Stream: implementers
Topic: Task vs Procedure Boundaries
Michelle (Moseman) Miller (Jul 17 2018 at 14:25):
Seeking feedback on how systems differentiate between Task vs Procedure, so we can beef up the boundaries section of these resources.
Background: This topic surfaced when a question was raised whether to use Task or Procedure to represent medication reconciliation was completed. DaVinci landed on using Task due to it being more administrative in nature. However, please note that Procedure recently expanded its scope to include activities performed ON, WITH, or FOR a patient to accommodate long term services (such as installing a wheel chair ramp, flashing doorbell, transportation, or walking the dog).
Lloyd McKenzie (Jul 17 2018 at 14:32):
Task is intended for a few things:
- checklist items where you've got a hierarchy of steps to be performed (possibly assigned to different people)
- asking for things to be done to a record/tracking things done to a record (e.g. "please suspend", "please cancel", "please fulfill"
- tracking the details of the fulfillment process (e.g. "has the specimen been drawn? the blood centrifuged? preliminary results recorded? waiting on sign-off?")
Lloyd McKenzie (Jul 17 2018 at 14:33):
Procedure is more about actions that result in physical or mental change
Lloyd McKenzie (Jul 17 2018 at 14:34):
However, it would be useful to know what sorts of divisions of records actually exist in real systems - is there a boundary between where you capture information about surgeries, physio therapy and training from where you track "Dr. X would like this prescription to be suspended"?
Grahame Grieve (Jul 17 2018 at 21:28):
Task is an intent, where as procedure is an event record (technically, those are the act.mood mappings). Doesn't that define a very big differentiation?
Grahame Grieve (Jul 17 2018 at 21:28):
this difference is clear in the scope definitions for the 2 resources
Lloyd McKenzie (Jul 17 2018 at 21:41):
Task spans both intent and event
Lloyd McKenzie (Jul 17 2018 at 21:42):
It tracks the execution through to completion. A Task can be "in progress". A ServiceRequest can't - the ServiceRequest can only be active - i.e. an active authorization.
Lloyd McKenzie (Jul 17 2018 at 21:43):
(Though this point does mean we also need to differentiate ServiceRequest from Task...)
Grahame Grieve (Jul 17 2018 at 21:43):
better update the mappings then
Lloyd McKenzie (Jul 17 2018 at 21:51):
RIM mappings?
Grahame Grieve (Jul 17 2018 at 22:15):
y
Lloyd McKenzie (Jul 17 2018 at 22:31):
Proper RIM mappings on this are going to be a real pain. The set of statuses probably cover at least 3 different acts and I don't really know how to express that within the mapping syntax we have. We do have mappings to both the Request and Event patterns.
Eric Haas (Jul 24 2018 at 17:10):
Here is what I have summarized from this stream and would like to add to the boundaries section of Task:
Task spans both intent and event and tracks the execution through to completion. Task is intended for "administrative" actions like requesting and tracking things to be done to a record, or keeping track of a checklist of steps to be performed as part of a fulfilment process. In contrast to Task, Procedure is an event record and is more about actions that result in changes to a patient. and ServiceRequest is a record of a request for a service to be performed that would result in a procedure.
Eric Haas (Jul 24 2018 at 17:26):
and this to ServiceRequest:
Eric Haas (Jul 24 2018 at 17:32):
ServiceRequest is a record of a request for a service to be performed that would result in a procedure. In contrast to ServiceRequest, Task which spans both intent and event and tracks the execution through to completion and is intended for "administrative" actions like requesting and tracking things to be done to a record, or keeping track of a checklist of steps such to be performed as part of a fulfilment process. A ServiceRequest can be higher-level authorization that triggered the creation of Task, or it can be the "request" resource Task is seeking to fulfill.
Lloyd McKenzie (Jul 25 2018 at 00:23):
On Task, last sentence, change "and ServiceRequest..." to "ServiceRequest is a record of a proposal/plan or order for a service to be performed that would result in a Procedure, Observation, DiagnosticReport, ImagingStudy or similar resource." Same change for first sentence for ServiceReuqest.
Lloyd McKenzie (Jul 25 2018 at 00:23):
Fine with the remainder.
Brian Zimbelman (Jul 25 2018 at 01:38):
So let's see if were all in agreement for the following examples:
1. Provider contact instructions (Call provider if SBP < 90, ....)
2. Specialist Consult Order (consult cardiology ...)
3. Order to perform an intervention (Take vitals, BGL, IV start, etc.)
4. Wound change directions/order.
5. HIM request for documentation correction.
Lloyd McKenzie (Jul 25 2018 at 02:02):
1. Task (though we may need to make the definition clearer)
2. ServiceRequest
3. ServiceRequest
4. ServiceRequest
5. Task
Michelle (Moseman) Miller (Jul 25 2018 at 12:55):
For #1, couldn't that also be a CommunicationRequest?
Lloyd McKenzie (Jul 25 2018 at 14:16):
You could, though CommunicationRequest doesn't have the notion of pre-condition and the focus of CommunicationRequest is "please share information X" and it's not totally clear what the 'X' would be here.
Michelle (Moseman) Miller (Jul 25 2018 at 16:24):
The reason why I mentioned CommunicationRequest was due to its scope including the following statement:
A physician requesting notification from the nurse if a patient's temperature exceeds a value
Lloyd McKenzie (Jul 25 2018 at 16:26):
Sounds like some differentiation between CommunicationRequest and Task would be a good idea too... :)
Michelle (Moseman) Miller (Jul 25 2018 at 16:28):
Does Task handle pre-conditions? If so, where?
Lloyd McKenzie (Jul 25 2018 at 16:33):
Not coded ones, no. But I expect a lot of tasks won't be coded - the instructions will just be in Task.code.text
Eric Haas (Jul 25 2018 at 20:05):
OK updated BNRs
Task spans both intent and event and tracks the execution through to completion. Task is intended for "administrative" actions like requesting and tracking things to be done to a record, or keeping track of a checklist of steps to be performed as part of a fulfilment process. In contrast to Task, Procedure is an event record and is more about actions that result in changes to a patient. ServiceRequest is a record of a proposal/plan or order for a service to be performed that would result in a Procedure, Observation, DiagnosticReport, ImagingStudy or similar resource. CommunicationRequest is record of a request for a communication to be performed between patients, practitioners, related persons, organizations, and/or devices.
ServiceRequest is a record of a proposal/plan or order for a service to be performed that would result in a Procedure, Observation, DiagnosticReport, ImagingStudy or similar resource. In contrast to ServiceRequest, Task which spans both intent and event and tracks the execution through to completion and is intended for "administrative" actions like requesting and tracking things to be done to a record, or keeping track of a checklist of steps such to be performed as part of a fulfilment process. A ServiceRequest can be higher-level authorization that triggered the creation of Task, or it can be the "request" resource Task is seeking to fulfill.
Floyd Eisenberg (Sep 30 2018 at 19:56):
Consider the ability to identify the status or outcome of a service: Status
Workflow
[Intent – proposed, planned, order, etc.]
Scheduled
Initiated (for lab test this might mean specimen obtained)
In progress (may include sub-levels e.g., lab test – received in lab, on machine, machine output, verification)
Finished (e.g., result reported/available to others)
Adequacy
Fully able to provide an answer for next step in workflow
Partially able to provide an answer but sufficient not to repeat
Partially able to provide an answer but needs repeat to be sure
Unable to provide an answer
Outcome
Patient-centered results that lead to next steps in evaluation or treatment
May require additional information (e.g., pathology report from biopsy obtained at a procedure)
Last updated: Apr 12 2022 at 19:14 UTC
