We created PKB to allow data to move from wherever it is to wherever it is needed whenever the patient wants it. Fast Healthcare Interoperability Resources (FHIR) is the global industry standard for passing healthcare data between systems. We are ensuring that our information model and APIs meet this standard so they can be used to transfer data quickly and easily, no matter what the care setting is. In 2022 and early 2023, we are dedicating most of our development time to this project.
The benefits of this work include:
satisfying our customers’ need to transfer data in FHIR format
making it easier for third-party development teams and organisations to build applications using data stored in records
making our codebase easier to work with so that our developers can develop new features more efficiently
This project has multiple stages:
Providing FHIR endpoints to allow organisations’ data to be sent to patient records and read back in STU3 or R4 versions of FHIR
Mapping existing data in records to the FHIR data model and migrating data from our existing database to a FHIR database
Aggregating data from different sources into an aggregated FHIR database (as data will continue to be sent in different formats from different sources)
Providing a read only FHIR endpoint for customers to pull data from the aggregated database
Linking our web application to the aggregated database so that users can see this data in records
Ensuring that our regular functionality is in place for data received via our FHIR endpoint, e.g. sending email notifications about new data, privacy labels, registration invitations
Steps 2 - 5 are being completed one dataset at a time, starting with appointments.
FHIR endpoints to read/write data organisations’ data : RELEASED
We decided to support both FHIR STU3 and R4 because some customers in England and the Netherlands are still on STU3, while many app developers prefer R4 and the US government has mandated R4. Our intention is that each customer can send data in the FHIR version they like. We support this by separating transmission and storage of data from processing and aggregation. This strategy eases integration, as customers with an existing body of data in FHIR format can replicate that into PKB without filtering or transforming it.
Organisations can use PKB as an integration engine for data sets that are not yet displayed on PKB’s UI.
Moving appointments to an aggregated FHIR store : RELEASED
We are aggregating data from the isolated FHIR stores into a view of the patient’s whole record — this will be exposed as a read-only FHIR API and linked to our web application.
Appointments are now available in our aggregated FHIR database. This is true for appointments that have been sent to records by any source and by any route, e.g. our FHIR API, our HL7 API, our web application.
We expected the mapping, migration and aggregation of appointments to be a learning exercise because it is the first dataset we are aggregating. We now know what’s needed to repeat this process for other datasets more efficiently.
Making appointments available via a FHIR API and in our web application: IN PROGRESS
We are integrating a read only R4 endpoint so that the aggregated appointment data can be pulled from patient records in FHIR R4 format and linking our web application to the aggregated database so that patients can see the appointments in their records. We hope to complete this for appointments in November.
This work includes putting access rules in place so that our existing consent model applies and making sure we can notify patients about new data in their records via email notifications.
When this stage is complete, we’ll know how to repeat the process for other data sets and so can parallelise this work across more developers.
Conditions, medications, observations: IN PROGRESS
Each data set will be mapped, migrated, aggregated and made available via the read-only FHIR API and our web application. We are prioritising the data sets fromLondon’s Discovery Data Service as this will provide the GP and community records to patients treated in London starting with conditions, medications and observations.
We’ll be working on these data sets from October 2022.
The remaining data types will be sequenced depending on customers’ abilities – as usual, we prioritise releasing the most data to the most patients.
We now add NHS Health Check measurements recorded at GP practices to patients’ records. Thelist of measurements includes measurements such as BMI, blood pressure, and pulse. In November, we’ll start processing NHS Health Checks test results.
This is part of ourEMIS Extract service integration being developed in partnership with North East London CCG, as part of their award-winning digital platform for mental health recovery.
Performance improvements: IN PROGRESS
In early 2022, EMIS updated their Extract Service so we migrated from the legacy Extract Service to their new platform. As part of this migration, we have improved the performance of our data processing so that we can add data to records quickly. We’ll monitor the performance when we start processing NHS Health Check tests.
Patients see a ‘Manage’ option on their appointment which takes them to their organisation’s partner booking system to make changes. Once the patient is done, they can return to their record. When the appointment is updated by the organisation, this will also be updated within PKB
This feature will be available for users once a customer’s preferred appointment management partner has completed their components of the integration. This work has been assessed and is being scheduled by a number of partners. Please contact your preferred appointment management partner and Patients Know Best will be happy to talk them through the newly available APIs to enable this workflow.
Appointment change requests: RELEASED
Patients can now request to cancel or change their appointments from their record using appointment messaging. This is a feature that is configurable and can be switched on and off at an Organisation level.
On the ‘View appointment’ page, patients select ‘Request change’ or ‘Request cancellation’. When they do this, a message will be sent to the responsible team (nominated by the organisation), who can review their request and make the change on their internal system. The updated appointment details will then be visible in the patient’s record.
Appointments UI and accessibility improvements: RELEASED
We have refreshed the ‘View appointment’ page. The new page:
Highlights important details like location, date and time.
Links to other information to help patients prepare for and get the most out of their appointments, for example symptom tracking or care plans.
Meets Web Content Accessibility Guidelines. You can read more about our work on accessibility in this blog post.
Has a clear layout for all screen sizes.
Messaging user experience and accessibility: IN PROGRESS
We have improved messaging to make it easier and more intuitive to use. The changes are:
The look and feel is similar to other messaging applications, such as WhatsApp and Messenger.
The page looks great on all screen sizes.
The page meets the accessibility standards set out in Web Content Accessibility Guidelines version 2.1 AA.
The message subject is now at the top of the page for clarity.
There is an ‘Options’ button with available actions for the user. For example, adding additional users to the conversation or handing over the conversation to another clinician.
We’re currently applying these changes for consultations.
Restrict single sign-on access to one record at a time: IN PROGRESS
PKB has proprietary APIs that organisations can use to provide single sign-on from their local systems to PKB. We will allow organisations accessing PKB to restrict the view to one record at a time. This means that when a clinician opens a patient’s PKB record from their local system the buttons to navigate away from that record will not be available.
Carers can’t add other carers: IN PROGRESS
Carers will no longer be able to add other carers
Remove from teams via HL7 API
It is possible to add patients to teams via our HL7 API. Next, we want to give customers a way to remove patients from teams. We have published the draft specification for this API for feedback.
Web application changes
These are projects that we’re currently scoping with customers and hope to schedule in 2023.
GP data from EMIS ES and TPP SystmOne
We are currently reviewing options for making GP data available for more patients. This data would be added for patients once their record has been created so that as soon as they register they can see it in their record.
NHS App Wales
PKB will be available for NHS App users in Wales, where an organisation has chosen to offer PKB to their patients.
Web application changes
Accessibility: Website navigation
PKB is committed to meeting WCAG standards. The first changes we will make will be to the navigation bar of the patient view. OurAccessibility Statement has been published in our user manual. We’ve been testing our designs with users to make sure that it’s intuitive and easy-to-use.
We will allow organisations to add calculations to their questionnaires so that they can score patient’s responses in PKB. We’ve been compiling the requirements and reviewing the requests that we’ve received from customers for this feature. Once we have confirmed the specification, this will be scheduled.