Release notes for the Healthy child programme events specification 1. Introduction 2 2. Audience 2 3. What has changed? 2 3.1. SNOMED 2 3.2. FHIR version 3 2 3.3. Event Changes 3 Copyright 2017 Health and Social Care Information Page 1 of 6
1. Introduction In early November 2017, PRSB published in draft the Healthy Child Record Standard. It consisted of two documents and a link to a further third. Healthy Child Record specification this specifies the format of an electronic care record supporting the Healthy Child Programme, including the clinical headings and sub headings which provide the standardised structure for that record. Healthy Child Events Specification this provides the detailed content for the events, including values and business rules used to support the creation of the FHIR Events Catalogue. At the point of publication, the FHIR Events were in alpha phase in version 2 https://nhsconnect.github.io/digital-child-health/generated/chapter.1.about/index.html This document articulates the changes made as part of the formal endorsement process 2. Audience This document is aimed at anyone who has previously looked at, coded against, reviewed the draft content, or has any interest in the PRSB Healthy Child Standard and the related FHIR specifcations. 3. What has changed? Firstly, it should be pointed out that the Healthy Child Record Specification has not changed at all. This underwent substantial consultation throughout 2017. The changes are focused on the Healthy Child Events Specification and focus on giving greater clarity around what is expected to be recorded and how. 3.1. SNOMED As part of the move to single terminology, SNOMED CT, for the direct management of care of an individual, across all care settings in England, as recommended by the National Information Board (NIB) https://www.gov.uk/government/publications/personalised-health-andcare-2020. Secondary care, acute care, mental health, community systems, dentistry and other systems used in direct patient care must use SNOMED CT as the clinical terminology, before 1 April 2020 (https://digital.nhs.uk/snomed-ct) The Event specification has been updated to include a list of recommend SNOMED CT terms and/or refsets that the data items within the record should conform to. 3.2. FHIR version 3 Messages have been released to STU-3 into a Beta Phase on 31/04/2018 and incorporates all changes referenced in this document https://developer.nhs.uk/apis/dch-beta/ A further change has seen the addition of a further column within the Event specification which specifies the required binding to either required or extensible or preferred. https://www.hl7.org/fhir/valueset-binding-strength.html Copyright 2017 Health and Social Care Information Page 2 of 6
3.3. Event Changes The next sub section will detail each event where changes have taken place. This could be a change of any size, although most have been deemed small as we have gone through the process. CH001 Additional Demographics - Religion data item amended from Required to Mandatory CH002 Admission Details - Time added into event to match Record Specification - Name of location and patient location added as an optional field to ensure event has multiple uses in Social Care CH003 Allergies and Reactions - Description of Reaction to allow both free text and SNOMED as per INTEROpen curation process - Type of Reaction options limited to two as per INTEROpen curation - Certainty options matched to INTEROpen curation - Severity options matched to INTEROpen curation CH004 Assessment Scales - Two new data items added to allow a Subscale name and Subscale score for any assessment done other than Ages and Stages. CH005 Birth Details - Failed Delivery set to two options. - Skin Problem added as an option in Physical Problems Detected At Birth, replacing Erythematous skin rash and Vesicular skin rash - Identical Twin Indicator amended from Required to Optional - Location of Birth amended from Mandatory to Required as this requires an ODS code which would not be possible when Delivery Place Type Code does not = 0, 2, 3, 4 or 7) into Type of Deilvery that is related to the baby rather than the mother CH006 Blood Spot Sample Taken - New event codes created and CH006 renamed. This is based on feedback from Northgate and Sitekit. It was always intended to be 3 separate events, but was not clear enough in the Event Specifcation o CH006 Blood Spot Sample Taken o CH034 Blood Spot Card Received o CH035 Blood Spot Test Outcome - Allow both National Codes and SNOMED to be publisbed and received in Blood Spot Test Outcome - Removed code 902 from CF outcome - Removed code 307 from Sickle cell outcome as this was incorrect Copyright 2017 Health and Social Care Information Page 3 of 6
