MESH Messaging - NHS Carenostix

What is MESH?

MESH is the NHS's secure messaging system for healthcare organisations to exchange sensitive information safely and securely. Carenostix integrates with MESH for:

Secure inter-organisational communication
Clinical document transmission
Test results distribution
Administrative notifications
Reports and audit information

MESH Features

End-to-end Encryption: TLS encryption with NHS certificates
Non-repudiation: Sender and recipient cannot deny message exchange
Delivery Confirmation: Automatic acknowledgment of message receipt
Audit Trail: Complete message history and audit logging
Message Tracking: Real-time message status monitoring
Scheduled Delivery: Configure message delivery schedules
Large Files: Support for large clinical documents and scans

Message Types Supported

DATA Messages

Standard clinical data exchange including HL7 messages, patient records, and test results

REPORT Messages

Formal clinical reports, pathology reports, and audit notifications

ACKNOWLEDGMENT Messages

Confirmation of message receipt and processing status

MESH Configuration

Setting up MESH integration requires:

Mailbox ID: Unique organisation identifier (e.g., X26OT123)
Mailbox Password: Authentication credentials (securely stored)
Shared Key: Additional authentication factor
Client Certificate: X.509 certificate for mutual TLS
CA Certificates: NHS root and intermediate certificates
MESH API Endpoint: https://msg.spine.nhs.uk (production)

Message Flow Example

1. Order Submission: GP creates order in Carenostix

2. HL7 Generation: System generates ORM^O01 HL7 message

3. MESH Wrapping: Message wrapped in MESH envelope with destination mailbox

4. Transmission: Message sent via MESH to laboratory mailbox

5. Delivery Confirmation: Laboratory acknowledges receipt via MESH ACK

6. Result Processing: Lab processes order and sends results back via MESH

7. Unwrapping: Results extracted and processed into system

8. Notification: Requesting clinician notified of results

API Example

POST /api/mesh/send
{
  "recipient": "X26LB001",
  "message_type": "DATA",
  "subject": "Test Results for Patient NHS 1234567890",
  "content": "HL7 message content...",
  "attachments": ["report.pdf"]
}

Response:
{
  "status": "submitted",
  "message_id": "MESH12345",
  "recipient_mailbox": "X26LB001"
}
            

Error Handling & Retries

Automatic retry with exponential backoff on delivery failure
Dead letter queue for permanently failed messages
Administrator notification for failed MESH messages
Manual retry capability from admin portal
Comprehensive error logging and audit trail