Stream: implementers
Topic: dispenser profession / role
Jose Costa Teixeira (Jun 23 2020 at 14:51):
What would be a good way to say "the performer of this dispense is Dr. X who happens to be a physician"?
Lloyd McKenzie (Jun 23 2020 at 14:54):
Practitioner captures qualifications. PractitionerRole captures functional role
Jose Costa Teixeira (Jun 23 2020 at 14:56):
I looked at PractitionerRole, - the thing is that PractitionerRole does not seem to define "person X did this in the quality of Y", but it is rather definitional saying "this person has normally these roles".
Lloyd McKenzie (Jun 23 2020 at 15:20):
"Did X" is covered by how they are referenced. So MedicationDispense.performer (and specifically performer.function) says what they did. PractitionerRole.code indicates the capacity in which they were acting.
Jose Costa Teixeira (Jun 23 2020 at 16:28):
so medicationdispense.actor would be a PractitionerRole so that we can have the capacity (pharmacist etc)?
And practitionerRole does not have the practitioner name, which we would need.
Jean Duteau (Jun 23 2020 at 17:03):
not quite. to answer your initial question, i believe that it would be MedicationDispense.performer.function with either "dispenser" or "performer" and MedicationDispense.performer.actor would be the Practitioner with a qualification of 'physician'.
Jean Duteau (Jun 23 2020 at 17:05):
if you wanted to specify the role that they were playing when they were a part of the dispense, then you need PractitionerRole: MedicationDispense.performer.actor would be a PractitionerRole with PractitionerRole.code of 'attending physician' (or some role that you needed to convey) and PractitionerRole.practitioner pointing to the Practitioner.
Melva Peters (Jun 23 2020 at 17:08):
I'm not sure that the role that the practitioner would be playing when they were dispensing would ever be "attending physician". If you are dispensing something, then the role you are playing is "dispenser". They may have other qualifications as well.
Jean Duteau (Jun 23 2020 at 17:09):
true, I was trying to figure out a role that a physician would be playing when dispensing. :)
Jean Duteau (Jun 23 2020 at 17:10):
and "dispenser" is adequately conveyed in the MedicationDispense.performer.function, so I was also trying to think of an example that provided additional information beyond the function, i.e. the Attending Physician Joe Smith (who has a medical license) was the dispenser for this dispense.
Melva Peters (Jun 23 2020 at 17:22):
I would have thought that Practitioner would be enough since it includes qualifications. My experience when I would on the regulatory side was that if you are dispensing the requirements that apply related to your qualifications as a dispenser regardless of whether you are a physician. There are typically a small number of "dispensing physicians" in practice. Most of the time the practitioner is administering the medication and there isn't really a dispense or if there is a dispense, it happens after the fact.
Jose Costa Teixeira (Jun 23 2020 at 17:34):
.function is "dispenser". Beyond that, the requirement is to provide:
"The dispenser was Dr. X, and he is registered as a pharmacist. In the national healthcare professionals DB he has the id 1234567"
Jean Duteau (Jun 23 2020 at 17:39):
yeah, then you don't need PractitionerRole, just Practitioner.
MedDispense.performer.function = dispenser
MedDispense.performer.actor = Practitioner
Practitioner.qualification.code = pharmacist
Practitioner.qualification.identifier = 1234567 (if that is his pharmacist license number)
Jose Costa Teixeira (Jun 23 2020 at 17:53):
Jean Duteau said:
yeah, then you don't need PractitionerRole, just Practitioner.
MedDispense.performer.function = dispenser
MedDispense.performer.actor = Practitioner
Practitioner.qualification.code = pharmacist
Practitioner.qualification.identifier = 1234567 (if that is his pharmacist license number)
I was not really happy with qualification - it says "Certification, licenses, or training pertaining to the provision of care"
Jose Costa Teixeira (Jun 23 2020 at 17:54):
and the identifier is not "pharmacist license number" - it's not specific to pharmacists (which is why we need the type of professional - otherwise it would be easy to figure it our from the code)
Jean Duteau (Jun 23 2020 at 19:13):
if that's just a national provider identifier, then it goes on the Practitioner.identifier, I was just assuming it was his license number.
Jean Duteau (Jun 23 2020 at 19:14):
Jose Costa Teixeira said:
I was not really happy with qualification - it says "Certification, licenses, or training pertaining to the provision of care"
If you're saying that this Practitioner is a pharmacist, then you are saying that he has a license to be a pharmacist and it goes in the qualification.
Jean Duteau (Jun 23 2020 at 19:14):
i have my own problems with the bundling of licensing and training, but, for now, that's where it goes.
Jose Costa Teixeira (Jun 23 2020 at 19:35):
Well, that may be a way out indeed. But besides the semantics (capacity and qualifications are not the same) the practitioner.identifier does not say anything about being a pharmacist. It's a "healthcare person number" which is not bound to specific profession. While we don't fix that, I would not want to make any strong assumptions now, since I don't want to undo them later.
Jean Duteau (Jun 23 2020 at 19:38):
I was suggesting that you still send the qualification.code of 'pharmacist'. If you don't have the license number, that's fine, it still says that this practitioner is a pharmacist.
Peter Jordan (Jun 23 2020 at 21:20):
Interesting discussion! Thus far in NZ, we've put a reference to Practitioner in MedicationDispense.performer.actor, with MedicationDIspense.performer.function being 'packager' (using the example binding to the medicationdispense-performer-function ValueSet) in mappings from our National ePrescription Service (NZePS) - based on CDA - to FHIR.
