Description of use case on Spine via the FHIR® Reasonable Adjustments API
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1 Multiple Conditions Read
Pre
- Practitioner creates RARecord, recording Consent from Patient and that Impairment is ‘Learning Disability’.
- Patient declines to record a specific Adjustment at this time. see Create RARecord Use Case
- Practitioner adds Impairment ‘Mental Health Condition’, supporting Information ‘Patient diagnosed with Stranger anxiety (disorder). Consider home-visit.’
Main
- Patient arrives for appointment; Practitioner retrieves Patient’s RARecord.
- ClientSystem queries ServerSystem to retrieve RARecord
- ClientSystem submits Read Consent request (for Patient, Active, etc.)
- ServerSystem submits Read Consent response
- ClientSystem submits Read Flag request (for Patient, Active, etc.)
- ServerSystem submits Read Flag response
[Read Consent and Read Flag not illustrated - these are identical to existing Read RA Record Use Case]
- ServerSystem submits Read Flag response
- ClientSystem submits Read List request (for Patient, Active, etc.) (xml) (json)
- ClientSystem unpacks contained Condition resources and establishes referenced Provenances
- ClientSystem submits Read Consent request (for Patient, Active, etc.)
- ClientSystem queries ServerSystem to retrieve RARecord
2.1 Read List request - xml example
http request & headers
GET https://clinicals.spineservices.nhs.uk/STU3/List?
patient=999999998&
status=current&
code=http://snomed.info/sct|1094391000000102&
_format=xml HTTP/1.1
Authorization: Bearer [jwt_token_string]
FromASID: 123456123456
ToASID: 987654456789
TraceID: 0fd9c402-3bca-48a4-a5c3-06c5dd064a76
Prefer: return=representation
InteractionID: urn:nhs:names:services:raflags:List.read:1
http body
None
2.2 Read List request - json example
http request & headers
GET https://clinicals.spineservices.nhs.uk/STU3/List?
patient=999999998&
status=current&
code=http://snomed.info/sct|1094391000000102&
_format=json HTTP/1.1
Authorization: Bearer [jwt_token_string]
FromASID: 123456123456
ToASID: 987654456789
TraceID: 0fd9c402-3bca-48a4-a5c3-06c5dd064a76
Prefer: return=representation
InteractionID: urn:nhs:names:services:raflags:List.read:1
http body
None
2.3 Read List response - xml example
http response & headers
HTTP/1.1 200 OK
Date: Tue, 24 Jul 2018 12:00:00 GMT
Content-Type: application/fhir+xml
http body
Read List response bundle XML Example
<Bundle xmlns="http://hl7.org/fhir">
<id value="2dce9ecf-75c6-4ad5-a770-4f035419c229"/>
<meta>
<profile value="http://hl7.org/fhir/bundle"/>
</meta>
<type value="searchset"/>
<total value="1"/>
<link>
<relation value="self"/>
<url value="https://clinicals.spineservices.nhs.uk/STU3/List?patient=999999998&status=active&code=http://snomed.info/sct|1094391000000102&_format=xml"/>
</link>
<entry>
<fullUrl value="https://clinicals.spineservices.nhs.uk/STU3/List/130f416a-055d-4a5d-a453-2b7c2de3b57b"/>
<resource>
<List xmlns="http://hl7.org/fhir">
<id value="130f416a-055d-4a5d-a453-2b7c2de3b57b"/>
<meta>
<versionId value="9554c538-1661-43b1-921b-efcbd2991c90"/>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-RARecord-List-1"/>
</meta>
<contained>
<Condition xmlns="http://hl7.org/fhir">
<id value="57f04652-6dd0-4135-a560-f9091b1b26fa"/>
<meta>
<versionId value="557ccfc3-0c78-48bf-aedd-70cc08af2ba1"/>
<lastUpdated value="2018-07-23T11:00:00+00:00"/>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-RARecord-Condition-1" />
</meta>
<clinicalStatus value="active"/>
<category>
<coding>
<system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-ConditionCategory-1"/>
<code value="issue"/>
<display value="Issue"/>
</coding>
</category>
<code>
<coding>
<system value="https://fhir.nhs.uk/STU3/CodeSystem/RARecord-ConditionCode-1"/>
<code value="5"/>
<display value="Learning or understanding or concentrating"/>
</coding>
</code>
<subject>
<reference value="demographics.spineservices.nhs.uk/STU3/Patient/999999998"/>
</subject>
</Condition>
</contained>
<contained>
<Provenance>
<id value="8ce7de6b-1307-432d-8e96-ae6a613ca3e4"/>
<meta>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/RARecord-Provenance-1"/>
</meta>
<target>
<reference value="Condition/57f04652-6dd0-4135-a560-f9091b1b26fa"/>
</target>
<recorded value="2018-07-23T11:00:00+00:00"/>
<activity>
<coding>
<system value="http://hl7.org/fhir/v3/DataOperation"/>
<code value="CREATE"/>
<display value="create"/>
</coding>
</activity>
<agent>
<role>
<coding>
<system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-SDSJobRoleName-1"/>
<code value="R0260"/>
<display value="General Medical Practitioner"/>
</coding>
</role>
<whoReference>
<reference value="https://sds.spineservices.nhs.uk/STU3/Practitioner/2ee4tr6a9"/>
<display value="Dr.D"/>
</whoReference>
