Stream: implementers
Topic: patient / [marital status, address, gender]
natus (May 15 2017 at 19:00):
Hi,
I am surprised do find :
- marital status,
- address
- gender
in the patient resource. This kind of information is supposed to change at each encounter. For this reason, I would suggest move them into encounter resource ?
Thanks for clarifications
Abbie Watson (May 15 2017 at 19:03):
An encounter is a billing holdover from fee-for-service days. If those fields get updated on the patient file during an encounter, better to create a new version of the patient record.
natus (May 15 2017 at 19:16):
Hi,
Many thanks. As written in the Patient documentation:
A Patient record is generally created and maintained by each organization providing care for a patient
So if I understand, the "meta" element, and "versionId", "lastUpdate" are the stuff to maintain versionning of those information, isn'it ? see https://www.hl7.org/fhir/resource.html#Meta
Abbie Watson (May 15 2017 at 19:19):
Yup, exactly. And each version is loosely associated with an encounter (to the extent that the patient data actually changes and gets versioned; not guaranteed to happen).
natus (May 15 2017 at 19:22):
Thanks for the warning, I understand this limitation: an Encounter is linked to a Patient.id and not to a versionId of the patient
Abbie Watson (May 15 2017 at 19:25):
Exactly. In effect, the Encounter is only saying we saw this particular Patient, and if you go to fetch the Patient, you'll get the latest version of the patient chart, unless you ask for the chart history, in which case you can match timestamps to find out what data was changed during that encounter. That's the general idea.
Sunanda Veeraganti (May 16 2017 at 11:26):
@natus I can agree that address of the patient might change at each encounter. But what is the possibility of changing marital status and gender of the patient at each encounter?
Abbie Watson (May 16 2017 at 13:49):
Depends on how granularly the system models those things. Perhaps the system has codes such as ['single', 'dating', 'living together', 'engaged', 'married', 'separated', 'divorced', 'widowed']. If the patient only visits the practice once every 6 months, they could easily change that status each time they visit over the course of 3 years.
natus (May 16 2017 at 18:20):
I ended by adding the information in two resources:
1) the patient resource gets the last version of adress, ethnicity, gender....
2) the observation resource gets each value. Have a look to social history category of observation : http://hl7.org/fhir/codesystem-observation-category.html#observation-category-laboratory
Last updated: Apr 12 2022 at 19:14 UTC
