FHIR Chat · which resource is best to use · implementers

Stream: implementers

Topic: which resource is best to use

Lakshmi Thrivarna (Nov 12 2018 at 07:04):

Hi All, There are 98 Episode of care definitions.
http://www.prometheusanalytics.net/deeper-dive/definitions-readable
For example, Episode of care of Asthma includes the following core components
Trigger codes
SubTypes
Relevant Diagnosis
Relevant Procedures
Relevant Pharmacy
SubType Groups.
Which resource is best to use to capture all these information?

Lloyd McKenzie (Nov 12 2018 at 12:13):

PlanDefinition might be the best fit, but not sure whether it'll be a "good" fit. @Bryn Rhodes ?

Bryn Rhodes (Nov 12 2018 at 15:28):

Yes, I think a PlanDefinition is a good fit here, it's effectively describing the set of rules for what constitutes an episode of care. The definitions about relevant diagnoses, procedures, and medications would be specified as CQL expressions that, when evaluated in the context of a specific patient would produce the set of resources that should be associated with the episode of care.

Bryn Rhodes (Nov 12 2018 at 15:28):

I'm not sure I understand what SubTypes and SubType Groups are, but they feel like categorizations to me, and so I don't see that they would change the basic representation approach.

Lakshmi Thrivarna (Nov 14 2018 at 05:11):

Thank you @Lloyd McKenzie @Bryn Rhodes Can you suggest how to implement these EpisodeOfCare Definitions using PlanDefinitions?

Lloyd McKenzie (Nov 14 2018 at 10:10):

Is it accurate to say with your data elements that the objective is to say "if diagnoses that look like this or procedures that look like this or medications that look like this exist in the patient THEN that data should be grouped within an episode of this type"?

Lakshmi Thrivarna (Nov 16 2018 at 07:36):

@Lloyd McKenzie Yes, Thank you for reply. We agree with your plan. But how to use it in a practical way using PlanDefinition resource?
suppose We have an encounter this encounter will have diagnosis, procedures and medications. These are like triggers codes.
we want to connect these encounter to episode of care. This is a actual use case, so how to use it.

Lloyd McKenzie (Nov 16 2018 at 08:09):

@Bryn Rhodes, you're probably most qualified to describe this

Bryn Rhodes (Nov 21 2018 at 22:48):

So, just to make sure I understand what this is trying to accomplish, the scenario is that I have a clinical data repository, and I want to be able to create episodes-of-care retroactively by linking events based on criteria, and what we're after is a way to describe that process in the abstract so it can be shared as an "episode-of-care" definition. With that as a working description of what we're after, this would look like a Library of CQL defining the content of interest, and a PlanDefinition that brings together the triggering mechanisms, the additional conditions that determine whether the episode-of-care should be created, and actions to link the events that meet the criteria to the newly created episode-of-care.

Bryn Rhodes (Nov 21 2018 at 22:49):

So, that would look quite a bit like the PlanDefinition resources that we use to describe event-condition-action rules when distributing decision support, here for example.

Bryn Rhodes (Nov 21 2018 at 23:10):

Specifically then, we'd need a root action to create the episode of care, and then sub-actions for each of the kinds of events we wanted to link to the new episode of care and a way to say that that's what we want to do. I'm just spitballin' here, but something like:

<PlanDefinition>
  <action>
    <title value="Create an episode of care to link the related events"/>
    <trigger>
      <type value="named-event"/>
      <name value="process-episodes"/>
    </trigger>
    <condition>
      <kind value="applicability"/>
      <expression>
        <language value="text/cql"/>
        <expression value="ShouldCreateEpisodeOfCare"/>
      </expression>
    </condition>
    <definitionCanonical value="ActivityDefinition/episode-of-care"/>
    <type value="create"/>

    <!-- Sub action to link related encounters to the new episode of care -->
    <action>
      <title value="Link related encounters"/>
      <type value="update"/>
      <definitionCanonical>
        <extension>
          <url value="cqf-expression"/>
          <valueExpression>
            <language value="text/cql"/>
            <expression value="RelatedEncounters"/>
          </valueExpression>
        </extension>
      </definitionCanonical>
      <dynamicValue>
        <language value="text/cql"/>
        <path value="episodeOfCare"/> <!-- This is the path to the episodeOfCare element of the related encounter -->
        <expression>
          <language value="text/cql"/>
          <expression value="%parent_target"/> <!-- This assumes the ability to "assign" a reference -->
        </expression>
      </dynamicValue>
    </action>
  </action>
</PlanDefinition>

Last updated: Apr 12 2022 at 19:14 UTC