We have detected that you are using Internet Explorer to visit this website. Internet Explorer is now being phased out by Microsoft. As a result, NHS Digital no longer supports any version of Internet Explorer for our web-based products, as it involves considerable extra effort and expense, which cannot be justified from public funds. Some features on this site will not work. You should use a modern browser such as Edge, Chrome, Firefox, or Safari. If you have difficulty installing or accessing a different browser, contact your IT support team.
BETA – Use of FHIR-based APIs
All NHS digital, data and technology services should support FHIR-based APIs to enable the delivery of seamless care across organisational boundaries.
In a complex national health and care service the ability to provide timely and accurate information at the point of care is vital. It enables better clinical decision making, better experience for the patient and, most importantly, better outcomes.
To achieve this, information needs to flow with the patient, between different organisations, often using different systems, and to do this safely and securely requires the adoption of standards that will enable interoperability.
Our vision is to drive interoperability across the health and care system by ensuring that the national standards developed to support the exchange of information and data are adopted and implemented. The standards must be useful, useable, and used by the people who need them.
Interoperability priority areas
Existing programmes of work have identified the immediate priority areas for development that will deliver significant benefits to the system. These are: medicines and allergies reconciliation (care connect profiles); acute and emergency discharge summaries (Transfers of Care); use of the NHS Number and uptake of SNOMED CT.
A recent interoperability questionnaire of providers, vendors, and other professional bodies conducted by INTEROPen, working with PRSB, NHS England and NHS Digital has largely validated these interoperability priorities.
Transfer of Care
The transfer of care specifications are part of the NHS Standard Contract with the initial set of specifications covering:
- discharge from inpatient care
- discharge from mental health
- discharge from A&E
- outpatient clinic letters
Read more about Transfers of Care
Read more about the Transfers of Care technical specifications
CareConnect
The CareConnect content consists of specifications for individual resources as well as the record level collection of the same resources. In addition to the data models, APIs are also defined for implementation. These specifications will support the transfer of information for medications, allergies, observations, diagnoses, procedures and a range of other information.
As with Transfer of Care, CareConnect forms part of the NHS Standard Contract requirements.
CareConnect API developer information
The CareConnect API is an API definition based on the CareConnect profiles, as curated and published by INTEROPen.
The current scope of the development was to create an API that can be used in a point-to-point fashion, so as to allow read-only access to clinical data within care systems. The API has been developed as a RESTful API using the HL7 FHIR standard (STU3 version).
The content scope of the API includes the following information:
- patient
- allergies
- procedures
- problems
- observations
- encounters
- medications
- immunisations
- implementation guide
The API implementation guide describes the CareConnect API and provides help with implementation. It's created in a public GitHub repository. Feedback on the implementation guide can be emailed to apilabs@nhs.net or sent via the GitHub issues feature.
Reference implementation
A reference implementation of the API has been created to demonstrate the functionality of the CareConnect API and to assist the development community with implementing the API . The reference implementation is based on the FHIR HAPI project as an open source project. The project is published as a set of Docker images, to allow easier local deployment.
Access the open source code.
Access the design documentation.
NHS Digital hosts the Care Connect reference implementation.
A secured version of the reference implementation is available by changing ‘http’ to ‘https’ on the endpoints. If you access the secure side you will need to get a token generated first. Instructions are in the security section of the implementation guide.
Roadmap
The roadmap of work includes:
- enhancements to leverage the Spine Security Proxy
- enhancements to add a 'get record' retrieval method
- enhancements to align resource profiles to revised INTEROPen CareConnect profiles
Specifications available today
Fast Healthcare Interoperability Resources (FHIR) are part of an international family of standards developed by HL7 and are the direction of travel globally. The information models and APIs developed using this standard provide a means of sharing health and care information between providers and their systems no matter what setting care is delivered in.
Through collaboration with healthcare providers (NHS and social care organisations), system vendors (such as EPR and integration engine suppliers) and standards bodies (such as the Professional Record Standards Body (PRSB) and INTEROPen) a number of FHIR profile and specifications have been published and are being implemented. For example - Transfer of Care and CareConnect, with more in development.
National services such as National Record Locator Service (NRLS) are available today in interoperable FHIR standards. Work is underway to convert existing national services such as the Electronic Referrals System (eRS) and the Electronic Prescriptions Service (EPS) to use FHIR standards. This work will continue until critical national services and enablers are FHIR compatible.
In addition to these systems, there are a number of national enabler components which support uptake of the standards such as the CareConnect Reference Implementation which we are committed to further developing.
Figure 1 shows the interoperability specifications available today.
Please refer to appendix for details regarding each specification.
Potential future areas
A number of new interoperability strategic needs have been identified and are in various stages of development and early evaluation. We will develop a clear roadmap for them in consultation with providers, vendors and other key stakeholders over the coming months.
