Stream: implementers
Topic: Recording consent & dissent
Richard Kavanagh (Feb 06 2020 at 09:32):
With regards to clinical procedures, I am looking to see how we can record consent (http://hl7.org/fhir/STU3/consent.html) but also we have occasions where patients actively dissent from procedures - how should this be recorded with FHIR?
Mohammad Jafari (Feb 06 2020 at 15:47):
The consent resource is capable of recording opt-out and deny decisions by the patient which I think would cover the case for dissent. If you can share more about your use-case we'd be able to discuss how those decisions can be modeled with more details.
Richard Kavanagh (Feb 06 2020 at 16:48):
Thanks @Mohammad Jafari example dissent scenarios are:
-- Dissent to having a flu immunization
-- Dissent to a surgical procedure
Craig Newman (Feb 06 2020 at 19:05):
For the Immunization refusal, that can be captured in an Immunization resource itself. In R4, .status can be "not-done" with the reason in .statusReason. In R3, the elements are a bit different (.notGiven and .explanation.reasonNotGiven) but it's basically the same. Consent still be used if you want to have a consistent method for recording lack of consent regardless of what the procedure is.
Mohammad Jafari (Feb 06 2020 at 19:19):
I think there is a different between lack of consent and and refusal (dissent). Lack of consent is not actively tied to a specific event or action by the patient but a refusal is. For example, if a patient has signed a form and refused a specific procedure, then that can certainly be captured in a consent resource using the opt-out or deny provisions. But "lack of consent" is a different state which may result in workflow decisions (e.g., direct patient to a consent form).
David Pyke (Feb 06 2020 at 20:33):
The Treatment Consent use case was added in R4 with the addition of the Treatment scope. Using STU3 for that kind of consent isn't in the design. If you need that, it may be possible to add an extension that creates the equivalent by making the Consent as "treatment".
Richard Kavanagh (Feb 06 2020 at 21:12):
Thanks for your comments - plenty to think about. We'll be delivering STU3 and R4 versions so we will have to shape it accordingly.
Last updated: Apr 12 2022 at 19:14 UTC
