Provision of Care Implementation Manual
	Programme	NPFIT	DOCUMENT NUMBER
	Sub-Prog/Project	Comms & Messaging	National Prog	Org	Prog/Proj	Doc Type	Seq
	Prog. Director	Tim Jones	NPFIT	FNT	TO	DPM	0099.01
	Sub-Prog/Proj Mgr	Margaret Baldock
	Author	Core Technical Team	Version No.		1.7
	NPO/PSO Contact	Sarah King	Status		Issued

 

 

Contents

 

 

Change History

In Version	Author	Date	Amendment Details
1.0	Core Technical Team	10/05/04	Issued.
PoC Interim Release	Core Technical Team	21/05/04	Examples and tabular views added.
1.1	Core Technical Team	25/06/04	Harmonise Discharge and Care Event Report with clinical statement pattern. Removal of Transfer Request and all associated interactions.
1.2	Core Technical Team	20/08/04	Fixed hyperlinks.
1.3	Core Technical Team	08/09/04	Harmonise Discharge and Care Event Report with clinical statement pattern v1.3. Added copy recipient interactions. Changes to use new control act wrapper.
1.4	Core Technical team	17/09/04	Further changes made to all messages to conform with clinical statement pattern v1.3. Changes made to all messages to ensure conformance with relevant portions of Medication Management models. Other detailed changes made to models and tabular views: see section 10.
1.5	Core Technical Team	29/10/2004	Updated to new versions of Infrastructure Artefacts. New trigger event for message withdrawal New interactions for new wrapper versions.
1.6	Core Technical Team	06/12/2004	Further changes made to all messages to align with clinical statement pattern v1.5 Updated to new versions of Infrastructure Artefacts. Changes made to all messages to ensure conformance with relevant portions of Medication Management models. Other detailed changes made to models and tabular views: see section 9.
1.7	Core Technical Team	07/01/2005	Updated to reflect changes made to handle Medication & prescribing

 

 

1    Overview

Phase 1 of Provision of Care focuses on discharge and shared care processes and the associated communications between primary care and secondary care. The message definitions within this document support the following Care communications:

 

• Care event report
• Discharge.

 

All clinical statements carried within messages shall be classified by one and only one CRE category

1.1    Error Correction

The following messages in this domain may be withdrawn using the Generic ‘Withdrawal’ message Notify Message Withdrawal – UKCI_MT010101UK02 as defined in the Infrastructure Domain. The use case is where a message is sent on an incorrect NHS Number.

 

Discharge

Care Event Report

 

2    Storyboards

 

2.1    Discharge

Mrs Wilma Flintstone has been treated in hospital under the care of Mr Stones the Urology Consultant.   Following successful removal of a Staghorn Calculus she is now well enough to be discharged home and back to the care of her GP Dr Helpful.  She has been advised to increase her fluid intake to at least 3 litres of fluid a day and an appointment has been made for her to be seen in Mr Stones OPD Clinic in 6 weeks time   All relevant information relating to her in patient stay is collated on the Hospital system and a discharge message to the primary care service provider is passed across the Transaction and Messaging service to the senders (GP) system.  This allows Dr Helpful to view the details of her hospital stay and he is aware of the advice given and the appointments made for her at Mr Stones clinic. Although not relevant to Wilma’s current health issue, it should be noted at this point that Wilma is a known Mental Health patient who has had numerous admissions in past years for control of her schizophrenia.

 

2.2    Care Event Report

The Clinical scenarios for Provision of Shared Care in Phase 1 can both be viewed as Care event reports:

-        Primary care (GP) care event.  This is a new communication: sent at the end of a care event to PSIS with relevant clinical information of the event

-        Outpatient clinic care event. This is an existing clinical communication:  the clinic letter is now being exchanged between primary and secondary care.

 

A care event may be defined as a care provision event for a service user. Care events may consist of component activities and may link to other care events.

For the purposes of this document we define a Care event report as: Information about a care event (e.g. when it took place, where, who was involved in which organisation, etc) and optionally information about the care provided during the care event (including care activities performed, patient observations generated, plans made for further care).  Care events may be linked together (e.g. a set of care events may have occurred during an in-patient spell), as many of the activities and observations made during care events (e.g. to related different stages of an activity’s lifecycle, or to build up episodes of care). 

 

3    Application Roles

The applications involved in the Provision of Care processes play specific roles.  These, along with the interactions associated with each role, are identified below.

