Stream: Orders and Observation WG
Topic: Representing an order for disposable medical supplies?
May Terry (Jun 17 2020 at 18:02):
I'm trying to represent an order for disposable medical supplies that are essential accessories for a given device (e.g.: diabetes lancets, reagent strips, etc. would need to be ordered as essential supplies for a glucometer) as part of a payer-to-payer exchange use case.
The codes for these supplies would be HCPCS (e.g.: A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips).
My understanding is that O&O recommended the use of DeviceRequest with a codeReference to a Device resource and using the Device.type attribute for the HCPCS code.
Question: Is this what O&O recommends? If not, what suggestions do you have to address this use case?
On the surface, it seems odd to reference such supplies using the Device resource given that the Device attributes seem more appropriate for a single device item rather than a set of disposable supplies that should be grouped as part of a kit.
Vassil Peytchev (Jun 17 2020 at 18:16):
There is SupplyRequest, but what is requested (SupplyRequest.item) still points to device...
Jose Costa Teixeira (Jun 17 2020 at 18:29):
are these supplies for a patient's device? Or are they to have in stock / for several patients?
If it's for a patient - DeviceRequest
If it's NOT for a patient - SupplyRequest
May Terry (Jun 17 2020 at 18:29):
Vassil Peytchev said:
There is SupplyRequest, but what is requested (SupplyRequest.item) still points to device...
Yeh, I was looking at SupplyRequest, but I was also told that O&O discouraged using that resource for "home supplies". Not sure what the reason was...I'm getting all this info second-hand in PCDE discussions.
May Terry (Jun 17 2020 at 18:31):
Jose Costa Teixeira said:
are these supplies for a patient's device? Or are they to have in stock / for several patients?
If it's for a patient - DeviceRequest
If it's NOT for a patient - SupplyRequest
Thanks @Jose Costa Teixeira - so then going back to the Device reference in DeviceRequest, what would be the recommendation for storing the HCPCS code specifying the "kit" containing 50 lancets? Just looking to create an example that makes sense.
Lloyd McKenzie (Jun 17 2020 at 20:03):
Typically it would be DeviceRequest, but in some systems, it may show up as a MedicationRequest (because the system that handles drug prescriptions treats the syringes, test strips, etc. as if they were drugs).
Lloyd McKenzie (Jun 17 2020 at 20:04):
Agree it shouldn't be SupplyRequest - because that's not patient-centric.
Melva Peters (Jun 17 2020 at 20:14):
I agree with @Lloyd McKenzie - these often would be MedicationRequests as they are dispensed from a pharmacy and a "prescription" is needed for insurance coverage.
Lloyd McKenzie (Jun 17 2020 at 20:33):
Technically, the insurer should accept MedicationRequest or DeviceRequest as a prescription.
Jose Costa Teixeira (Jun 17 2020 at 20:53):
(nice finding of a case that overlaps medication and devices).
If it is for me to have the strips at home, yes, devicerequest (or medrequest)
Jose Costa Teixeira (Jun 17 2020 at 20:53):
about the codes:
Jose Costa Teixeira (Jun 17 2020 at 20:54):
normally there is a unique code for "box of 50 strips" (like the EAN / GTIN number)
Melva Peters (Jun 17 2020 at 21:29):
There may be an identifier assigned by a national regulatory, but my experience is that many insurance companies assign their own identifier.
Jose Costa Teixeira (Jun 17 2020 at 21:42):
Yes, but the gtin is defined by the manufacturer
Jose Costa Teixeira (Jun 17 2020 at 21:48):
9662774298192
Jose Costa Teixeira (Jun 17 2020 at 21:48):
This is an example of a gtin
Jose Costa Teixeira (Jun 17 2020 at 21:50):
If i want to order a box , i use this as the code
Jose Costa Teixeira (Jun 17 2020 at 21:51):
If I want to explicitly state that the box contains 50 - even if that is redundant - then I can use a contained DeviceDefinition to express that
Jose Costa Teixeira (Jun 17 2020 at 21:51):
If I want to order just one strip, well, that's a challenge
May Terry (Jun 17 2020 at 22:24):
Jose Costa Teixeira said:
If i want to order a box , i use this as the code
I'm not sure that the EAN/GTIN would appear in a claim or something that would be sent from a provider to a payer. Would be great if someone can give me a good FHIR-validated example of how this would be represented with DeviceRequest... a glucometer, a box of lancets, and a box of reagent strips. That will at least be a good conversation starter to show to payers and ask if they are able to support it based on the data they currently receive.
Jose Costa Teixeira (Jun 17 2020 at 22:27):
Depends on the catalogs you have in place
Lloyd McKenzie (Jun 17 2020 at 22:34):
In principle, you could specify the code for the box, but in quantity indicate a unit of 1 strip
May Terry (Jun 18 2020 at 01:38):
okay. I guess I'll ask the payers at the PCDE meeting to see if they actually get EAN/GTIN idenfiers and if providers actually send them that as part of an Order, even if I already have a pretty good idea what that answer will be... thanks!
Jose Costa Teixeira (Jun 18 2020 at 02:10):
Note that the answer is not 'use gtin'. The answer is 'use DeviceRequest and use a code, typically the code for the sellable product which can be eg. GTIN'
May Terry (Jun 18 2020 at 02:25):
ah..ok. thanks for the clarification! For PCDE, HCPCS is used for designating supplies and DME in the Medicare Database local and national coverage documents so that's my starting point.
I guess summarizing a couple of different replies I've received today, I suppose that we can represent each of the essential supplies as an individual DeviceRequest with the HCPCS code in DeviceRequest.code and then use RequestGroup if several of them need to be grouped together.
Last updated: Apr 12 2022 at 19:14 UTC
