Stream: IG creation
Topic: Custodian Extension in FHIR Care Plan
Gay Dolin (Sep 15 2020 at 19:04):
I'm needing to create an extension in the FHIR Care Plan to represent a custodian. Do you have a sense of what custodian would look like? The ask is that custodian be allowed to be a provider and/or an organization, and possibly a patient. The ask also is that if there is a custodian that is a provider, there should also be an organization. If the custodian is a patient, there need not be an organization. Would a custodian practitioner + org be nested together?
Or not, something like this:
<custodian>
<reference value="Practitioner/example"/>
<display value="Dr Adam Careful"/>
</custodian>
<custodian>
<reference value="Organization/example"/>
<display value="HealthLevelSevenDialyisClinic"/>
</custodian>
Eric Haas (Sep 15 2020 at 19:11):
Would look like this extension:
http://hl7.org/fhir/us/davinci-deqm/StructureDefinition-extension-reportingVendor.html
make the reference a choice of Org/Pract/PractRole
Gay Dolin (Sep 15 2020 at 19:30):
Thanks Eric!
Lloyd McKenzie (Sep 15 2020 at 19:47):
How is custodian different from CarePlan.author?
Lloyd McKenzie (Sep 15 2020 at 19:48):
The author is the person/org that has overall responsibility for the plan
Lloyd McKenzie (Sep 15 2020 at 19:48):
Contributors indicate who is involved in editing.
Lloyd McKenzie (Sep 15 2020 at 19:48):
Not clear you need an extension at all @Gay Dolin
Gay Dolin (Sep 15 2020 at 19:56):
The concept of author is overloaded and the definition is not accurate in Care Plan - an author is not necessarily an owner of the Care Plan. For example, primary nurse get a new patient. She is responsible for authoring the care (initial) Care Plan. Contributors may follow on and add data /plans. However, primary nurse quits. Now who owns the plan? It is the same paradigm that exists in FHIR Provenance or in CDA and C-CDA on FHIR wrt the difference between author and custodian. See JIRA: https://jira.hl7.org/browse/FHIR-28544 . Also - If you look at the eLTSS guide they essentially changed the definition of author in Care Plan in their IG - though they did not add a custodian :-)
Lloyd McKenzie (Sep 15 2020 at 20:27):
My leaning is that author = owner and contributors = who writes content. Have you checked w/ PatientCare whether they agree that an extension is necessary/appropriate? (@Michelle (Moseman) Miller )
Gay Dolin (Sep 15 2020 at 20:46):
Yes. They agree. Although Michelle has been peripheral in the discussions
Lloyd McKenzie (Sep 15 2020 at 22:19):
What would be the use-case for having all 3 - an owner, an author and contributors?
Gay Dolin (Sep 15 2020 at 22:24):
To me they are orthogonal concepts. Happy Valley Clinic owns the Care Plan (Custodian) along with say, a Care manager. Primary Physician or Nurse initiated the Care Plan. Social worker and PT contribute to the care plan
Lloyd McKenzie (Sep 15 2020 at 22:31):
CarePlan.author says nothing about 'initiation' - it talks about responsibility. If we're going to introduce the concept of 'custodian', I think the definition of 'author' needs to be refined so there's a clear distinction. Personally, I'm not sure why it matters who initiated. If you know that Happy Valley Clinic owns the CarePlan and that Dr. Smith, the social worker and PT are contributors, I think that covers what most people need to know, no?
Gay Dolin (Sep 15 2020 at 23:31):
I agree author definition in Care plan could us improvement. Per Provenance: Author: A party that originates the resource and therefore has responsibility for the information given in the resource and ownership of this resource. Custodian: The entity that is accountable for maintaining a true an accurate copy of the original record. So Happy Valley Clinic would be the custodian :-). Even in Provenance, author and custodian definitions seem to overlap. https://www.hl7.org/fhir/valueset-provenance-agent-type.html
Gay Dolin (Sep 15 2020 at 23:42):
I just also know that in the real world the person that authors the care plan is not always the person who remains the responsible entity or person. For example, Medicare requires THE HOME HEALTH AGENCY updating of the care plan every 30 -60 days in home care (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c07.pdf). A nurse will be the author, but 60 days past and that nurse may no longer work at the agency - but the Home Health Agency will always be responsible for maintains the care plan regardless of the person author which also needs to be documented
Lloyd McKenzie (Sep 16 2020 at 02:08):
The provenance definition and the CarePlan definition aren't necessarily always the same. It may be that CarePlan.author should be renamed to CarePlan.custodian.
Gay Dolin (Sep 16 2020 at 16:27):
That's a thought! :-)
Last updated: Apr 12 2022 at 19:14 UTC
