Atomic Unit to capture the advance treatment preferences for a patient.
Important: This site is under development by NHS Digital and is intended to provide all the technical resources you need to successfully develop the End of Life API.
Warning: This site is information only, intended for those engaged with NHS Digital on the development of the End of Life API. You are advised not to develop against these specifications until a formal announcement.
Advance Treatment Preferences
The following FHIR profiles are used to form the Advance Treatment Preferences Atomic Unit:
- EOL-Patient-1
- CareConnect-Organization-1
- CareConnect-Practitioner-1 (EOL mandates name.text)
- CareConnect-PractitionerRole-1
- CareConnect-Location-1
- CareConnect-EOL-Procedure-1
- EOL-ATPProblemList-List-1
- EOL-ATPProblemHeader-Condition-1
- EOL-ATP-CarePlan-1
- EOL-ADRT-Flag-1
Advance Treatment Preferences data item mapping to FHIR profiles
The Advance Treatment Preferences data items are fulfilled by elements within the FHIR resources listed below:
| EOL Data Item | FHIR resource element | Mandatory/Required/Optional |
|---|---|---|
| Date of Change in List | EOL-ATP-ProblemList-List.date | Mandatory |
| Problem or Condition | EOL-ATPProblemList-List.entry.item.reference | Optional |
| Details of Problem or Condition | EOL-ATPProblemHeader-Condition-1.code.text | Mandatory |
| Treatment Level | EOL-ATP-CarePlan-1.activity.detail.code.text | Optional |
| Intervention | EOL-ATP-CarePlan-1.activity.detail.description | Optional |
| ReSPECT Care Priority | Optional | |
| Extension.respectPriorityScale.valueInteger | Mandatory | |
| Extension.respectPriorityScaleStatement.valueString | Optional | |
| Professional recording changes to List of Problems and Interventions | EOL-ATP-ProblemList-1.source | Mandatory |
| Advance Decision to Refuse Treatment Coded | EOL-ADRT-Flag-1.code | Optional |
| Advance Decision to Refuse Treatment Additional Notes | EOL-ADRT-Flag-1.code.text | Mandatory |
| Date of Advance Decision to Refuse Treatment | EOL-ADRT-Flag-1.period.start | Mandatory |
| Issue of Anticipatory Medicines Code | CareConnect-EOL-Procedure-1.code | Optional |
| Issue of Anticipatory Medicines Additional Notes | CareConnect-EOL-Procedure-1.code.text | Mandatory |
| Location of Anticipatory Medicines | CareConnect-Location-1.name | Optional |
EOL-ADRT-Flag-1.code and CareConnect-EOL-Procedure-1.code (codeableConcept) Guidance
Where the sending system supports a terminology system:
- The codeableConcept.coding element MUST be populated with:
- system: identity of the terminology system (e.g. SNOMED-CT)
- code: symbol in syntax defined by the system
- display: representation defined by the system
- the codeableConcept.text field MUST be populated with the display value from the codeableConcept.coding.display element e.g. ‘Asthma (disorder)’
- the codeableConcept.text field MAY contain free text to capture more detail associated with the codeableConcept.coding.code e.g. ‘Patient uses blue inhaler to relieve symptoms’
Where the sending system does not support a terminology system:
- the codeableConcept.text field MUST be populated with a text description of the concept as a human readable narrative e.g ‘Asthma’.
- the codeableConcept.text field MAY contain free text to capture more detail associated with the concept e.g. ‘Patient uses blue inhaler to relieve symptoms’
Advance Treatment Preferences ERD
Problem List Example XML
Problem Header Condition Example XML
Care Plan Example XML
Flag Example XML
Care Connect Profiles
Where possible, Care Connect profiles have been used to develop the End of Life API. On this occasion it has not been possible to do this. The table below highlights the Care Connect profile(s) replaced with a bespoke version and the rationale behind this.
| Care Connect Profile | Rationale for Change | New Component Required |
|---|---|---|
| CareConnect-List-1 and | ReSPECT scale complex extension required | extension.resPECTScale |
| CareConnect-ProblemList-1 | ||
| CareConnect-Condition-1 and | Problem description is mandatory | Change of cardinality to ‘code’ element from 0..1 to 1..1 |
| CareConnect-ProblemHeader-Condition-1 |
End of Life will engage with the healthcare community and INTEROPen in the future to propose these changes to the Care Connect profiles(s).