Amend an appointment for a patient at an organisation

Use case for amending an appointment for a patient with a given organisation

Use case

This API is used to amend the Description or Comment, or Cancellation Reason where applicable, of a patient’s future appointment, obtained via use of either Retrieve a Patient’s Appointments, or Read an Appointment APIs. Any appointment, ie irrespective of booking organisation, can be amended by a consuming organisation participating with the appointment hosting organisation in a GP Connect deployment.

The typical flow to amend an appointment is:

Search by NHS Number for, or otherwise obtain, a Patient resource.
Search for Appointment resources for the Patient resource.
Choose an Appointment resource and update its description and/or comment. If the appointment has been cancelled then the cancellation reason may also be updated.

Important: The Appointment Management capability pack is aimed at administration of a patient’s appointments. As a result of information governance (IG) requirements, the amend appointments capability has been restricted to future appointments. More details are available on the Design decisions page.

Security

GP Connect utilises TLS Mutual Authentication for system level authorization
GP Connect utilises a JSON Web Tokens (JWT) to transmit clinical audit and provenance details

Prerequisites

Consumer

The consumer system:

SHALL have previously resolved the organisation’s FHIR endpoint base URL through the Spine Directory Service
SHALL have previously traced the patient’s NHS Number using the Personal Demographics Service or an equivalent service
SHALL have previously found the appointment ID using Retrieve a patient’s appointments

API usage

The consumer system SHALL only use the amend appointment capability to amend future appointments where appointment start dateTime is after the current date and time. If the appointment start date is in the past the provider SHALL return an error.

Request operation

FHIR relative request

PUT /Appointment/[id]

FHIR absolute request

PUT https://[proxy_server]/https://[provider_server]/[fhir_base]/Appointment/[id]

Request headers

Consumers SHALL include the following additional HTTP request headers:

Header	Value
`Ssp-TraceID`	Consumer’s TraceID (i.e. GUID/UUID)
`Ssp-From`	Consumer’s ASID
`Ssp-To`	Provider’s ASID
`Ssp-InteractionID`	`urn:nhs:names:services:gpconnect:fhir:rest:update:appointment-1`
`If-Match`	The Appointment’s current ETag, e.g. `W/"23"`

Payload request body

The request payload is a profiled version of the standard FHIR Appointment resource. See FHIR resources page for more detail.

Consumer systems:

SHALL send an Appointment resource that conforms to the GPConnect-Appointment-1 profile.
SHALL include the URI of the GPConnect-Appointment-1 profile StructureDefinition in the Appointment.meta.profile element of the appointment resource.

Important: It is recommended that Consumers read the Appointment they wish to amend (via Read an appointment or Retrieve a patient’s appointments), then update the fields allowed below in place. Attempting to recreate the Appointment resource from local transformed data formats/structures is not advised, and may result in the provider system rejecting the amendment due to an unintended change or missing field.

Only the following data-elements can be modified when performing an appointment amendment:

description
comment
Appointment cancellation reason extension, which SHALL only be amended when the appointment status is cancelled.

Note: For providers who only support the mandatory description element and not the comment element. If a comment is received as part of the amendment the provider SHOULD append the content of the comment to the description within the appointment so that the additional information is not lost.

To reduce the risk of information being truncated when stored on the providers side, consumers SHALL impose:

a 100 character limit on the appointment description element when editing a GP Connect appointment.
a 500 character limit on the appointment comment element when editing a GP Connect appointment.

On the wire a JSON serialised request would look something like the following:

{
  "resourceType": "Appointment",
  "id": "9",
  "meta": {
    "versionId": "636068818095315079",
    "profile": [
      "https://fhir.nhs.uk/STU3/StructureDefinition/GPConnect-Appointment-1"
    ]
  },
  "contained": [
    {
      "resourceType": "Organization",
      "id": "1",
      "meta": {
        "profile": [
          "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Organization-1"
        ]
      },
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "A00001"
        }
      ],
      "name": "Test Organization Name",
      "telecom": [
        {
          "system": "phone",
          "value": "0300 303 5678"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-BookingOrganisation-1",
      "valueReference": {
        "reference": "#1"
      }
    }
  ],
  "status": "booked",
  "description": "Free text description updated.",
  "start": "2016-05-30T10:00:00+01:00",
  "end": "2016-05-30T10:25:00+01:00",
  "slot": [
    {
      "reference": "Slot/1",
      "display": "Slot 1"
    }
  ],
  "created": "2017-10-09T13:48:41+01:00",
  "comment": "Free text comment.",
  "participant": [
    {
      "actor": {
        "reference": "Patient/1",
        "display": "Mr. Mike Smith"
      },
      "status": "accepted"
    },
    {
      "actor": {
        "reference": "Location/32",
        "display": "Leeds GP Clinic"
      },
      "status": "accepted"
    }
  ]
}

