Booking and Referral Standard

A patient journey - from the patient presenting with symptoms, to appropriate treatment then discharge - often involves two or more NHS services. Booking, clinical and administrative information need to follow the patient at all stages of this journey. This frequently requires paper processes and multiple healthcare IT systems which can be inefficient.

The BaRS ensures healthcare professionals receive the information they need, in a format they can use, integrated into their existing healthcare IT systems.

The Government's Plan for Digital Health and Social Care states:

It's now available for the following care journeys:

• between NHS 111/ clinical assessment services (CAS) and emergency departments (also known as A&E)
• between NHS 111/CAS and urgent treatment centres (UTC)

With the care journeys below to follow:

• between 999 and CAS for referral
• between 999 and CAS for ambulance validation

You can monitor supplier progress in implementing BaRS on our supplier status page.

The experience gained from these initial implementations will help to improve the standard ahead of making it available to all appropriate NHS services in England, such as pharmacy, via their healthcare IT systems.

We are going to:

• build the necessary national infrastructure and components that will underpin delivery of BaRS
• provide a messaging standard that allows multiple systems to communicate with each other in a simple and logical way
• publish a standard that supports the administrative task of booking a patient into their next care setting, as well as providing the correct and relevant clinical referral information to care givers so that they can make or accept a patient referral
• produce a standard that is accepted, agreed and adopted by health care system providers and rolled out across the health system to improve patient experience and care outcomes

National interoperability standards, such as BaRS and the digitisation of booking and referrals are important priorities for the NHS as described in the Long Term Plan, Future of Healthcare Vision and NHS Transformation Directorate Delivery Plan.

An interoperability standard for patient booking and referrals will have several benefits.

Patients will:

• be able to efficiently book appointments and time slots with the service that's right for them
• get the right advice and treatment when they most need it, safely and easily

Healthcare workers will:

• receive the information they require, and in sufficient detail, to enable them to undertake the patient care activity requested
• be able to triage the patient without asking them to unnecessarily repeat information already collected earlier in their journey
• send and receive booking and referral data that is integrated into existing healthcare IT systems - this avoids working across 2 or more applications or systems and saves time

IT suppliers and care providers should find it easier and more efficient to implement a single, agreed national interoperability standard, rather than supporting the multiple and varied standards currently in operation.

Commissioners and Integrated Care Systems will find it easier to integrate care journeys across care settings using existing systems.

A recent government report has acknowledged the work already done in this area and the benefits of sharing booking and referral data between healthcare IT systems and across care settings:

Throughout each development cycle of the standard, the BaRS programme will consider and maintain patient clinical safety through ongoing clinical risk management activities.

The Clinical Safety Standards listed below are mandatory under the Health and Social Care Act 2012. BaRS programme and supplier responsibilities for each of the standards are described underneath.

DCB0129: Clinical Risk Management: its application in the manufacture of health IT systems

• The BaRS programme is responsible for implementing DCB0129 to achieve endorsement from the NHS Digital Clinical Safety Group (NHSD CSG)
• Suppliers are responsible for implementing DCB0129 for each release of their BaRS conformant product
  • Suppliers supporting public beta deployments will submit their clinical safety case report and hazard log to NHSD CSG to attain Clinical Authority to Release

DCB0160: Clinical Risk Management: its application in the deployment and use of health IT systems

• Providers are responsible for compliance with DCB0160 to manage clinical safety for their local deployment

The BaRS programme has delivered, as part of the standard, a clinical safety case report and supporting hazard log in accordance with DCB0129. The purpose of the clinical safety case report and associated hazard log is to identify, assess and manage clinical safety hazards arising from the creation and implementation of the BaRS. It demonstrates that associated hazards have been identified and managed, where possible, to ensure they do not give rise to unacceptable risks to patients and delivery of care. Whilst this has informed the development of the BaRS, any APIs developed to work with BaRS are not within the boundaries of the BaRS Programme. Where risks have been identified that are outside of the BaRS Programme boundary, they are transferred to the relevant party in the hazard log.

For communication and management of risk, suppliers and providers must:

• review and integrate the risks identified into their own hazard log where risk(s) have been transferred
• implement the appropriate mitigation stipulated

The NHSE Clinical Safety Group (CSG) has fully endorsed the clinical safety management approach followed by the BaRS programme in support of the development and publication of BaRS version 1.0.0. The endorsement does not result in a transfer of risk to the NHSE CSG in respect of any part of the BaRS version 1.0.0. The element of clinical risk management remains the responsibility of the manufacturer of the BaRS conformant solution and the deploying organisation.

Contact us for a copy of the BaRS Clinical Safety Case Report and BaRS Hazard Log.

An NHS England Direction to enable NHS Digital to develop an interoperability standard for patient record systems and a related API (Booking and Referral Standard Service) has been published for the BaRS programme. A record has also be added to the NHS Digital GDPR Register.

BaRS Privacy Notice - A note for healthcare providers 

Healthcare providers using BaRS are responsible for transparency to patients.  If patients do not understand that their data is traversing NHS Digital systems as part of the referral service, there could be a breach of the fairness principle of UK GDPR.    

BaRS, developed by NHS Digital, does not directly collect any information except in the case of 111 online.  NHS Digital does not store any personal data except for 'online identifiers' of sending and receiving providers, e.g. IP Address/Event Logs and the NHS Number (if provided) which is stored for audit purposes.

We encourage all healthcare providers who will be using BaRS to review the Privacy Notice and update their transparency information accordingly.

The Data Alliance Partnership Board (DAPB) has approved a BaRS as an Information Standard.  This means that all healthcare IT systems suppliers delivering systems to  healthcare providers in applicable care settings should work with their customers to determine any necessary changes. A corresponding Information Standards Notice, reference DAPB4060 has been issued to support adoption and use of the Standard.

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