Stream: implementers
Topic: Patient eligibility for a procedure
Halina Labikova (Jan 28 2021 at 17:35):
My publisher issue has been solved, so I'm going to repurpose this thread.
I wonder whether anyone here has experience in modelling the concept of "patient eligibility for a [procedure type]"? I would like to avoid having to precoordinate the whole concept into the observation code. Any thoughts on having "eligibility for a procedure" in the code and "[procedure type]" in the component.code? I haven't found this concept being tackled in any of the public IGs that I'm familiar with, so suggestions would be greatly appreciated.
John Moehrke (Jan 28 2021 at 18:56):
seems like something the #Da Vinci streams might be answering...
Brendan Keeler (Jan 28 2021 at 22:24):
Sounds like prior authorization
Lloyd McKenzie (Jan 29 2021 at 04:58):
Are you talking about clinical eligibility (age, health condition, consent, etc.) or coverage eligibility? The latter would indeed by prior authorization, which uses the Claim and ClaimResponse resources. If you're in the U.S., then the Da Vinci PAS IG is the right target
Halina Labikova (Feb 01 2021 at 08:14):
Thanks for the answers! I was referring to clinical eligibility.
Lin Zhang (Feb 01 2021 at 16:22):
Maybe related to indications of a procedure.
Lloyd McKenzie (Feb 01 2021 at 16:23):
Clinical eligibility requirements are typically expressed as "preconditions" in the protocol (PlanDefinition) or order (RequestGroup or sometimes directly on the request resource). Measures that drive eligibility are typically captured as Observations. We've discussed whether CoverageEligibilityRequest and CoverageEligibilityResponse (which are currently insurance-focused) should be generalized to support capturing eligibility assertions for other types of programs, but so far no one has actively pushed for this.
Last updated: Apr 12 2022 at 19:14 UTC
