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

Use case

Important: The Appointment Management capability pack is aimed at administration of a patient’s appointments. As a result of information governance (IG) requirements the book appointment capability has been restricted to future appointments. See Design decisions.

The typical flow to book an appointment is:

1. Search by NHS Number for, or otherwise obtain, a Patient resource.
2. Search for available Slot resources by date range.
3. Create an Appointment for the chosen Slot and Patient resources.

Refer to Consumer sessions illustrated for how this API use case could be used in the context of a typical consumer appointment management session.

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 obtained the details for one or more free slots that are to be booked.
• SHALL have previously performed a GP Connect Find a Patient request to obtain the logical identifier for the patient on the organisation’s FHIR server.

API usage

The consumer system SHALL only use the book appointment capability to book future appointments, where the 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.

Adherence is expected to local business rules, agreements and policies defining good practice in GP Connect-enabled cross-organisational appointment booking. This will discourage for example the over-booking and subsequent cancellation of Slots.

Booking multiple adjacent slots

To book more than one slot in the same Book Appointment message, a consumer needs to be able to identify which adjacent slots may be booked together. This is determined by the following rules:

• Two slots (Slot A and Slot B) are adjacent when the start time of Slot B equals the end time of Slot A
• The adjacent slots SHALL reference the same Schedule resource
• The adjacent slots SHALL both have the same deliveryChannel value
• If the slots do not conform to one or more of the rules above, they SHALL NOT be accepted as part of the same appointment booking

Request operation

FHIR® relative request

POST /Appointment

FHIR absolute request

POST https://[proxy_server]/https://[provider_server]/[fhir_base]/Appointment

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:create:appointment-1

Payload request body

The request payload is a profiled version of the standard FHIR Appointment resource. See the 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.

The following data elements are mandatory (that is, data MUST be present):

• a patient participant of the appointment.
• a location participant of the appointment, representing the physical location where the appointment is to take place (see Design decisions page).
• an actor reference in any supplied participant.
• the start and end of the appointment.
  • where multiple slots are being booked, the start SHALL be the start time of the earlier slot, and the end shall be the end time of the latest slot
• the status identifying the appointment as “booked”.
• the slot details of one or more free slots to be booked.
  • where multiple slots are being booked, they SHALL meet the conditions required to be booked together - see Booking multiple adjacent slots
• the bookingOrganisation extension referencing a contained organization resource within the appointment resource.
  • the contained organization resource SHALL represent the organization booking the appointment.
  • the contained organization resource SHALL conform to CareConnect-GPC-Organization-1 profile.
  • the contained organization resource SHALL contain an identifier with the organisation’s ODS code.
  • the contained organization resource SHALL contain at least Name and Telecom details.
  • the contained organization resource SHALL include the type element with a value matching the organization type sent as a searchFilter with the Search for free slots request. If organization type was not passed to the searchFilter then type SHALL not be populated.
• the created element SHALL be populated with the date and time the appointment was created.

The following data elements SHOULD be included when available:

• a practitioner participant of the appointment.

The following data elements MUST NOT be included:

• reason
• specialty

Note: The provider system receiving the bookingOrganization details SHALL store, return and display these details as required by the Must-Support flag.

Element specific guidance

The following guidance around the Appointment resource element SHALL be followed when populating any of the listed fields:

Resource Element	Guidance
Appointment.description	This field SHALL be populated with a “Summary Label”, a brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Consumers SHALL impose a character limit of 100 characters for this element.
Appointment.comment	This field SHALL be used for “Patient specific notes” and any additional comments relating to the appointment. Consumers SHALL impose a character limit of 500 characters for this element.
Appointment.reason	Consumers and providers SHALL NOT use the appointment reason element as the GP Connect appointment management capability is for administration of appointment booking and should not be used to transfer clinical data between systems. As the reason element is for recording ‘clinical’ codes it goes against the purpose of the GP Connect Appointment Management capability, so it should not be used by consumers or providers.
Appointment.specialty	This field SHALL NOT be populated

Resource guidance

The following guidance SHALL be followed when populating an appointment resource:

• For providers who only support the mandatory description element and not the comment element. If a comment is received as part of the booking the provider SHOULD append the content of the comment to the description within the appointment so that the additional information is not lost. The consumer imposed character limit specified above should restrict the total number of characters received so that all providers can store any text they receive.
• If the consumer wishes to include patient temporary contact details for the purposes of the appointment they SHALL include them within the description element of the appointment, so that the details are retained against that specific appointment.
• Elements within the appointment (such as ‘comment’ and ‘description’) SHALL only contain limited amounts of information to support the appointment. The content of the appointment SHALL NOT be used for “Transfer of Care” clinical information.

Warning: Due to differences in the provider systems and the amount of information their data models can hold, there is a risk that information sent within the appointment may be truncated by the provider system if too large. Consumers and providers should be aware and try to limit risk where possible or make users aware of the risk when booking or amending an appointment. The consumer imposed character limit specified above should help mitigate this risk.

