Stream: cds hooks
Topic: Encounters
Kevin Olbrich (May 15 2018 at 11:37):
@Kevin Shekleton @Isaac Vetter It would be helpful for those of us developing CDS services to understand a bit about how actual EHR users use 'Encounter's. Are they always available when seeing a patient? Are there scenarios where a clinician might not have an active encounter ? Are there scenarios where the User will actually be a mid-level or other user who is recording data or acting on behalf of a physician? If so, how is the attending physician identified? How do you determine what to fill the reason with? Are the diagnoses populated?
Kevin Shekleton (May 16 2018 at 08:12):
Great questions @Kevin Olbrich.
In our EHR, the user can open a patient's chart without an Encounter so in this case, no encounter id will be sent with the hook context. Users cannot act on behalf of a physician per se, but might not have the ability to do something until another user (eg, physician) signs off on their action (for instance, ordering certain types of meds). Fields like reason and diagnosis are populated by the user and whether these fields are documented depend upon how the hospital configures their system.
Kevin Olbrich (May 16 2018 at 08:17):
Ok, so that tells me that Encounter may be present and may be useful if it's there, but I need to build a fallback if it isn't. It also tells me that the User at the keyboard may or may not be the Practitioner that I will want to ascribe an activity to. That's very helpful. Thanks.
Chris Courville (May 16 2018 at 16:28):
Kevin Olbrich (May 17 2018 at 07:52):
@Kevin Shekleton @Isaac Vetter do either of your EHRs use the primary diagnosis extension? (http://hl7.org/fhir/extension-encounter-primarydiagnosis.html)
Dennis Patterson (May 17 2018 at 08:10):
Cerner's FHIR server does not use this extension
Kevin Olbrich (May 17 2018 at 08:21):
@Dennis Patterson Do you expose a problem list?
Kevin Olbrich (May 17 2018 at 08:25):
@Jeffrey Danford Can you provide some feedback on how AllScripts handles Encounters?
Dennis Patterson (May 17 2018 at 08:29):
We support searching Conditions for those with the category of 'problem' - https://fhir.cerner.com/millennium/dstu2/general-clinical/condition/#search
Isaac Vetter (May 17 2018 at 08:29):
Hey Kevin - we also don't support this extension.
Brian Postlethwaite (May 17 2018 at 08:57):
(note that extension changed between dstu2 and 3 - now is part of core encounter)
Jeffrey Danford (May 17 2018 at 09:16):
Allscripts users can also open a Patient outside the context of the encounter, so encounter wouldn't always be available to pass. We've added conditions to Encounter in the STU3 version of the API which should be available in our sandboxes and should be available in a week or so. No extensions on Encounter currently.
Kevin Olbrich (May 17 2018 at 09:20):
@Jeffrey Danford Thanks! Is there a way to get at a 'problem list' or is that just searching for Conditions on a patient?
Jeffrey Danford (May 17 2018 at 09:25):
Condition?patient=, or Patient/{id}/Condition. Category=problem and clinicalStatus=active should get the patient's current problem list.
Last updated: Apr 12 2022 at 19:14 UTC
