The Clinical Data Consumer sends FHIR-based queries to the Clinical Data Repository which exposes data in a clinical data repository

The Clinical Data Repository is responsible for the persistent storage of clinical data items (observations, conditions, immunisations, etc). E.g. PHR, EHR and EPR

Links to detailed elaboration on this actor can be found in:

• IHE Query for Existing Data for Mobile (QEDm). IHE refers to this actor as Clinical Data Source.
• HL7 Internation Patient Access, IPA refers to this actor as clinical records system.

Provides lookup or query services for master Organisation, Facility, Location, Practitioner, Healthcare Service, OrganisationAffiliation, and Endpoint records which meet specific criteria.

The Event Consumer Actor receives events.

The Event Service is an Event Messaging Endpoint for Trust Integration Engine (TIE) or similar Messaging Systems.

The Event Source Actor produces events based event triggers which occur during clinical activity (e.g. patient discharged).

Repository for form definitions.

Links to detailed elaboration on this actor can be found in:

• HL7 Structured Data Capture in this guide. This actor is referred to in this guide as a Form Manager.
• IHE Retrieve Form for Data Capture (RFD)

The Form Repository is responsible for both the persistent storage of forms (and many archetypes).

Links to detailed elaboration on this actor can be found in:

• HL7 Structured Data Capture
• IHE Retrieve Form for Data Capture (RFD)

Provides pre-population and data extraction services

Links to detailed elaboration on this actor can be found in:

• HL7 Structured Data Capture. This actor is referred to in this guide as a Form Manager.
• IHE Retrieve Form for Data Capture (RFD)

This is a facade service.

This acts as an Anti-Corruption-Layer which transforms data models in external services to an enterprise canonical data model/domain model.

Central repository of codesystems (e.g. UK SNOMED CT), valuesets and concept maps.

Links to detailed elaboration on this actor can be found in:

• NHS England Terminology Server, this refers to this actor as terminology server
• IHE Sharing Valuesets, Codes, and Maps (SVCM).

This is a Service Facade to IM1 Patient

This is influenced by HL7 International Patient Access

This is not a complete description of the API and so does not represent the actual implemented API or capabilities of the GP provider. This is a facade to the GP System IM1, this is not the API provided by the GP System.

This is a Service Facade to IM1 Transaction

This is not a complete description of the API and so does not represent the actual implemented API or capabilities of the GP provider. This is a facade to the GP System IM1, this is not the API provided by the GP System.

This is a Service Facade to IM1 Transaction

This is not a complete description of the API and so does not represent the actual implemented API or capabilities of the GP provider. This is a facade to the GP System IM1, this is not the API provided by the GP System.

This is a Service Facade to Organisation Data Service - FHIR API

This facade is related to IHE Mobile Care Services Discovery (mCSD)

This is a Service Facade to Personal Demographics Service - FHIR API

This facade is related to IHE Patient Demographics Query for Mobile (PDQm)

The CDR adheres to the following standards:

• UK SNOMED CT and LOINC for our clinical terminology.
• NHS Data Dictionary for identifiers and values, such as NHS Number, GMC, GMP, ODS, etc.
• HL7 UK Core

The CDR closely follows:

• HL7 International Patient Access Server
• IHE Query for Existing Data for Mobile (QEDm) Server
• HL7 UK - UK Core Access

Questionnaire Daily Physical Activity based on time based measures from HL7 Physical Activity Implementation Guide

Questionnaire Exercise Activity based on activity based measures from HL7 Physical Activity Implementation Guide

Questionnaire Vital Signs Definitions based on NHS England Clinical Observations

Data capture definition for A011 Create Referral (Deprecated)

Extension to UKCore AllergyIntolerance and includes elements from HL7 International Patient Access

Extension of UKCore-Composition

Extension to UKCore Condition and includes elements from HL7 International Patient Access

Extension of UKCore-DiagnosticReport

Extension to future UKCore DocumentReference and includes elements from HL7 International Patient Access

Extension of UKCore-Encounter

Extension to UKCore Immunization and includes elements from HL7 International Patient Access

Extension of UKCore-MedicationRequest and includes elements from HL7 International Patient Access

Extension of UKCore-Observation and includes elements from HL7 International Patient Access

Extension of UKCore Organization and includes elements from IHE Mobile Care Services Discovery (mCSD)

Extension of UKCore-Patient and includes elements from HL7 International Access

Extension of UKCore Practitioner and includes elements from IHE Mobile Care Services Discovery (mCSD)

Based on HL7 Structured Data Capture

Based on HL7 Structured Data Capture

Extension of UKCore-ServiceRequest

Is based on requirements present in e-Referral Service - FHIR API, converted to HL7 FHIR R4.

Based on FHIR Workflow

Backport of CodeableReference in HL7 FHIR R4 to support coded Conditions rather than resource references.

Common Resource Identifiers

This is aimed at being HL7 v2 compatible, in particular HL7 v2 OBX and HL7 FHIR Observation, see Segment OBX to Observation Map for detailed mapping.

Only use in FHIR Reference if the NHS Number is not known or unverified.

NHS Data Dictionary: NHS NUMBER, COMMUNITY HEALTH INDEX NUMBER and HEALTH AND CARE NUMBER

NHS Data Dictionary ORGANISATION_CODE

NHS Data Dictionary ORGANISATION SITE IDENTIFIER

Use ODS Site code relevant for organisation. E.g. Use Mid Yorkshire Hospitals NHS Trust (RXF) version of Pinderfields Hospital (RXF05) when referring to Mid Yorks, not others in the director

A Reference data type where the referenced resource is expected to be resolvable RESTfully.

