More FHIR videos

Rene Spronk has created a number of video’s that feature FHIR – in fact we looked at one just recently where the FHIR chiefs signed a poster of themselves in Chicago (with the proceeds to go to a good cause – I live in hope…)

I had occasion to go back and have a look at some of them, and there are a couple of recent ones worth mentioning – one serious, and one not so much…

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Clinical Scenarios in FHIR – II

In a previous post we talked about the clinical connectathon coming up at the next Working Group Meeting, and described how we could use FHIR resources to represent one of the scenarios – the chronic care scenario. Looking back, much of that scenario was around the creation and maintenance of a Care Plan (which might be worth a re-visit at some point). In this post, we’re going to shift gears a bit and look and another scenario created by the Patient Care Working Group – the Acute Care Scenario.
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Modelling Encounters in FHIR: Part 2

I was having a chat with some colleagues in New Zealand (who shall remain nameless, but you know who you are PJ & KA) about Encounters – specifically how to model an encounter (using openEHR archetypes as it happens), and it became evident that we were talking about slightly different things by the word ‘encounter’. I was referring to the FHIR encounter – a resource that has mainly administrative information about a contact with a patient (date, time, participants and so on), but my colleagues were referring to the more holistic concept of encounter – including all the clinical information collected during that encounter, actions performed, and so on.

So that we were talking about the same thing, I volunteered to write down how you could express these concepts in FHIR – so here it is. A simple Primary Care (Ambulatory Care in the US) consultation, which has a clinical note (subjective and objective) plus a prescription.

primary care observation

Note that I’ve used a Composition resource to establish the context of the Consultation note. This is a versatile resource (as most of them are in truth), which is also used in a FHIR document, although it doesn’t have to be – as this example shows.

The composition references the encounter, and also – through the sections of the composition – the clinical findings and actions that occurred during the consultation. There is some duplication of data – eg dates are in both encounter and composition – but nothing to get too concerned about.

This is how you could store the record in a data store, and of course it’s really easy to serialize into a FHIR document if you want to send a copy of the record to someone else – it would be an atom feed with 7 entries/resources in it with the appropriate references (see an example of a similar FHIR document here). Of course, you would also need to include copies of the referenced resources like Patient and Practitioner (that I left off the picture for simplicity) that would increase the resource count slightly.

Interestingly, this layout is very similar to how a CDA document would be represented – with the Composition (plus Patient and Practitioner) as the CDA header, and the Encounter, Clinical Findings and Medications Prescribed as sections. Co-incidence? I think not…

So: in our modelling work we really need to model the Encounter as a separate Entity with references to the clinical parts of the consultation, rather than a single model that seeks to encompass the whole thing (IMHO).

Creating a FHIR document for the January Connectathon

I had intended to talk in some detail about the Composition resource next, as this is one of the key resources for a FHIR document, but because the January connectathon is getting close I’m going to do a series of posts to directly support people attending connectathon, and wanting to experiment with the document track. I’m planning 4 posts in this series:

  • How a client would create a FHIR document (incidentally for the remainder of this series, I’m going to refer to a FHIR document just as  ‘document’, so when you see this, I’m NOT talking about CDA. Later posts will talk more about the relationship between the two).
  • How a server could process a document. There are a few possibilities…
  • How to find the document on the server later, and render it to the client.
  • A wrap up on the Composition resource and anything else left over.

I do intend to spend a lot more time on FHIR & CDA, but this should at least cover the basics.
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FHIR: meet #CDA

CDA (Clinical Document Architecture) is undeniably the most successful HL7 version 3 standard. It’s being used very widely around the world for representing clinical data, and is one of the core standards for many jurisdictions – like Meaningful Use in the US. Obviously, if FHIR is to succeed, then it needs to have some way of doing what CDA does now (and including all the good thinking that has gone into CDA).

Another reason to start thinking about CDA is that the next FHIR connectathon at the January Working Group Meeting next year is going to have FHIR documents as one of the themes, so it makes sense to start thinking about how this all works.
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