There are numerous benefits that are expected to be achieved through the implementation of electronic ToC including the delivery of ‘Paperless 2020’
NHS Digital have developed a Test Harness with GP Synthetic Client and Hospital Synthetic Client capabilities. The Test Harness is hosted in the OpenTest environment and can operate as a GP Synthetic Client or Hospital Synthetic Client. Secondary care organisations would send via MESH, messages to a GP synthetic client, which would send back responses as if from an enabled real GP IT system.
There is an existing conformance certification (accreditation) process for the MESH API, and the Rhapsody product has achieved this certification, see:
MESH is the transport layer and ITK provides the distribution envelope. Organisations change their Org code, i.e. Organisation Data Service (ODS) code on a regular basis due to activities such as merges at Trust and General Practice level. ODS provides important addressing or identifying information (such as security certification) for MESH and ITK. The MESH End Point Lookup function can discover the MESH Mailbox ID by providing an ODS code.
CDA has been deprecated for use within ToC to minimise the burden on supporting multiple send / receive types. The previous levels are still valid and can be applied equally to FHIR. The messages will contain the same components: meta data about the document, text of the document and coded entries. The embedding of PDFs etc. as the document is not a valid implementation and as a minimum structured text is expected. Structured, coded entries should also be included where possible.
It will be required that support for MeSH is available but the architecture will be up to local determination.
A ‘first of type’ organisation will include GDE’s, fast followers and leapfrogs who are committed to and are able to implement the requirements before the due date outlined in the NHS Standard Contract.
SNOMED CT is the clinical vocabulary chosen to replace Read codes within the NHS. SNOMED CT must be adopted by all general practice service providers before 1 April 2018, with Secondary Care, Acute Care, Mental Health, Community systems and other systems used in the direct management of care of an individual moving to SNOMED CT before 1 April 2020.
The proposed capability is for any type of message and will work by transferring documents into the GP workflow/system where the receiving system will manage receipt. Currently, there isn’t a generic document structure as focus has been on the four ToC types. These documents will have common FHIR resources but not follow a generic structure.
The ToC message should contain structured narrative, coded content. The message should be human readable, machine readable and machine to machine transferable, once scrutinised by the GP.