Stream: implementers
Topic: Adding PractitionerRole to Composition
Rick Geimer (Jun 06 2017 at 15:52):
While working on CDA to FHIR conversion, I realized that we have no good place in Composition to store a Practitioner's relationship to an organization such as we have in CDA (author.assignedAuthor.representedOrganization). Practitioner.identifier.assigner seems to just be scoped to the Practitioner's ids and could include mutliple orgs not related to this document, and Practioner.qualification.issuer seems to be scoped to their professional certification, not their role in creating the document.
I created a tracker to address this, but wanted to hear thoughts on whether linking document Practitioners to their Organizations is a need for documents in general, or something that belongs as an extension in a profile.
http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13488
Igor Sirkovich (Jun 06 2017 at 17:50):
@Rick Geimer , have you looked at PractitionerRole: http://www.hl7.org/fhir/STU3/practitionerrole.html ?
Rick Geimer (Jun 06 2017 at 18:06):
@Igor Sirkovich Yes, hence the title of the thread "Adding PractitionerRole to Composition" :). Should have made that clear in the text though, that what I am proposing is adding references to the PractitionerRole resource from Composition so that the role and the Organization the Practioner is related to are both reachable by traversing from the first Bundle entry in a document.
Igor Sirkovich (Jun 06 2017 at 18:29):
Sorry, I didn't look at the title :)
John Moehrke (Jun 06 2017 at 21:26):
IHE noticed the same missing for author of a DocumentReference... this is all fallout of PractionerRole change late in STU3... normal maintenance churn.
Rick Geimer (Jun 07 2017 at 21:00):
@John Moehrke So I am guessing that if we make a change to Composition, you are in favor of a parallel change to DocumentReference?
John Moehrke (Jun 08 2017 at 13:04):
Generally, if one needs to make a change to the header part of Composition, it should be considered if it is a useful change to DocumentReference. This is where these two Resources 'look' very similar, although their similarity is only at this metadata level. Any delta in this metadata level is likely not proper, and when it is it should be strongly justified. Yes, IHE has submitted a CP to add PractionerRole to DocumentReference author. I initially put it in as GF#13266, but simply adding PractitionerRole may be the solution. The issue I have is that PractitionerRole seems overly complex simply to indicate what an actor's role was in the creation of the document.
Lloyd McKenzie (Jun 08 2017 at 14:53):
It's important to remember that the role will be what hat they were wearing, not what function they performed. PractitionerRole is used to link Provider person, organization and organizational role. It can also include the appropriate contact and other information associated with that linkage. All of that information is potentially relevant. The only information that's not super-relevant is the period and status information, but frankly that wasn't terribly relevant when we referenced Practitioner either.
Rick Geimer (Jun 08 2017 at 16:13):
Closing the loop here, @Lloyd McKenzie, I saw you post the following to the gForge tracker: "The workflow project proposes adding PractitionerRole as an additional choice to most of the existing choices of Practitioner|Patient|RelatedPerson|Organization|Device". We discussed this on SDWG today, and will likely go this route (adding PractitionerRole to Composition.author, Composition.attester, etc. We will likely vote on this next week. @John Moehrke if you agree we will do the same for DocumentReference.
Brett Marquard (Jun 09 2017 at 13:23):
@Rick Geimer Didn't on SDWG we discuss dropping practitioner in favor of PractitionerRole? Maybe I was sleepy at the end....I don't have a strong opinion but want folks to be aware that is on the table.
John Moehrke (Jun 09 2017 at 13:26):
I understand the potential cleanlyness of only having PractitionerRole, but I think sometimes direct attribution to Practitioner is all that is needed. Question that would raise is if one must/should/must-not include a practitioner directly and indirectly through a PractitionerRole?
Lloyd McKenzie (Jun 09 2017 at 13:40):
Practitioner is useful if the organization and role are already intrinsic (i.e. there only is one) or it's not known/not relevant.
Lloyd McKenzie (Jun 09 2017 at 13:40):
Thus the Workflow pattern suggests including both.
Brian Postlethwaite (Jul 10 2017 at 04:52):
Just as CareTeam has included onBehalfOf Organization
Last updated: Apr 12 2022 at 19:14 UTC
