Using MESH to deliver specific SNOMED codes to PASs

open forum
1

We’re looking at using MESH drop specific administrative SNOMED codes to patients’ records on their practice’s PAS; does anyone know if this is possible and whether the main PASs can import the codes from the MESH mailbox? I’ve seen importing documents mentioned but not codes.

2

MESH is just a transport. It just delivers messages and doesn’t know about details of the payload or message (which could be a xml, json, HL7v2, EDIFACT, word, pdf, etc).

The way I’ve done this with a (EMIS) GP Practice is to use EMIS partner programme API. This was directly with EMIS but you can also use IM! IM1 Pairing integration - NHS Digital which uses similar API’s but also includes NHS Digital assurance process.

3

Thanks Kev,

what we’ve worked out so far is that we can drop a message into a practice’s MESH inbox but it’s the link between the mailbox and the PAS which is unclear; if we send a message with a patient NHS number, date of birth and code such as 300734005 “uses telephone”, can a PAS pick it up and add the code to the patient’s record? If so, what do we need to do to make that happen?
I’m looking at the IM1 side as well, our devs are keen to keep things PAS agnostic and stay away from partnership programmes if possible.

4

No, you need to be implementing a message not a transport.
If you search on this site for kettering XML you’ll find ways of sending documents to GP’s over MESH. Here KetteringXML is the message.
I don’t know of a way of sending codes to GP systems other IM1 (or possibly Observations via GP Links)

5

right, plan B it is then, thank you for the help!

6

Agree with Kevin. We did implement once a CDA message on MESH but was asked by 2 clinical system suppliers not to send it as NHS Digital decided to kill CDA for FHIR…

7

This isn’t going to solve your immediate need but you could suggest an API here https://nhs-digital-api-management.featureupvote.com/

I believe there are roughly three common requests:

  1. Send a document to GPs (not just FHIR Documents like Transfer of Care or Digital Meds - also known as the FHIR Generic Receive)
  2. Send Observations to GPs (General HL7v2 ORU_R01, not limited to pathology)
  3. Send completed Templates/Questionnaires to GPs - this probably includes your use case

Not sure if everyone wants to use MESH, gut feeling GP’s could provide a generic FHIR $process-message endpoint or MESH, either of these three messages could go via these transports.
(This is related to FHIR Messaging mentioned on this NHS Digital Medicines spec NHS Digital FHIR Medicines)

8

Thanks gents.
We’re looking at IM1 now, tried talking to EMIS and TPP to see if what we want to do is actually possible but were told we had to register with NHS Digital before either supplier would answer that question.

That said, I’ve just seen your post from two years back about a FHIR encounter example; is that still valid?

9

This is really quite a poor state of affairs isn’t it? Anyone know different to this? Surely the IM1 capabilities MUST be in the public domain somewhere?

10

It’s evolved. We are seeing more focus on using NHS Data Dictionary codes as seen in Medicines APIs such as EPS NextGen and new COVID19 Vaccinations (CSV feed and Imms history API)

This is a page discussing the topic NHS Digital FHIR Medicines (Retired - 2.1.14)
and this looks at how Practitioners should be identified NHS England FHIR Implementation Guide (deprecated)

11

“Contractually prevented from discussing this” was the line both suppliers gave me.

12

Thanks Kev, will take a look.