Clinician on FHIR - January 2017, San Antonio

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Introduction

The January 2017 Clinician-on-FHIR event will be hosted on Friday January 20, 2017.

Weekly preparatory conference calls are being hosted on Tuesdays at 5:00 - 6:00 pm US Eastern.

First Clinician-on-FHIR call starts: Tuesday October 4, 2016

Conference call details: please see HL7 email broadcast

Planning

Master Plan for San Antonio Clinicians on FHIR - January 2017 - draft - date: 2016-10-25

Tracks to be addressed

• Care Plan
• Emergency care, covering:
• Medication
• Diagnostic Request, Report and Observation
• Family Member History - Clinical Genomics

- Details of planning notes for each track can be accessed through the following wiki page:

- January 2017 Clinician-on-FHIR Planning Notes

• Goal = create at least one (or more if possible) meaningful example(s) (actual JSON resource instance) for each FHIR resource otherwise the limitation of the FHIR resource is identified.

Supporting Tool and Information

• Tool

- Participants registered for the Clinician-on-FHIR event are strongly recommended to familiarise themselves with the clinFHIR tool

- A new user interface has been created to support creation of clinical story built from a set of FHIR resources based on the clinical scenario described in the Tracks section below

- Logon to the clinFHIR site:

- [clinFHIR.com/]

- Connect to the FHIR servers by selecting the appropriate Data Server (e.g. Public HAPI DSTU3), Conformance Server and Terminology Server

- click on the "Tool" icon on the top right hand corner of the clinFHIR page and select "simple builder" option

(Note - "simple builder" will soon be changed to "scenario builder")

• Supporting Information

- Dr David Hay has provided some very useful information on this new "simple builder" ("scenario builder") tool.

- clinFHIR "simple builder" Getting started guide (created by Emma Jones)

- Information on this tool can be accessed from his blog:

- Building a set of Resources in FHIR

Clinician-on-FHIR Tracks

Care Plan

• Track lead: Emma Jones/Laura
• Clinical Secenario

- Patient with Type 2 Diabetes managed by multi-disciplinary care team with PCP as care coordinator

- Multi-disciplinary care plan created by PCP after discussions with patient to coordinate care management

• FHIR resources used in this track:

- CarePlan which references the following resources:

CareTeam, Goal, Condition, Observation, DiagnosticRequest, ReferralRequest, MedicationRequest

+/- Vaccination

Issue to be resolved - what to use for Patient Instruction?

• Diabetic Care Plan Test Data

Emergency care

• Track lead: Jim McClay/Laura
• Clinical Scenario

- Patient presents at ED suspected of exhibiting communicable disease signs and symptoms

- ED intake/triage workflow is initiated

- Physician/Nursing evaluation workflow is initiated

- Travel history screening, Observation and diagnostic tests, triggering CDC communicable diseases management protocol

• FHIR Resources used:

Questionnaire, QeustinnaireResponse, Observation, DiagnosticRequest, DiagnosticReport, ClinicalImpression, Condition

+/- MedicationRequest, ReferralRequest

• ED Workflow information: Refer to HL7 Domain Analysis Model: Emergency Care Release 1 - US Realm January 2016

Diagnostic Track

• Track lead: Rob Hausam
• Clinical Scenario

- Type 2 Diabetes patient

- PCS instructs patient to perform the following at home as per CarePlan

- BSL x 3/day; BP x 1/day; Body weigh x1/week

- At follow-up consultation in 4 weeks, PCP reassess patient and requested:

- Fasting blood glucose, Fasting lipids

- At follow-up consultation, patient also complains of productive cough (greenish sputum) and fever

- PCP requested: sputum for microbiology test

• FHIR Resources used:

Observation, DiagnosticRequest

Medication

• Track leads: Melva/John Hatem
• Clinical Scenario

- Type 2 DM patient

- PCP reviews patient's medication history, performs medication reconciliation where necessary, requests diabetic medications (and other relevant medications, e.g. antibiotics for respiratory infection), updates medication list, medications dispensed by pharmacist, and administered by patient

• FHIR Resources used:

Medication, MedicationRequest, MedicationDispense, MedicationAdministration, MedicationStatement, MedicationList (List resource)

• Questions: what about new instructions to patient? recommendation to prescriber?

Plan medication management in CarePlan resource: medication order through to administration

Family Member History

• Track lead/co-leads:Grant Wood/Gil Alterovitz
• Scenario

- To be completed

Technical Connectathon

The HSSP community is running a project, which is a FHIR based Care Coordination Service.
Details about this project are available at the Clinicial-on-FHIR planning notes wiki page:

• January 2017 Clinician-on-FHIR Planning Notes

• What's new for the January 2017 Technical Connectathon?

- There will be a small team of clinicians working alongside the FHIR developers to test how well the clinical workflow may work alongside the technical workflow

- The CarePlan track has been selected for this new joint initiative

- Care Plan test data created by the Care Plan team will be used in this track

- Lessons learnt from the technical connectathon will be used as inputs into the Clinician-on-FHIR CarePlan track in the Friday event