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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 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

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.

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:

  • NHS 111 Report
  • NHS Ambulance Request
  • NHS Repeat Caller
Yes – non-FHIR Yes Available for use. In widescale use across the 111 estate.

Technology Reference data Update Distribution

GP Data Access (IM1)

These are proprietary APIs published by the Primary Care suppliers. Each supplier has their own API. They cover three areas:

  • APIs delivering real time access to patient record and appointment booking for patient facing applications such as NHS App
  • Desktop based APIs for tight practice-based application integration 
  • Bulk data – provides bulk data as CSV, delivered by sFTP, mostly for secondary use purposes
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:

  • View Access Record (HTML)
  • View Access Record (Structured) initially Medications and Allergies only.
  • Appointment Management
  • Writeback into the Record for unstructured consultation update. Facility would also support Digital Medications and Transfer of Care (subject to commissioning) 

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.

https://digital.nhs.uk/services/gp-connect/gp-connect-specifications-for-developers

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 https://developer.nhs.uk/apis/ 

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:

  • eDischarge (inpatient discharge summary) Document 
  • Mental Health eDischarge Document 
  • Emergency Care eDischarge Summary Document
  • Outpatient Letter Document 
Yes

Yes – record structure

No – resource level specifications

Available for use.  Pilots underway.

Dependency on GP system suppliers limiting progress.

https://digital.nhs.uk/services/interoperability-toolkit/developer-resources/transfer-of-care-specification-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:

  • Pharmacy Immunisation Administration
  • Pharmacy Emergency Medication Supply

Currently published as “Beta” standards.

Further initiatives using FHIR standards currently in development:

  • Enable creation of a “Medication Dose Syntax” that can safely describe medication dosages.
  • Enable communication between prescribing systems and stock controls systems within hospitals
  • Provide means of using the dose syntax with admission communications
  • Provide means of using the dose syntax with discharge communications
Yes Yes

Available for use.

https://digital.nhs.uk/services/fhir-apis/guidance-for-developers/digital-medicine-specification

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: https://digital.nhs.uk/services/transfer-of-care-initiative/assessment-discharge-and-withdrawal---developer-resource

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. https://developer.nhs.uk/apis/optout/

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. https://developer.api.nhs.uk/nhs-api

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. https://digital.nhs.uk/services/organisation-data-service/guidance-for-developers
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. https://developer.nhs.uk/apis/ods/

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 https://developer.nhs.uk/apis/

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. https://digital.nhs.uk/services/spine/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 https://developer.nhs.uk/apis/

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 https://developer.nhs.uk/apis/

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 https://developer.nhs.uk/apis/

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: https://developer.nhs.uk/apis/

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:

  • Transfers of Care
  • Digital Medicines
  • GP Connect
  • Digital Child Health
Yes No Available for implementation now as a beta test. https://digital.nhs.uk/services/interoperability-toolkit/developer-resources/itk3-test-harness/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. https://developer.nhs.uk/apis/nrl/
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.
https://fhir.hl7.org.uk/

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. https://developer.nhs.uk/apis/ems-beta/
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. https://digital.nhs.uk/services/message-exchange-for-social-care-and-health-mesh
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. https://digital.nhs.uk/services/nhs-identity/guidance-for-developers/an-introduction-to-nhs-identity
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. https://digital.nhs.uk/about-nhs-digital/our-work/transforming-health-and-care-through-technology/empower-the-person-formerly-domain-a/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:

  • Transfers of Care
  • Digital Medicines
  • GP Connect
  • Digital Child Health
Yes No Available for implementation now as a beta test. https://digital.nhs.uk/services/interoperability-toolkit/developer-resources/itk3-test-harness/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. https://developer.nhs.uk/apis/nrl/
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.
https://fhir.hl7.org.uk/

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. https://developer.nhs.uk/apis/ems-beta/
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. https://digital.nhs.uk/services/message-exchange-for-social-care-and-health-mesh
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. https://digital.nhs.uk/services/nhs-identity/guidance-for-developers/an-introduction-to-nhs-identity
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. https://digital.nhs.uk/about-nhs-digital/our-work/transforming-health-and-care-through-technology/empower-the-person-formerly-domain-a/nhs-login
Last edited: 8 October 2019 8:56 am