FHIR Chat · fax · cda to fhir

Stream: cda to fhir

Topic: fax

Grahame Grieve (Apr 15 2016 at 02:31):

how is a fax nuber represented in CCDA?

Lisa Nelson (Mar 07 2020 at 12:48):

This is how you represent a fax number in CDA:
<telecom use="WP" value="fax:+1(555)555-2000"></telecom>

The problem we face right now is the value set bound to the use attribute is insufficient for today's use cases, which include support for Direct Addresses (currently needed) and FHIR endpoints (emerging need). We currently represent a Direct address like this.

<telecom use="DIR" value="mailto:DrJohn@direct.WoodRiverHealth.com"/>
<telecom use ="DIR" value="mailto:WoodRiverHS-office@direct.WoodRiverHealth.com"/>

I think we would represent a FHIR endpoint for information communication uses like this:

We don't have @use values that are a good fit for information processing expected to happen via FHIR API calls or for when we want to be more specific about the use.

For example, when a practice uses direct, they may or may not expose addresses for individual physicians or admin support personnel. They also may establish handy Direct addresses for which multiple individuals manage the secure flow the digital information. For example, addresses for digitally communicating with other providers, payers, and patients about these sorts of things (think of the typical telephony system that helps to route phone calls to the right department):
- Medication Refills or Questions
- Care Coordination
- Dental
- Behavioral Health
- Referrals
- Billing-Claims

Once UTG is really rolling, I would like to use this simple need, "How do I use the UTG process to add more use concepts to the telecomunicationAddressUse value set ?" to see how this need would be addressed (@Ted Klein , @Carol Macumber could I do this as part of your pilot? )

** Detail **
Value Set for use in the telecom tag (SEEMS TOO LIMITED FOR TODAY'S USE CASES):
1 A: AddressUse V190
2 S: HomeAddressUse (H) V10628 H home address
A communication address at a home, attempted contacts for business purposes might intrude privacy and chances are one will contact family or other household members instead of the person one wishes to call. Typically used with urgent cases, or if no other contacts are available.

3 L: (HP) 10629 HP primary home
The primary home, to reach a person after business hours.

3 L: (HV) 10630 HV vacation home
A vacation home, to reach a person while on vacation.

2 S: WorkPlaceAddressUse (WP) V19613 WP work place
An office address. First choice for business related contacts during business hours.

3 L: (DIR) 20891 DIR Direct
Indicates a work place address or telecommunication address that reaches the individual or organization directly without intermediaries. For phones, often referred to as a 'private line'.

3 L: (PUB) 20892 PUB Public
Indicates a work place address or telecommunication address that is a 'standard' address which may reach a reception service, mail-room, or other intermediary prior to the target entity.

2 L: (BAD) 10641 BAD bad address
A flag indicating that the address is bad, in fact, useless.

2 L: (TMP) 10640 TMP temporary address
A temporary address, may be good for visit or mailing. Note that an address history can provide more detailed information.

1 L: (AS) 10633 AS answering service
An automated answering machine used for less urgent cases and if the main purpose of contact is to leave a message or access an automated announcement.

1 L: (EC) 10634 EC emergency contact
A contact specifically designated to be used for emergencies. This is the first choice in emergencies, independent of any other use codes.

1 L: (MC) 10636 MC mobile contact
A telecommunication device that moves and stays with its owner. May have characteristics of all other use codes, suitable for urgent matters, not the first choice for routine business.

1 L: (PG) 10635 PG pager
A paging device suitable to solicit a callback or to leave a very short message.

** End Detail ***

Secondarily, I would love to see our alignment efforts address the question, "How do we align CDA and FHIR on the possible uses for various communication endpoints, such as FHIR endpoints established for specific information communication uses, Direct endpoints established for specific information communication uses, fax numbers established for specific information communication uses, and phone numbers established for specific information communication uses?"

Lloyd McKenzie (Mar 07 2020 at 16:13):

UTG won't allow changes to FHIR telecommunication address use. It's a fixed binding to a 'code' datatype and is hard-coded in schema and code all over the place. The only way it can change is through a change request resulting in a new release of FHIR. There's a US-core extension for 'direct' addresses - https://build.fhir.org/ig/HL7/US-Core-R4/StructureDefinition-us-core-direct.html. ('Direct' is generally U.S. specific and isn't widely used outside the U.S. so it doesn't belong in core.)

Note that pager is a system, not a use. The v3 value set was thoroughly reviewed at the time the FHIR set was created and all of those excluded were excluded by conscious choice. Anyone is free to make a change request arguing for the inclusion of a new concept, but "we had it in v3" or "we had it in v2" won't be sufficient by itself.