In early development | In early stages of evaluation |
---|---|
Urgent care appointments | ADT messaging |
Ambulance handover | eRostering |
Medications dose syntax | Integrated care planning |
Pharmacy stock control | Mental health crisis care planning |
Pathology | Care setting specific records: Acute, Outpatient, Dental, Ophthalmology, Mental Health, Community, A&E, Social Care |
Digital child health | |
Maternity | |
CareConnect Generic Record | |
Clinical observations |
Next steps
We will continue to work on ensuring key national services and enablers are compatible with FHIR standards and APIs, and support interoperability between local health and care organisations by continuing to provide a set of critical national capabilities such as National Record Locator Service, Spine Secure Proxy, and National Events Management Service.
We recognise that getting standards into practice is an adaptive change process and needs to be driven through service transformation. In this way, there are not standards programmes but service transformation programmes where we embed standards. Consequently, we will look to embed standards in programmes such as the Global Digital Exemplars, Local Health and Care Records and as part of centrally funded programmes such as Health System Led Investment to better capture opportunities for change. We will also support local health and care organisations to embed interoperability standards across a variant endpoint estate. In addition, we will look to embed these interoperability standards into future commercial frameworks such as GP IT Futures and the Health System Supplier Framework.
The health and social care service has benefited greatly from the collaboration of providers (NHS and social care organisations), system vendors (such as EPR and integration engine suppliers) and standards bodies (such as the PRSB and INTEROPen) and we will continue to work collaboratively with clear accountabilities to develop and implement interoperability standards.
In addition, we will enable the ecosystem by providing interoperability reference tools and sandboxes for developers and continue to partner with like-minded organisations, like the DRIVE unit at Great Ormond Street Hospital, to create vibrant forums for innovation.
Appendix: Interoperability specifications currently available
The following tables describe the technical specifications that exist or are in development within NHS Digital. For each a brief description is provided together with its development status and a link to where further information can be obtained.
Local/regional services
Resource | Description of technical specification | Technical standard | Contnet standard | Status | Location |
---|---|---|---|---|---|
NHS 111 |
A collection of APIs to support the NHS 111 integrated workflow, all created some time ago using the HL7v3 standard. These APIs are widely deployed and in use:
|
Yes – non-FHIR | Yes | Available for use. In widescale use across the 111 estate. | |
GP Data Access (IM1) |
These are proprietary APIs published by the Primary Care suppliers. Each supplier has their own API. They cover three areas:
|
Yes – non-FHIR | No | Available for use. Proprietary APIs implemented across the estate. | Access to the APIs and documentation is controlled by the NHS Digital IM1 team and associated pairing process. |
GP Connect |
A collection of FHIR based APIs to provide modern, consistent APIs for the Primary Care systems. These APIs consist of:
The View Access Record (HTML) API is in First of Type with the target for full roll out approval for the majority of the market in Q4 18/19. The roadmap for delivery is available directly from the programme. |
Yes |
Yes – record structure No – resource level specifications |
Available for use. Specifications are subject to minor change as all are being developed against. View Access Record (HTML) is in First of Type. All suppliers have built to the specification. Appointment Management will be in First of Type early in Q4 18/19 with the two suppliers who make up the majority of the market. Structured Medications and Allergies will be in First of Type in Q4 18/19. Other specifications are starting the curation process in Q4 18/19 subject to resource availability. |
|
Urgent Care Appointments |
A new FHIR based API, still in early stages of development to allow enable the booking of appointments into unscheduled care settings. UEC / 111 suppliers will be entering First of Type in Q4 18/19 to book appointments into the GP Systems. |
In development | In development | In development. | https://github.com/nhsd-a2si/docs-dos-api |
End of Life Care |
A new FHIR based API, still in development to allow the sharing of End of Life Care preferences. Discussions are underway to secure a First of Type partner to test the API to validate the API with. |
Yes |
Yes – record structure No – resource level specifications |
Available for use as alpha. | https://nhsconnect.github.io/FHIR-END-OF-LIFE-API/index.html |
GP2GP Record Transfer |
An older API based on the HL7v3 standard used for moving patient’s healthcare records between Primary Care suppliers. Deployed across all Primary Care suppliers. |
Yes | Yes | Available for use. In widespread use across the primary care estate. |
TRUD - NHS Messaging Implementation Manual and also at the NHS Digital API catalogue |
Transfer of Care |
A collection of four different FHIR based clinical documents used to facilitate the transfer of care between care professionals. All of these clinical documents make use of associated standards published by the Professional Record Standards Body (PRSB). The documents consist of:
|
Yes |
Yes – record structure No – resource level specifications |
