Stream: implementers
Topic: CareTeam Questions
Sebastiaan Raap (Jul 03 2019 at 13:51):
Hi all, a few questions regarding the CareTeam resource:
1. What is the meaning of CareTeam.period?
Current description: Time period team covers
Question:
Which period does this item cover?
a. The period the team exists or is in effect? OR
b. The period the team delivers care to the ‘subject’?
Considerations:
- Some teams exist to act if the need arises, such as a resuscitation team. In case of such a team ‘period’ could have meaning a.
- If a patient has one or more problems, meaning b. would be most useful.
- However, the meaning of ‘period’ should not depend on whether the team is assigned to a subject or not.
2. What is the meaning of CareTeam.participant.period?
Current description: Time period of participant
Question:
Which period does this item cover?
a. The period the participant is a member of the team in general? OR
b. The period the participant delivered care in a specific role?
Considerations:
- A participant may have more than one role within the team or may, for example, change form a role with a small responsibility to a role with a large responsibilty.
- If the answer to the question is ‘period of membership of the CareTeam in general’, then how can one specify the period in which the participant fulfilled a specific role in the care for the subject?
3. What is the meaning of CareTeam.reasonCode?
Current description: Why the care team exists
Question:
In what way does the meaning differ from reasonReference?
Considerations:
- ‘reasonReference’ has the same description, but the type is ‘Reference(Condition)’. ‘Condition’ requires a ‘subject’, so it seems that ‘reasonReference’ represents the medical problem/disease of the subject for which the care team delivers care.
- Does ‘reasonCode’ represent the disease/problems for which the team can be assigned in general? If not, then what is the meaning of this item?
Lloyd McKenzie (Jul 03 2019 at 18:29):
1. It's the period of time the team is in existence. If the subject changes, that would typically be considered a new team instance.
2. It would be for the specific role
3. One lets you describe the reason with code or text, one lets you point to a resource
Lloyd McKenzie (Jul 03 2019 at 18:29):
Feel free to submit a change request proposing altered wording if you think clarification is needed in the spec.
Sebastiaan Raap (Jul 04 2019 at 07:01):
About 2: In the current resource, multiple roles can be assigned to a participant, so if one changes from one role to two roles, one must create a new Participant?
Participant "mister x" has been coordinator(role 1) and GP (role 2) from 2019-01-01 until 2019-06-01. On 2019-06-01 it is decided that "mister x" turns over the coordination role to someone else and is just GP (role 1) from now on wards. So he will have only the GP Role from 2019-06-01.
The only way to model this in CareTeam is to create two Participants for mister X, one with 2 roles and a stated period from 2019-01-01 until 2019-06-01 and one with just one role, stated with a startdate of 2019-06-01. Am I thinking correctly?
Lloyd McKenzie (Jul 04 2019 at 14:49):
In the end, whether you create a new participant depends on your policy. If you want the team to show a record of who was doing what when, then yes. If that's not so important, then no.
dsh (Jan 18 2020 at 02:43):
I understand, that one instance of CareTeam is assigned to a single Patient and the same Patient may be cared of by multiple CareTeam(s). But in real world it seems a Care Team say composed of 5 practitioners cares for multiple patients about 10 to 15 and in night shifts even more.
So I have a hospital where they have 10 care team names and they want to list all Patients that are being cared for by a given care team name.
Is there a way to accomplish this? i.e. list Patients that have been assigned the same CareTeam ?
it seems there may not be a 1-to-1 correspondence between real world concept of care team and FHIR resource CareTeam and any given point in time there would be more CareTeam resources than Patient resources, since CareTeam.subject cardinality is 0..1 .
