Reasonable Adjustments record, i.e.
This query relies on the England FlagCategory and FlagCode-MISSING SearchParameters.
Flag endpoint search
This section describes how to query from the Flag endpoint using FHIR search
NOTE: For every additional record/resource added, the flag-detail element in the Patient Flag resource will need updated.
If the flag-detail extension is used, then references to all Reasonable Adjustment resources can be included in the England Flag Patient Flag resource.
This will return all associated flag resources for Reasonable Adjustments.
http://localhost:8080/fhir/Flag?patient.identifier=9912003888&_include=Flag:detail&_include=Flag:patient
This limits the search to patients that have the identifier 9912003888
patient.identifier=9912003888
This includes all references in the flag detail extension that have been defined in the England FlagDetail SearchParameter.
&_include=Flag:detail
This includes the associated patient resource.
&_include=Flag:patient
This query relies on the England FlagCategory, England FlagCode, and England FlagDetail SearchParameters.
Remove Reasonable Adjustment Record
Overview
A patient and/or practitioner decide to remove the reasonable adjustment record.
For high level requirements, see Home.
Use Case
System Interactions
In the following sequence diagram, a patient and/or practitioner decide to remove the reasonable adjustment record. All adjustment records are deleted.
The following resource types will be deleted from the record:
Example
Multiple resources can be deleted using a transaction bundle. This RemoveRARecord-Bundle-Example demonstrates deleting the following resources
- PatientFlag-AlanMann-Example example.
- RA-Flag-Example example.
- RA-Condition-Example example.