Available for use. Pilots underway. Dependency on GP system suppliers limiting progress. |
Transfer of care specifications versions
|
Digital Medicines |
Two different FHIR based clinical documents used to facilitate the exchange of data between community pharmacies and primary care. All of these clinical documents make use of associated standards published by the Professional Record Standards Body (PRSB). The documents consist of:
Currently published as “Beta” standards. Further initiatives using FHIR standards currently in development:
|
Yes | Yes |
Available for use. |
|
Social Care – Assessment, Discharge and Withdrawal |
A set of FHIR based messaging APIs to support the exchange of structured information between health and social care organisations. |
Yes | Yes | Available for use as part of beta. Implementation as part of funded first of types in progress. |
The APIs are published as Beta APIs and are located at: |
National Services
Project | Description of technical specification | Technical standard | Content standard | Status | Location |
---|---|---|---|---|---|
National Data Opt-Out |
A FHIR based API for setting opt-out preferences. |
Yes | Yes | Available for use as part of beta testing. | |
NHS.UK Data Services |
A collection of APIs to allow access and syndication of NHS.UK data. These APIs are Live. |
Yes – non-FHIR | Yes | Available for use. | |
Directory of Services (Urgent Care) |
The Directory of Services (DoS) provides APIs to allow third-party systems to retrieve service information. Currently, a combination of search functions and individual record retrieval is supported. | Yes – non-FHIR | Yes | Available for use. | https://github.com/nhsd-a2si/docs-dos-api |
Organisation Data Service (ODS) |
Two APIs exist in this space both deployed into Live service May 2018. The ORD API is an XML/JSON based API that is aligned to the existing DCB standard for representing ODS organisation data. The primary use case for this API is for local synchronisation of the ODS data store to a local copy. |
Yes – non-FHIR | Yes | Available for use. | |
The ODS Lookup API is a FHIR based API available as either XML or JSON. The primary use case for this API is the discovery and retrieval of data around single organisations. | Yes | Yes | Available for use. | FHIR® ODS Lookup API | |
Personal Demographics Service (PDS) |
The original PDS API is a HL7v3 API and has been live for many years. It is extensively deployed across the service. |
Yes – non-FHIR | Yes | Available for use. Requires updates to utilise FHIR standard. |
TRUD - NHS Messaging Implementation Manua and also at NHS Digital's API catalogue |
A 'PDS Mini Service' API also exists for accessing PDS data (also a HL7v3 API). This allows access with different IG rules, though as a consequence will only return a minimal subset of the overall PDS record and allows for much reduced query functionality. PDS Mini services were originally deployed by industry but is now also available directly from Spine. |
Yes – non-FHIR | Yes | Available for use. Requires updates to utilise FHIR standard. |
Spine Mini Service Provider for Personal Demographics Service |
|
Visitors and Migrants |
This is a FHIR based RESTful API that provides 'read only' access to indicators used to support the Department of Health (DoH) Cost Recovery program for secondary care treatment provided to patients that are not eligible to receive free NHS care. | Yes | Yes | Available for use as part of beta testing. | https://nhsconnect.github.io/visitor-and-migrants/index.html |
Summary Care Record |
The Summary Care Record API is based on the HL7v3 standard and has been 'Live' for many years. Initiative in development to provide a means of accessing audit information regarding access to SCR. |
Yes - non-FHIR | Yes | Available for use. Requires updating to utilise FHIR standard |
TRUD - NHS Messaging Implementation Manua and also at NHS Digital's API catalogue |
Child Protection Information System (CP-IS) |
The CP-IS API is based on the HL7v3 standard and has been live for some time. |
Yes – non-FHIR | Yes | Available for use. Requires updating to utilise FHIR standard. | TRUD - Child Protection Information Sharing Domain Message Specification |
FGM Risk Indication System |
The Female Genital Mutilation risk indication system is a FHIR based API currently published as a 'Release Candidate'. |
Yes | Yes | Available for use. | FHIR Implementation Guide |
Electronic Prescribing Service |
The APIs in this area were created as HL7v3 APIs and have been live for many years. EPS is extensively deployed across the service. |
Yes – non-FHIR | Yes | Available for use. Requires updating to utilise FHIR standard. |
TRUD - NHS Messaging Implementation Manua and also at NHS Digital's API catalogue |
EPS Prescription Tracker |
This API has been developed to complement the EPS APIs above. The API uses an XML/JSON format that is loosely connected to the HL7v3 standard. The API is currently being enhanced to meet new use cases. |
Yes – non-FHIR | Yes | Available for use. Requires updating to utilise FHIR standard. | https://nhsconnect.github.io/spine-eps-tracker/index.html |
Electronic Referrals System (eRS) |
The eRS system makes used of the APIs originally created for the 'Choose and Book' system created as part of the National Programme. These APIs have been deployed for some time. |
Yes – non-FHIR |
Yes – technical elements No – record standard |
Available for use. Requires updating to utilise FHIR standard. |
TRUD - NHS Messaging Implementation Manua and also at NHS Digital's API catalogue |
