BETA – Use of FHIR-based APIs

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.

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 here.

Read more about the Transfers of Care technical specifications here.

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 is hosting two instances of the reference implementation. These can be accessed via the internet and do not require an N3 network.

Main/stable release environment.
Development environment.

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

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.

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.

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.

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

National Services

Enablers