Stream: argonaut
Topic: COVID-19
Grahame Grieve (Mar 03 2020 at 23:15):
I have a request from a university linked vendor who is trying to rush a smart on fhir app into production to do advance screening of patients who have appointments for Covid-19, with the intent that you can separate patients with risk factors from others.
Grahame Grieve (Mar 03 2020 at 23:17):
They've asked me to help with that process. I'm not sure that I can do that much, but they're telling me that their institution partners are desperate for this, and have no other path
Grahame Grieve (Mar 03 2020 at 23:18):
Its's based on a FHIR questionnaire. I've offered to host the questionnaire itself in github but I don't know if that's a goer
Grahame Grieve (Mar 03 2020 at 23:18):
what are vendors doing about this? is this something that should be accelerated through the process? can we do that?
Lloyd McKenzie (Mar 03 2020 at 23:25):
The NLM app can run questionnaires. The big question is triggering the SMART app at the right time, and that would take CDS Hooks. If they can mandate triggering themselves, then it'd just be a question of getting the NLM app approved. No clue if that's been progressed or not. @Paul Lynch
Paul Lynch (Mar 03 2020 at 23:36):
@Lloyd McKenzie If you mean whether the NLM Questionnaire SMART on FHIR app is approved by EHR vendors for launching in deployed EHR systems, the answer is no. I looked into doing that at one point and it cost a significant amount of money (with at least one vendor).
Grahame Grieve (Mar 03 2020 at 23:48):
there's 2 parts - the questionnaire, and the infrastructure that runs it. The source is interested in getting the infrastructure in place. The questionnaire is changing rapidly. But if we get it out there as a questionnaire, then anyone can pick it up
Paul Lynch (Mar 04 2020 at 00:12):
The app is open source, so anyone who wanted to could install their own copy. Also, the demo of it allows anyone to upload a Questionnaire, though the FHIR server it talks to resets weekly. We could always add a Questionnaire to the "base" to which we reset.
Adam Flinton (Mar 04 2020 at 07:53):
In the usual disclaiming all knowledge sort of way I have a strong feeling that our messaging links between our GP software & 111 (the UK phone based triage system) might be seeing some love at present. Basic idea is to stop people going to health care settings & thus potentially infecting others (inc healthcare workers) & requiring places to be shut for deep cleaning. So in essence call to 111 > stay at home/self-isolate > send people round to test & inform GP of potential patient.
Adam Flinton (Mar 04 2020 at 08:11):
e.g. from a few years back: https://www.lmc.org.uk/visageimages/Miscellaneous%20items%20/NHS111MessagingtoEMISWebPractices19022015.pdf
Josh Mandel (Mar 04 2020 at 14:00):
Re: questionnaire form filling - submitting, https://github.com/smartmarkers has a mobile app approach (@Raheel Sayeed you may have thoughts to share)
Michele Mottini (Mar 04 2020 at 20:58):
I don't understand which process they need help with? The development or deploying it? Which EHR do they want to connect to?
Grahame Grieve (Mar 05 2020 at 01:14):
epic and cerner, I think, at least.
Isaac Vetter (Mar 05 2020 at 04:08):
Hey Grahame, Argonauts -- overall, I'd expect apps providing novel functionality beyond simple screening tools to be of great interest to health systems gearing up for COVID-19.
Isaac Vetter (Mar 05 2020 at 04:08):
For Epic, there are three methods to deploy a commercial SMART app into a health system's Epic instance:
Isaac Vetter (Mar 05 2020 at 04:09):
1) patient-facing apps are deployed within 12 hours to a health system, at the developer's choosing, via this tool: https://open.epic.com/MyApps.
Isaac Vetter (Mar 05 2020 at 04:09):
2) provider-facing apps are deployed, following some paperwork between the health system and Epic, within 12 hours to a given health system, at the developer's and health system's choosing, via this tool: https://uscdi.epic.com/
Isaac Vetter (Mar 05 2020 at 04:09):
3) patient or provider-facing apps are deployed, following paperwork between the developer, Epic and the health system, a monetary cost to the developer and an app review, via the developer program: https://apporchard.epic.com/
Isaac Vetter (Mar 05 2020 at 04:09):
The speed at which #1 and #2 happen depends entirely upon the developer and the institution. It is also possible for the institution to remove the 12 hour wait time for deployment as well. We're also getting a lot faster at #3 as well, but definitely not measured in hours.
Grahame Grieve (Mar 05 2020 at 05:34):
thanks Isaac - I'll pass that on
Paul Lynch (Mar 05 2020 at 21:16):
Isaac Vetter said:
1) patient-facing apps are deployed within 12 hours to a health system, at the developer's choosing, via this tool: https://open.epic.com/MyApps.
It looks like this option is read-only. Is that the case? Is #2 read-only also? Also, is there support in either #1 or #2 for Questionnaire and QuestionnaireResponse? I did not see those resources listed either at https://open.epic.com/Interface/FHIR or https://uscdi.epic.com/
Michele Mottini (Mar 05 2020 at 22:04):
No US vendor to the best of my knowledge supports Questionnaire or QuestionnaireResource - you have to use Observation or DocumentReference
Michele Mottini (Mar 05 2020 at 22:05):
...and what you get with free API is usually read-only, because that is what the regulation mandates - everything above and beyond that is usual a paid option (if available at all)
Isaac Vetter (Mar 05 2020 at 22:24):
Hi Paul, to confirm Michele's encyclopedic knowledge of the state of FHIR deployment -- we don't currently support Questionnaire/Response.