3.1    Initiating Service Provider - REPC_AR350000UK01

The Initiating Service Provider is responsible for initiating the following Provision of Care interactions: Discharge and Care Event Report. 

The Initiating Service Provider receives responses to the above interactions from the Receiving Service Provider. 

 

Initiating Service Provider Interactions

 

3.2    Receiving Service Provider - REPC_AR360000UK01

The Receiving Service Provider receives, acts upon and provides the requested services for the following Provision of Care interactions: Discharge and Care Event Report.

The Receiving Service Provider initiates responses for the above interactions to the Initiating Service Provider.

 

Receiving Service Provider Interactions

 

3.3    Copy Recipient REPC_AR370000UK01

This application role receives copies of the Discharge Summary or Care Event Report. The Copy Recipient (Tracker) does not have any responsibility other than to acknowledge receipt of the message at the application level.

 

Copy Recipient interactions

 

 

 

4    Trigger Events

 

4.1    Completion of Discharge - REPC_TE410000UK01

The Completion of Discharge trigger event indicates that a discharge summary has been prepared for a patient.

 

 

4.2    Communication of Care Event - REPC_TE420000UK01

The Communication of Care Event trigger event indicates that a care event report has been provided.

 

 

4.3    PoC Message Withdrawal - REPC_TE430000UK01

For the Discharge and Care Event Report messages to be withdraw,  the trigger event is the realisation that the PoC message was in error, in that it contained an incorrect NHS Number and should never have been sent.

Structured Name	PoC Message withdrawal
Type	State Transition
State Transition	PoC message is withdrawn

 

 

 

 

5    Interaction Diagrams

    

    

 

 

6    Interactions

 

 

6.1    Discharge - REPC_IN410000UK07

The Discharge communicates a summary of service user care events and care data and a notification that the responsibility for the care of a service user has been transferred to another service provider.

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Service Provider	REPC_AR360000UK01
Trigger Event	Completion of Discharge	REPC_TE410000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Discharge	REPC_MT400101UK07

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.2    Care Event Report - REPC_IN420000UK07

The Care Event Report communicates information about a care event and optionally information about the care provided during the care event.

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Service Provider	REPC_AR360000UK01
Trigger Event	Completion of Care Event	REPC_TE420000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Care Event Report	REPC_MT410101UK07

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.3    Discharge Copy - REPC_IN430000UK05

Sending of a copy of the Discharge to any copy recipient. This for information only, the recipient does not have to take any action other than acknowledge receipt at the application level.

 

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Copy Recipient	REPC_AR370000UK01
Trigger Event	Completion of Discharge	REPC_TE410000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Discharge	REPC_MT400101UK07

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.4    Care Event Report Copy - REPC_IN440000UK05

Sending of a copy of the Care Event Report to any copy recipient. The report is for information only, the recipient does not have to take any action other than acknowledge receipt at the application level.

 

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Copy Recipient	REPC_AR370000UK01
Trigger Event	Completion of care event	REPC_TE420000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Care Event report	REPC_MT410101UK07

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.5    Withdraw Discharge - REPC_IN450000UK02

Withdrawal of a discharge message.

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Service Provider	REPC_AR360000UK01
Trigger Event	PoC Message Withdrawal	REPC_TE430000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Generic withdrawal message	UKCI_MT010101UK02

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.6    Withdraw Care Event Report - REPC_IN460000UK02

Withdrawal of a Care Event Report.

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Service Provider	REPC_AR360000UK01
Trigger Event	PoC Message Withdrawal	REPC_TE430000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Generic withdrawal message	UKCI_MT010101UK02

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.7    Withdraw Discharge Copy - REPC_IN470000UK02

Withdrawal of Discharge Copy.

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Copy Recipient	REPC_AR370000UK01
Trigger Event	PoC Message Withdrawal	REPC_TE430000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Generic withdrawal message	UKCI_MT010101UK02

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

6.8    Withdraw Care Event Report Copy - REPC_IN480000UK02

Withdrawal of Care Event Report Copy.

