Stream: v2 to FHIR
Topic: Modeling AOEs in Lab results
Riki Merrick (Mar 16 2021 at 22:43):
We are trying to define a FHIR version of a COVID-19 at home test result with Ask at Order Entry Questions (must have all the information needed for V2 ELR R1 message - example attached) and want to hear your thoughts on how to best include the HHS questions.
We think from a modeling perspective they belong in Observation.basedOn(ServiceRequest.supportingInfo(Observation)).
Using the approach from the V2 to FHIR mapping, that each OBR becomes a diagnostic report we would end up with:USCoreDiagnosticReport for labs
Referencing UsCoreLabObs (an observation that has to be a lab)
Contains the single Covid test lab result
Referencing Observation.basedOn(ServiceRequest.supportingInfo(Observation))
Contains the "QA Pairs" for the sorta kinda AOE observations
Alternatively use USCoreLabObs
Represents the single lab result
Referencing Observation.basedOn(ServiceRequest.supportingInfo(Observation))
Contains the "QA Pairs" for the sorta kinda AOE observations
Other ideas were to use observation.HasMember to represent the AOEs.
We didn't think we needed to model them using questionaireResponse, though the USCoreDiagnosticReport profile allows Observation.basedOn(ServiceRequest.supportingInfo(QuestionnaireResponse)).
Given that there will be a lot of references, we think this should be communicated as a bundle to avoid pingbacks to the application that originates the FHIR communications, but would like community input here as well.
And would you structure this differently, if they were "true" Ask at Order Entry Questions needed for proper result interpretation?
Riki
Riki MerrickVernetzt, LLCrikimerrick@gmail.com
cell: 916.216.0052
skype: riki.merrick
Lloyd McKenzie (Mar 17 2021 at 14:07):
My recommendation would be to skip the DiagnosticReport. You're not looking at an attested report, you're looking at a simple question/answer pair - and Observation is more than sufficient for that. Agree that multiple Observations are probably better than a single QuestionnaireResponse because the former are more computable. As for Bundle, you could certainly send a transaction and ask to record all of the data. However, if some/all of the Observations are intrinsically tied to the ServiceRequest and have no relevance or independent existence outside the ServiceRequest, you could just 'contain' them in the ServiceRequest.
Gay Dolin (Mar 17 2021 at 15:15):
Great! - My leaning was also to skip DiagnosticReport. The simpler the better in this use case. And "contained" is also a great idea for this use case.
Last updated: Apr 12 2022 at 19:14 UTC
