Stream: implementers
Topic: Mapping CDA.author.representedOrganization to Practitioner
Simone Heckmann (Aug 15 2017 at 13:44):
We're currently mapping aCDA-structure to FHIR and it are having some issues with mapping author.representedOrganization to Practitioner, since the latter doesn't allow a direct reference to Organization. We'd have to create a PractitionerRole for this. However, this Resource would be completely empty except for the references to Practitioner and Organiziation, as we don't get any details about the Role from the CDA structure.
I suppose that the creation of Practitioner resources as author/source of something (be it a Document, a *Request or any snippet of information is fairly common and in most of these cases, little more is known about the author than a name, maybe contact details and the organization.
It seems laborious to always have to do the extra step of creating a PractitionerRole in these cases.
How do others handle this?
Lloyd McKenzie (Aug 15 2017 at 14:02):
In STU4, author will likely be able to point to PractitionerRole directly.
Simone Heckmann (Aug 15 2017 at 14:19):
That doesn't exactly make things easier, since you still need three resources to capture the author, unless you cheat:
<PractitionerRole> <practitioner> <display value="Dr. L. McCoy"/> </practitioner> <organization> <display value="Starfleet"/> </organization> </PractitionerRole>
Lloyd McKenzie (Aug 15 2017 at 14:35):
For Organization, capturing only display will be typical. Understand the challenge with the split of PractitionerRole from Practitioner, but the challenge is that from a registry perspective, one Practitioner can often be tied to multiple roles and organizations
Stefan Lang (Aug 15 2017 at 14:50):
For Organization, capturing only display will be typical.
Not, if the use case requires or at least allows identifiers. But that's a detail, since you can extend the "cheat" to also contain that.
Stefan Lang (Aug 15 2017 at 14:56):
The point is: CDA allows an assignedAuthor to have a representedOrganization without a person or device as an author:
CDA_Author.png
Stefan Lang (Aug 15 2017 at 15:00):
The equivalent to that, even in STU4, would then be a PractitionerRole without a Practitioner.
That is technically allowed, but it feels like a misuse of PractitionerRole to use it only to refer a Composition to an Organization.
Lloyd McKenzie (Aug 15 2017 at 15:06):
You can have a bare Organization if you want in FHIR
Patrick Werner (Aug 15 2017 at 15:07):
but i can't reference it from Composition.author
Simone Heckmann (Aug 15 2017 at 15:08):
I understand the requirement for PractitionerRole in the context of Practitioner directories or Appointment Management. I just think it doesn't scale very well for the many many cases in which we only have very scarse Information about (external) Practitioners.
Lloyd McKenzie (Aug 15 2017 at 15:13):
@Patrick Werner I'd certainly encourage a change request to add Organization to the choice.
Lloyd McKenzie (Aug 15 2017 at 15:16):
@Simone Heckmann Well, if you need to know details of the Organization, the Role and the Practitioner individual, that is going to put you at 3 resources, even if you only need a couple of elements from each. Containment is an option if you don't have enough information for them to stand alone. Do you have a proposal for how we could make it easier/less painful?
Stefan Lang (Aug 15 2017 at 15:22):
I suppose, since PractionerRole is the one thing not required to resemble CDA's assignedAuthor, the proposed author(Organization) would be that pain-free solution.
Patrick Werner (Aug 15 2017 at 15:25):
https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13745
Patrick Werner (Aug 15 2017 at 15:27):
i just saw there was already a Item for adding author: https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13362&start=0
Simone Heckmann (Aug 15 2017 at 15:41):
@Lloyd McKenzie Hmmm. I guess my initial idea was to have something like a "primaryOrganization" or "defaultOrganization" directly at the Practitioner, that can be used, whenever details of the Role are unknown and you really just want to capture the fact that the Practitioner is part of that Organization (and probably only that Organization)... Practitioner directory IGs could easly constrain that to 0..0 to prevent ambiguities...
Lloyd McKenzie (Aug 15 2017 at 18:57):
I don't think "default" is going to work terribly well. If a clinician works at two hospitals and one clinic, the notion of "default" is going to be challenging. If you have control of the practitioner record, then you could easily just limit the number of roles (and thus the number of organizations) to 1. If not, then you need to recognize that practitioners can be associated with multiple organizations and you need to use PractitionerRole (even if a contained PractitionerRole) to identify the specific organization.
Richard Townley-O'Neill (Aug 17 2017 at 01:52):
Also, adding primaryOrganization to Practitioner will give another location to look for details of the organisation, making queries more complex.
Brian Postlethwaite (Oct 16 2017 at 02:23):
And primaryOrganization is just from a single point of view.
Would the definition of that be where he works the most? or where he's taking new patients, or ...
Last updated: Apr 12 2022 at 19:14 UTC