 

Sending Role	Initiating Service Provider	REPC_AR350000UK01
Receiving Role	Receiving Copy Recipient	REPC_AR370000UK01
Trigger Event	Completion of care event	REPC_TE430000UK01
Transmission Wrapper	Send Message Payload	MCCI_MT010101UK12
Control Act Wrapper	Control Act	MCAI_MT040101UK03
Message Type	Generic withdrawal message	UKCI_MT010101UK02

 

 

Receiver Responsibilities

Reason	Interaction
Application Acknowledgement	Application Acknowledgement MCCI_IN010000UK13

 

 

7    Message Definitions

7.1    Discharge - REPC_MT400101UK07

The Discharge informs the recipient that responsibility for the service user has been transferred and contains a summary of care events and care data.

 

          

 

7.1.1    Scenario: Surgical

A patient arrives at a Day Case Clinic for an operation. The patient has the operation with no complications and is discharged home.

   

7.1.2    Scenario: Medical

A patient is admitted to hospital with chest pain. The patient is diagnosed as having a Myocardial Infarction, is treated, recovers and is discharged home.

   

7.1.3    Scenario: Maternity

A pregnant patient is admitted to a Central Delivery Unit of a Maternity Hospital in labour. After a short labour the baby is delivered. Mother and baby are both well and are discharged home after 6 hours.

   

 

7.2    Care Event Report - REPC_MT410101UK07

The Care Event Report communicates information about a care event and optionally information about the care provided during the care event.

 

           

 

7.2.1    Scenario: Simple - Single Problem

A patient attends his GP complaining of a sore throat. The patient is examined and prescribed antibiotics.

   

7.2.2    Scenario: Multiple Care Professionals

A child has been suffering with asthma for 2 days. His mum decides that he needs to see the doctor. Whilst he is at the doctors he is given a nebuliser and his medication dose is changed.

   

7.2.3    Scenario: Vaccination

A mother brings along her child for a second set of baby vaccinations.

   

7.2.4    Scenario: Patient not Present

Three days after vaccinations a child is not behaving as normal. Her mother rings the surgery for advice.

   

7.2.5    Scenario: Home Visit

A GP performs a home visit on a newly registered patient.

   

7.2.6    Scenario: Single Care Professional

A patient attends an outpatient appointment. He is seen and given an appointment to come in for surgery at a later date.

   

7.2.7    Scenario: One Stop Clinic

A patient has been suffering with chest pain for a number of weeks. Her GP decides to refer her to a Rapid Access Chest Pain clinic. She attends and is assessed.

             

 

8    Glossary of Terms

PSIS	Personal Spine Information Service.
ETP	Electronic transfer of Prescriptions.

 

 

 

9    Changes for V1.7

9.1    General Changes

• Changes relate to both messages, unless stated otherwise.
• PrescribedItem and associated relationships and  acts have been removed from the ClinicalStatementChoice.
• The Clinical Statement Choice has been replaced by a CMET, Clinical Statement Choice (UKCT_MT140900UK01).
• The CMET Medication Choice (UKCT_MT141000UK01) has been added. This contains 8 new CMET acts:
  • A_Recommend - UKCT_MT140101UK01 - for Recommendations.
  • A_AdministerMedicationSingle - UKCT_MT140201UK01 - for a Single Medication Administration.
  • A_PlanMedicationAdministration - UKCT_MT140301UK01 - for planned Medication Administration.
  • A_RequestMedicationSupply - UKCT_MT140401UK01 - for Medication Supply requests.
  • A_SupplyMedication - UKCT_MT140501UK01 CMET - for Medication Supply.
  • A_RequestMedicationSupplyAbort - UKCT_MT140601UK01 - for request to abort Medication Supply.
  • A_AdministerMedicationCourse - UKCT_MT140701UK01 - for a course of Medication Administration.
  • A_RequestMedicationAdministration - UKCT_MT140801UK01 - for Request Medication Administration.
• TransportInformation Act, now uses values from the ActMood subset x_ActMoodOrdPrmsEvn.(Discharge message only)
• The vocabulary used for FocalActCategory has been corrected  to FocalActCategory.
• The name attribute of the Place entity has changed from PN to TN
• Schemas have been generated with a different version of the schema generator than that used by all other domains (p12_5 ).
• The relationship between the ClinicalStatementChoice Organizer and the Component has had a cardinality change (from 2..* to 0..* ).

9.2    Changes to Interactions.

• Discharge interaction changed to - REPC_IN410000UK07
• Care Event Report interaction changed to REPC_IN420000UK07
• Discharge Copy interaction changed to - REPC_IN430000UK05
• Care Event Report Copy interaction changed to REPC_IN440000UK05