# Clinical Document sharing in the NHS

**Category:** [FHIR](https://openhealthhub.org/c/fhir/31)
**Created:** 2019-12-15 08:57 UTC
**Views:** 1754
**Replies:** 0
**URL:** https://openhealthhub.org/t/clinical-document-sharing-in-the-nhs/2164

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## Post #1 by @mayfield.g.kev

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](https://build.fhir.org/ig/IHE/ITI.MHD/index.html) 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](https://developer.nhs.uk/apis/itk3messagedistribution/index.html). 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](https://www.hl7.org/fhir/STU3/messaging.html) (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').

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**Canonical:** https://openhealthhub.org/t/clinical-document-sharing-in-the-nhs/2164
**Original content:** https://openhealthhub.org/t/clinical-document-sharing-in-the-nhs/2164