Illustration of the use of MESH and ITK3 to send a document

All messages sent in order to update GP systems through GP Connect Messaging capabilities have the following NHS Spine integration requirements:

• use of MESH to send messages
• use of ITK3 to provide a standard FHIR Message format

Additionally, as most of these messages will be intended to update the care record at the patient’s registered practice, most messaging use cases will make use of an additional MESH capability:

• MESH Endpoint Lookup Service

Use cases not intending to update the care record at the patient’s registered practice will make use of the MESH API.

Example 1: Integrate with Spine to send a consultation report as a document

The following diagram illustrates the systems involved, and their responsibilities, in sending the consultation report document:

The steps shown in the diagram are detailed below:

1. The sender system constructs a FHIR Message according to the ITK3 standard which contains the details of the consultation which has taken place. The message is placed in the /OUT directory.
2. The MESH Client installed at the sender practice picks up the message from the /OUT directory and sends the message securely to the central Spine MESH server.
3. The Spine MESH server extracts patient’s Surname, Date of Birth and NHS Number from the To_DTS field in the MESH message .CTL file, and then performs a PDS lookup using these details in order to discover the ODS code of the patient’s registered practice.
4. The Spine MESH server calls the MESH Endpoint Lookup Service and returns the practice mailbox details.
5. The Spine MESH server places the message into this mailbox.
6. The MESH Client at the registered practice collects the message from registered practice mailbox and writes the collected message to the /IN directory.
7. The Registered practice GP system picks up the message from the /IN directory and updates the GP system. This is likely to be done through raising a workflow task containing the message contents.

Example 2: Integrate with Spine to send an Online Consultation Report as a document to an alternative care provider (for example, cmmunity pharmacy)##

The following diagram illustrates the systems involved, and their responsibilities, in sending the Online Consultation Report document:

The steps shown in the diagram are detailed below:

1. The sender system uses the MESH API Address Lookup function to request the receiving organisation MESH mailbox ID (two lookups are initiated, one for the alternative care provider, one for the patient’s register GP).
2. The Spine MESH service returns two responses containing the MESH mailbox ID for the alternative care provider and the patient’s registered GP practice.
3. The sender system constructs a FHIR Message according to the ITK3 standard which contains the details of the consultation which has taken place. The message is sent to the alternative care provider using the MESH API Send Message function labelled “For Action”.
4. The sender system constructs a FHIR Message according to the ITK3 standard which contains the details of the consultation which has taken place. A copy of the message is sent to the patient’s registered GP practice using the MESH API Send Message function labelled “For Information”.
5. The Spine MESH server places the messages in the receiving organisations mailboxes to await collection.
6. The receiving organisation (community pharmacy) uses the MESH API download message function to download the messages from their MESH mailbox.
7. The receiving organisation (patient’s registered GP practice) uses the MESH API download message function to download the messages from their MESH mailbox.