NHS Integration

NHS Integration Overview

An integration connects two different platforms so they can share data and work together. An electronic patient record (EPR) integration therefore connects an EPR platform with other digital systems to enable the proper flow of clinical data between the two systems.

Unlike EPRs, which records the care provided by one institution or practice, electronic health records (EHRs) focus on the total health of the patient, from cradle to grave, and are designed to share information between healthcare professionals – so an EHR integration would allow access to information from all the clinicians involved in the patient’s care. It means that when a patient attends an outpatient clinic, the clinician can view all their medical history and medications, regardless of which prior service provided the care – as well as all communications between services. EHRs underpin NHS England’s target of becoming paper-free by meeting a level of core digitalisation by 2024.

For pharmacists, the technology used in delivering pharmaceutical care is the Patient Medication Record (PMR) system, which is now widely used to manage patient care.

NHS Integration Options

The UK NHS offers multiple integration options for software system designers – targeting a range of different use-cases, from repeat-prescription apps to remote medical systems.

Blueberry has worked on many NHS integration software projects, including the UK’s first repeat prescription app for start-up company, Dimec, which was subsequently sold to the Co-op.

We have unrivalled experience in this area and are ready to help you deliver complex integrations that deliver significant improvements in patient care.

Note, however, that NHS integration presents significant challenges due to the high standards of data protection and information security that need to be met by anyone working with patient data.

There’s also a minefield of new terminology to navigate – from MESH to DSPT and beyond. Luckily, we’ve provided a terminology guide at the bottom of this page.

NHS API Use Cases

The NHS provides a wide range of different APIs (Application Programming Interfaces), covering multiple different application scenarios. The main scenarios they support are as follows:

Patient Services	You’re creating an app or web application allows individual patients to access data and request services. In this scenario, you would integrate with NHS Login to confirm patient identity – for example using the PDS API to obtain an NHS number, and then use IM1 to retrieve data from GP systems on behalf of the patient.
Digital Pharmacy	You’re creating an online pharmacy system which needs to interact with medicines and patients. Typically, you’ll use IM1 to submit prescriptions and work with the DM+D database.
Clinical Services	You’re creating an application which assists clinicians. Generally, you’ll integrate with the NHS Smart Card system to allow secure login by clinicians, and then use SCR and GP Connect APIs to obtain patient data for the clinician.
Submitting Data	You’re creating a telemedicine app, which is used by patients to record medical information – e.g., measurements. You want to push this data back into the GP record, so the GP can see it. This is a challenging case, which is less well supported, and will possibly require a Transactional API.

NHS API Guide

NHS API Access

Only a few NHS APIs are available on the public internet. Sensitive NHS data requires a Health and Social Care Network (HSCN) connection, which is the private network that connects all NHS organisations – making the API only accessible on HSCN.

Obtaining an HSCN connection is relatively straightforward (involving a self-service registration process using an Organisation Data Service (ODS) code). But you need to be able to demonstrate that you have a patient-related application, and you must pay a high monthly fee – we’ve seen people paying £900 per month or more. There are multiple HSCN providers, so you should get quotes from all of them.

One of the main APIs that is publicly accessible is PDS-FHIR, but this is extremely limited when accessed outside HSCN – it just supports converting patient metadata into an NHS number.

Note that IM1 does not need an HSCN line, and certainly not for patient facing services or Bulk API.

Medical Software Compliance

The NHS takes data security and information governance very seriously. Access to all NHS APIs follows a strict process which usually includes:

Multiple forms to be completed by the applying organisation, specifying things such as the ODS number of the company (anyone can apply) through to the details of the organisations data security officer.
A managed testing process – often outsourced to commercial companies. Under this process, you implement a first version of your integration against a sandbox or test system. You then run specific tests and send the results to the NHS.

These NHS processes are usually time-consuming. For most API integrations, the elapsed time from starting the project to getting an approved integration is usually measured in months. This time is mostly spent waiting for your action to be reviewed by the NHS, as the process can be slow.

In many cases, the NHS will require you to meet specific goals:

DSPT. If you process NHS patient data under a contract with the NHS, then your organisation must meet the Data Security and Protection Toolkit standard.
GDPR is UK’s legal framework for data protection, which includes a requirement to undertake a Data Protection Impact Assessment (DPIA) if you are handling personal health data.
The Supplier Conformance Assessment List (SCAL) defines a set of both organisational and technical requirements based on your integration’s functionality and required APIs. The SCAL also references the tests you need to complete, and you must produce a separate SCAL for each API.