Am I correct?
dsh (Jan 19 2020 at 15:48):
@Lloyd McKenzie ^
dsh (Jan 19 2020 at 17:10):
I think I found a way /CareTeam?identifier=MCH_BLACK&_include=CareTeam:subject:Patient
Now I want to fetch Encounters that refer to the same Patient ideally in the query by CareTeam ... not sure if that is possible
David Hay (Jan 19 2020 at 17:25):
You might also want to consider using Organization to describe these 'groupings' of Practitioners. This is a debate we're having also...
dsh (Jan 19 2020 at 17:30):
@David Hay yes we are using Organization for grouping of Patient and Practitioner, we have to as the app is multi-tenant
dsh (Jan 19 2020 at 17:31):
Not sure what the best approach is to minimize the network time to fetch the data of Patients in a CareTeam that have not been discharged
one approach is using some background thread to pre-fetch the resources and in doing that if multiple sub-queries are to be done then its not a big deal
David Hay (Jan 19 2020 at 17:33):
I was suggesting that instead of using CareTeam to describe the 'fixed' teams (like Diabetics Assessment for example) that you use Organization for that. Again just a thought - we've not yet come to a landing ourselves...
dsh (Jan 19 2020 at 17:37):
hmmm.... interesting use of Organization, so far I was thinking of Organization as Hospital/Clinic/Vendor etc, thanks for enlightening me
however if you use Organization to represent the concept of care team then Patient.managingOrganization will be used for this relationship, right?
dsh (Jan 19 2020 at 17:38):
and how would you keep the relationships in sync i.e. when patient is discharged he is obviously not being cared for the same team any longer.
@David Hay ^
David Hay (Jan 19 2020 at 17:41):
In this scenario you'd use the CarePlan to indicate that a given 'team/Organization' was involved in the patients care - eg detail.performer...
dsh (Jan 19 2020 at 18:38):
You might also want to consider using Organization to describe these 'groupings' of Practitioners. This is a debate we're having also...
@David Hay what's the idea of using Organization for grouping Practitioners when CareTeam has .participant --> .member --> .reference referring to Practitioner ? Is using Organization better than using CareTeam or am I missing something more subtler ?
David Hay (Jan 19 2020 at 19:46):
Don't think one is better than another - depends on the use case. If you want to say that the diabetic assessment 'team' will assess the patient, then Careplan.activity.detail.performer can refer to the Org that represents the Diabetic assessment 'team'. If you want to say that Dr. Smith is involved personally, then you can have Careplan.activity.detail.performer refer to the individual.
It's all about whether the 'CareTeam' resource makes sense to be used when it's not specific to a patient, and I don't think there's a single correct answer. Others may have different opinions!
Katie Wheatley (Mar 04 2020 at 08:49):
Is CareTeam.period intended to carry the start date and end date relating to when the CareTeam was set up and disbanded or does it carry the start and end dates relating to when the team had a relationship with a specific patient/subject? Similarly for CareTeam.participant.period - does this carry the start and end dates relating to when the participant joined the CareTeam or the start/end dates relating to when they began and ended their relationship with the subject or patient of the CareTeam?
Alok Tiwari (Mar 04 2020 at 10:28):
I just want to ask to all members . I am new in FHIR so just want to know is it possible to use FHIR For PHP Application? If yes then how?
Mareike Przysucha (Mar 04 2020 at 10:58):
Hello @Alok Tiwari. You are probably interested in the following stream https://chat.fhir.org/#narrow/stream/179166-implementers/topic/PHP. There the topic is "PHP and FHIR" while here questions about CareTeam are discussed.
Alok Tiwari (Mar 04 2020 at 11:00):
Thanks @Mareike Przysucha
Jose Costa Teixeira (Mar 04 2020 at 11:48):
Katie Wheatley said:
Is CareTeam.period intended to carry the start date and end date relating to when the CareTeam was set up and disbanded or does it carry the start and end dates relating to when the team had a relationship with a specific patient/subject? Similarly for CareTeam.participant.period - does this carry the start and end dates relating to when the participant joined the CareTeam or the start/end dates relating to when they began and ended their relationship with the subject or patient of the CareTeam?
CareTeam.subject is optional, so it should be for the time the careteam exists, not the time it is assigned to the patient.
Jose Costa Teixeira (Mar 04 2020 at 11:49):
your implementation may impose constraints on that.
Last updated: Apr 12 2022 at 19:14 UTC
