FHIR Chat · ServiceRequest Dosing information · Orders and Observation WG

Stream: Orders and Observation WG

Topic: ServiceRequest Dosing information

view this post on Zulip Eric Haas (Feb 24 2018 at 01:07):

@Michelle (Moseman) Miller @Rob Hausam @Melva Peters @John Hatem @Lloyd McKenzie @Hans Buitendijk

This issue has been discussed at several WGM's and I was asking for some use cases to help us visualize the issue and discussion.
Well trying to apply a Michelle tracker to servicerequest using one of her examples I stumbled upon a use case creating a ventilator example with order detalis. I have not used a ventilator since vet school so the details may be way off but I think the concept of all the dosing details are illustrative of the issues.

There are several dose like details in this example: sensitivity, pressure, flow that are present in a non structured way.

Assuming this is a valid use case - this brings up several questions:

  • Is this best represented in the order as a structured data using a dosing element like Meds resources do?
    * If so can we generalized Dosing to represent stuff like this as well?

  • Or is there some other structure like an ad-hoc protocol or pre-existing protocol that should be referenced in instantiates (I really don't know how protocols are used in the real world of - but I imagine an anesthesiologist or whoever writes the order jotting downs some settings. )
    * what if is a form filled out by the orderer - right now that could only be referenced by supportingInfo as a binary or DocRef -Is this even a use case ?

view this post on Zulip Lloyd McKenzie (Feb 24 2018 at 01:19):

I wouldn't rely on a protocol - the request resource should be able to express what's needed without one. SupportingInfo doesn't define the order, it provides information necessary in executing the order. E.g. a height and weight for a patient when ordering a drug and allowing the pharmacy to determine the dose; gender or age information to allow a lab to determine normal ranges, etc.

view this post on Zulip Lloyd McKenzie (Feb 24 2018 at 01:21):

I would expect for us to be able to handle discrete data about the flow rates. (Whether that's core or extension is up to the WG)

view this post on Zulip Eric Haas (Feb 24 2018 at 01:23):

Could you just reference 'Protocol Z' though? .... and I would like to know pharmacy's take on generalizing Dosing.

view this post on Zulip Lloyd McKenzie (Feb 24 2018 at 01:24):

Sure

view this post on Zulip Rob Hausam (Feb 24 2018 at 12:07):

I'm not sure if you could just reference a protocol in the ventilator settings case. You may be able to and want to use a protocol to calculate the ventilator settings in a given instance, and Intermountain, particularly, has published research showing (as I recall it) that outcomes are better if a protocol is used to do this rather than relying on "expert" clinicians. But you still need to represent the individualized settings in each instance (possibly a CarePlan can be used to do this?). Generalizing the Dosing structure seems like it could be a possibility, but I haven't looked at any details on that.

Last updated: Apr 12 2022 at 19:14 UTC


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