A010 - Search by clinical term in parameters

e-Referral Service (e-RS) e-Referral Service FHIR API
1

As we have been looking into our primary care development we have a query about one of the parameters in the example for A010.

Where there is an option to search by clinical term. It looks like you could use a SNOMED code as a search parameter. Is this a correct understanding and is it a piece of the functionality that is supported and used in DOS? The code in the clinical term is not a SNOMED code even though that is what the system is populated with.

I had a look at the profile here too but that didn’t help much,

https://simplifier.net/stu3-fhir-assets/ers-servicesearchcriteria-parameters-1

This is the example (had to remove the links as I’m new and only allowed to post 2):

{
“resourceType”: “Parameters”,
“meta”: {
“profile”: [
“eRS-PatientServiceSearch-Parameters-1”
]
},
“parameter”: [
{
“name”: “requestType”,
“valueCoding”: {
“system”: “eRS-RequestType-1”,
“code”: “APPOINTMENT_REQUEST”
}
},
{
“name”: “sortBy”,
“valueCoding”: {
“system”: “eRS-SortBy-1”,
“code”: “IWT”
}
},
{
“name”: “patient”,
“valueIdentifier”: {
“system”: “nhs-number”,
“value”: “9912003888”
}
},
{
“name”: “referringClinician”,
“valueIdentifier”: {
“system”: “sds-user-id”,
“value”: “021600556514”
}
},
{
“name”: “searchCriteria”,
“resource”: {
“resourceType”: “Parameters”,
“meta”: {
“profile”: [
“eRS-ServiceSearchCriteria-Parameters-1”
]
},
“id”: “ServiceSearchCriteria-1”,
“parameter”: [
{
“name”: “priority”,
“valueCoding”: {
“system”: “eRS-Priority-1”,
“code”: “URGENT”
}
},
{
“name”: “indicativeAppointmentWaitTimeLimit”,
“valueUnsignedInt”: 15
},
{
“name”: “postcode”,
“valueString”: “BR1 1AB”
},
{
“name”: “distanceLimit”,
“valueUnsignedInt”: 23
},
{
“name”: “clinicalTerm”,
“valueCoding”: {
“system”: “http://snomed.info/sct”,
“code”: “1003”
}
},
{
“name”: “organisation”,
“valueIdentifier”: {
“system”: “Organization”,
“value”: “R69”
}
},
{
“name”: “ageAndGenderAppropriate”,
“valueBoolean”: true
}
]
}
}
]
}

Thanks

Pete

2

Hey Pete,

Here is the current position relating to e-RS and Clinical Terms (CTs).

Background:
• a customised version of the SNOMED CT (v6) was introduced into Choose and Book c.2009 & carried over to e-RS in 2015. There have been no updates to the CTs within CAB/e-RS since 2009
• When introduced, SNOMED CTs were associated to the in-built list of specialities/clinic types within the system at that time
• Providers adding CTs to their DoS has reduced steadily since they were introduced. Only 67% of services added to e-RS since 2015 contain 1 or more clinical term
• Recent Analysis has confirmed that <1% of searches by referrers and referring admin were using Clinical Term

Changes:
As a result of the above, and as part of our e-RS Professional Application (web-based e-RS) UI enhancements:
• the option to search by CT in the General Directory Service Search is no longer available (this was as of our release on Fri 3rd Oct 24)
• the ability to search on CT when creating a referral has been removed in the Pro-App (this was removed in our release on Fri 9th May 25)

Users will still be able to search using Speciality/Clinic Type and/or Named Clinician as they currently do in the majority of cases.

Recommendation:

Partners shouldn’t build their solution to solely on the e-RS CT search via the Patient Search endpoint as the impact is:
• Referring users will potentially have up to 1/3 of clinically appropriate service not returned in the search results
• Services not returned in search results could be more clinically appropriate, or necessary for referral pathway- resulting in possible delay to the patient if a referral has been rejected
• Patient Choice will also be impacted if appropriate services are omitted

I hope this helps,

Lucy

3

Thanks Lucy that is really helpful.

We were just considering whether we should include this as an extra parameter. As you have removed it from the general directory search and Pro-App and from your comments on coverage and declining use it sounds like there is not much point in us giving our users this as a search option.

We will just use the other parameters available.

Thanks

Pete