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Use Case: Regional Shared Care Records

Regional Shared Care Records: sharing NW Genomics cancer reports into regional shared care records - currently the Greater Manchester Care Record (GMCR), with Lancashire and South Cumbria to follow - via a wire-tap on the Laboratory Report (LAB-3) feed.

References

1. Regional Integration Engine (RIE) - the RIE performs this wire-tap as part of its normal Report Process
2. LTW - Laboratory Report (LAB-3)
3. HIE - Sharing Laboratory Reports (Document) - the IHE ITI-105/MDM_T02 pattern this follows
4. Wire Tap - the Enterprise Integration Pattern this reuses
5. ctDNA NHS England Unified Genomic Record (UGR) - Phase 1 of that use case reuses this same wire-tap

Clinical Pathway Overview

What is being tested

This page isn't about one specific clinical test - it's about making an existing cancer genomics report, already reported to the ordering clinician as usual, also visible to a patient's wider Greater Manchester care team via GMCR (delivered into GraphNet).

The end-to-end clinical journey

1. Cancer genomic test ordered and reported as normal - the usual Regional Integration Engine (RIE) Order/Report process (LAB-1/LAB-3) applies; nothing about the original order or report changes.
2. Report reaches the ordering clinician - as usual.
3. RIE wire-taps the report - if the patient is in the GMCR catchment and the report is cancer-related, a copy is converted and filtered for GMCR.
4. Copy delivered to GraphNet - the converted copy is sent into GMCR/GraphNet.
5. Visible to the wider care team - a GP or another Greater Manchester clinician, not just the ordering team, can now see the report via GMCR.

flowchart LR
    A[Cancer genomic test<br/>ordered and reported] --> B[Report reaches<br/>ordering clinician]
    B --> C[RIE wire-taps<br/>and filters report]
    C --> D[Copy delivered<br/>to GraphNet]
    D --> E[Visible to wider<br/>Greater Manchester care team]

Why this matters for developers

• This is a copy/sharing mechanism layered on top of the existing LAB-3 report - it doesn't change how the test is ordered or reported to the originating clinician.
• Whether a given report reaches GMCR at all depends on the filtering rules in Current Process below (patient catchment and cancer-only Test Codes) - not every report is copied.

Actors

Transactions

Current Process

For reports, the RIE will wire-tap the ORU_R01 to send a copy of the report to GMCR. This involves:

1. Converting the ORU_R01 to an MDM_T02 message (NW Standard).
2. Filtering to only include patients who have a postcode in Greater Manchester, or who have a GP registered with GMCR (identified by the GP practice's ODS code, "QOP ODS").
3. Filtering out non-cancer reports (using the Test Codes carried in the DiagnosticReport).
4. Converting the message to the GraphNet-specific flavour of HL7.
5. Sending the MDM_T02 message to GraphNet.

flowchart LR
    RIE["RIE<br/>(receives LAB-3 report,<br/>ORU_R01)"] -->|"1. Convert to MDM_T02"| Conv["MDM_T02<br/>(NW Standard)"]
    Conv -->|"2. Filter: Greater<br/>Manchester postcode<br/>or GMCR GP (QOP ODS)"| F1{"In GMCR<br/>catchment?"}
    F1 -->|No| Drop1(["Not sent"])
    F1 -->|Yes| F2{"3. Cancer<br/>Test Code?"}
    F2 -->|No| Drop2(["Not sent"])
    F2 -->|Yes| Conv2["4. Convert to<br/>GraphNet HL7 flavour"]
    Conv2 -->|"5. Send MDM_T02"| GMCR["GraphNet<br/>(GMCR)"]

The sequence diagram below shows the same process as a message exchange, following the same HIE - Sharing Laboratory Reports (Document) Document Publisher/Document Consumer pattern used elsewhere in this IG - the HL7 v2 MDM_T02 transaction is what's actually used today; IHE ITI-105 is the future/FHIR-based alternative the Transactions table above already flags as a possibility:

sequenceDiagram
    participant iGene as iGene<br/>Order Filler
    participant RIE as RIE<br/>Intermediary / Document Publisher
    participant GMCR as GraphNet (GMCR)<br/>Document Access Provider / Document Consumer

    iGene ->> RIE: LAB-3 Report (ORU_R01)
    RIE ->> RIE: Wire-tap, filter (catchment + cancer<br/>Test Code) and convert to<br/>GraphNet HL7 flavour
    RIE ->> GMCR: HL7 v2 MDM_T02 Message
    GMCR -->> RIE: Response HL7 v2 ACK

Note: The DocumentReference + attachment on the LAB-3 report currently forms the basis for this feed - see Data Models below.

Future Process

Lancashire and South Cumbria

Lancashire and South Cumbria's Shared Care Record is expected to follow a similar wire-tap/filter/convert pattern to the GMCR process described above - the RIE wire-taps the same LAB-3/ORU_R01 feed, applies a Lancashire and South Cumbria-specific patient/report filter, and delivers the result to their shared care record system. The destination format (HL7 v2 MDM_T02, or a future IHE ITI-105 FHIR document) and the exact filtering rules are yet to be defined - see ctDNA NHS England Unified Genomic Record (UGR) for how the NHS England Unified Genomic Record Phase 1 adapts this same wire-tap.

sequenceDiagram
    participant iGene as iGene<br/>Order Filler
    participant RIE as RIE<br/>Intermediary / Document Publisher
    participant GMCR as Lancashire and South Cumbria<br/>Document Access Provider / Document Consumer

    iGene ->> RIE: LAB-3 Report (ORU_R01)
    RIE ->> RIE: Wire-tap, filter (catchment + cancer<br/>Test Code) and convert to<br/>GraphNet HL7 flavour
    opt HL7 v2 MDM_T02 (current)
        RIE ->> GMCR: HL7 v2 MDM_T02 Message
        GMCR -->> RIE: Response HL7 v2 ACK
    end
    opt IHE ITI-105 Simplified Publish (future)
        RIE ->> GMCR: POST /DocumentReference
        GMCR -->> RIE: Response OperationOutcome
    end

Data Models

The DocumentReference + attachment on the LAB-3 report (see Regional Integration Engine (RIE) - Genomic Model - Placer Order (LAB-1) and Reports (LAB-3)) currently forms the basis for this feed.

flowchart LR
    RIE["RIE<br/>(receives LAB-3 report as<br/>DocumentReference + PDF)"]
    Transform["Transform to<br/>HL7 MDM_T02"]
    GMCR["Greater Manchester<br/>Care Record (GMCR)<br/>cancer only"]
    LSC["Lancashire & South Cumbria<br/>Shared Care Record (stub)"]

    RIE -- "LAB-3 Report<br/>(DocumentReference + PDF)" --> Transform
    Transform -- "MDM_T02" --> GMCR
    Transform -. "Future - IHE ITI-105 (FHIR)?" .-> LSC

Examples

​No example is published yet for the MDM_T02 feed itself. See Example: Laboratory Report for the LAB-3 report this feed is wire-tapped from.

Security Considerations

Includes:

• OAuth2 Standard for Authorisation
  • including use of JWT access tokens and future support for SMART-on-FHIR Scopes
• FHIR AuditEvent/IHE BALP for Audit Logging
• TLS for Transport Security/Encryption

Developer Guides

• 04 - Reports: HL7 v2 ORU^R01 into FHIR - converts a lab's own HL7 v2 report into a FHIR R01 Message, and on to the MDM_T02 document feed this page describes

See Developer Guides for the full notebook series.