Other Software Integration Resources

When working on NHS projects, you’ll probably encounter the following:

DM+D – this is a database of medicines. It converts a drug name, formulation, and dose into a unique ID. However, there are some complexities: first, it works at two levels – generic and actual, with generic covering the medical properties, and actual covering the brand names. Second, it’s large, and you usually must filter it to exclude items that don’t relate to your specific needs.

ODS Codes – every organisation within the NHS, and organisations who work with the NHS have an ODS code. You’ll need to apply for one if you’re working with the NHS.

Pharmacy Systems

Blueberry has worked on multiple digital projects in the Pharmacy sector – in particular IM1 integrations for several companies. Digital Pharmacy projects often include NHS integration, but there is usually no direct contact with NHS organisations – we work with the company operating the pharmacy to help make their systems more efficient. This can make things a little easier.

One interesting aspect of Digital Pharmacy projects is integration with the PMR (Patient Medical Record) Systems. PMR systems are used by pharmacies to track patients and manage and issue prescriptions. There are several major systems in the UK, including EMIS ProScript Connect, Cegedim, Titan, RxWeb, V-Rx, and Analyst. Blueberry has worked with all these systems across many projects, and we understand the integration options well.

Planning an NHS Integration Project

We recommend the following steps:

First, make sure you know the types of integration you’d like to do. Who will be using the patient data – patients themselves or clinicians – or just your staff?
Second – apply for an ODS code – you will probably find it necessary. It’s free.
Third – read the pages in this section, and then consider calling us – we can give you impartial and confidential free advice on the right route to take.

NHS API Terminology:

IM1

IM1 is an integration standard defining how existing GP clinical systems providers should allow third parties to connect with their systems. IM1 allows suppliers to integrate their system with any principal clinical GP system through an interface mechanism.

ODS

The Organisation Data Service (ODS) issues and manages unique identification codes and accompanying reference data for organisations that interact with any area of the NHS. ODS codes are used in almost every IT system across the NHS. If your company is interacting with data, you’ll need to apply for an ODS code.

PDS

The Personal Demographics Service (PDS) is the national electronic database of NHS patient details such as name, address, date of birth and NHS number (known as demographic information) and medical information. The PDS API provides access to the demographic data held by the NHS Spine.

REST

Representational State Transfer is a set of architectural/design principles for APIs that when followed, assist in the implemenation of simple, reliable, and scalable APIs. The key principles for REST include, client-server architecture, providing a uniform interface between decoupled components, and ensuring requests are stateless. While REST is not a protocol, REST APIs often make use of common web protocols including HTTP, JSON and XML for exchanging data.

RESTful

Interfaces are often referred to as being “RESTful” when they follow principles of “REST” – in other words, a RESTful interface is one that doesn’t store state.

SCR

The Summary Care Record (SCR) supports patient care in urgent and emergency care settings. The SCR stores a defined set of key patient data for every patient in England except those who elect not to allow it to be disclosed. The data provides a summary record created from information held on GP clinical systems. The SCR FHIR API is used for primary care.

SNOMED CT

SNOMED CT is a clinical vocabulary readable by computers. Used in electronic health records. It gives clinical IT systems a single shared language, which makes exchanging information between systems easier, safer, and more accurate. It contains all the clinical terms needed for the whole NHS, from procedures and symptoms through to clinical measurements, diagnoses, and medications.

SOAP

Simple Object Access Protocol (SOAP) is a technical standard used when sending information to APIs. SOAP allows processes running on disparate operating systems (such as Windows and Linux) to communicate using Extensible Markup Language (XML).

SSP

Spine Secure Proxy is a system within the Spine used to securely broker API calls between external systems.

Spine

The NHS central ‘Spine’ is a collection of national applications, services and directories which support the health and social care sector in the exchange of information in national and local IT systems. Clinical information is held in the Personal Spine Information Service (PSIS) and demographic information is held in the Personal Demographics Service (PDS). The Spine also supports other systems and services such as the e-Referral Service and the Electronic Prescription Service.

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Integrating with NHS Systems