Stream: implementers
Topic: Advance Directive
Gana Pemmanda (Apr 04 2016 at 17:58):
What is the correct way to implement advance directive in FHIR? In the case, where the patient (individual) has recorded his Advance Directive as a voice recording or video recording, how will this be captured?
As I was digging through the documentation it seemed like it could be a FHIRDocument where Composition.class (https://hl7-fhir.github.io/composition-definitions.html#Composition.class) has a code -> [LP173409-6 Advance directive]. Is my interpretation correct? But still not sure how to capture the format or a reference to where the recording is stored.
Lloyd McKenzie (Apr 05 2016 at 01:22):
Document is a way of packaging information - Composition is just the table of contents. Consent is being modeled right now as a profile on Contract. My guess is that AdvanceDirective would be managed in the same way (though there are some who have wondered whether separate resources for things like Consent might be better).
Gana Pemmanda (Apr 06 2016 at 00:23):
Thanks Lloyd! I will look into Consent Directive..
Grahame Grieve (Apr 07 2016 at 20:53):
Advance directives vary greatly. Consent + questionnaire might well be the best way to handle this
Gana Pemmanda (Apr 08 2016 at 03:57):
Thanks Grahame.. Will explore further.
John Moehrke (Apr 12 2016 at 12:48):
Consent Directive is -- PRIVACY Consent Directive. We are not developing for all directives. Just Privacy Consent Directive. It is possible that there is something re-usable, but possibly not. Most different is that an Advanced Directive is not necessarily a 'Contract', but rather a legal statement.
Paul Knapp (Apr 12 2016 at 14:28):
So is a DNR,but that can be handled via contract, and contract does allow you to reference questionaire answers.
Peter Bernhardt (May 26 2016 at 16:10):
Trying to figure out how an Advance Directive would get expressed in a FHIR Resource. A colleague pointed me to to Flag. I guess this could work with the appropriate code value. Anyone else looking at this?
Peter Bernhardt (May 26 2016 at 16:13):
And just found this tracker item: GF#7871
John Moehrke (May 26 2016 at 16:27):
I don't know of anyone that has taken that usecase up. It is explicitly not in the scope of the current Consent, which is Privacy focused. Not sure what workgroup would best handle it. Not sure it is urgent enough to have a FHIR resource specific to it.
Lloyd McKenzie (May 26 2016 at 23:02):
Flag would allow you to indicate that an advanced directive exists, but I think the content of it would need to be elsewhere. I don't think it's the same thing as Consent. What need do you have for discrete data. If a PDF is good enough, your Flag could point to a Binary.
Erich Schulz (May 26 2016 at 23:19):
interesting flag doesn't have a mechanism to point to resource (other than the author and subject, and the "encounter". The encounter being defined "This alert is only relevant during the encounter." so that doesn't allow pointing to an AHD directive...
Lloyd McKenzie (May 26 2016 at 23:21):
It does, but it's an extension at the moment. We didn't think most systems that have flags have the capacity for a detailed link.
Lloyd McKenzie (May 26 2016 at 23:22):
(Click on Profiles to see the common extension profile.)
Grahame Grieve (May 27 2016 at 21:40):
I think that there's plenty of interest around advance directives at the policy level, and i've got personal experience with them. But mostly, they are questionnaires, and I'm not aware of any need to have the information in them be generally computable. mainly I would think, the data wouold be useful for secondary analysis, so I would argue that a questionnaire meets the needs. Happy to be corrected in theis regard
Robert McClure (Jun 01 2016 at 15:42):
@Grahame Grieve Perhaps I'm misunderstanding but wouldn't comutability be valuable if the specific procedures not to be implemented (i.e.: No intubation, no IV fluids, etc.) are encoded so that an alert would fire if one was ordered while in the hospital?
John Moehrke (Jun 01 2016 at 16:24):
The measure for FHIR is : What are systems doing today... not what might they do in the future. So what level of computable processing are systems doing today with regard to Advanced Directives? FHIR can always add extensions, and then make them core...
Grahame Grieve (Jun 01 2016 at 22:51):
Rob, maybe so. but I'm not aware of any practice in this regard now.
Keith Boone (Dec 05 2016 at 18:46):
Does anyone have any thoughts on where Advance Directives go or whether they deserve a resource of their own? Are these part of CarePlan resource in some way?
Grahame Grieve (Dec 05 2016 at 19:44):
officially this is scoped in the Consent resource, but we say that the use of this is not investigated, and we might change our minds
Grahame Grieve (Dec 05 2016 at 19:44):
it would be good for some one and committee to take on doing requirements analysis
Last updated: Apr 12 2022 at 19:14 UTC