I would add to Michele's response that there's at least a few ways in which https://uscdi.epic.com/Sandbox offers APIs not mandated by regulation -- first and foremost, its existence despite the current lack of any mandated regulation of USCDI.
Michele Mottini (Mar 05 2020 at 22:37):
Thanks Isaac - did not appreciate that about the USCDI thing
David Hay (Mar 05 2020 at 23:11):
@Brian Postlethwaite ?
Brian Postlethwaite (Mar 06 2020 at 00:32):
Where is the questionnaire response data going? Or is it converted to something else and then going back into the EMR?
Would they be expecting pre-pop?
Is this patient or provider facing?
Brian Postlethwaite (Mar 06 2020 at 00:34):
And from a business perspective, who would be picking up the cost?
Øyvind Aassve (Mar 19 2020 at 15:37):
Any progress on the mentioned profiling work mentioned in this thread? Support for exchange of COVID-assessments/ screenings has come up as a topic from Norwegian authorities as well. We are looking into Questionnaire, but openEHR has also developed an archetype that could possibly be basis for an Observation - https://openehr.org/ckm/templates/1013.26.267/mindmap
Lloyd McKenzie (Mar 19 2020 at 17:36):
You're going to want to query/analyze, so while Questionnaire might be ok for initial capture, you're going to need to get it into Observations
Keith Boone (Mar 19 2020 at 17:38):
@Lloyd McKenzie I have a transform for that ...
Hans Buitendijk (Mar 19 2020 at 17:41):
or Encounter or EpisodeOfCare, etc. depending on the question and its detail of interest.
Øyvind Aassve (Mar 19 2020 at 20:30):
This is a project where time to market is days, so the initial focus is simplest form of data capture - with use of Questionnaire. Some kind of transform to Observation would be very helpful for query/analisys data in a possible second phase. If anyone has some kind of reference to such a profile, we would be keen to have a look.
Grahame Grieve (Mar 26 2020 at 02:24):
more on this - @Danielle Friend @Jenni Syed @Eric Haas @Brett Marquard can you have a quick look at this discussion: https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Remote.20Appointment - has Argonaut and/or you vendors solved this ?
Jenni Syed (Mar 26 2020 at 13:06):
I don't think we have anything specific in argo appt to cover this. In our system, we're working on improving it - we link to HealthCare services that contain the video links (usually one for patient and one for doc). Interestingly, it looks like the appt type may not specifically call out that it's a tele visit. I'll try to get some more details. We are actually working on updating our doc on fhir.cerner.com because it contains an example of the telemedicine appt, but doesn't provide much direction, and is suddenly very popular :)
Jenni Syed (Mar 26 2020 at 13:08):
Here's our example for reference: http://fhir.cerner.com/millennium/r4/scheduling/appointment/#example---video-visit
Jenni Syed (Mar 26 2020 at 13:12):
I'll try to get more details and post over there, but would be interested if we want to standardize more on this
Eric Haas (Mar 26 2020 at 22:52):
We created the Argo Scheduling IG but AFAIK not a lot of uptake: http://www.fhir.org/guides/argonaut/scheduling/index.html
Eric Haas (Mar 26 2020 at 22:56):
basically for this would define it covid like symptoms or reason for visit as a "visit-type" since is operation based the appt scheduler would magically return slots for video appts.
Grahame Grieve (Mar 29 2020 at 06:00):
follow up on this:
Grahame Grieve (Mar 29 2020 at 06:00):
http://www.healthintersections.com.au/?p=3017
Pier Alberto Gibellini (Mar 30 2020 at 14:42):
Good morning, I'd like to share with you the approach Dedalus is having with FHIR modelling for the COVID-19 emergency, with a particular focus on scenarios in Italy and France (currently). This includes also modelling for appointments, encounters, and questionnaireresponses mentioned in this topic. On appointment, we decided for "virtual". You can find our public contributions here (profiles and examples): https://simplifier.net/covid-19, there's also a short abstract and a visual map to better understand the content available. Hope it can be helpful!
Abbie Watson (Aug 17 2020 at 14:08):
Hello,
So... I've been working on assembling a Provider Directory of HHS Covid19 Community Testing Sites, and am thinking of making it available for Connectathon 25. Is there an Inferno or Touchstone testing suite for the Provider Directory implementation guide? Does the Argonaut track include testing of Provider Directory during connectathon?
Symptomatic-SANER-CommunityTestingSites-HHS-National-20200731.jpg
Robert Scanlon (Aug 17 2020 at 14:13):
Inferno does not have any tests for the Provider Directory IG now. Those would have to be written. For Touchstone, @Richard Ettema would be able to answer.
Carie Hammond (Aug 19 2020 at 20:04):
@Abigail Watson I work with @Richard Ettema at AEGIS and our Touchstone tool has DaVinci Provider Directory tests here: https://touchstone.aegis.net/touchstone/testdefinitions?selectedTestGrp=/FHIRSandbox/DaVinci/FHIR4-0-0-Test/PDex/03-PlanNet&activeOnly=false&contentEntry=TEST_SCRIPTS
Please feel free to reach out at touchstone_support@aegis.net if you need any help registering or trying to access these tests. We'd be glad to help.
Last updated: Apr 12 2022 at 19:14 UTC