Example request body

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

{
  "resourceType": "Appointment",
  "meta": {
    "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.",
  "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

Provider systems:

• SHALL return a http status “409” with an error message “DUPLICATE_REJECTED” when an appointment can not be booked because the referenced slots within the appointment resource no longer have the status free, such as when the slot has been used to book a different appointment between the “search for free slots” request and the “book appointment” request.
• SHALL return an error if Appointment.reason is included in the appointment resource send by the consumer.
• SHALL return a GPConnect-OperationOutcome-1 resource that provides additional detail when one or more request fields are corrupt or a specific business rule/constraint is breached.

For example:

• the submitted start and end date range does not match that of the requested Slot(s)
• one or more of the requested Slot resources does not exist or already has a status of busy
• a business rule imposed by Slot Availability Management is breached, e.g. an organisational slot limit
• multiple slots were requested for booking but do not meet the criteria for booking multiple adjacent slots

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

Important: Provider systems MAY implement business rules to protect the responsible use of the booking API, in line with current business rules already in place, to prevent misuse of appointment booking outside of the GP Connect API implementation.

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 201 Created HTTP status code on successful execution of the operation.
• SHALL return a Location header as described in FHIR API guidance.
• SHALL return an Appointment resource that conform 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 each 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": "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"
      }
    },
    {
      "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.",
  "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;

Appointment appointment = new Appointment();

appointment.Status = Appointment.AppointmentStatus.Booked;
appointment.Start = System.DateTimeOffset.Now;
appointment.End = System.DateTimeOffset.Now.AddMinutes(30);

var slotReference = new ResourceReference();
slotReference.Reference = "Slot/1982";
appointment.Slot.Add(slotReference);

var patientParticipant = new Appointment.ParticipantComponent();
patientParticipant.Actor = new ResourceReference();
patientParticipant.Actor.Reference = "Patient/2";
patientParticipant.Status = Appointment.ParticipationStatus.Accepted;
appointment.Participant.Add(patientParticipant);

var locationParticipant = new Appointment.ParticipantComponent();
locationParticipant.Actor = new ResourceReference();
locationParticipant.Actor.Reference = "Location/1";
locationParticipant.Status = Appointment.ParticipationStatus.Accepted;
appointment.Participant.Add(locationParticipant);

appointment.created = new FhirDateTime(DateTime.Now);
Organization organization = new Organization();
organization.Name = "Example Organization Name";
var contactPoint = new ContactPoint();
contactPoint.System = ContactPoint.ContactPointSystem.Phone;
contactPoint.Value = "0300 303 5678";
organization.Telecom.Add(contactPoint);
organization.Id = "1";
appointment.Contained.Add(organization);
var reference = new ResourceReference
{
Reference = "#1",
};
appointment.AddExtension("https://fhir.nhs.uk/StructureDefinition/extension-gpconnect-booking-organisation-1", reference);

Appointment appointmentCreated = client.Create<Appointment>(appointment);

FhirSerializer.SerializeResourceToJson(appointmentCreated).Dump();

Java

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

FhirContext fhirContext = FhirContext.forStu3();
IGenericClient client = fhirContext.newRestfulGenericClient("http://gpconnect.aprovider.nhs.net/GP001/STU3/1/");

Appointment appointment = new Appointment();
appointment.setStatus(AppointmentStatusEnum.BOOKED);

Calendar startTime = Calendar.getInstance();
Calendar endTime = Calendar.getInstance();
endTime.add(Calendar.MINUTE, 30);
appointment.setStart(new InstantDt(startTime));
appointment.setEnd(new InstantDt(endTime));

appointment.setSlot(Collections.singletonList(new ResourceReferenceDt("Slot/1982")));

Appointment.Participant patientParticipant = new Appointment.Participant();
patientParticipant.setActor(new ResourceReferenceDt("Patient/2"));
patientParticipant.setStatus(ParticipationStatusEnum.ACCEPTED);
appointment.addParticipant(patientParticipant);

Appointment.Participant locationParticipant = new Appointment.Participant();
locationParticipant.setActor(new ResourceReferenceDt("Location/1"));
locationParticipant.setStatus(ParticipationStatusEnum.ACCEPTED);
appointment.addParticipant(locationParticipant);

Organization organization = new Organization();
organization.setName("Test Organization Name");
ContactPointDt telecom = new ContactPointDt();
telecom.setSystem(ContactPointSystemEnum.PHONE);
telecom.setValue("0300 303 5678");
organization.setTelecom(Collections.singletonList(telecom));

ExtensionDt extension = new ExtensionDt(false);
extension.setUrl("https://fhir.nhs.uk/StructureDefinition/extension-gpconnect-booking-organisation-1");
extension.setValue(new ResourceReferenceDt(organization));
appointment.addUndeclaredExtension(extension);

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

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

Tags: appointments