First, what is MESH?
MESH (Message Exchange for Social Care and Health) is the NHS national messaging service, managed by NHS England. It's the secure, standardised "postal network" that NHS organisations use to send documents and data to each other — for example, a hospital Trust sending a discharge summary or an outpatient letter to your practice. You can read NHS England's overview of MESH here.
When you set Anima up for document processing, we help you create a new MESH mailbox that is linked to Anima. NHS England then puts redirect rules in place so that documents sent to your practice via MESH are delivered straight into Anima — where they're processed by Annie (our AI), coded, and routed to your team — rather than only into EMIS.
For most EMIS practices this works really well: once MESH is live, the large majority of clinical letters that used to land in EMIS start streaming into Anima automatically. If you'd like a refresher on how MESH is set up, see the full step-by-step guide: Anima Document Processing: Guide to MESH integration (EMIS practices) and the help centre article Ingestion: MESH integration setup: EMIS practices.
What's happening
You've turned MESH on, and most of your documents are arriving in Anima as expected, but you've noticed that some are still going straight into EMIS and bypassing Anima entirely. NHS 111 reports are the most common example, but it can also include certain hospital letters (for example outpatient clinic letters, pharmacy letters, or specific clinic outcome letters).
Those documents aren't being picked up by Anima's coding and workflow tools and they remain in your EMIS workflow as they did before.
This is expected behaviour for a subset of documents, and it doesn't mean anything is broken with your MESH setup. It's almost always down to how the sender chooses to deliver that particular document.
Why it happens
1. The sender is using non-MESH methods
Clinical documents are sent to your practice by hospital Trusts and other secondary care senders. MESH is the national standard for delivering these documents, so when a sender uses MESH, Anima receives the document directly.
However, some senders deliver some document types via alternative, non-MESH routes. Common examples include:
MIG (Medical Interoperability Gateway) — a proprietary integration used by some Trusts.
Docman Connect.
Other direct system-to-system transfers configured to drop documents straight into EMIS.
Because these routes bypass MESH, they also bypass Anima, meaning the document lands directly in EMIS Web.
The key point: this is a routing decision. Your MESH mailbox and redirect rules are working correctly, MESH is just not being used as the delivery method.
2. The document is being sent by an alternate MESH ID (less common)
Every MESH message carries a workflow ID describing its document type. We subscribe your mailbox to a specific set of IDs (the ones that contain clinical documents requiring coding). Usually this is by design (the other IDs tend to be correspondence that does not need Anima coding). It is still worth checking if a document type you'd expect Anima to code is landing in EMIS. Let us know and we can check the ID and add it to your coverage where appropriate.
How to fix it
Option 1: If low volumes, routinely monitor EMIS
If it's only a handful of documents such as 111 Reports arriving in EMIS, there are a number of practices willing to continue monitoring EMIS for incoming documents. This is because the senders may not have the resources to switch delivery method and the volumes and letter complexity can be sufficiently completed within EMIS.
Option 2: Encouraging a switch in delivery methods
The fix in principle: the sending Trust or provider updates their routing rules to deliver your practice's documents via MESH (i.e. to your Anima-linked MESH mailbox). For most senders this is a configuration change on their interface engine but can in some cases require more technical work on their part (which we are happy to provide guidance on).
The standard approach:
Tell us what you're seeing (e.g. "NHS 111 reports" or "letters from [Trust]") — we'll check which senders are and aren't using MESH.
Identify the key senders — ensuring we have a full scope of who to communicate with (hopefully the bulk of letters being sent into EMIS are from the same senders).
Send a request to each sender's integration team using the template below. Anima is happy to be cc'd to answer technical questions.
We'll validate the switchover and confirm when documents start arriving via the new route.
Template: request to a sender's integration team
Subject: Request to route documents via MESH for [PRACTICE NAME] (ODS: [CODE])
Dear Integration Team,
I am the [your role] at [PRACTICE NAME] (ODS code: [CODE]). We are using Anima to manage our clinical document processing and would like incoming clinical correspondence routed to us via MESH (Message Exchange for Social Care and Health).
We've identified that some documents from you currently arrive via a non-MESH route, which bypasses our workflow which reduces our ability to efficiently process and action patient letters.
The request: Please update your interface engine routing rules for our practice (ODS code [CODE]) to send clinical documents via MESH. Could you confirm whether this is possible or if there are any alternate delivery methods you may be able to offer (i.e. emails)? Once confirmed, we'd be happy to share MESH mailbox details. If you're not the right contact, please forward this to your Integration / Digital leads. Our software provider, Anima, is cc'd and happy to answer any technical questions.
Kind regards,
[Your name] · [Practice name and ODS code]
Note: if you're seeing a particularly high volume of letters going directly into EMIS, for example a large share of your daily correspondence or a major Trust/secondary care provider in the region, please treat this as a priority and liaise with your Anima contacts. A high volume usually points to one or more significant senders routing everything via a non-MESH method, and it's worth us working alongside you to identify exactly which senders are involved and confirm the best path forward so that the bulk of your documents reach Anima. We may be able to help coordinate with other practices who are in similar positions in the region.
Need help?
Your Anima Customer Success Manager can help identify the right senders, tailor the template, and join calls with integration teams. You can also reach us at [email protected].