Stream: implementers
Topic: Fate of DeviceUseStatement
Eric Haas (Nov 16 2016 at 00:34):
We in the HL7 OO Workgroup have been reviewing DeviceUseStatement and have been struggling to find anyone who has implemented DeviceUseStatement and are equally struggling to justify whether it is a useful resource to maintain. We think most of what is does is being represented by Observation We have a GForge comment to withdraw the DeviceUseStatement resource proposal ( it has never been formally approved for inclusion in the specification.) .and remove it from the STU3 specification. If anybody is using it let us know.
ravi.kuchi (Nov 16 2016 at 03:41):
Hi Eric, We use deviceusestatement to represent the dialysis related device used in the procedure. For example Catheter, Graft in our world.
Grahame Grieve (Nov 16 2016 at 03:47):
isn't that just Procedure.usedReference?
ravi.kuchi (Nov 16 2016 at 03:57):
The DeviceUsestatement serves the purpose of finding all the access(Dialysis) types the Patient has. I am not sure if we can use Procedure.usedReference to represent all the available access types if the Patient is having his first dialysis session and we need to pull up his bodysite and device(Catheter) info before we start the procedure. We can settle if we have a way to represent this.
Eric Haas (Nov 16 2016 at 04:07):
We just dispositioned a GFORGE comment for Devices to state what Grahame stated. I think Procedure is the place for linking bodyside to devices too.
Lloyd McKenzie (Nov 16 2016 at 04:13):
DeviceUseStatement was introduced by CDS. @Bryn Rhodes are there any issues with punting it?
Eric Haas (Nov 16 2016 at 05:59):
I pinged @Claude Nanjo as well as CQI and DSS
Bryn Rhodes (Nov 16 2016 at 10:36):
Yeah, it was relevant for data requirements coming from decision support and quality measurement. Not sure that a Procedure would satisfy it. It's the same as the difference between a MedicationStatement and a MedicationAdministration. I may not have any knowledge of when the device was applied, but that doesn't mean I can't make a meaningful statement about its present state.
Eric Haas (Nov 16 2016 at 21:04):
" It's the same as the difference between a MedicationStatement and a MedicationAdministration." Yes but do system actually do the same with Device. My discussions have led me to believe they use Observation. is this actually actually being used for decision support and quality measures?
Lloyd McKenzie (Nov 16 2016 at 21:15):
So the issue is that quality measures want to track whether recommendations around device use are being followed. But there's no consistent way this is typically tracked in existing EHR systems. So the resource is intended to provide a way for systems to track device usage in a consistent way, not a reflection of current system capabilities. The real question is: do any EMR systems actually intend to implement it?
ravi.kuchi (Dec 02 2016 at 19:22):
Yes, we at Fresenius are using this resource and it's implemented in production across 3000+ clinics. This resource gives us the dialysis access sites of the patients which the clinic needs to know before they start the dialysis procedure.
Eric Haas (Dec 04 2016 at 07:20):
I would appreciate if you could describe your use case in some detail with a concrete example. That would help us get some forward momentum on moving this resource to draft status. BTW are you using DSTU2 and planning to migrate soon to STU3?
ravi.kuchi (Dec 04 2016 at 14:06):
Here is our UseCase: We are in the Dialysis World and a Patient has to get the Vascular Access done before he starts dialysis procedure. A patient is recommended to have at least 2 access sites that could be any of AV fistula, AV graft, and venous catheter etc... And each of these accesses may be in different stages like, ready to use, Maturing, infected, blocked & terminated. All our clinics need to track this information which is a combination of Patient, Bodysite & device. The Patient may get his Vasuclar access process done outside our clinic administration(3rd party helathcare) which would mean that it is not possible for us to get the Procedure associated with it recorded in our EHR. So, we are using the DeviceUseStatement as means to record all his(patient) access types which is a critical information that feeds into our dialysis process.
ravi.kuchi (Dec 05 2016 at 20:09):
We are Currently on DSTU2 and planning to migrate once DSTU3 is released.
Eric Haas (Dec 05 2016 at 21:33):
Thanks @ravi.kuchi this is helpful - can send a example of a resource instance.
ravi.kuchi (Dec 05 2016 at 21:40):
<resource>
<DeviceUseStatement xmlns="http://hl7.org/fhir">
<id value="1"/>
<contained>
<BodySite xmlns="http://hl7.org/fhir">
<id value="1"/>
<modifier>
<coding>
<code value="Site"/>
<display value="Above Elbow"/>
</coding>
<text value="Above Elbow"/>
</modifier>
<modifier>
<coding>
<code value="Location"/>
<display value="Left"/>
</coding>
<text value="Left"/>
</modifier>
<modifier>
<coding>
<code value="Location2"/>
<display value="Brachiobasilic"/>
</coding>
<text value="Brachiobasilic"/>
</modifier>
</BodySite>
</contained>
<bodySiteReference>
<reference value="#1"/>
</bodySiteReference>
<device>
<reference value="Device/AV Fistula Transposed"/>
</device>
<notes value="Active"/>
<recordedOn value="2008-04-04T00:00:00-04:00"/>
<subject>
<reference value="Patient/XXXXXXX"/>
</subject>
</DeviceUseStatement>
</resource>
<resource>
<Device xmlns="http://hl7.org/fhir">
<id value="AV Fistula Transposed"/>
<type>
<text value="AV Fistula Transposed"/>
</type>
</Device>
</resource>
<resource>
<Patient xmlns="http://hl7.org/fhir">
<id value="XXXXXXXX"/>
<extension url="http://hl7.org/fhir/StructureDefinition/us-core-race">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/StructureDefinition/us-core-race"/>
<code value="Black or African American"/>
</coding>
<text value="Black or African American"/>
</valueCodeableConcept>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/us-core-ethnicity">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/StructureDefinition/us-core-ethnicity"/>
<code value="Not Hispanic or Latino"/>
</coding>
<text value="Not Hispanic or Latino"/>
</valueCodeableConcept>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/patient-nationality">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/StructureDefinition/patient-nationality"/>
<code value="United States of America"/>
</coding>
<text value="United States of America"/>
</valueCodeableConcept>
</extension>
<identifier>
<type>
<coding>
<system value="http://hl7.org/fhir/v2/0203"/>
<code value="MR"/>
</coding>
</type>
<system value="http://hl7.org/fhir/v2/0203"/>
<value value="XXXXXXXXXX"/>
</identifier>
</Patient>
</resource>
Ardon Toonstra (Feb 08 2017 at 15:19):
@Eric Haas , we are planning to use the DeviceUseStatement as well, based on the modelled Dutch Clinical Building Blocks: https://zibs.nl/wiki/MedischHulpmiddel(EN) This model divides the actual Device and Bodysite / dates / notes.
Eric Haas (Feb 08 2017 at 19:17):
Thanks....We discussed at the last WGM and will be looking at identify the use cases and boundaries between Device and DeviceUseStatement in the upcoming cycle.
Last updated: Apr 12 2022 at 19:14 UTC
