FHIR Chat · Primary care provider · implementers

Stream: implementers

Topic: Primary care provider

Aleksandra Pavlyshina (Aug 12 2016 at 11:11):

Hi @all,
In our application, we need to capture a patient's Primary care provider in order to raise an issue 'Patient does not have a primary care physician
' if this is the case. I see several ways to do it (in DSTU2, we are currently stuck to it):

• specify PCP in the Patient.careProvider Reference(Practitioner) and then check if this field has a reference to a practitioner;
• specify PCP in the EpisodeOfCare.careTeam.member Reference(Practitioner) with the EpisodeOfCare.careTeam.role = SCTID: 446050000 Primary care physician (occupation) and then check if current episode of care has a care team member with the SCTID: 446050000 role.

What is the best approach? I'm wondering if anyone else has a similar use case. And, if so, how they approached it.

Grahame Grieve (Aug 12 2016 at 19:56):

why would you not use the first apporach?

Aleksandra Pavlyshina (Aug 30 2016 at 12:24):

The problem is that I need to capture an answer to the question 'Does the patient have adequate access to this provider? Yes/No' for each Medical Care Provider (to trigger corresponding issues in our application).
I'm not sure how to save it to a QuestionnaireResponse in the appropriate context (isn't it incorrect to save it to the Practitioner resource as a contained QR, is it?). Should it be a QuestionnaireResponse with source = Patient, item.subject = Practitioner (who is the care provider who we asking the patient about), and item.text = 'Does the patient have adequate access to this provider?'?
Should this be done through an extension to EpisodeOfCare.team.participant, or there are better ways?

Brian Postlethwaite (Aug 30 2016 at 20:48):

I'm a little lost with what the issue is here.
A questionnaireresponse would be stored against the patient that just has the values.
You could do some pre-population from the patient context to check if either of those 2 fields exist (non standard techniques only at this point) however the result would jsut be storing a boolean to record the snapshot in time of what was observed, or entered for the patient.
If you wanted to enter the primary care provider, then yes/no doesn't seem valid.
If was a search, could do [base]/Patient?general-practitioner:missing=true or other similar queries.

Aleksandra Pavlyshina (Aug 31 2016 at 14:57):

Sorry, I really was not clear with my questions. In our application, we record Provider Network and capture it as FHIR CareTeam and Practitioners resources, and there are the following options on the form for each Medical Team Member:

• name, role (like Oncologist, Cardiologist, etc), address, telecom
• Primary Care Provider true/false
• Does the patient have adequate access to this provider? Yes/No
  So in fact, there were two questions:
  1) Where to store the value showing "the patient does not have proper access to the practitioner". This is a boolean value that triggers an issue, and not sure where to store this. Currently, we are storing it in a contained QuestionnaireResponse within the Practitioner resource (which is incorrect because is not in the context of a patient and episode of care).
  2) Should we represent PCP as a CareTeam.participant with 2 roles: role1 = 'Primary Care Physician', role2 = 'PP' Primary Care Provider (http://hl7.org/fhir/ValueSet/v2-0286),
  or as a CareTeam.participant with 1 role = 'Primary Care Physician', and reference in Patient.generalPractitioner to this practitioner;
  or both two roles in CareTeam, and reference in Patient.generalPractitioner.
  I feel confused because there are several possible ways, and I'm not sure which is better.

Lloyd McKenzie (Aug 31 2016 at 17:20):

"does the patient have proper access" sounds like an extension - I wouldn't embed a QuestionnaireResponse just to capture a single element. For the second, Brian was indicating that they're looking at allowing multiple roles for one Practitioner on CareTeam. In the interim, I'd probably repeat them multiple times.

Last updated: Apr 12 2022 at 19:14 UTC