Virtually Healthcare HL7 FHIR Implementation Guide
0.1.0-current - ci-build United Kingdom flag

Virtually Healthcare HL7 FHIR Implementation Guide, published by Virtually Healthcare. This guide is not an authorized publication; it is the continuous build for version 0.1.0-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Virtually-Healthcare/Virtually-Healthcare-FHIR-Implementation-Guide/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Requirements: Actor Definitions

The following artifacts define the types of individuals and/or systems that will interact as part of the use cases covered by this implementation guide.

Clinical Data Consumer

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

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:

Directory Service

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

Event Consumer

The Event Consumer Actor receives events.

Event Service

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

Event Source

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

Form Registry

Repository for form definitions.

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

Form Repository

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:

Form Service

Provides pre-population and data extraction services

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

Service Facade

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.

Terminology Repository

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

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

Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

Facade - IM1 Patient EMIS

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.

Facade - IM1 Transaction EMIS

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.

Facade - IM1 Transaction TPP

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.

Facade - Organisation Data Service - FHIR API

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

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

Facade - Personal Demographics Service - FHIR API

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

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

Virtually Healthcare - Clinical Data Repository

The CDR adheres to the following standards:

The CDR closely follows:

Structures: Questionnaires

These define forms used by systems conforming to this implementation guide to capture or expose data to end users.

Pharmacy Nomination (for EMIS PFS)
Questionnaire-DailyPhysicalActivity

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

Questionnaire-ExerciseActivity

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

Questionnaire-VitalSigns

Questionnaire Vital Signs Definitions based on NHS England Clinical Observations

Questionnaire-eRSReferralRequest

Data capture definition for A011 Create Referral (Deprecated)

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

AllergyIntolerance

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

Composition

Extension of UKCore-Composition

Condition

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

DiagnosticReport

Extension of UKCore-DiagnosticReport

DocumentReference

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

Encounter

Extension of UKCore-Encounter

Immunization

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

MedicationRequest

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

Observation

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

Organization

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

Patient

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

Practitioner

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

Questionnaire

Based on HL7 Structured Data Capture

QuestionnaireResponse

Based on HL7 Structured Data Capture

ServiceRequest

Extension of UKCore-ServiceRequest

ServiceRequestReferral

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

Task

Based on FHIR Workflow

Structures: Data Type Profiles

These define constraints on FHIR data types for systems conforming to this implementation guide.

Codeable Reference

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

Common Resource Identifiers

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.

Medical Record Number

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

NHS, HCSN and CHI Numbers

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

Organisation Code

NHS Data Dictionary ORGANISATION_CODE

Organisation Site Identifier

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

Reference - RESTful

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

Reference - RESTful or Logical

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

SDS User Profile Id

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

Staff Enterprise Number

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.

UK Professional License

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

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

ExtCodeableReference

Replace with R5 backport or UKCore extension if they exist

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Medical Record System

A list of medical record systems.

SmokingStatus

Virtually Smoking Status

UK Common Resource Identifiers

UK Common Resource Identifiers

UK National Insurance Identifiers

UK NHS National Insurance Identifier

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

UK Professional License

UK Professional License

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

UK StaffNumber

UK StaffNumber

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

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Medical Record System

Medical Record Systems

Staff Number

UK Staff Numbers

UK Professional License

UK Professional License

UKCommonResourceIdentifiers

UK Common Resource Identifiers

UKNationalIdentifier

UK National Insurance Provider Identifier

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

243
93d2c059-a934-4796-827b-dee1158cc4dc
Bundle `Document` - Referral Letter

FHIR Document Referral Letter for Jack Dawkins

Condition - Dyspnoea

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 Cardiovascular event-risk

Condition-EMIS-IM1-Hypertension-monitoring

Condition EMIS IM1 Hypertension monitoring

Condition-EMIS-PFS-Cardiovascular-event-risk

Condition EMIS PFS Cardiovascular event-risk

DocumentReference-EMIS-IM1-Letter

DocumentReference EMIS IM1 Letter encounter

DocumentReference-EMIS-PFS-Letter

DocumentReference EMIS PFS Letter encounter

Example QuestionnaireResponse - QuestionnaireResponse-EMIS-PFS-patient-3-pharmacy-nomination
Immunization-EMIS-IM1-Influenza vaccination

