Requests and FHIR Workflow

This guidance is under active development by NHS Digital and content may be added or updated on a regular basis.


Workflow is an essential part of healthcare - orders, care protocols, referrals are the drivers of most activity within in-patient settings and a great deal of activity in community care as well. FHIR is concerned with workflow when there's a need to share information about workflow state or relationships, when there's a need to coordinate or drive the execution of workflow across systems and when there's a need to define allowed actions, dependencies and conditions on behavior.


The basic process for workflow is shown below:

Worklow has many know processes which normally involves a Request and a response (Event), such as:

Request Event
Prescription Dispense
Test Order Laboratory Report
Test Order Imaging Report
Referral Procedure / Consultation

These are mostly implemented as

  • HL7 v2/v3/FHIR Messages
  • Documents (via email, fax, etc)
  • EHR exchanges

These requests are often sent within one interaction which has a number of issues, this is described in Traditional Workflow

This guide focuses on alternative approaches to these requests (and associated events) which is generally caled called workflow, this workflow is based around clinical and health administration processes.

Use Cases


The workflow interactions all built on shared patient records:

Workflow Management

Workflow Management covers optimisations of workflow.

Organization of this guide

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