Stream: implementers
Topic: multiple patients on appointment
Jens Villadsen (Oct 30 2019 at 22:19):
Appointment allows to have 0..* patients listed as participants, yet the description mentions no intended case of supporting this as in eg. group appointments. Was and is it the intention that appointments should/could be shared among patients, and if that is indeed the case, shouldn't it have been modelled as a reference to a Group resource instead? This puzzles me especially as I'm in the case of having to model appointments with multiple patients as participants. As I'm about to make the design of group appointments (and the surrounding security model) I would very much like to know the original intention regarding having multiple patients on a single appointment. I imagine someone from the PA WG could have a good response?
Lloyd McKenzie (Oct 30 2019 at 22:23):
@Brian Postlethwaite
Jens Villadsen (Oct 30 2019 at 22:56):
From the spec:
In general, it is expected that appointments will result in the creation of an Encounter. The encounter is typically created when the service starts, not when the patient arrives. When the patient arrives, an appointment can be marked with a status of Arrived.
The patient is not mentioned in plural. I would also imagine that if multiple patients indeed was intended to be supported that the status field would reflect this. A single status does not make sense for multiple patient attendances at the same time if they differ.
Brian Postlethwaite (Oct 30 2019 at 23:14):
A group could be used and seems quite reasonable. However would then not permit making tracking so easy (Appointment Responses for each patient in a group session) , or detecting conflicts with patient scheduling.
We could create a standard extension for the group, with these notes and the discussion here.
The single status is for the overall appointment. If you're tracking multiple status for each patient, have seperate appointments.
Jens Villadsen (Oct 31 2019 at 08:03):
But what was the original intention allowing multiple patients?
David Pyke (Oct 31 2019 at 13:38):
I can see the need for group/multi patient appointments due to counselling sessions or other types of group supports. Many systems would need the ability to set appointments for a program or group and then add and remove patients as needed
Jens Villadsen (Oct 31 2019 at 14:30):
I would still like to hear the original intend not using groups here - @Brian Postlethwaite
Martin Grundberg (Oct 31 2019 at 19:44):
Interested in this as well. We allow for group appointments in our EHR. I know as an example that physiotherapy is done in groups, eg pool training.
I do think weve implemented it as separate appointments per patient as well as one for the group. This is to be able to track both the group appointment as a single appointment, and each individual patients appointment for their participation and arrival status.
Jens Villadsen (Oct 31 2019 at 19:55):
@Martin Grundberg - then how do you update the appointment? some special logic where you provide an extension on all 'child' appointments as a link to the group appointment in order to do transactional consistent updates?
Martin Grundberg (Oct 31 2019 at 20:13):
@Jens Villadsen , we haven’t implement FHIR support for it yet :) So we haven’t put too much thought into it. But yes, as of now we would probably need two things: 1) extension for referencing the Group as an “actor” or “subject” for the appointment, and 2) extension for a “partOf” to say that the patients appointment is part of the group appointment.
But again, haven’t thought about it in detail.
Brian Postlethwaite (Oct 31 2019 at 20:58):
Original intent was to have a single appointment and enumerate the participants from the group to track acceptances in the one appointment. Then multiple encounters to record the actuals.
Brian Postlethwaite (Oct 31 2019 at 20:59):
Just like you'd see in a mail client meeting request (and replies)
Jens Villadsen (Oct 31 2019 at 21:10):
@Brian Postlethwaite so what's your take on group appointments? I haven't thought it all through but in essence I actually can't see the benefits of using a Group here. Not much is gained AFAICS
Brian Postlethwaite (Oct 31 2019 at 21:16):
It would be ok as a participant as a request shortcut. But would need to have the patient optionally included to for tracking if/when they reply
Brian Postlethwaite (Oct 31 2019 at 21:16):
Then if you don't track status doesn't matter.
Jens Villadsen (Oct 31 2019 at 21:17):
i dont track appointmentresponses ...
Jens Villadsen (Oct 31 2019 at 21:18):
in my setup appointments are sort of decretes
Last updated: Apr 12 2022 at 19:14 UTC