A Reference data type where the referenced resource could be resolvable RESTfully or pointed to logically.

In NHS Englands Spine Directory Service this is the uniqueIdentifier in the nhsOrgPerson and nhsOrgPersonRole object (confirm this is true). This MISSING formal definition of this type

HL7 v3/OID: 1.2.826.0.1285.0.2.0.67

UK Professional Licence should take precedence over staff numbers (i.e. SDS User Id) in HL7 FHIR Reference and other interoperability standards.

E.g. SDS User ID and Ministry of Defence Doctor.

NHS Data Dictionary CONSULTANT CODE and GENERAL MEDICAL PRACTITIONER PPD CODE.

Replace with R5 backport or UKCore extension if they exist

A list of medical record systems.

Virtually Smoking Status

UK Common Resource Identifiers

UK NHS National Insurance Identifier

E.g. NHS Number (England and Wales) and CHI Number (Scotland)

UK Professional License

E.g. GMC, HCPC, GMP, etc numbers.

UK StaffNumber

E.g. SDS User Id and Ministry of Defence Doctor Number

Medical Record Systems

UK Staff Numbers

UK Professional License

UK Common Resource Identifiers

UK National Insurance Provider Identifier

FHIR Document Referral Letter for Jack Dawkins

Condition Dyspnoea Jack Dawkins NHS Number: 9912003888

Loosely based on NHS Digital End of Life Care FHIR STU3 - Advance Treatment Preferences Atomic Unit

Condition EMIS IM1 Cardiovascular event-risk

Condition EMIS IM1 Hypertension monitoring

Condition EMIS PFS Cardiovascular event-risk

DocumentReference EMIS IM1 Letter encounter

DocumentReference EMIS PFS Letter encounter

Immunization EMIS IM1 Influenza vaccination

Immunization EMIS IM1 Pneumococcal vaccination declined

MedicationRequest EMIS IM1 Amoxicillin 125mg/5ml oral suspension sugar free

MedicationRequest EMIS PFS Atorvastatin 10mg tablets

Patient Held Device Data Capture - Activity Duration

Patient Held Device Data Capture - Average Heart Rate

Patient Held Device Data Capture - Average Resting Heart Rate

Form based Data Capture - Blood pressure

See also HL7 Blood pressure

For Device based data capture populate device instead of derivedFrom

Form based Data Capture - Body Mass Index

See also HL7 FHIR Body Mass Index

For Device based data capture populate device instead of derivedFrom

Form based Data Capture - Body height

See also HL7 FHIR Body height

For Device based data capture populate device instead of derivedFrom

Form based Data Capture - Body temperature

See also HL7 FHIR Body temperature

For Device based data capture populate device instead of derivedFrom

Form based Data Capture - Body weight

See also HL7 FHIR Body weight

For Device based data capture populate device instead of derivedFrom

Patient Held Device Data Capture - Calories per Day

Patient Held Device Data Capture - Calories per activity

Patient Held Device Data Capture - Daily Step Count

Patient Held Device Data Capture - Exercise Activity Walking

Form based Data Capture - Head circumference

See also HL7 FHIR Head circumference

For Device based data capture populate device instead of derivedFrom

Form based Data Capture - Heart rate

See also HL7 FHIR Heart rate

For Device based data capture populate device instead of derivedFrom

Form based Data Capture - Oxygen Saturation

See also Hl7 FHIR Oxygen Saturation

For Device based data capture populate device instead of derivedFrom

Patient Held Device Data Capture - Peak Activity Heart Rate

Patient Held Device Data Capture - Peak daily heart rate

Patient Held Device Data Capture - Physical Activity Panel

Form based Data Capture - Respiratory rate

See also HL7 FHIR Respiratory rate

For Device based data capture populate device instead of derivedFrom

See also HL7 FHIR Vital Signs

Observation EMIS IM1 Plasma glucose level

Observation EMIS IM1 Systolic blood pressure

Observation EMIS IM1 Urine protein test not done

Observation EMIS IM1 Weight

Observation EMIS PFS Plasma glucose level

Observation EMIS PFS Systolic blood pressure

Observation EMIS PFS Urine protein test not done

Observation EMIS PFS Weight

Organisation The Moir Medical Centre (C81010), imported from ODS CSV Downloads

Organization NHS England ODS FHIR Api - Leeds Teaching Trust (RR8)

Organization NHS England ODS FHIR Api - The Moir Medical Centre (C81010)

Loosely based on NHS Digital End of Life Care FHIR STU3 - Demographics Atomic Unit

Clinical Data Reposotory Rachel Kanfeld

Patient NHS England PDS FHIR Api - Int Environment Matthew Sheppard (9876543210)

EMIS IM1 Patient Arthur Thomas

EMIS IM1 Patient Daniel O'Donnell

EMIS IM1 Patient William Dyer

EMIS PFS Patient Daniel O'Donnell

TPP IM1 Anne Smith

TPP IM1 Anthony Avocet

Practitioner EMIS IM1 Pauline Steele

Practitioner TPP IM1 Amit Chawla

Referral Letter

​Example conversion of $ers.createReferral multishortlist to FHIR R4 ServiceRequest in a Clinical Data Repository

Task-EMIS IM1 Elderly health assessment

Task EMIS IM1 Medication review

Task EMIS PFS Prescription Refill