Acute API - Appointment.Type and DocumentReference.class

The FHIR site suggests using SNOMED valuesets for these fields but on most systems I’ve encountered they’ve been English Specialty codes (believe Scotland uses a different code set)

IHE UK has also suggested using SNOMED (See Annex B at - Note I’ve gone with the SNOMED codes for document types Annex A)

Does anyone have any thoughts on this? We can map the codes but it would be 80-90% of systems I come across would need to map [It’s probably ideal to have a direct link or use UK specialty codes for reporting, which could be a big reason for using UK codes]

p.s. NHS Scotland specialties can be found here

Hi Kevin,

I suggest you consider these subsets:

Correspondence Care Setting

Correspondence Document type

These are essentially a superset of English and Scottish specialty codes, endorsed by PRSB and SNOMEDised. On of the key intended use-cases was the GP2GP/GPSOC Document metadata archetype.



I thinking of this from a practical point of view, we make life harder for ourselves by introducing SNOMED.

Looking at FHIR, it’s a many relationship for DocumentReference, so both could be supported. So I’d say it’s a MUST support NHS England or Scotland specialties and SHOULD support SNOMED equivalents. Reason is that most systems will require England/Scotland codes.

Notice GP Connect has gone with SNOMED but I wonder if specialty codes are used that much on GP Systems.

Hi Kevin,

Some sort of speciality /document type coding is used in GP systems, if only to tag eDocuments, e.g. in Scotland to support Docman Folders. The need to standardise this became apparent in the context of GP2GP to support moving this kind of metadata when patients change practice/system.

I’m all for quick wins but this does seem like an opportunity to move things forward on a 4-country basis and ultimately make life easier. The mappings have already been done.

Doctype-and-CareSetting-lists-with-SNOMED-CT-20120306.xlsx (43.0 KB)

Yes, the standardised specialty type is of very high clinical value for this common use-case for GPs: a specialty-specific document trail traceable through a long complex clinical history.
It’s implemented in Scotland by the standard use of Docman since 2009, and EDT automates the sender’s allocation of specialty (and care setting) metadata – avoids human misfiling errors.

Clinical Informatics Adviser

I’m sold on using SNOMED codes with a suggestion we have that spreadsheet centrally maintained (I want to look into FHIR value sets to see if it can provide lookup service for this)

How would we get agreed an published across the UK?

It would be very useful with many (NHS) organisations going paperless to start getting the metadata for Documents in sync (presumption is we will go to some form of cross enterprise document sharing at some point). Getting it wrong (now) can be very costly with extensive rewrites, complex mapping exercises or even document formats - e.g. storing documents as TIFF’s when we know the probable standard will be PDF (and CDA).

Ian - are we ok to use those mappings to English - Scottish specialties?

Looks likely to be part of national record locator service

Hi Kevin,

This work actually originated in Scotland but developed 4-country and was subsequently SNOMEDised by Leo Fogarty for UK use - so yes the specialty list and associated document-type list should be identical in Scotland, although they may use non-SNOME coding at present.

Or have I misunderstood the question?

@colin.brown99 - are you in a position to clarify

We’ve asked for Class to be included in National Record Locator POC.

I’d sent along a copy the spreadsheet as we’ll probably need to create a ConceptMap between NHS Eng/Scot codes and SNOMED.

@Kevin - you should probably have a word with Leo Fogarty directly to clarify what mappings already exist. This work was done in the past. I have no idea if it has been maintained. Leo work for both NHS Digital and NHS Scotland so is in a good position to advise.


@ian Thanks for the info.

Are you aware of mappings to from NHS (England) Service/Specialty to UK SNOMED Service - the spreadsheet posted earlier is to UK SNOMED Specialty.
Alternatively UK SNOMED Service to UK SNOMED Specialty map … Not the biggest fan of coding at the moment :slight_smile:

p.s. I’m only sketching out solutions. Showing ideas rather than finished products.