Clinical Document sharing in the NHS

I working on an EPR project where I will need to move clinical data to other NHS systems.

My assumption is it will need to be turned into a letter (format = PDF). Thats the main way of sharing the clinical information. I will have exceptions, if it’s a discharge letter and it needs to go to a GP System I will also need to output the letter in FHIR Document format (this is set by Transfer of Care).

I believe these business rules are correct, not ideal but I’m concentrating on what I have to do rather than what I want to do.

On a technical level this leads to the question:

How do I package up these documents/letters?

The only UK standard I have found is IHE MHD and that appears to be the standard adopted in London and Lancashire LHCR. Although we don’t appear to have a UK version, that would work.

For FHIR Documents I’ve already mentioned Transfer Of Care but this points to ITK3 FHIR Messaging with MESH. However I believe I can ignore the MESH part of this (MESH is irrelevant with a local exchange) and let the NHS trust/LHCR handles this.

If I can do this, then I can use IHE MHD to talk to NHS Systems. Likewise if the trust needs to use Kettering formant, I can still send as IHE MHD and let the trust send it on using kettering XML format plus MESH.

Some comments on IHE MHD:

  • It’s a bit of an overkill for the problem, it has a number of IHE XDS requirements especially around metadata which aren’t needed for general use.
  • Doesn’t appear to take into account NHS standards.
  • It uses transactional bundles for moving around documents. Not a big problem but from a technical (FHIR) POV it’s too flexible and the payload would be better defined using FHIR Messaging (which would say you bundle must contain X, Y and Z and match the approach with Transfer Of Care without MESH). This would simplify implementation and testing.

So I believe I need to follow IHE MHD. Are there any tools or systems I can use to test I have followed this standard? (I can use my own system but that’s ‘marking my own homework’).