NHS.net mail to CDA/MESH app


I’ve been thinking about this for a while. The diagram above represents a ‘simplified’ design. I’ve simplified the inputs to just being a document (FHIR Binary) and metadata (FHIR DocumentReference). In reality in a NHS trust it’s likely to be a custom XML format or HL7v2 message - however both normally contain the document and some metadata.

In a NHS trust we normally do something like this in the Trust Integration Engine (TIE) but also something like this will exist on the system/organisation sending or receiving the document.

So it’s looking like a standard pattern with maybe a standard app

For it to work in you scenario, you’d need to get the senders to use it. Here you would register what capabilities you support in the directory. So for PDF’s they would need to go to the ‘GP Connect Send Task’ route (when your supplier supports it) and HTML goes the Kettering XML route.

I believe an app like this can be done using open source components such as Apache Camel, HAPI, NHS CCRI, Rabbit/Artemis MQ, Angular 6, Activiti, spring boot (sounds like a lot but it’s mostly plugging it together).

It doesn’t work with documents received by NHS Net email

Mark, hi, we do this within our RIVIAM service. Currently, we deliver PDF documents to EMIS and TPP in real-time ever day for the clinical services we support. We are in the process of developing a service that will take a document from an account in NHS email and then deliver into EMIS and TPP. We mark the documents with the meta data of NHS Number and the patient’s core details that allows both TPP and EMIS to manage in work flow.

Happy to discuss how we can help.



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Hi Paul, yes please. What’s the best way to link up?

Hi Phil

Having used DocMan, I’m loathed to introduce it. I really dont like it.

We have terrible problems with inbound GP2GP documents from DocMan, its an external app that adds to the complexity of using the clinical system & EMIS Web’s document management is perfectly adequate.

I want something that will sit between nhs.net and EMIS Web without additing to Web.

But thanks for the suggestion :slight_smile:

Hi Kev

It sounds like you are working for a trust that is substantially more IT literate than some of our local providers.

Our mental health trust for example has just switched to emailing correspondence. This is great. It used to take them 6-8 weeks to post out clinic letters, so I’m immensely happy to have stuff emailed within a few days.

But their workflow is simply, write the letter in Word and email it to us. I can’t believe Southampton is the only place where this is happening too, so there must be a lot of practices facing similar workflow problems around the country.

best wishes

I have worked in trusts implementing paperless 2020, integration/sending documents is too complex and my interest is making it simple (but not too simple it adds other problems)

The tool that Paul suggests looks very interesting, it does what I was suggesting earlier hides the complexity and more. It’s something a trust could use instead of NHS mail and enable automation in receiving systems (in smaller organisations like GP’s) .

Hi, we use Docman to autoprocess our nhsmails in primary care. Works quite well. I know what you mean, though, about having a whole extra app to worry about when you are trying to keep things simple.

I have used Docman in the past but have moved to EMIS and just use the EMIS functionality.

Would be interested if you find anything.


Email is no better than Fax in my opinion. Add the complexity of importing into the GP system and the workflow becomes more complex.

We have MESH from our local trust and also access to their documents via IHE interface which is also helpful.

I also find webmail frustrating. Do many people have local outlook installed?


Thats more than I’d expect from a trust but - it should be what is expected??

Hi Phil, I agree fax/post/email are all the same thing, just very in speed of delivery.

We have a outlook installed on a backoffice PC and use that to process nhs.net emails to the generic ac. Thankfully we don’t have to wrestle with webmail interface!

Its a great pity that the move to all referrals being paperless this Sept didn’t also place a requirement for all correspondence to be sent back electronically into systems, but hey.

We all need a tool that just patches our current problems, but hopefully would become redundant in the near future

Interesting thread - I’m involved in developing an app that currently makes use of NHS.net to deliver pdfs to GP surgeries - @Paul interested in anything you can say about how your RIVIAM service hooks into EMIS & TPP

Dave, hi, we use MESH and an old messaging format support by the GP systems. It took us a lot of testing to get the service to work as there are different encodings involved in both GP Systems. We haven’t tested with Vision but I expect it to work.

Happy to talk ptargett@riviam.com


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Hi, you can contact me on ptargett@riviam.com I am away on holiday this week so may be a delay in responses :slight_smile:

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Thank you @paultargett you’re a star - I’ll email later in the week - have a great hols!

The links to the official standards for sending outpatient letters and discharge summaries to GP’s (Transfer of Care in the diagram above):

Technical links: This is to eDischarge which I believe is most mature at the moment Introduction to ITK3 eDischarge | ITK3 eDischarge

GP Connect is working on Send Task which would allow PDF’s/HTML documents to be sent to the GP system. This is a link to EMIS webpage https://www.emishealth.com/services/interoperability/gp-connect/
The tech spec should appear here https://nhsconnect.github.io/gpconnect/tasks.html (it’s just a place holder at present)

All of these use MESH (formerly known as DTS) to send documents to GP systems. Paul mentions another method which uses Kettering XML to send html documents to GP’s. This is a link to Visions notes on Kettering XML http://www.inps.co.uk/sites/default/files/Kettering%20Format%20Messages%20in%20Vision.pdf

They mostly use the same metadata. An example of metadata is represented below, this is from an app which is used to put documents (html/pdf/FHIR documents) into the Care Connect Reference Implementation using the FHIR based CareConnectAPI:

This patient has two FHIR Documents (so not pdf/html) but the metadata is the same.
This is a link to the raw data in the reference implementation CCRI - Document Search on patient 1170

The metadata it uses is based on the one used in the National Record Locator Service (NRLS) Tech link: Introduction to NRLS FHIR® API | FHIR-NRLS-API

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“Up here”, Secondary Care use WinVoicePro (Voice Technologies) to dictate or type a letter which then gets sent to a national EDT (Electronic Document Transfer) hub and it ends up in Docman at the practice as a PDF - assuming the sender has identified the correct Practice Number for the patient. This works okay, but it would be much better if we could design a web service that publishes the type of document it can receive along with a bit of metadata e.g. patient and practice ID, specialty etc. On receipt, the web service passes this document and metadata to a recipient service at the practice - this could be EMIS web or Docman if we wanted to retain existing systems. Equally, the document management functionality could be built as a different service, with the final document passed to the primary care system. May be one for a Hackday ??

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Do suppliers attend hackdays? I was wondering if a connectathon may be more suitable (I’m thinking something like this http://wiki.hl7.org/index.php?title=FHIR_Connectathon_2#Submit_a_document )

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I’d be interested to hear if you made any progress on this front. I am in same position trying to innovate how our community pharmacy app send documents securely to EMIS/Tpp workflow. Did you find a solution for third parties to use?