Implementing Q45 (Reporting) for Reasonable Adjustment Flags

Patient Flags Reasonable Adjustment Flag
1

Hi all,

Our team is currently working on integrating the Reasonable Adjustment Flag (RADF) into our system via the Patient Flags FHIR API. We are working through the “Demonstrate technical conformance for the Patient Flag API – Reasonable Adjustments” form and are looking for some architectural guidance regarding Q45 - Reporting.

The requirement states:

“Identify patients with Reasonable Adjustment Flag record. It should be possible to generate a list of all patients registered on the local system who have a Reasonable Adjustment Flag record.”

The Challenge:
Some of our services have potentially thousands of registered patients. Crucially, while we maintain a list of registered patients, our system is designed not to store or persist any flag-related information locally.

Because we do not retain any local indicator of a flag’s presence, generating this report dynamically requires us to query the Patient Flags endpoint for every single patient registered to a service. Running thousands of separate, sequential API calls to generate a single list is highly inefficient, raises concerns around hitting NHS API rate limits, and creates performance bottlenecks.

Our Questions:

  1. Bulk/Batch Querying: Are there any current endpoints, or plans on the roadmap, that would allow us to query the API for multiple patients (e.g., passing a batch of NHS numbers) simultaneously?

  2. Best Practices for Q45 at Scale: For systems that intentionally do not store flag-related information locally, what is the NHS-recommended pattern for fulfilling this Q45 reporting requirement without hammering the API?

  3. Report Content Specifications: To ensure we meet the criteria for Q45, what exactly needs to be included in the generated output? Is a simple aggregate count of patients sufficient, or does it need to be a detailed list containing NHS numbers, our local system IDs, etc.?

Any insights from suppliers who have already cleared this conformance hurdle, or official guidance from the integration team, would be greatly appreciated!

Thanks in advance,

Dave Elliott
Mayden

2

Our Questions:

Bulk/Batch Querying: Are there any current endpoints, or plans on the roadmap, that would allow us to query the API for multiple patients (e.g., passing a batch of NHS numbers) simultaneously?

  • There is currently no endpoint to allow you to bulk query the Patient Flag API for multiple patients, however we can consider implementing this functionality. Do get in touch to discuss this specific requirement and give us insight into your use case, email us on enquiries@nhsdigital.nhs.uk.

Best Practices for Q45 at Scale: For systems that intentionally do not store flag-related information locally, what is the NHS-recommended pattern for fulfilling this Q45 reporting requirement without hammering the API?

* This requirement is not in scope for read-only integrations because you are not holding the data. If you were holding a local copy and recording the flags you will need to be able to generate a list. If you are only viewing, you do not own the data and therefore are not expected to report on data that you do not own.

Report Content Specifications: To ensure we meet the criteria for Q45, what exactly needs to be included in the generated output? Is a simple aggregate count of patients sufficient, or does it need to be a detailed list containing NHS numbers, our local system IDs, etc.?

  • The reporting requirement in this case is not necessary as you are carrying out a read only.

Hope the above helps, do get in touch if you have any further questions/queries.

Thank you.