Immunization EMIS IM1 Influenza vaccination

Immunization-EMIS-IM1-Pneumococcal-vaccination-declined

Immunization EMIS IM1 Pneumococcal vaccination declined

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

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

MedicationRequest-EMIS-PFS-Atorvastatin-10mg-tablets

MedicationRequest EMIS PFS Atorvastatin 10mg tablets

Observation CDR - Activity Duration

Patient Held Device Data Capture - Activity Duration

Observation CDR - Average Heart Rate

Patient Held Device Data Capture - Average Heart Rate

Observation CDR - Average Resting Heart Rate

Patient Held Device Data Capture - Average Resting Heart Rate

Observation CDR - Blood pressure

Form based Data Capture - Blood pressure

See also HL7 Blood pressure

For Device based data capture populate device instead of derivedFrom

Observation CDR - Body Mass Index

Form based Data Capture - Body Mass Index

See also HL7 FHIR Body Mass Index

For Device based data capture populate device instead of derivedFrom

Observation CDR - Body height

Form based Data Capture - Body height

See also HL7 FHIR Body height

For Device based data capture populate device instead of derivedFrom

Observation CDR - Body temperature

Form based Data Capture - Body temperature

See also HL7 FHIR Body temperature

For Device based data capture populate device instead of derivedFrom

Observation CDR - Body weight

Form based Data Capture - Body weight

See also HL7 FHIR Body weight

For Device based data capture populate device instead of derivedFrom

Observation CDR - Calories per Day

Patient Held Device Data Capture - Calories per Day

Observation CDR - Calories per activity

Patient Held Device Data Capture - Calories per activity

Observation CDR - Daily Step Count

Patient Held Device Data Capture - Daily Step Count

Observation CDR - Exercise Activity Walking

Patient Held Device Data Capture - Exercise Activity Walking

Observation CDR - Head circumference

Form based Data Capture - Head circumference

See also HL7 FHIR Head circumference

For Device based data capture populate device instead of derivedFrom

Observation CDR - Heart rate

Form based Data Capture - Heart rate

See also HL7 FHIR Heart rate

For Device based data capture populate device instead of derivedFrom

Observation CDR - Oxygen Saturation

Form based Data Capture - Oxygen Saturation

See also Hl7 FHIR Oxygen Saturation

For Device based data capture populate device instead of derivedFrom

Observation CDR - Peak Activity Heart Rate

Patient Held Device Data Capture - Peak Activity Heart Rate

Observation CDR - Peak daily heart rate

Patient Held Device Data Capture - Peak daily heart rate

Observation CDR - Physical Activity Panel

Patient Held Device Data Capture - Physical Activity Panel

Observation CDR - Respiratory rate

Form based Data Capture - Respiratory rate

See also HL7 FHIR Respiratory rate

For Device based data capture populate device instead of derivedFrom

Observation CDR - Vital Signs Panel

See also HL7 FHIR Vital Signs

Observation-EMIS-IM1-Plasma-glucose-level

Observation EMIS IM1 Plasma glucose level

Observation-EMIS-IM1-Systolic-blood-pressure

Observation EMIS IM1 Systolic blood pressure

Observation-EMIS-IM1-Urine-protein-test-not-done

Observation EMIS IM1 Urine protein test not done

Observation-EMIS-IM1-Weight

Observation EMIS IM1 Weight

Observation-EMIS-PFS-Plasma-glucose-level

Observation EMIS PFS Plasma glucose level

Observation-EMIS-PFS-Systolic-blood-pressure

Observation EMIS PFS Systolic blood pressure

Observation-EMIS-PFS-Urine-protein-test-not-done

Observation EMIS PFS Urine protein test not done

Observation-EMIS-PFS-Weight

Observation EMIS PFS Weight

Organization CDR - The Moir Medical Centre (C81010)

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

Organization NHS England - Leeds Teaching Trust (RR8)

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

Organization NHS England - The Moir Medical Centre (C81010)

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

Patient - Jack Dawkins NHS Number: 9912003888

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

Patient CDR - Rachel Kanfeld

Clinical Data Reposotory Rachel Kanfeld

Patient NHSEngland - Matthew Sheppard (9876543210)

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

Patient-EMIS-IM1-Arthur-Thomas

EMIS IM1 Patient Arthur Thomas

Patient-EMIS-IM1-Daniel-ODonnell

EMIS IM1 Patient Daniel O'Donnell

Patient-EMIS-IM1-William-Dyer

EMIS IM1 Patient William Dyer

Patient-EMIS-PFS-Daniel-ODonnell

EMIS PFS Patient Daniel O'Donnell

Patient-TPP-IM1-Anne-Smith

TPP IM1 Anne Smith

Patient-TPP-IM1-Anthony-Avocet

TPP IM1 Anthony Avocet

Practitioner-EMIS-IM1-Pauline-Steele

Practitioner EMIS IM1 Pauline Steele

Practitioner-TPP-IM1-Amit-Chawla

Practitioner TPP IM1 Amit Chawla

Referral Letter

Referral Letter

ServiceRequest - Create

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

Task-EMIS-IM1-Elderly-health-assessment

Task-EMIS IM1 Elderly health assessment

Task-EMIS-IM1-Medication-review

Task EMIS IM1 Medication review

Task-EMIS-PFS-Prescription-Refill

Task EMIS PFS Prescription Refill

ers-Referral-Request
questionnaireresponse-daily-physical-activity
questionnaireresponse-exercise-activity
questionnaireresponse-vital-signs