Stream: implementers
Topic: Use of Organization Resource to determine plan membership
Floyd Eisenberg (Feb 28 2017 at 20:25):
I have a use case to define a patient's membership in a health plan, a Patient-Centered Medical Home (PCMH), or a treatment program (e.g., HIV program, diabetes treatment program), etc. One issue is to determine the time enrolled in the program and the final date of enrollment. I have been looking at the FHIR Organization resource in which organization has many options for definition and there are multiple organization types based on the value set (https://www.hl7.org/fhir/organization-definitions.html#Organization.type). A few questions:
Floyd Eisenberg (Feb 28 2017 at 20:25):
1. Can I use the Organization Resource to request start and stop time for participation in the 'organization' (i.e., participation period)?
Floyd Eisenberg (Feb 28 2017 at 20:26):
2. Will an EHR or financial application store the enrollment date and expiration date for participation in a health plan? in a treatment program for which specific payment is applied? A PCMH?
Floyd Eisenberg (Feb 28 2017 at 20:27):
3. The definition for organization type is quite broad - should it apply to treatment programs or is there another resource that would be better?
Floyd Eisenberg (Feb 28 2017 at 20:28):
4. Is there some standard value set of types of treatment programs, health plans, etc? The Public Health Data Standards Consortium developed a value set for payer types (now included in VSAC) -is the Organization resource intended to use that value set or is there a more specific one?
Igor Sirkovich (Feb 28 2017 at 20:36):
@Floyd Eisenberg , Organization resource is not intended to be used for to represent membership in a health plan or any program. I think you should look into Coverage for membership in a health plan.
Igor Sirkovich (Feb 28 2017 at 20:37):
It has period element for Coverage start and end dates.
Floyd Eisenberg (Feb 28 2017 at 20:37):
what is the intent for organization?
Igor Sirkovich (Feb 28 2017 at 20:41):
A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, etc.
Igor Sirkovich (Feb 28 2017 at 20:42):
For example, this would be an insurance company that provides a plan/coverage to a patient.
Floyd Eisenberg (Feb 28 2017 at 20:42):
So the organization would be the identifier for the insurance company. And it would have a coverage? I'm confused. Note - the use case is also to determine the patient is managed by a specific organization (clinical practice, etc). So what resource is used there?
Igor Sirkovich (Feb 28 2017 at 20:43):
The the coverage would have a reference to both organization (payor) and patient (beneficiary)
Igor Sirkovich (Feb 28 2017 at 20:44):
I would suggest to look at CareTeam
Floyd Eisenberg (Feb 28 2017 at 20:45):
And could I expect an EHR to have the information about enrollment period? The information I have is that such enrollment dates are not necessarily present in the EHR.
Floyd Eisenberg (Feb 28 2017 at 20:46):
I think Care Team and Health Plan still miss identifying those patients enrolled in a specific treatment-type program (such as an HIV treatment program)
Igor Sirkovich (Feb 28 2017 at 20:47):
Period is an optional element. If you don't have this information, you don't have to populate it.
CarePlan would be likely a fit for your treatment program requirement.
Floyd Eisenberg (Feb 28 2017 at 20:53):
Will need to review with others - Care plan is not what I was seeking - it is patient specific. I need a program that is applied to multiple patients and may use multiple care plans.
Igor Sirkovich (Feb 28 2017 at 20:59):
CarePlan can be defined for an individual patient or a group, can be be part of other CarePlan(s).
Igor Sirkovich (Feb 28 2017 at 21:01):
Depending on your use case, another option might be HealthcareService
Brian Postlethwaite (Feb 28 2017 at 23:22):
I wouldn't be thinking HealthcareService as that is not patient related. I think the resource you are looking for is EpisodeOfCare.
This is what we use for enrolment in a specific program in our solutions. (community care programs, Aged Care programs, rehabilitation programs etc)
It has the details of the patient, the organization, the period of time, and its purpose (EoC.type).
Last updated: Apr 12 2022 at 19:14 UTC
