Introduction

Patients move between care settings and responsibility for them is handed over from one clinician to another. Transfer of care messaging ensures that the clinical context and information about the patient is transferred when this occurs.

To receive and process Transfer of Care FHIR documents, GP IT suppliers are expected to provide their practice solutions with a Generic FHIR Receiver (GFR) and Payload Processor (PP) capability. The GFR is a crucial common requirement across several current NHS Digital programmes.

The scope for Transfer of care currently covers:

• Inpatient and Day Case Discharge Summary Document – An ITK3 FHIR Document containing Transfer of Care information supporting inpatient and day case discharges typically between an acute hospital and GP practice.
• Emergency Care Discharge Summary Document – An ITK3 FHIR Document containing Transfer of Care information supporting a discharge typically between an emergency care department and a GP practice.
• Inpatient and Day Case Discharge Summary (Mental Health) Document – An ITK3 FHIR Document containing Transfer of Care information supporting a mental health adult discharge summary to a GP practice.
• Outpatient Clinic Letter Document – An ITK3 FHIR Document containing Transfer of Care information between the hospital clinic and the GP and other relevant parties following a consultation in a clinic.

The four defined Transfer of care messages uses the Messaging Exchange for Social Care and Health (MESH) service for transport and the Interoperability Toolkit (ITK) version 3.0 specification as the message distribution specification. 

Description

Transfer of Care is about standardisation of the correspondence elements. As this is an interoperability piece of work, both secondary care and primary care need to support the standardisation changes. These are as follows:

• CLINICAL CONTENT LAYER – PRSB headings/sections & subheadings/elements
• TERMINOLOGY LAYER – SNOMED-CT and dm+d
• TECHNOLOGY LAYER – FHIR (HL-7) as the structure for carrying information
• TRANSPORT LAYER – MESH for direct electronic transfer to GP IT foundation systems
• BUSINESS LAYER – ITK3 Response Codes fed back to the Hospital from the GP IT foundation system confirming message has been processed and is relevant.

Documentation

The latest FHIR specifications for the Transfer of Care payload can be accessed at https://developer.nhs.uk/transfer-care-specification-versions/.   

Contextual detail and specifications pertaining to the MVP aspect of this work can be accessed via the Transfer of Care Payload V0.7 document below: 

The Transfer of Care FHIR messages will use the ITK3 (Interoperability Toolkit) specification available here https://developer.nhs.uk/interoperability-tool-kit-itk-specification-versions/.

Suppliers should also consider the advice for practices and practitioners given in the Good Practice Guidelines for GP Electronic Patient Records (chapters 8d and 10) in designing message handling services and workflows for processing Transfer of Care messages.

Compliance, Assurance and Testing

It is expected that Transfer of Care conformance requirements will be held within a single consolidated Supplier Requirements Assessment List. This list will take the form of a spreadsheet and the content will cover all programmes dependent on the GFR. (Macros within the spreadsheet will allow filtering of requirements by the programme.)

The requirement areas are expected to include the use of MESH (Client and Server), the ITK3 messaging distribution specification, Transfer of Care payload specification and for GP IT suppliers, the GFR requirements. The Supplier Requirements Assessment List is not a Target Operating Model, and therefore no checking of end-to-end system integration is expected.

NHS Digital has developed an ITK3 Test Harness which is available for testing purposes by implementers. The ITK Test Harness can operate in the mode of receiving primary care practice solution, and in the mode of a sending hospital system. The latter would be of most interest to GP IT providers wishing to receive messages into a prototype GFR. Further information on the Test Harness can be found at https://developer.nhs.uk/itk3-test-harness/. 

FHIR messages can be sent using MESH from sender to recipient as per the ITK3 specifications. To ensure that senders are clear on the successful receipt or otherwise of their messages, the ITK3 Test Harness produces standard acknowledgements, including those reporting failures of messages. The ITK3 full acknowledgement response pattern can be found at https://developer.nhs.uk/apis/itk3messagedistribution/explore_response_patterns_1.html.

A pack of Transfer of Care Test messages can be obtained from https://developer.nhs.uk/itk3-test-harness/itk3-test-harness-test-message-examples/

For further advice, access to testing resources, and support contact itkconformance@nhs.net

Capability Associations and Interop Dependencies

This section lists the Capabilities this Standard is associated with and any other Interoperability Standards which are needed to meet this Standard (subject to change or refinement)

Roadmap