This is a request for comments and is a rough gist of ideas coming from standards teams. This is not an official NHS England comment and is solely my own opinion (including views from an online consultation provider I work with)
Admission, Discharge and Transfers (ADT) is a well establised and supported pattern in the NHS for notifying practitioners, providers and systems of changes to a patients health administration record.
It is most commonly implemented in the NHS using HL7 v2 ADT, for a full description see NHS England HL7 V2 ADT Message Specifications.
Some common HL7 v2 messages are listed below alongside FHIR Resource types.
| Event Message (ADT) | Example Plain Text |
|---|---|
| Patient Admission (ADT_A01) | Robert Brown (NHS Number 9876543210) has had an emergency admission to the Emergency Dept of St James Hospital Leeds Teaching NHS Trust on 15 Jun 2023 at 1615 |
| Patient Transfer (ADT_A02) | Robert Brown (NHS Number 9876543210) has been transferred from the Emergency Dept of St James Hospital Leeds Teaching NHS Trust to the Observation Ward on 15 Jun 2023 at 1945 |
| Patient Discharge (ADT_A03) | Robert Brown (NHS Number 9876543210) has been discharged as an inpatient from the Observation Ward of St James Hospital Leeds Teaching NHS Trust ot 17 Jun 2023 at 1153 |
| Register Outpatient (ADT_A04) | Robert Brown (NHS Number 9876543210) has had a follow up outpatient encounter with Leeds Teaching NHS Trust on 20 Jun 2023 at 1533 |
| Patient Pre-Admit (ADT_A05) | Robert Brown (NHS Number 9876543210) has follow up outpatient appointment with Leeds Teaching NHS Trust on 20 Jun 2023 at 1533 |
| Add Person or Patient Information (ADT_A28) | Robert Brown (NHS Number 9876543210) has registered with Leeds Teaching NHS Trust |
| Update Person Information (ADT_A31) | Robert Brown (NHS Number 9876543210) address and email contact details have changed |
| Merge Patient (ADT_A40) | Robert Brown (NHS Number 9876543210) records MRN 123 and MRN 5678 have been merged. MRN 123 is now Roberts main record. |
The high level of adoption of this standard is very high in NHS Secondary Care and is currently supported in other sectors including GP System providers. It is unlikely this will be replaced by HL7 FHIR in the short term.
Suppliers/Providers wishing to use FHIR are recommended to follow FHIR RESTful and not use FHIR Messaging as this does not reflect modern interoperability patterns.
This gives the following mappings:
| Event Message (ADT) | V2 Segment Focus | FHIR Resource |
|---|---|---|
| Patient Admission (ADT_A01) | PV1 | Encounter (POST) |
| Patient Transfer (ADT_A02) | PV1 | Encounter (POST) |
| Patient Discharge (ADT_A03) | PV1 | Encounter (POST) |
| Register Outpatient (ADT_A04) | PV1 | Encounter (POST) |
| Patient Pre-Admit (ADT_A05) | PV1 | Appointment (POST) |
| Update patient information (ADT_A08) | PV1 | Appointment / Encounter (PUT) |
| Add Person or Patient Information (ADT_A28) | PID | Patient (POST) |
| Update Person Information (ADT_A31) | PID | Patient (PUT) |
| Merge Patient (ADT_A40) | PID | Patient (POST) |
Suppliers may consider adopting IHE Patient Identifier Cross-referencing for mobile (PIXm) Patient Identity Feed FHIR ITI-104
It is expected that middleware technology such as Trust Integration Engines (TIE) will continue to be used, it is expected the use of Publish-subscribe patterns will increase, please see FHIR Subscription (Note: this link is to FHIR R4B Subscription which is more mature than FHIR R4 and is compatible with the majority of FHIR R4 resources and so UKCore profiles)
Although FHIR RESTful is preferred should you wish to go down a FHIR Messaging route, the following links provide guidance: