Stream: implementers
Topic: Program Enrollment
Peter Bernhardt (Jul 14 2016 at 17:30):
Has there been any discussion/modelling been done around managing program enrollment information in FHIR? A profile on Eligibility or Account comes to mind. This may be peculiar to US realm, but maybe not.
Brian Postlethwaite (Jul 15 2016 at 00:26):
Not sure if this could map into EpisodeOfCare?
Here in Australia an organization is required to have an active/approved EpisodeOfCare for many govt programs that funding is allocated to, and from there an account is allocated to the EoC and funding runs through that.
(I don't how that works in the US though)
Peter Bernhardt (Jul 15 2016 at 12:53):
@Brian Postlethwaite Yes, related to EpisodeOfCare and/or CarePlan. My initial take on this would be that Program would be a profile on Account to identify the program and the terms of participation. Created once a patient, for example, agreed to participate in a study or government program. But I haven't gotten too deep into this yet. Thanks for the response.
Brian Postlethwaite (Jul 15 2016 at 23:39):
No problems, the contract could hold the details of theofficial agreement, and then the EoC as the container, and the CarePlan to fo the planning with. All makes sense there.
Paul Knapp (Jul 17 2016 at 21:13):
Or a profile on Enrollment when that gets flushed out.
Lloyd McKenzie (Jul 18 2016 at 03:33):
Enrollment sounds like a business process similar to admission. Patients both join and leave programs. We don't have a resource for "admission", just admission and discharge information on Encounter. My leaning would be for us to follow a similar pattern for program participation.
Peter Jordan (Jul 18 2016 at 04:32):
In NZ, enrollment in the Health & Disability Sector is principally used in relation to funding-related programmes and is predicated on the distinct, but related, concepts of eligibility and entitlement. For example, eligible patients, who also meet the entitlement criteria, have to enroll with a single general practice in order to receive subsidized treatment.
Lloyd McKenzie (Jul 18 2016 at 04:54):
Enrollment is also used to manage participation in clinical trials and also has an eligibility checking phase, though there generally isn't an entitlement aspect. (In the end, I think you can treat entitlement as just another aspect of eligibility.)
Peter Jordan (Jul 18 2016 at 05:46):
Agreed - eligibility and entitlement, in this context, are just different types of qualification criteria. During the NZ National Enrolment System project we landed on eligibility as a precursor to entitlement but I, for one, never found the distinction all that helpful - just indicative of the fact that law is all about making fine, and often artificial, distinctions.
Last updated: Apr 12 2022 at 19:14 UTC
