Stream: Patient Care WG
Topic: Tracking drains, catheters, etc.
Lloyd McKenzie (Jul 19 2021 at 13:18):
I received a question about how FHIR tracks various 'ports' that have been installed into a patient - drains, catheters, IV lines, arterial lines, etc. In v3, we would have used 'Access' for these, but I don't think there's an equivalent resource in FHIR (at least not yet). The specific question is how you track these when transferring a patient, but presumably you'd also want to be able to reference them for things like recording where a particular IV drip should enter, where a specimen came from, etc. (so @Melva Peters, this may also be of interest to Pharmacy).
The closest we seem to have is Device, but Device doesn't seem to have an ability to indicate where in the patient it's installed.
Is anyone doing this? If not, how would you expect to do it if/when you get around to it?
Josh Mandel (Jul 19 2021 at 13:28):
On a related note, how do you indicate where an implant or stent has been placed without something like your body site element on Device?
Michelle (Moseman) Miller (Jul 26 2021 at 23:50):
@Lloyd McKenzie @Josh Mandel I can add these questions to the upcoming PC FHIR conference call on Thursday, but I wonder if DeviceUsage is a possibility since it references both the Device and the BodySite/BodyStructure. That said, it probably depends on the use case (e.g. request, procedure, or usage).
Michelle (Moseman) Miller (Aug 02 2021 at 13:45):
Patient Care Work Group briefly discussed this topic at the end of our last call and came to the same conclusion that it depends on your use case:
- DeviceUsage (OO owns) - use when there is an assertion about an existing device
- ServiceRequest (OO owns) - use when requesting/ordering a procedure to insert a device
- Procedure (PC owns) - use when documenting the procedure to insert/implant a device
Lloyd McKenzie (Aug 02 2021 at 15:00):
How would you indicate that a particular port was to be used for a drug administration - or that it was used when extracting a specimen?
Michelle (Moseman) Miller (Aug 06 2021 at 18:19):
Patient Care had a lengthy discussion about ports yesterday, per https://confluence.hl7.org/display/PC/2021-08-05+Patient+Care+FHIR+Conference+Call. Key takeaways:
- Using a Triple-Lumen Catheter example, we would expect there to be a Device for each of the ports (e.g. proximal, distal, and medial), and those component Devices are part of the overall triple-lumen device. (OO @Hans Buitendijk should confirm PC's recommendation)
- When ordering a med admin, the order MAY occasionally specify the port by name (e.g. proximal port) -- but this seemed to PC as a potential gap in MedicationRequest since we couldn't locate a Device reference (need Pharmacy @Melva Peters to weigh in). In many cases, the MedRequest doesn't need to specify the port due to policy or clinical knowledge about where to administer (e.g. TPN)
- For MedAdmin documentation, there is a MedicationAdministration.device, dosage.site, and/or bodySite (BodyStructure) extension available.
- For specimen requests, ServiceRequest.supportingInfo can reference the port-specific Device.
- For specimen documentation (e.g. blood draw), Specimen has bodySite, but PC saw a potential gap since we couldn't locate a reference to Device. (need OO @Riki Merrick @John David Larkin Nolen @Rob Hausam to weigh in)
CC: @Emma Jones @Stephen Chu
John David Larkin Nolen (Aug 06 2021 at 19:25):
Good timing! We are chatting about BodyStructure on next Tuesday's OO on FHIR call, including to-from locations that are needed for procedures. https://confluence.hl7.org/display/OO/2021-08-10+FHIR Looping @Marti Velezis
Riki Merrick (Aug 06 2021 at 20:25):
Right now the specimen type gets concatenated to describe what was collected with which method from which body site - and even using what approach site (if that is different from the source site) - I think we had discussed adding a reference to procedure to the specimen.collection backbone, but that woudl be to a procedure instance - so sounds like we shoudl consider maybe adding a specimen.collection.deviceType or something like that (I assume you don't need the serial / lot number, but rather need to know what kind of catheter, correct? - and a specimen can be the device itself (not this use case, I know)
Michelle (Moseman) Miller (Aug 07 2021 at 01:02):
@Riki Merrick The picture below might help, but Patient Care was wanting to document which port was used. A single device (e.g. triple lumen catheter) can have multiple ports. We were thinking that each port could be represented as a Device component, which share the same parent device per Device guidance. If OO agrees, then Specimen would ideally reference the component Device (port).
In FHIR, the Device represents either the device in total, or a component of a larger device when there is a need for individual tracking of a component. A Device as a component then points to the parent device it is part of.
John David Larkin Nolen (Aug 09 2021 at 19:32):
We talked about this on the 8/9 Specimen call. OO will add specimen.collection.device to help with this. https://confluence.hl7.org/display/OO/2021-08-09+Specimen
Rob Hausam (Aug 09 2021 at 19:48):
And we've already agreed to add a Specimen.collection.procedure element (tracker? - in the queue to be applied).
Melva Peters (Aug 09 2021 at 21:01):
@Michelle (Moseman) Miller I've added to the Pharmacy agenda for next week.
Marti Velezis (Aug 09 2021 at 23:08):
@Michelle (Moseman) Miller I thought at first you were talking about subcutaneous ports. I have been working on a class diagram for central venous catheters in VANGUARD that I can share with the group when it is complete -- and we do have characteristics including the different parts of the catheter (e.g., tip, cuff, lumen). If I understand your request - you want to identify which hub/lumen is used (either for delivery or collection), is that correct? Do you want to describe it as "proximal", "medial" or "distal" or are you looking for something more descriptive -- e.g., lumen size, volume , flow rate, etc.)?
@John David Larkin Nolen - can you add this to our OO on FHIR agenda?
John David Larkin Nolen (Aug 10 2021 at 15:01):
@Marti Velezis absolutely!
Michelle (Moseman) Miller (Aug 10 2021 at 16:27):
@Marti Velezis Patient Care was responding to Lloyd's earlier question, so perhaps @Lloyd McKenzie can elaborate if additional details were needed for his use case (e.g. lumen size, volume, flow rate etc). When PC discussed his question last week, PC was thinking more along the lines of the port name (e.g. proximal, medial, distal)
Lloyd McKenzie (Aug 10 2021 at 17:27):
I didn't have specific requirements beyond "where is this sort of thing captured". I presume that device properties should be able to handle most of the properties we might be interested in seeing as the solution landed on is Device.
John David Larkin Nolen (Aug 10 2021 at 18:56):
Discussed on OO on FHIR call. We can see multiple ways of doing this. One way (like @Lloyd McKenzie describes) using device properties where you just need to be able to describe the attributes of the device. To address the scenario when you need to identify a specific part of the device for delivery or collection (such as the brown port), you can use the existing parent-child relationship in the Device resource -- or we could resurrect the DeviceComponent resource. @Rob Hausam @Marti Velezis @Hans Buitendijk @Jose Costa Teixeira
Melva Peters (Sep 22 2021 at 13:18):
@Michelle (Moseman) Miller can you tell me what the status is on this issue? Is there a thought that the information needed can be represented in Device? We don't have this in MedicationRequest, but can add an attribute that references Device (if that is the direction). We have an attribute that references device in MedicationAdministration (0..*). We don't believe that that bodysite attribute in MedicationAdministration is the correct place for this information.
Jose Costa Teixeira (Sep 25 2021 at 21:35):
I think we landed on using a child Device.
Last updated: Apr 12 2022 at 19:14 UTC
