Overview of the e-RS FHIR API
Designed as a RESTful API, the e-RS FHIR API supports two versions of the FHIR standard: FHIR STU3, tailored to CareConnect profiles, and FHIR R4, aligned with the NHS England FHIR Implementation Guide. The API facilitates critical operations, including the creation of referrals, booking of appointments, and management of advice and guidance requests. Its primary goal is to enable efficient communication and data exchange between healthcare providers, ensuring that patients receive the care they need without unnecessary delays or paperwork.
The API supports two distinct access modes. The application-restricted mode allows unattended, read-only operations authenticated via a signed JWT, while the healthcare worker mode provides full access to all endpoints but requires the presence and strong authentication of a healthcare professional via NHS Care Identity Service 2 (CIS2).
Features and Functionalities
The API’s functionality caters to both primary and secondary care providers. Primary care users can create new referrals, upload and manage patient letters, search for and shortlist services, and even defer bookings when appointment slots are unavailable. Additionally, they can create requests for advice and guidance, facilitating better decision-making in patient care.
Secondary care providers, on the other hand, benefit from features that help them manage referrals effectively. These include accessing referral worklists, retrieving referral attachments and clinical information, accepting or rejecting referrals, and managing advice and guidance conversations. Importantly, the API does not provide access to patient demographic details, which must be obtained via the Personal Demographic Service (PDS).
Accessing the API
Integration with the e-RS FHIR API requires meeting specific security and access requirements. The application-restricted mode is designed for scenarios where human user authentication is not feasible, such as automated workflows. This mode restricts access to read-only operations like retrieving referral worklists, appointment slots, and advice and guidance summaries.
The healthcare worker mode provides access to all endpoints but mandates authentication and authorisation through CIS2. To meet the NHS’s high security standards, users must authenticate at Identity Assurance Level (IAL3) and Authenticator Assurance Level (AAL2 or AAL3). This ensures that only authorised healthcare professionals can make changes, such as creating new referrals or updating appointment details.
Integration and Testing
The API supports multiple environments to facilitate development and integration. Developers can begin testing in the sandbox environment, which is open-access and supports limited scenarios. More robust testing can be conducted in the integration environment, where data persistence and witness testing ensure readiness for production. For early testing of new features, an alpha environment is also available, although it may experience downtime or breaking changes.
Before transitioning to the live production environment, applications must pass through a comprehensive onboarding process. This involves registering with the NHS e-RS Partners Service, submitting a Supplier Conformance Assessment List (SCAL), and completing witness testing. Successful integration culminates in obtaining a Connection Agreement and live service access.
Error Handling and Support
The e-RS FHIR API provides detailed error handling through standard HTTP status codes. Responses in the 200 range indicate success, while codes in the 400 and 500 ranges signal client and server errors, respectively. Endpoint-specific errors are documented to guide developers in troubleshooting.
To support developers and organisations, the NHS offers guidance through the e-RS Partners Service. This includes detailed documentation, sandbox access, and a direct line of communication for resolving integration challenges.
Benefits of Integration
Integrating with the NHS e-RS FHIR API offers significant advantages. For healthcare providers, it ensures faster, more accurate referrals and reduces administrative overhead. Patients benefit from improved access to care, timely referrals, and enhanced collaboration between healthcare professionals. For software developers, the API’s adherence to FHIR standards simplifies the integration process and aligns with global interoperability initiatives.
Conclusion
The NHS e-RS FHIR API is a vital tool for modernising healthcare systems, offering a robust framework for efficient referral management. By adhering to rigorous security standards, providing flexible access modes, and supporting comprehensive testing environments, the API ensures seamless integration for healthcare providers and developers. As the healthcare industry continues to embrace digital transformation, tools like the e-RS FHIR API will play a crucial role in improving patient outcomes and operational efficiency. For organizations ready to take the leap, the onboarding process provides a clear path to harnessing the power of this innovative service.
