Stream: implementers
Topic: Encounters as part of a care plan
Grahame Grieve (Apr 17 2019 at 00:55):
@Cooper Thompson @Brian Postlethwaite @Russell Leftwich @Michelle (Moseman) Miller I'm visiting a client today who are looking at managing the process of care, and we're wondering whether you should be able to link an encounter to a care plan that prompted it as one of the activities in the care plan? I don't see a link in either direction?
Grahame Grieve (Apr 17 2019 at 01:04):
as in, during an episode of care, you will have several different concurrent care plans that drive the process of care e.g. post-op /post-anasthetics, and these will change overtime, and drive sub-encounters. Same applies to a mental health referral where you'll get various appointments/consultations as driven by various care plans. Yet there seems to be no link between careplan and these encounters
Grahame Grieve (Apr 17 2019 at 01:08):
there's also no direct link between EpisodeOfCare and CarePlan - also seems like an oversight?
Lloyd McKenzie (Apr 17 2019 at 01:11):
Encounter ought to have a basedOn reference and one of the eligible targets should be CarePlan.
Grahame Grieve (Apr 17 2019 at 01:12):
y
Lloyd McKenzie (Apr 17 2019 at 01:14):
Should allow for most types of requests. Encounter might also be due to a DeviceRequest, MedicationRequest, CommunicationRequest, etc.
Lloyd McKenzie (Apr 17 2019 at 01:15):
80% rules apply to the presence of the element, not what it points to
Grahame Grieve (Apr 17 2019 at 01:17):
Encounter ought to have a basedOn reference
There's a workflow extension for that, yes?
Grahame Grieve (Apr 17 2019 at 01:20):
related question: do we anticipate having care teams for a group where the group is defined by kind, not instance? the description suggests you wouldn't use care team within an organization for something not linked to a particular patient or group of patients?
Grahame Grieve (Apr 17 2019 at 01:31):
further question - can a care plan include 'fill out this questionnaire to see how things are going'?
Brian Postlethwaite (Apr 17 2019 at 01:55):
Yes you can have a patient-less CareTeam as noted. We've also profiled it that way in VhDir too.
Brian Postlethwaite (Apr 17 2019 at 01:56):
The questionnaire in the care plan makes sense. It's added in as an activity.Detail.definition
Grahame Grieve (Apr 17 2019 at 02:11):
how does a questionanire provide a definition?
Russell Leftwich (Apr 17 2019 at 03:42):
Is that not what CarePlan.encounter is?
Lloyd McKenzie (Apr 17 2019 at 04:01):
CarePlan.encounter says that the scope of the CarePlan is limited to the Encounter. Encounter.basedOn(Encounter) would say that the Encounter occurred (at least in part) because it was called for by the CarePlan - and in this case the CarePlan would be broader in scope than that one Encounter.
Grahame Grieve (Apr 17 2019 at 04:43):
yes broader in scope
Michelle (Moseman) Miller (Apr 17 2019 at 12:42):
Multiple topics in this discussion:
- CarePlan.activity.outcomeReference can reference the resulting Encounter (event). Since Encounter's event-basedOn can also reference the CarePlan, seems like we risk having circular references.
- CarePlan.activity.detail.instantiatesCanonical can reference the Questionnaire (definition) and then CarePlan.activity.outcomeReference can reference the QuestionnaireResponse (event)
- CareTeam.category = LA27975-4 for event-focused care teams, which aren't patient specific. Scope and Usage section acknowledges this via the following sentence:
CareTeam can also be organizationally assigned without a subject in context, such as a code blue team or emergency response team
Dave Carlson (Apr 17 2019 at 13:57):
further question - can a care plan include 'fill out this questionnaire to see how things are going'?
See recent discussion on this question: https://chat.fhir.org/#narrow/stream/179255-questionnaire/topic/Defining.20a.20question.20as.20part.20of.20an.20order
Dave Carlson (Apr 17 2019 at 13:59):
Using either servicerequest-questionnaireRequest extension on a care plan ServiceRequest activity, or a Task, seems like a better choice than an activity definition reference to Questionnaire.
Emma Jones (Apr 17 2019 at 14:58):
Response to Grahame first question - carePlan.activity.reference should include encounter and episodeOfCare resources.
Lloyd McKenzie (Apr 17 2019 at 15:31):
outcomeReference isn't quite circular as it's tying a specific planned activity to the Encounter, while the Encounter is pointing to the CarePlan overall. As well, this wouldn't be a reference that I'd expect would be maintained as a closed loop. I.e. it'd be fine for the Encounter to point to the CarePlan but there wouldn't yet be (and might never be) and outcomeReference to the Encounter.
Lloyd McKenzie (Apr 17 2019 at 15:32):
ServiceRequest or Task represent detailed orders to complete the Questionnaire. If you're just stating a planned intent, CarePlan.activity.reference would be fine.
Grahame Grieve (Apr 17 2019 at 19:53):
@Michelle (Moseman) Miller thanks. I missed outcomeReference because I found reference - I feel as though there's a naming problem there. I created GF#20909 to clarify the first sentence on CareTeam.
Last updated: Apr 12 2022 at 19:14 UTC
