How National Record Locator (NRL) works (draft)

The National Record Locator (NRL) allows health or social care workers to find and access patient information shared by other health and social care organisations across England, to support the direct care of a patient.

The NRL service provides the National Record Locator - FHIR API, which allows systems to:

• create pointers to patient records
• search for pointers
• retrieve information about available records

• access records directly from the source organisation using the appropriate retrieval method

For example, an ambulance clinician treating a patient away from their home area can use an existing clinical system to discover whether another organisation holds relevant information about that patient. NRL returns information about where the record is held, and the system can then retrieve the record directly from the source organisation.

It works like this:

1. 'Provider' organisations share 'pointers' to their patient records with NRL.
2. 'Consumer' organisations search NRL for record 'pointers' - usually for a specific patient, using their NHS number.
3. The consumer uses the 'pointer' to get the patient record directly from the provider.

1. Provider and consumer organisations sign up to use the service. Their point-of-care software must be integrated with NRL (although NRL consumers have the option to use the National Care Records Service).
2. Provider organisations use their point-of-care software to share a list of the patient records they have. For each record, they share the patient's NHS number, some basic information about the record and a 'pointer' to the full record.
3. On an ongoing basis, they notify NRL of any changes.
4. When a patient interacts with a consumer organisation, the health or social care worker uses their point-of-care software to retrieve a list of all patient records from NRL. This is usually based on the patient's NHS number, but it is also possible to search in other ways, for example by care provider.
5. If the worker wants to view a particular record, their point-of-care software uses the 'pointer' to access the full record directly from the provider. A record could be a document, such as a PDF, an application, such as the Greater Manchester Care Record, or raw data.
6. In some cases, a record 'pointer' points to a PDF. To keep things secure, the software retrieves the record via our Spine Secure Proxy (SSP). They might also need to look up some care provider details in our Spine Directory Service. 
7. In some cases, a record 'pointer' isn't available. When this happens, the worker can instead view a web page with contact details for the care provider - using the URL included with the record pointer.
8. In some cases, a record 'pointer' points to an entire application, such as the Greater Manchester Care Record. This allows the end user to deep-link into that application, and view that service in the context of the patient. This feature is called 'in-context launch'.

All interactions between point-of-care applications and NRL are via the NRL APIs.

For both providers and consumers, operations are restricted to the document types agreed when they signed up.