In addition, the programme has developed several new APIs that make use of the FHIR standard. There are a mixture of APIs of varying maturity. The earlier FHIR APIs are now live with the more recent ones still at an Alpha status. |
Available for use. | The locations of the APIs are published at NHS Digital's API catalogue |
Enablers
Project | Description of technical specification | Technical standard | Content standard | Status | Location |
---|---|---|---|---|---|
Interoperability Toolkit (ITK) |
There are two versions of the ITK. The original, older version (Version 2.x) is a proprietary XML based standard which has been adopted in a number of areas. Significant areas of use include Spine Mini Services and the national NHS 111 solution. | Yes – non-FHIR | Yes | Live and in use. | The ITK 2.x standard is 'Live' and is published on TRUD |
The ITK3 versions is part of the delivery of a number of other systems, including:
|
Yes | No | Available for implementation now as a beta test. |
|
|
National Record Locator Service (NRLS) |
This is a FHIR based API that is currently in development with a Beta status. The NRLS is expected to be released in a phased manner. The first phase of NRLS has now been implemented. |
Yes | Yes - metadata | Live and in use as of November 2018. | Introduction to NRL FHIR® API |
Care Connect Profiles |
The Care Connect profiles are a set of nationally agreed FHIR profiles localised for the UK. They have been co-produced by the INTEROPen collaborative through a process of curation, which includes vendor involvement. They are used as underpinning components for the delivery of many other national APIs referenced within this document. |
Yes – resources No – record level |
No |
Data structures ready for use. Work required to support API elements such as parameters. |
|
Event Management Service |
This is a set of FHIR based APIs to support the dissemination of information using events. Allowing for events to be raised and delivered to parties with valid subscriptions. | Yes | Yes | Available for beta testing. | Introduction to National Events Management Service |
Message Exchange for Social Care and Health (MESH) |
MESH is a messaging service available across health and social care that enables the safe, secure delivery of electronic messages. The service is extensively used. |
Yes - non-FHIR | Yes – technical transport | In widescale use. |
|
NHS Identity | NHS Identity is the new authentication service which will allow staff to authenticate to clinical applications over the internet and using a range of devices in addition to a smartcard such as a tablet or a phone. The service is currently being configured and implemented and a pilot accessing SCRa via iPads in the London Ambulance Trust will commence in March 2019. | Yes | Yes | In development. Currently being piloted. |
NHS Identity: guidance for developers
|
NHS Login | National solution for verifying the identity of those requesting access to digital health records and services. | Yes | Yes | In development. Currently being piloted. | NHS login |
Enablers
Project | Description of technical specification | Technical standard | Content standard | Status | Location |
---|---|---|---|---|---|
Interoperability Toolkit (ITK) |
There are two versions of the ITK. The original, older version (Version 2.x) is a proprietary XML based standard which has been adopted in a number of areas. Significant areas of use include Spine Mini Services and the national NHS 111 solution. | Yes – non-FHIR | Yes | Live and in use. | The ITK 2.x standard is 'Live' and is published on TRUD |
The ITK3 versions is part of the delivery of a number of other systems, including:
|
Yes | No | Available for implementation now as a beta test. | ITK3 Messaging Distribution specification versions | |
National Record Locator Service (NRLS) |
This is a FHIR based API that is currently in development with a Beta status. The NRLS is expected to be released in a phased manner. The first phase of NRLS has now been implemented. |
Yes | Yes - metadata | Live and in use as of November 2018. | Introduction to NRL FHIR® API |
Care Connect Profiles |
The Care Connect profiles are a set of nationally agreed FHIR profiles localised for the UK. They have been co-produced by the INTEROPen collaborative through a process of curation, which includes vendor involvement. They are used as underpinning components for the delivery of many other national APIs referenced within this document. |
Yes – resources No – record level |
No |
Data structures ready for use. Work required to support API elements such as parameters. |
|
Event Management Service |
This is a set of FHIR based APIs to support the dissemination of information using events. Allowing for events to be raised and delivered to parties with valid subscriptions. | Yes | Yes | Available for beta testing. | Introduction to National Events Management Service |
Message Exchange for Social Care and Health (MESH) |
MESH is a messaging service available across health and social care that enables the safe, secure delivery of electronic messages. The service is extensively used. |
Yes - non-FHIR | Yes – technical transport | In widescale use. | |
NHS Identity | NHS Identity is the new authentication service which will allow staff to authenticate to clinical applications over the internet and using a range of devices in addition to a smartcard such as a tablet or a phone. The service is currently being configured and implemented and a pilot accessing SCRa via iPads in the London Ambulance Trust will commence in March 2019. | Yes | Yes | In development. Currently being piloted. | |
NHS Login | National solution for verifying the identity of those requesting access to digital health records and services. | Yes | Yes | In development. Currently being piloted. |