CH007 Clinical Risk Factors - No changes identified CH008 Conditions/Diagnoses - Condition End Date added - Condition Onset Date to allow free text and date, rather than just date - Fetal Diagnoses flag added CH009 Discharge Details - Changed Encounter Type from Mandatory to Required and removed other option - Added in Name of Location as per admission details CH010 Early Years Progress - Site Code, Professional Name/Type amended from Mandatory to Required CH011 Emergency Care Discharge CH012 Examination Findings - Looks and feel will be quite different to what was originally published, however data items behind it are the same. - Added free text and coded options together on same row to be modelled in FHIR. Most 'free text' rows have been removed - Descriptions updated to make it clearer what is being examined, and new codes to be requested CH013 Family History - Maternal Problems in Pregnancy now a data item within Family History, still populating Birth Details part of the Record. - Paternal/maternal option removed as the codes provided in the relationship of the person with the condition to the child allow recording of both paternal and maternal, and new codes to be requested CH014 Feeding Status - First Milk feed now has Donor Milk as an option - Time of First Milk Feed added to ensure alignment with MSDS - 'Other' option removed from Predominant Feeding Method data options CH015 Immunisation Administration - Dose Sequence changed from Required to Optional - Outcome Status changed from Mandatory to Optional. Both based on feedback from PHE to record vaccinations as per SNOMED CT including dose/outcome. Removed the data option GIVEN as not necessary based on SNOMED. - SNOMED collation of all immunisations on the HCP since 2007 in progress and a refset to be requested. Copyright 2017 Health and Social Care Information Page 4 of 6
CH016 Individual Requirements - Added in SNOMED for cognitive/mobility, allowing free text as well as per SCCI ISN for accessible information - Amended Individual Needs Person Indicator from Required to Mandatory - Changed data item name from Cognition to Cognitive CH017 Information and Advice Given - No changes identified CH018 Measurements, and new codes to be requested - Birth Weight changed from Mandatory to Required as will also come as part of Birth Notification PDS message CH019 Medication - Course Status options updated to match FHIR - Data items from row 11 down amended to optional as per PRSB standard - Course Status changed from Required to Optional - Dose Direction Description changed from Required to Optional - Dose Direction Duration changed from Required to Optional - Additional Instructions changed from Required to Optional - Indication changed from Required to Optional as per INTEROpen curation CH020 Developmental Skills - Result of Observation/Enquiry options limited to three. CH021 Newborn Hearing - Type of Test data item removed as this is all included in the SNOMED CH022 Parent, Guardian or Personal Comment - No changes identified CH023 Personal Contacts - Household member and Significant Individual only require a positive response, rather a YES/NO response CH024 Physical Examination - Time was in original PRSB Event Specification, and needs to be in the FHIR Specification Copyright 2017 Health and Social Care Information Page 5 of 6
CH025 Plan and Requested Actions - Actions free text field no longer limited to 900 characters for FHIR purposes CH026 Professional Comment - Comment free text field no longer limited to 900 characters CH027 Professional Contacts - Team moved from Mandatory to Required - Care Professional Association has a new option for Ended for the Population Failsafe - Start Date and End Date moved from Mandatory to Required - Reason added as a free text to capture why an association was started/ended (optional field) CH028 Referral - Urgency of Referral data option changed from 2 Week Wait to Urgent - Specialty Referred to renamed to Service Referred to CH029 Safety Alerts CH030 Social Context Household - Any Household member has/had social services support set to a TRUE/FALSE value - Removed Household Composition and Significant Individuals data items as duplication of CH023 Personal Contacts event CH031 Social Context Person CH032 Educational History - Type of Educational Establishment has one extra option added for university CH033 Legal Information CH034 Blood Spot Card Received - New event code created, split off from CH006 CH035 Blood Spot Test Outcome - New event code created, split off from CH006 Copyright 2017 Health and Social Care Information Page 6 of 6