Stream: implementers
Topic: GP Encounter Report
Alexander Henket (Jan 17 2018 at 08:35):
I'm trying to model the way GPs do encounter in The Netherlands (and possibly abroad) in FHIR. For every Encounter there are 1..n complaints that a patient wants to dicuss.
Every complaint leads to journal entries of type S-O-A-P (Subjective - Objective - Assessment - Plan). A journal entry has an id, code (S-O-A-P), effectiveTime, text, author and MAY additionally be associated with an ICPC-1-NL code.
- S is always plain text -- patient describes his compliant
- O may be textual, but may also be some observation (length, weight, lab test, ...)
- A is always plain text and has most chance of being associated with an ICPC code
- P may be text, but could also be a prescription, careplan, referral, ...
Every set of S-O-A-P may be related to an "Episode", a health concern.
I think I could use Observation like this, as long as every S-O-A-P is text or a real observation.
- Observation.code = LOINC 67781-5 Summarization of encounter note Narrative
- Observation.context = Encounter
- Observation.extension = context EpisodeOfCare
- Observation.related.type = has-member
- Observation.related.target = Observation S/O/A/P
That does not work for prescription or careplan.
For now I have landed on Composition per S-O-A-P set instead:
- Composition.type = LOINC 67781-5 Summarization of encounter note Narrative
- Composition.encounter = Encounter
- Composition.event = EpisodeOfCare (not entirely accurate...)
- Composition.section.code = S/O/A/P
- Composition.section.text = S/O/A/P text (status = additional)
- Composition.section.entry = Observation | MedicationRequest | CarePlan
- Composition.section.extension = ICPC code
Anyone care to share how they solved structured encounter reporting, preferably with similar requirements? @Michelle (Moseman) Miller is this a topic for New Orleans?
@Ben Schrijver
Grahame Grieve (Jan 17 2018 at 11:20):
have you looked at ClinicalAssessment
Alexander Henket (Jan 17 2018 at 16:03):
I.e. http://hl7.org/fhir/clinicalimpression.html? Thanks, no I had not... checked it just now. According to http://wiki.hl7.org/index.php?title=Clinical_Assessment it is suited for the A in SOAP, but looking into the elements it appears to be capable for more
- ClinicalImpression.context = Encounter
- ClinicalImpression.problem = S in SOAP text (semantically awkward match..)
- ClinicalImpression.investigation = O in SOAP
- ClinicalImpression.summary = A in SOAP text
- ClinicalImpression.action = P in SOAP (awkward match for textual P, I'm missing Observation)
Not sure where I'd put the ICPC code for the Assessment or how to connect an EpisodeOfCare. @Russell Leftwich / @Elaine Ayres is there room for discussion in the New Orleans agenda?
Eric Haas (Jan 17 2018 at 17:25):
@Michelle (Moseman) Miller and PC and SD are looking at a Clinical Notes structure using Composition for S and A , since there are not many fans of ClinicaImpression. ( I am ). As I understand this discussion S, A = Clinical Notes ( aka A stripped down Composition) you could have
Composition.type = LOINC 67781-5 Summarization of encounter note Narrative
Composition.encounter = Encounter
Composition.event = EpisodeOfCare (not entirely accurate...)
Composition.section.code = S/O/A/P
Composition.section.entry= Clinical Notes ( aka A stripped down Composition) |Observation | MedicationRequest | CarePlan
Composition.section.extension = ICPC code
PC will be talking about this for Mon Q2 (PC, SD, FHIR-I),
Russell Leftwich (Jan 17 2018 at 17:36):
@Alexander Henket I think this would be worthwhile discussion in New Orleans. @Elaine Ayres will not be there. What is best quarter to have this discussion.
Michelle (Moseman) Miller (Jan 17 2018 at 19:42):
Eric is correct. This is on the agenda to discuss in New Orleans Mon Q2, which is a joint quarter with SD, PC, and FHIR-I.
http://wiki.hl7.org/index.php?title=January_2018_WGM_New_Orleans;_Jan_27_to_Feb_8
Michelle (Moseman) Miller (Jan 17 2018 at 19:53):
I would just add that SD advised that Composition.section.text can be used for the note narrative, itself, without requiring a reference to another resource(Composition.section.entry). Some of the recent meeting minutes include:
- PC - Nov 30 - http://wiki.hl7.org/index.php?title=2017-11-30_Patient_Care_FHIR_Call#Clinical_Note
- SD - Dec 14 - http://www.hl7.org/documentcenter/public_temp_5FDD4E7F-1C23-BA17-0C08E37E733EAB03/wg/structure/minutes/Minutes%202017%2012%2014.rtf
Next steps included testing this proposal at a Connectathon
CC: @Brett Marquard
Grahame Grieve (Jan 19 2018 at 10:12):
which stream is testing this?
Michelle (Moseman) Miller (Jan 19 2018 at 16:01):
The meeting minutes said "Maybe add a Notes track under the Documents Track (future) or clinicians on FHIR" but @Brett Marquard can confirm
Brett Marquard (Jan 19 2018 at 16:01):
I just contacted Documents track lead to see about adding
Brett Marquard (Jan 19 2018 at 16:01):
I vaguely remember discussing on the PC call and it was too quick for some vendors to participate
Brett Marquard (Jan 19 2018 at 16:02):
BUT, I still think a conversation within the Current NOLA Document track with plans for future track makes sense
David Hay (Jan 20 2018 at 18:53):
Could this be done at COF?
Alexander Henket (Jan 23 2018 at 09:35):
@Russell Leftwich I can't make Thursday Q3/Q4. Otherwise I'll try to be flexible. So: when will you have
Michelle (Moseman) Miller (Jan 23 2018 at 14:43):
@Alexander Henket This topic is planned for Monday Q2, which is a Patient Care hosted quarter with SD and FHIR-I.
Alexander Henket (Jan 25 2018 at 12:21):
I'll make sure to be there. Thanks.
Alexander Henket (Jan 25 2018 at 15:02):
For those interested @Michelle (Moseman) Miller / @Eric Haas: I've created an example of my current spec @Simplifier:
https://simplifier.net/NictizSTU3/gp-EncounterReport
https://simplifier.net/NictizSTU3/gp-EncounterReport-example-1
I also have a Bundle example converted from V3 containing gp-EncounterReports among other things:
https://simplifier.net/NictizSTU3/Bundle-gp-patient-summary-response-example-01
Alexander Henket (Jan 29 2018 at 10:59):
I've created a brief overview of what I'd like to achieve and where my issues are for todays discussion. The powerpoint is attached to [GF#12676] - http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=12676
Last updated: Apr 12 2022 at 19:14 UTC
