Foundations: how the concepts fit together

Start here if clinical records, digital systems or National Health Service (NHS) procurement are unfamiliar. These six pages introduce the concepts and connect them to the proposed Defence technology architecture. Each page supplies the terms needed for the next. Use the glossary for quick lookup.

Begin with the care that needs support

A patient needs continuing care. Clinicians need an account of earlier care, tools to record new decisions, and ways to communicate with other services. The organisation must establish who may use the information, who acts on it and what software to obtain. The distinction to carry through this section is the record's purpose, the system's functions and the work people must do. ^{003, 004, 018}

A map of the relationships

The arrows identify relationships to examine, not patient-data interfaces or an implemented Defence system. Records means their clinical roles; systems means the software that supports them. Governance includes assurance and buying. It applies throughout, even though its detailed explanation follows the records and workflows it governs.

flowchart TB
  accTitle: Relationships between care needs, record roles, systems and information work
  accDescr: Care needs determine record roles. Record roles guide system capabilities. Systems support information movement and clinical work. Governance and buying constrain system selection and the permitted information flows and work. The adjacent table explains each relationship, including assurance and procurement.
  careNeeds["Care needs"] --> recordRoles["Records"]
  recordRoles --> systemCapabilities["Systems"]
  systemCapabilities --> informationWork["Information and work"]
  governanceBuying["Governance"] --> systemCapabilities
  governanceBuying --> informationWork

This teaching model draws on the wiki's record architecture, clinical responsibilities and capability and assurance reference. ^{003, 018, 026, 116}

Follow one patient as the explanation develops

A hypothetical patient is registered with a general practitioner (GP). A specialist assesses the patient, orders an imaging test and sends the GP a report. The patient later changes GP practice. Each page adds one aspect of this example: the records, the software functions, the information and work, then the conditions for using and buying systems. This is an explanatory scenario, not a description of a deployed Defence workflow.

The proposed Defence Shared Care Record (DShCR) adds a comprehensive, primarily read-only overview across contributing source systems and relevant supporting tools. It connects information across services and over time, with authorised access to fuller source detail through the same view. Source systems keep their originating accounts; the GP record also maintains the continuing primary record of care (PRC). Integration, patient identity and provider-directory services support these relationships. The following pages explain their roles, core clinical information sharing and business continuity options. ^{212, 220}

Read the Foundations in order

NHS England is an initial reference. Published guidance supports the general concepts; proposed direction identifies the Defence capabilities sought. Open questions identify unsettled design and implementation choices. The final capability landscape brings the relationships together; the validation queue holds the detailed discovery work.

Next: Records and their purposes.