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 Flags

A patient flag (alert) warns anyone caring for the patient of something they must know before acting - a safeguarding plan, a needed adjustment, a risk. In care coordination a flag often points to a plan owned by someone else and tells the reader who to contact; it is not the plan itself.

References

• FHIR Flag (R4)
• HL7 IPS Flag - Alert, HL7 Europe Patient Summary - Flag - the Alerts section (LOINC 104605-1, see Templates)
• Dynamic Care Planning (DCP), Care Services Directory (mCSD), Patient Identity (PDQm)
• NHS England Patient Flags Service and Child Protection - Information Sharing (CP-IS) (checked 2026-11-02)
• CP-IS SMSP API standards, FGM-IS SMSP API standards
• PRSB Information Provided by Local Authorities in Shared Care Records - see PRSB Standards

Kinds of Flag

Flags and Care Plans

A plan-pointer flag is the "find" half of Dynamic Care Planning: it says a care plan exists and who holds it, without giving its content.

In FHIR R4, Flag cannot reference the plan without an extension; HL7 Europe notes its extension "will be replaced by Flag.supportingInfo" in R6 - which extension to use in R4 is To confirm. Until then the Flag and the CarePlan share subject and period, and the CarePlan can be found by search.

Actors (proposed)

Process Flow

sequenceDiagram
    participant LA as Flag Source<br/>(local authority)
    participant R as Flag Registry<br/>(CP-IS)
    participant C as Flag Consumer<br/>(emergency department)
    participant PDS as PDS
    LA ->> R: Create / end flag<br/>(plan type, dates, owner)
    Note over C: Child attends
    C ->> PDS: Find patient [ITI-78]
    PDS -->> C: NHS Number
    C ->> R: Query flags (NHS Number)
    R -->> C: Flag(s), plan summary, owner contacts, recent accesses
    R ->> LA: Notification of access<br/>(who, where, when)
    C ->> LA: Clinician contacts the owner if needed

NHS England Patient Flags Service

The Patient Flags Service "records and shares safeguarding and accessibility information", meant to be "visible wherever a patient receives care". It has three flags:

CP-IS

From the CP-IS SMSP standards:

• CP-IS holds per child: NHS Number, "plan details: type, start date and end date", the responsible local authority with office hours and emergency duty contact numbers, and the 25 most recent accesses from unscheduled care settings.
• A query "automatically triggers a notification to the relevant local authority" - the Flag Registry records access and notifies the Flag Source.
• CP-IS "does not store full social care or healthcare records" (NHS England CP-IS page) - the plan stays with the local authority.

Points to note:

• The reason is not shared. Local authority guidance says the reason for the plan (e.g. the category of abuse) is not passed to the NHS (Tameside, North Yorkshire); NHS England's pages do not say - To confirm. A CP-IS flag is not a Condition.
• Pre-birth plans show on the mother's record until 28 days after the expected delivery date, then the local authority closes the unborn plan and opens one on the baby's record (local authority guidance - To confirm against NHS England).
• Unscheduled care only. Scheduled care (e.g. a Referral Recipient in this guide) cannot use SMSP CP-IS access today, although a referral is also a point where the owner may need to know. Whether referrals should check flags is Open.

In the Closed Loop

HL7 v2

No HL7 v2 equivalent for querying flags (indicative). Flags are sometimes sent as local Z segments or OBX in ADT; this is a gap.

Gaps

• No IHE profile for flag registries; Flag is not in QEDm.
• No standard for notifying the flag owner on access (CP-IS does this in HL7 V3).
• FHIR R4 Flag cannot reference the CarePlan it points to without an extension.
• National flags are HL7 V3 / SMSP, not FHIR, and limited to unscheduled care - To confirm NHS England plans for a FHIR Patient Flags API.