Care Coordination and 360 Referrals (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Patient Administration (Core NHS Resources)

The general purpose patient administration model behind every referral: who the patient and the professionals are, which organisations and locations are involved, the encounters and episodes in which care happens, and the schedules and appointments that book it. It follows the FHIR R4 Administration module, with UK definitions from the NW GMSA IG and the Interweave (Yorkshire and Humber Care Record) IG.

References

• FHIR R4 Administration module - clinical registration and scheduling
• NW GMSA FHIR IG - Resource Profiles - source of the copied profiles, HL7 v2 PV1
• Interweave IG (0.1.0) - Encounter, Encounter Grouping, EpisodeOfCare, Location, Schedule, Slot
• NHS Data Dictionary HOSPITAL PROVIDER SPELL IDENTIFIER
• HL7 v2-to-FHIR PV1 to Encounter

Model

erDiagram
    Patient ||--o{ HospitalSpell : subject
    Patient ||--o{ Visit : subject
    Patient ||--o{ EpisodeOfCare : patient
    HospitalSpell {
        Identifier accountNumber "Hospital Provider Spell Identifier (AN)"
        Coding class "IMP"
    }
    Visit {
        Identifier visitNumber "Visit Number (VN)"
        Coding class "AMB, EMER, IMP, HH, VR"
    }
    EpisodeOfCare {
        Identifier localId
        code status
    }
    ServiceRequest {
        Identifier referralId
    }
    Appointment {
        Identifier appointmentId
    }
    Slot {
        instant start
    }
    Schedule {
        Reference actor "clinician, service, location"
    }
    Location {
        Identifier odsSiteCode
    }
    HospitalSpell ||--o{ Visit : "partOf (one level only)"
    EpisodeOfCare ||--o{ Visit : episodeOfCare
    EpisodeOfCare }o--o| ServiceRequest : referralRequest
    Visit }o--o| ServiceRequest : basedOn
    HospitalSpell }o--o| ServiceRequest : basedOn
    Visit }o--o| Appointment : appointment
    Appointment }o--o| Slot : slot
    Slot }o--|| Schedule : schedule
    Visit }o--o{ Location : location
    Location }o--o| Location : partOf

Identifiers

These identifiers are frequently confused. They identify different things, and the HL7 v2 identifier type (CX.5) and FHIR Identifier.type SHALL always say which one is meant.

Rules of thumb:

• An outpatient attendance has a Visit Number and no spell.
• An admission has a spell (Account Number); the stays within it may have their own Visit Numbers, partOf the spell.
• An A&E attendance followed by an admission is two encounters - the A&E Visit and the inpatient spell - linked if required by a grouping (Interweave Encounter Grouping) - see below.
• A virtual ward stay is a Hospital Spell (identifier type AN) whose location is the patient's home - no separate profile. Recording it as a spell is To confirm against NHS England virtual ward data collection rules.
• A community service, programme or team caseload is an EpisodeOfCare; each contact is a Visit within it.
• Every identifier carries its assigning organisation (ODS code in assigner), because none of these numbers is unique outside the trust that issued it.

Example: Hospital Provider Spell Identifier 1001166717^^^R0A^AN on the day case spell and Visit Number IP2026092101^^^R0A^VN on the stay within it; Visit Number OP2026090701^^^R0A^VN on the outpatient attendance, which has no spell.

Clinical Registration

Following the Interweave Encounter rules:

NW GMSA's Hospital Spell is described as related to the Interweave Encounter Grouping (the shell that holds the overall period and admission / discharge details). This guide uses the NW GMSA model (Hospital Spell and Visit) - To confirm that an A&E attendance followed by an admission is grouped the same way in both.

HL7 v2 mapping (indicative, from the NW GMSA PV1 and HL7 v2-to-FHIR):

Scheduling

The FHIR scheduling resources separate availability from booking:

sequenceDiagram
    participant B as Booking system<br/>(referrer, eRS, 111, service)
    participant S as Scheduling system<br/>(Referral Recipient)
    B ->> S: GET Slot?schedule.actor=...&status=free&start=ge...
    S -->> B: Free Slots
    B ->> S: POST Appointment (slot, patient, basedOn = referral)
    S -->> B: Appointment booked (Slot busy)
    S -->> S: Patient attends - Visit (Encounter.appointment)

Example: Schedule, Slot, Appointment, outpatient attendance.

How the Referral Uses Them