Urgent and Emergency Care

Introduction
Data Model Overview
FHIR Resources
Submission of UEC data to the CDR
UEC End-to-End Scenario

Introduction

The Welsh Emergency Care Data Set (WECDS) defines the data required from new Urgent and Emergency Care (UEC) applications. A phased approach is being taken to supporting the capture of UEC data within the Care Data Repository (CDR). The scope of the current (first) phase is the submission of UEC activity data relating to the arrival of a patient at an Urgent and Emergency Care (UEC) facility, their initial assessment (triage) and their discharge and departure from the facility. The data will be made available via the National Data Analytics Platform for secondary analysis of UEC facility utilisation.

A specific resource profile has been developed for a UEC encounter. This includes with dedicated extensions, value sets and code systems to support the relevant data requirements. As explicit support for data submission to the CDR, candidate message events, message definition instances and example data bundles are also provided within this implementation guide.

Data Model Overview

The UEC data for each patient attendance will be stored as a dedicated UEC Encounter resource linked to Condition resources for the chief complaint and any comorbidies noted during the attendance. The attendance context and involved clinicial staff will be captured through linking of the applicable FHIR administrative resources such as Organization, Location and PractitionerRole. The creation or update of a UEC Encounter or Condition will be associated with one or more Provenance instances, targeting the specific resource versions created.

The diagram below provides an overview of the involved FHIR resources and how they can be interconnected to support the relevant subset of the WECDS. The presence or absence of certain links will depend upon the specific use case and the progress through the UEC encounter.

The FHIR data model consists of the following resources:

FHIR Resources

Condition

The Condition resource should be used to capture both the chief complaint for the UEC attendance and any comorbidities recorded during the attendance.

Device

The Device resource represents the systems from which the UEC data submission was sourced.

UEC Encounter

The UEC Encounter profile is a specialisation of the standard Encounter resource which should be used to represent the attendance of the patient at the UEC facility, from the time of arrival to the time of departure. It makes use of the following UEC-specific value sets:

Location

A Location resource is referenced to identify the specific UEC facility (e.g. a specific minor injuries department) that the patient attended for the UEC encounter.

Organization

One or more Organization resources may be referenced from the encounter to identify the service provider (typically a Health Board) that is responsible for the UEC encounter, the organization that manages the UEC facility and, where applicable, the source organisation and the organisation to which the patient is discharged. Where different from the service provider, the following organisations may also be involved:

The patient's health board of residence (referenced from the Patient resource)
The health board employer of a participant (referenced from the PractitionerRole resource)

Patient

A Patient resource is referenced to identify the attendee at the UEC facility i.e. the subject of the UEC encounter.

PractitionerRole

A PractitionerRole resource is referenced to identify each UEC care professional participating in the care of the patient during their UEC attendance, including their specialty and the health board under which they were operating.

Provenance

The Provenance resource will capture metadata related to the creation or update of each affected resource instance (as the target of the provenance record) and may also be used to capture the subject demographics at the time of the encounter. Provenance content will be specifically determined and the appropriate instances assembled by the CDR message handler, so it will not appear within the submission message examples in the section below.

See the dedicated guidance page for clarification of the purpose and use of the Provenance resource: Provenance Guidance

Submission of UEC data to the CDR

FHIR Messaging Resources

Submissions of UEC data from UEC applications to the CDR will use the FHIR messaging paradigm and the following FHIR messaging resources:

The following resource will be used within the response bundle to convey any issues encountered by the CDR message handler:

OperationOutcome

See the dedicated guidance page for clarification of the purpose and use of the resources involved in FHIR messaging: FHIR Messaging Guidance

UEC Message Events

The following message events have been defined FOR TRIAL USE at Phase 1, pending the establishment of a naming convention for message events.

Message event	Submission point	Resources (if applicable to use case)
uec-arrival	On completion of registering the patient’s arrival at the UEC facility	UEC Encounter Patient Organization (service provider) Organization (attendance source) Organization (managing UEC facility) Location (UEC facility)
uec-triage	On completion of recording the triage assessment	UEC Encounter Patient Organization (service provider) Organization (attendance source) Organization (managing UEC facility) Location (UEC facility) ProfessionalRole (e.g. triage nurse) Condition (chief complaint) Condition (each comorbidity)
uec-discharge	On completion of the UEC attendance i.e. the point of discharge	UEC Encounter Patient Organization (service provider) Organization (attendance source) Organization (managing UEC facility) Location (UEC facility) ProfessionalRole (each professional) Condition (chief complaint) Condition (each comorbidity)

These message events have been captured in a dedicated code system that can be extended as the scope increases through the project phases:

CodeSystem-DataStandardsWales-UEC-MessageEvent

UEC Message Definitions

MessageDefinition resource instances have been defined FOR TRIAL USE for the Phase 1 UEC data submissions

UEC End-to-End Scenario

Scenario Overview

This scenario covers the attendance of a patient at a minor injuries facilty with a swollen ankle, from the point of arrival through to the discharge of the patient back to her home.

