BaRS Use Case 999-111 Referral

The Booking and Referral Standard is an interoperability standard for healthcare IT systems that enables booking and referral information to be sent between NHS service providers quickly, safely and in a format that is useful to clinicians. It will eventually be available in all care settings.

Benefits of BaRS

An interoperability standard for patient booking and referrals will have several benefits.

Patients will:

be able to efficiently book appointments and time slots with the service that's right for them get the right advice and treatment when they most need it, safely and easily

Healthcare workers will:

receive the information they require, and in sufficient detail, to enable them to undertake the patient care activity requested be able to triage the patient without asking them to unnecessarily repeat information already collected earlier in their journey send and receive booking and referral data that is integrated into existing healthcare IT systems - this avoids working across 2 or more applications or systems and saves time

IT suppliers and care providers should find it easier and more efficient to implement a single, agreed national interoperability standard, rather than supporting the multiple and varied standards currently in operation.

Commissioners and Integrated Care Systems will find it easier to integrate care journeys across care settings using existing systems.

Use of UK Core

• Appointment
• ServiceRequest
• Slot
• Schedule
• HealthCareService
• Flag
• QuestionnaireResponse

999-111 Referral

The following requirements have been identified for the transfer of cases from the 999 ambulance service trust (AST)to a 111 integrated care clinical assessment service (CAS) for the purpose of referral of an agreed cohort of non-ambulance (CAT5) dispositions.

User Stories

BaRS will first be implemented within two care journeys:

1. Between 999 and clinical assessment services (CAS) for referral or ambulance validation
2. Between NHS 111 and emergency departments (also known as accident and emergency or A&E)

999 - CAS for Referral

As a 999 Call Handler, I can:

• Select a suitable Service Provider to transfer the patient to
• Electronically transfer the case to the selected service
• Receive confirmation that the transfer request has been received and accepted by the service
• Update the transfer request if information changes
• Cancel the transfer request
• Know the status of the transfer request

So that

• I can search and find a Service Provider who will provide the advice and carew the patient requires.
• the case transfer is communicated to the relevant Service Provider
• I am confident that the patient is being managed
• the case is correctly prioritised and the receiving clinician is acting on up-to-date information
• the receiving service provider clinician doesn't waste his time on cancelled transfer requests
• if the patient calls back I can update or cancel the Referral if necessary

As a Receiving Service Provider Clinician, I can:

• See cases referred to my service appear on the appropriate clinical queue
• Have sufficient information to be able to prioritise a case for validation
• Always see the most up to date clinical queue
• See if the 999 service verified the patient's details with PDS
• Know if the call was from the patient or a third party
• See the third party details
• See contact details
• Understand why the patient was referred to me and what is expected of me
• To see the triage details that prompted the transfer request
• Have the most up-to-date information about the case
• Not have to re-enter triage information that is still relevant from the 999 triage
• Contact the sending service

So that

• The patient can be assessed by a clinician with the correct skillset
• I can complete the clinical assessment within the required timeframe to meet the patient’s needs
• I have confidence that I am managing my queue in the correct order at all times
• I only perform a PDS trace when needed (as I need a validated NHS Number to access additional patient details from other data sources e.g. Summary Care Record, Local Care Record, CP-IS).
• The appropriate triage logic is used
• I can address the person appropriately when I call them
• I call the patient to undertake the validation
• I can undertake the action that was expected by the sending service.
• I am informed when undertaking my assessment
• I am confident that I have the correct information to inform my clinical assessment
• I can use my time efficiently
• I can clarify any issues

As a Patient, I want:

• My data sharing consent to be adhered to
• My needs to be met as soon as possible
• Healthcare professionals to contact me via my preferred method of contact and preferred language
• Healthcare professionals to take note of what I say

So that

• Information is not shared with my GP/Other healthcare services without my consent
• I feel better and can get on with my life
• I am confident that I (or my representative) will be contacted by a health professional without delay and can communicate effectively with health advisors and clinicians
• I do not have to repeat myself unnecessarily

As a CAD System Supplier, I want:

• A single way to send transfer requests for a patient, regardless of the recipient
• A specification that all my customers will want to adopt
• The specification to be consistent with other new NHSD API specifications
• A detailed published technical specification for all 999-111 use cases
• A conformance process
• Usage guidance on implementing the technical specification

So that

• My system can be designed with one format in mind.
• I get a return on my investment
• It reduces my tech debt, I am not unnecessarily developing against multiple versions of FHIR, my developers are using the same data standards as other NHSD APIs they are developing for the product
• I can develop my system to the specification
• My system can be certified compliant to the published specification
• I can develop my system to the specification and best practice

As a CAS System Supplier, I want:

• A single way to receive transfer requests for a patient, regardless of the sending system
• A specification that all my customers will want to adopt
• The specification to be consistent with other new NHSD API specifications
• A detailed published technical specification for all 999-111 use cases
• A conformance process
• Usage guidance on implementing the technical specification

So that

• My system can be designed with one format in mind.
• I get a return on my investment
• It reduces my tech debt, I am not unnecessarily developing against multiple versions of FHIR, my developers are using the same data standards as other NHSD APIs they are developing for the product
• I can develop my system to the specification
• My system can be certified compliant to the published specification
• I can develop my system to the specification and best practice

As a 999 provider, I want:

• The Referral process to remove the need for a cold call transfer
• Reliable transfer of messages
• The specification to provide the necessary data to support statutory reporting submissions
• The specification to be compatible with the latest CAD systems and CDSS

So that

• The burden on staff is reduced and increase safety of transfer of information
• I have confidence a communication has been sent and received. I do not have to resort to local workarounds or backup processes (telephone calls) so that I know which organisation the duty of care sits
• I am able to meet my reporting obligation
• I am not restricted when procuring a new CAD or CDSS

As an IUC CAS Provider, I want:

• to respond to the transfer request within contracted timeframes
• the specification to provide the necessary data to support statutory reporting submissions
• the specification to be compatible with latest 111/CASsystems and CDSS

So that

• I meet my service KPIs
• I am able to meet my reporting obligation
• I am not restricted when procuring a new system/CDSS

As a Commissioner, I want:

• technology to support new service delivery models
• to collect data to support cross-organisational data analytics

So that

• I can redesign my services to meet population needs
• I can continually improve services
• I can make strategic decisions

As Digital Urgent and Emergency Care, I want:

• The development of the 999-111 transfer interoperability specification to align with the UEC Standards roadmap
• The development of any new standard to align with the UEC Standards policies and principles

So that

• UEC Interoperability solutions are appropriately prioritised for delivery
• there is a consistent approach to interoperability across UEC

As NHS England, I want:

• all patients to be treated in the lowest acuity care setting that can safely meet their clinical need

So that

• services can be run efficiently and effectively