Question
Anthony Breen · Oct 12, 2020

MESH integration to send Documents to GP's.

Hi,

I've successfully installed and configured the custom MESH API supplied by intersystems. I'm able to send HTML rendered documents directly to GP's using Kettering.xml. 

Ideally, I'd like to be able to send PDF/RTF files rather than HTML. Is this possible and if so can I still use Kettering xml? I know FHIR is the preferred method of transmission but i've tried sending a test FHIR message through MESH to EMIS but it's not displaying so I'm not sure if EMIS is able to display FHIR formatted messages. 

Thanks.

Anthony Breen

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Anthony,

There are some restrictions on what EMIS is able to receive at present, they are still in the process of rolling out further FHIR support. That said, I believe you should be able to send a PDF file via MESH/Kettering XML, you may just need to change the document type for it to be displayed correctly within EMIS. 

If you need further assistance, please feel free to reach out to me directly, I'm sure we can assist you with this.

Regards

Jon Payne

Thanks Jon.

I've been searching for an example of how to format the kettering xml so it can include a PDF but i haven't been able to find any. Do you have any examples or information on what  needs to be included so the PDF can be sent? 

Hi Anthony,

I've asked one of my team to send you an example of how to successfully get a PDF into EMIS, wrapped in kettering XML. You should receive it this morning.

Let us know if you have any more questions.

Jon

Hi John,

I've received the xml but i can't import it into our version of Healthshare as it was generated in IRIS. Do you have a version that is compatible with the following Heathshare version:

Cache for Windows (x86-64) 2017.2.1 (Build 801U) Wed Dec 6 2017 09:07:51 EST [HealthShare Modules:Core:15.03.9901 + Linkage Engine:15.03.9901]

Thanks.

Anthony Breen

Hi Jon

My organisation is looking to do a similar thing to the original post. We generate PDFs that need to be sent to practices. Most of our clients are EMIS with some on SystmOne and Vision.

We have the MESH API already set up but am looking for some documentation for the Kettering XML. From what I've read it seems that this format is widely used, but not officially supported by NHS Digital. Do you know if EMIS/SystemOne have rolled our FHIR support yet?

Hi John,

I am trying to achieve the same goal as Anthony, would it be possible for your team to send me the example you have sent Anthony please?

Many thanks

Warren

I'm also quite interested in this. If there is an example being shared, I'd love to see it.

MESH is just a message transport mechanism and is agnostic of payload type.  The key thing is the recipient system understands the format you're sending.  You can embed PDF files base64 encoded in a Kettering document, but whether that will work depends on whether EMIS is configured to ingest those PDFs.  

You need to configure the correct MESH Workflow ID so that EMIS understands what kind of message it is.  You can't fire random FHIR messages at another system and expect it to just understand it.  EMIS does understand standard NHSD FHIR Transfer of Care messages and Digital Medicines messages for example.

What kind of documents are these and have you checked the NHSD standard API catalogue for a suitable FHIR standard, and (assuming MESH transport) checked the list of approved MESH workflow IDs?

Thanks Adam,

I've been able to complete work on the MESH interface using Kettering xml to embed a PDF document and transmission to GP Practices.

OK, I just noticed the date after I'd posted the reply. 

Hi Anthony,

Would you be willing to share any of the information sent to you so that I could use to help with my implementation please?

I am trying to achieve the exact same goal in sending our Ambulance reports (PDF document) to a GP Practice using MESH and Kettering xml.

Many thanks in advance.

Warren Tivnen

Hi Warren,

Intersystems supplied the initial code for sending a PDF using Kettering xml and connect to MESH. If you ask their support team for this I'm sure they'll send you it. It was written by Paul Dayan.

It took a bit of work to integrate it into our existing transmission processing but quite straightforward.

Thanks.

Anthony Breen

Hi Anthony,

Thanks for the reply, and confirmation on the documentation you received. Paul has already sent this through however the messages show as undeliverable. I have no doubt that I am performing a school boy error somewhere down the line.

Can you please confirm which MESH workflow ID you are using?

Many thanks

Warren

Hi Warren,

I'm using the "DISCH_KET" workflow ID.

Initially, to test the transmission, I sent the document to our own MESH Mailbox. If you haven't already done so, it's a useful way to test. You'll need to set up the MESH receiver Business Service; if you haven't already done so.

Thanks.

Anthony Breen

Hi Anthony,

This is the same workflow ID that I am using which is good to know. I have sent several messages to our own MESH mailbox which are received fine without issue.

I will persevere and carry on with testing this.

Many thanks

Warren

Hi,

In that case it could be a problem with the receiving system. I'm sending to a GP Practice that uses EMIS Web. Have you checked that they're able to receive Kettering xml?

Thanks.

Ant

Hi Ant,

The receiving GP Practice is also using EMIS Web. I presumed, or should I say, hoped that this would be standardised across all EMIS users as well as my belief that DocMan send using Kettering xml and therefore they would be setup to receive Kettering xml.

We currently use DocMan however I want to test a theory as DocMan convert our pdf for EMIS users into a .tif and the conversion tool they use is increasing the size of the files so much that it crashes the EMIS system. 1 file grew from 2MB (original pdf)  to 37MB (converted .tif) during the conversion.

I have now configured the MESHLookup Operation within our system which again bears me bad news as their ODS Code and the "DISCH_KET" workflow ID doesn't return a mailbox.

Thanks

Warren

Hi,

I've found that even for the GP Practices that I can send documents too using "DISCH_KET" it doesn't confirm this when I use the MESH Lookup. 

To check the transmission process you could always send a very basic HTML document instead of sending a PDF. If it works then you know the problem is something to do with the PDF.

Thanks.

Ant Breen

Hi Anthony,

Thank you for the info r.e. the MESH Lookup, this was really useful and helped me persevere with this. I have now managed to get this working, which I am over the moon about.

Do you send to multiple EMIS sites and if so, how do you find the relevant MESH mailboxes if the lookup doesn't always return a mailbox? And to really push my luck, have you set anything up to send to a TPP site?

Many thanks for all of the information you have supplied so far.

Thanks

Warren

Hi Warren,

Glad to hear it's working.

We contact the GP Practices and ask for their MESH Mailbox ID's. We're only currently sending to EMIS Web.

Thanks.

Ant Breen