The required data submissions for this scenario are illustrated in the sections below for the three distinct message events. As the UEC application has no knowledge of the FHIR resources created by the prior submissions, the data sent will be cumulative. The relevant data from the prior step(s) will be resubmitted to ensure that all of the links can be fully resolved by the CDR message handler.

NOTE that any investigations, the problem list (formal diagnoses), problem management, the discharge information document and follow up are beyond the scope of the Phase 1 UEC data submissions.

Step 1 - UEC Arrival

The first data submission occurs after the patient arrival at the UEC facility has been registered.

Step Narrative
Step Data
Messaging Data Model
Message Definition
Example Bundle

Ms Marjorie Pryor attends the Emergency Unit Minor Injuries facility of University Hospital of Wales at 12:00 on 02/12/2025 with a painful swollen ankle. She has been advised to attend by her GP at North Cardiff Medical Centre and an appointment was booked for 12:15. She travelled to the appointment by bus. This was her first UEC attendance for the condition.

The case-specific details known at this stage are:

^{Patient identity: Ms Marjorie Pryor (CAV PAS Number A272114; NHS number not present)}
^{Patient address: 7 Llandaff Court, Penarth CF64 3JH}
^{Patient birth date: 1961-12-16}
^{Patient gender: Female}
^{Patient ethnic category: Any White Background, including Welsh, English, Scottish, Northern Irish, Irish, British}
^{Patient LHB of residence: Cardiff and Vale University Health Board}
^{Patient registered GP practice: North Cardiff Medical Centre}
^{Encounter UEC activity identifier: 123456789}
^{Encounter expected time of treatment: 2025-12-02 12:15}
^{Encounter mode of arrival: Public transport / taxi}
^{Encounter attendance category: Unplanned first Urgent and Emergency Care or Same Day Emergency Care Attendance for a new clinical condition (or deterioration of a chronic condition).}
^{Encounter activity type: Emergency Care Attendance at an Emergency Care Department Type Minor Injury Unit.}
^{Encounter care consultation mechanism: Face to face}
^{Encounter activity start time: 2025-12-02 12:00}
^{Encounter activity source: Referred by member of Primary Health Care Team}
^{Encounter activity source organisation: North Cardiff Medical Centre}
^{Encounter location (UEC facility): UHW Emergency Unit Minor Injuries, managed by University Hospital of Wales}
^{Encounter service provider: Cardiff and Vale University Health Board}

There are also some fixed values that will provide context within the FHIR Encounter resource:

^{Encounter class: emergency}
^{Encounter status: arrived}
^{Encounter service type: Emergency medicine service}

An XML rendering of the message definition is shown below. See the dedicated message definition page for JSON and other representations: MessageDefinition-DataStandardsWales-UEC-Arrival

<system value="email" />
<value value="fhir.standards@wales.nhs.uk" />
<use value="work" />

</telecom>

</contact>

<system value="https://fhir.nhs.wales/CodeSystem/DataStandardsWales-UEC-MessageEvent" />
<code value="uec-arrival" />
<display value="UEC arrival" />

</eventCoding>

<focus>

<code value="Encounter" />
<profile value="https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-Encounter-UEC" />
<min value="1" />
<max value="1" />

</focus>

<focus>

<code value="Patient" />
<profile value="https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-Patient" />
<min value="1" />
<max value="1" />

</focus>

<focus>

<code value="Organization" />
<profile value="https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-Organization" />
<min value="1" />
<max value="*" />

</focus>

<focus>

<code value="Location" />
<profile value="https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-Location" />
<min value="1" />
<max value="1" />

</focus>

</MessageDefinition>

An XML rendering of the example message bundle is shown below. See the dedicated example page for JSON and other representations: Example Message Bundle - UEC Arrival UHWEUMI (UHW Emergency Unit Minor Injuries)

</identifier>

Urgent and Emergency Care

Introduction

Data Model Overview

FHIR Resources

Condition

Device

UEC Encounter

Location

Organization

Patient

PractitionerRole

Provenance

Submission of UEC data to the CDR

FHIR Messaging Resources

UEC Message Events

UEC Message Definitions

UEC End-to-End Scenario

Scenario Overview

Step 1 - UEC Arrival

Step 2 - UEC Triage

Step 3 - UEC Discharge