<onBehalfOfReference>
<reference value="https://directory.spineservices.nhs.uk/STU3/Organization/a3e5i7"/>
<display value="Some GP Clinic"/>
</onBehalfOfReference>
</agent>
</Provenance>
</contained>
<contained>
<Condition xmlns="http://hl7.org/fhir">
<id value="6be8bee9-e727-4564-a904-49507576f8be"/>
<meta>
<versionId value="a9b91e41-30ad-43a4-a2da-79b9be622169"/>
<lastUpdated value="2018-07-24T10:01:00+00:00"/>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-RARecord-Condition-1" />
</meta>
<clinicalStatus value="active"/>
<category>
<coding>
<system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-ConditionCategory-1"/>
<code value="issue"/>
<display value="Issue"/>
</coding>
</category>
<code>
<coding>
<system value="https://fhir.nhs.uk/STU3/CodeSystem/RARecord-ConditionCode-1"/>
<code value="7"/>
<display value="Mental health"/>
</coding>
<text value="Patient diagnosed with Stranger anxiety (disorder). Consider home-visit"/>
</code>
<subject>
<reference value="demographics.spineservices.nhs.uk/STU3/Patient/999999998"/>
</subject>
</Condition>
</contained>
<contained>
<Provenance>
<id value="fe71140b-3a30-45a3-b492-695b5f5e3717"/>
<meta>
<profile value="https://fhir.nhs.uk/STU3/StructureDefinition/RARecord-Provenance-1"/>
</meta>
<target>
<reference value="Condition/6be8bee9-e727-4564-a904-49507576f8be"/>
</target>
<recorded value="2018-07-24T10:01:00+00:00"/>
<activity>
<coding>
<system value="http://hl7.org/fhir/v3/DataOperation"/>
<code value="CREATE"/>
<display value="create"/>
</coding>
</activity>
<agent>
<role>
<coding>
<system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-SDSJobRoleName-1"/>
<code value="R1974"/>
<display value="Community Learning Disabilities Nurse"/>
</coding>
</role>
<whoReference>
<reference value="https://sds.spineservices.nhs.uk/STU3/Practitioner/4tr6ee6a9"/>
<display value="Nurse N"/>
</whoReference>
<onBehalfOfReference>
<reference value="https://directory.spineservices.nhs.uk/STU3/Organization/a3e5i7"/>
<display value="Some Hospital Learning Disability Support Department"/>
</onBehalfOfReference>
</agent>
</Provenance>
</contained>
<status value="current"/>
<mode value="changes"/>
<title value="Reasonable Adjustment List"/>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="1094391000000102"/>
<display value="Reasonable adjustments for health and care access"/>
</coding>
</code>
<subject>
<reference value="demographics.spineservices.nhs.uk/STU3/Patient/999999998"/>
</subject>
<date value="2018-07-23T11:00:00+00:00"/>
<entry>
<deleted value="false"/>
<date value="2018-07-23T11:00:00+00:00"/>
<item>
<reference value="urn:uuid:557ccfc3-0c78-48bf-aedd-70cc08af2ba1"/>
</item>
</entry>
<entry>
<deleted value="false"/>
<date value="2018-07-23T11:00:00+00:00"/>
<item>
<reference value="urn:uuid:8ce7de6b-1307-432d-8e96-ae6a613ca3e4"/>
</item>
</entry>
<entry>
<deleted value="false"/>
<date value="2018-07-24T10:01:00+00:00"/>
<item>
<reference value="urn:uuid:6be8bee9-e727-4564-a904-49507576f8be"/>
</item>
</entry>
<entry>
<deleted value="false"/>
<date value="2018-07-24T10:01:00+00:00"/>
<item>
<reference value="urn:uuid:fe71140b-3a30-45a3-b492-695b5f5e3717"/>
</item>
</entry>
</List>
</resource>
<search>
<mode value="match"/>
</search>
</entry>
</Bundle>
2.4 Read List response - json example
http response & headers
HTTP/1.1 200 OK
Date: Tue, 24 Jul 2018 12:00:00 GMT
Content-Type: application/fhir+json
http body
Read List response bundle JSON Example
{
"resourceType": "Bundle",
"id": "2dce9ecf-75c6-4ad5-a770-4f035419c229",
"meta": {
"profile": [
"http://hl7.org/fhir/bundle"
]
},
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "https://clinicals.spineservices.nhs.uk/STU3/List?patient=999999998&status=active&code=http://snomed.info/sct|1094391000000102&_format=xml"
}
],
"entry": [
{
"fullUrl": "https://clinicals.spineservices.nhs.uk/STU3/List/e00c5a85-d34f-4075-96ac-b787deb484b1",
"resource": {
"resourceType": "List",
"id": "e00c5a85-d34f-4075-96ac-b787deb484b1",
"meta": {
"versionId": "5b703b55-cedc-4c19-b2aa-0666384eab1a",
"lastUpdated": "2018-07-23T11:00:01+00:00",
"profile": [
"https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-RARecord-List-1"
]
},
"status": "current",
"mode": "changes",
"title": "Reasonable Adjustment List",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "1094391000000102",
"display": "Reasonable adjustments for health and care access"
}
]
},
"subject": {
"reference": "demographics.spineservices.nhs.uk/STU3/Patient/999999998"
},
"date": "2018-07-23T11:00:00+00:00",
"entry": [
{
"deleted": false,
"date": "2018-07-23T11:00:00+00:00",
"item": {
"reference": "https://clinicals.spineservices.nhs.uk/STU3/Condition/57f04652-6dd0-4135-a560-f9091b1b26fa"
}
}
]
},
"search": {
"mode": "match"
}
}
]
}