Configuration for supported clinical areas

Introduction

The Access Record Structured capability requires the ability to configure the availability of clinical areas in a Provider system. In the event that a clinical area isn’t available, information for other clinical areas that are configured to be available would still be retrievable. This is required to support the following scenarios:

• to manage First of Type implementations - one or more clinical areas that still require development and/or assurance could be turned off to accelerate the deployment of clinical areas that have been developed and assured
• managing clinical safety incidents - when FRA has been awarded, one or more clinical areas could be turned off if there was a clinical safety incident relating to them

Also, in addition to the enablement switch defined in the non-functional requirements for GP Connect APIs, the Access Record Structured capability requires that one or more clinical areas can be turned off at individual sites.

Requirements

Clinical areas

The configuration of the Provider system MUST allow for clinical areas to be switched on or off for all sites without requiring a release. This MUST be achieved using a single configuration item or action. For example, in the case of a clinical safety incident with a clinical area where a provider would be required to turn off the clinical area across their entire estate. Where information for a clinical area isn’t returned, provider systems MUST return a warning for each clinical area that isn’t supported according to the rules below. The following clinical areas can be configured to be on or off:

• Medications
• Allergies
• Consultations
• Problems
• Uncategorised data
• Immunisations
• Investigations
• Referrals
• Diary entries
• Documents

The Documents item controls whether DocumentReference resources are returned as part of the structured response, this configuration item works independently of the Access Documents capability enablement switch.

Site switch

In addition to the above, the configuration of the Provider system MUST allow for the availability of a clinical area to be switched on or off at one or more sites without requiring a release. For example, in the scenario where there was a data quality issue with a clinical area at a single site. Where information for a clinical area isn’t returned, provider systems MUST return a warning for each clinical area that isn’t available according to the rules below.

Consumer systems

Consumer systems MUST be able to handle the unavailability of clinical areas and warn users that information hasn’t been returned.

Populating a warning

In the above scenarios, providers MUST respond in the following way:

• return a 200 OK HTTP status code to indicate successful retrieval of a patient’s structured record
• Include FHIR® resources for clinical areas that are switched on
• as part of the returned bundle, include a single OperationOutcome with an issue for each clinical area that is disabled, that is, any disabled clinical area that would have been included either in response to a query parameter or linked to from requested clinical information, where:
  • issue.code = not-supported
  • issue.severity = warning
  • issue.details.coding.system = https://fhir.nhs.uk/STU3/CodeSystem/Spine-ErrorOrWarningCode-1
  • issue.details.coding.code = NOT_IMPLEMENTED
  • issue.details.coding.display = Not implemented
• For each disabled clinical area the following MUST be supplied:
  • issue.details.text = <parameter-name> has been disabled`
  • issue.diagnostics = <parameter-name>
  • Where documents have been switched off ‘DocumentReferences’ MUST be returned in place of <parameter-name>.
  • Providers MAY choose to return an empty List resource as well as the OperationOutcome. This MAY be populated with limited information such as warningCode or emptyReason.

  The example shows a fully populated OperationOutcome for a request where the includeProblems clinical area has been turned off:

  {
    "resource": {
      "resourceType": "OperationOutcome",
      "id": "8b679981-e9be-4e37-b103-799295a6aec8",
      "meta": {
        "profile": [
          "https://fhir.nhs.uk/STU3/StructureDefinition/GPConnect-OperationOutcome-1"
        ]
      },
      "issue": [
        {
          "severity": "warning",
          "code": "not-supported",
          "details": {
            "coding": [
              {
                "system": "https://fhir.nhs.uk/STU3/CodeSystem/Spine-ErrorOrWarningCode-1",
                "code": "NOT_IMPLEMENTED",
                "display": "Not implemented"
              }
            ],
            "text": "includeProblems has been disabled",
          },
          "diagnostics": "includeProblems"
        }
      ]
    }
  }
  
  

Populating references to clinical areas that aren’t available

Where clinical areas are unavailable, references to them will need to be populated with a warning that the information is unavailable. However, if the clinical item that is unavailable is also marked as confidential, then the response should be as per the Confidential items guidance.

Where a clinical area has been turned off, it will create a section.section.entry (or section.entry) entry with the:

• List.entry.item.display set to “[Clinical area] items have been disabled.”

  Where [Clinical area] identifies the type of the clinical item that isn’t available.

  The example below shows references to two items, one for an observation and another for referrals that have been disabled in the provider system:

  {
    "item": {
      "reference": "Observation/6734572634"
    }
    },
    {
      "item": {
        "display": "Referral items have been disabled"
      }
    }