Error handling

The provider system:

SHALL return an GPConnect-OperationOutcome-1 resource that provides additional detail when one or more request fields are corrupt or a specific business rule/constraint is breached.
SHALL return an error if any appointment details other than the appointment comment, description or cancellation reason are amended. The appointment resource should be considered invalid and the provider system should return a 422 error with error code INVALID_RESOURCE.
SHALL return an error if the appointment being amended is in the past (the appointment start dateTime is before the current date and time).
SHALL return an error if the version identifier in the If-Match header does not match the Appointment’s current version identifier. See Managing resource contention.

Refer to Development - FHIR API guidance - error handling for details of error codes.

Request response

Response headers

Provider systems are not expected to add any specific headers beyond that described in the HTTP and FHIR® standards.

Payload response body

Provider systems:

SHALL return a 200 OK HTTP status code on successful execution of the operation.
SHALL return an Appointment resource that conforms to the GPConnect-Appointment-1 profile.
SHALL include the URI of the GPConnect-Appointment-1 profile StructureDefinition in the Appointment.meta.profile element of the returned appointment resource.
SHALL include the versionId of the current version of the appointment resource.
SHALL meet General FHIR resource population requirements populating all fields where data is available, excluding those listed below
SHALL NOT populate the following fields:
- reason
- specialty

{
  "resourceType": "Appointment",
  "id": "9",
  "meta": {
    "versionId": "6360688180953112345",
    "profile": [
      "https://fhir.nhs.uk/STU3/StructureDefinition/GPConnect-Appointment-1"
    ]
  },
  "contained": [
    {
      "resourceType": "Organization",
      "id": "1",
      "meta": {
        "profile": [
          "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Organization-1"
        ]
      },
      "identifier": [
        {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "A00001"
        }
      ],
      "name": "Test Organization Name",
      "telecom": [
        {
          "system": "phone",
          "value": "0300 303 5678"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-BookingOrganisation-1",
      "valueReference": {
        "reference": "#1"
      }
    },
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-PractitionerRole-1",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "https://fhir.nhs.uk/STU3/CodeSystem/CareConnect-SDSJobRoleName-1",
            "code": "R0260",
            "display": "General Medical Practitioner"
          }
        ]
      }
    },
    {
      "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-GPConnect-DeliveryChannel-2",
      "valueCode": "In-person"
    }
  ],
  "status": "booked",
  "description": "Free text description updated.",
  "start": "2016-05-30T10:00:00+01:00",
  "end": "2016-05-30T10:25:00+01:00",
  "slot": [
    {
      "reference": "Slot/1",
      "display": "Slot 1"
    }
  ],
  "created": "2017-10-09T13:48:41+01:00",
  "comment": "Free text comment.",
  "participant": [
    {
      "actor": {
        "reference": "Patient/1",
        "display": "Mr. Mike Smith"
      },
      "status": "accepted"
    },
    {
      "actor": {
        "reference": "Location/32",
        "display": "Leeds GP Clinic"
      },
      "status": "accepted"
    }
  ]
}

Examples

C#

Tip: C# code snippets utilise Ewout Kramer’s fhir-net-api library, which is the official .NET API for HL7® FHIR®.

var client = new FhirClient("http://gpconnect.aprovider.nhs.net/GP001/STU3/1");
client.PreferredFormat = ResourceFormat.Json;
var appointment = client.Read<Appointment>("Appointment/9");
// Update The Comment For The Appointment
appointment.comment = "Free text updated comment.";
var updatedAppointment = client.Update<Appointment>(appointment);
FhirSerializer.SerializeResourceToJson(updatedAppointment).Dump();

Java

Tip: Java code snippets utilise James Agnew’s hapi-fhir library.

// Read appointment to be updated
FhirContext ctx = FhirContext.forStu3();
IGenericClient client = ctx.newRestfulGenericClient("http://gpconnect.aprovider.nhs.net/GP001/STU3/1");
Appointment appointment = client.read().resource(Appointment.class).withId("9").execute();

// Amend appointment comment
appointment.setComment("Java Example Comment");

// Update appointment
MethodOutcome response = client.update()
	.resource(appointment)
	.prefer(PreferReturnEnum.REPRESENTATION)
	.preferResponseType(Appointment.class)
	.execute();

System.out.println(fhirContext.newJsonParser().setPrettyPrint(true).encodeResourceToString(response.getResource()));

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