The Resource Model for a Bundle containing all the data from a complete NZePS CDA - as created by ClinFHIR - can be viewed at https://terminz-itp.azurewebsites.net/Content/NZePStoFHIR.jpg
Jose Costa Teixeira (Jul 07 2020 at 12:19):
Still related to this, we want to send in the dispense the following:
- the practitioner ID of the dispenser (from which people can look up the specialty)
- the specialty explicitly.
Jose Costa Teixeira (Jul 07 2020 at 12:42):
The specialty could be in a contained resource. I ses two ways of doing it:
- performance.actor has a reference to a contained PractitionerRole which links to the practitioner
2 performer.actor has, in the same reference, use an internal reference AND a reference by identifier
Jose Costa Teixeira (Jul 07 2020 at 12:44):
Option 1:
{
"resourceType": "MedicationDispense",
"id": "medication-dispense-example-1",
"language": "fr-BE",
"contained": [
{
"resourceType" : "PractitionerRole",
"id" : "contained-pr1",
"practitioner":{
"identifier": [{
"system": "https://professional-registry",
"value": "27457532"
},{
"system": "https://national-registry",
"value": "1231324423"
}]
},
"speciality":{
"coding": [
{
"system": "https://specialties",
"code": "1439562",
"display": "Hospital Pharmacist"
}
]
}
}
],
"subject": {
"identifier": {
"system": "https://patient-registry",
"value": "6734534332"
}
},
"status": "completed",
"medicationCodeableConcept": {
"coding": [
{
"system": "https://cnk.apb.be/codings/cnk_product_codes",
"code": "1439562",
"display": "Topazolam tab 50x 1,0mg"
}
]
},
"performer": [
{
"actor": {
"reference":"#contained-pr1"
}
}
]
}
Jose Costa Teixeira (Jul 07 2020 at 12:47):
Option 2 seems simpler because it does not require the contained resource to be always there - can I use it?
{
"resourceType": "MedicationDispense",
"id": "medication-dispense-example-1",
"language": "fr-BE",
"contained": [
{
"resourceType" : "PractitionerRole",
"id" : "contained-pr1",
"speciality":{
"coding": [
{
"system": "https://specialties",
"code": "1439562",
"display": "Hospital Pharmacist"
}
]
}
}
],
"subject": {
"identifier": {
"system": "https://patient-registry",
"value": "6734534332"
}
},
"status": "completed",
"medicationCodeableConcept": {
"coding": [
{
"system": "https://cnk.apb.be/codings/cnk_product_codes",
"code": "1439562",
"display": "Topazolam tab 50x 1,0mg"
}
]
},
"performer": [
{
"actor": {
"reference":"#contained-pr1",
"identifier": {
"system": "https://professional-registry",
"value": "27457532"
}
}
}
]
}
Jose Costa Teixeira (Jul 07 2020 at 12:48):
the difference is in performer.actor: Can I use reference AND identifier, where reference is an internal reference to provide additional information about the practitionerrole?
Lloyd McKenzie (Jul 07 2020 at 14:14):
Reference and identifier can both be present, but if reference is present, I'd expect consumers to ignore the identifier. It's certainly not appropriate for it to convey additional information.
Lloyd McKenzie (Jul 07 2020 at 14:15):
In general, you should be pointing to an external Practitioner instance. If there is no endpoint you can point to and the information is persisted as part of the Dispense, then you could use contained Practitioner.
Jose Costa Teixeira (Jul 07 2020 at 14:39):
Lloyd McKenzie said:
Reference and identifier can both be present, but if reference is present, I'd expect consumers to ignore the identifier.
Even if it's internal reference? If so, then I can put my identifiers inside the contained as per option 1
Jose Costa Teixeira (Jul 07 2020 at 14:40):
Lloyd McKenzie said:
It's certainly not appropriate for it to convey additional information.
It is not additional to what is known about the PractitionerRole. It's additional to what we have in the Dispense - we only have roles like "dispenser" or "verifier" and I need "pharmacist" or "nurse"
Lloyd McKenzie (Jul 07 2020 at 14:40):
If you've already got a contained, there's no reason not to put the identifier there too
Jose Costa Teixeira (Jul 07 2020 at 14:41):
If you've already got a contained, there's no reason not to put the identifier there too
How else will I say that my internal reference (#contained-pr1) has thosee external identifiers?
Jose Costa Teixeira (Jul 07 2020 at 14:43):
Just to scope this: my need is to send out a dispense, the official identifier of the dispenser, and additionally the capacity/specialty/role of that person under which they dispensed.
Lloyd McKenzie (Jul 07 2020 at 15:13):
Does the practitioner exist as a RESTful endpoint? If so, just specify a Reference - no contained and no identifier. The reference will need to be resolved. If the practitioner information is only stored in the dispense and isn't maintained anywhere else, use a contained resource where the contained resource has an identifier and specialty
Jose Costa Teixeira (Jul 07 2020 at 15:44):
Practitioner may exist in the future as a REST but we want to a) work with what we (don't) have now and b) allow systems to get that information as it was at the time the resource was created, (which would also alleviate the need to bother or burden of a lookup)
Jose Costa Teixeira (Jul 19 2020 at 07:15):
(nevermind)
Last updated: Apr 12 2022 at 19:14 UTC
