Keith Boone, 2008 care provision reason

One of the requests I'm hearing from HITSP, Public Health, and IHE, is that there is a need to be able to query (e.g., using Care Record Query), for immunizations that were given to a patient as a result of a specific "program". careProvisionReason seems to allow for the specification of a code as being the reason for care, but in this particular case, the question isn't about a coded concept, but rather an identified program. I can turn an identifier into a code, but that's cheating. What would be the correct way to handle this? Is this feedback for the final version of the Care Record Query standard?

Keith _________________________________

Keith W. Boone Interoperability Architect GE Healthcare

Answer WG 29-5-2008: Keith,

thanks for your important question. Yes this would be cheating, so it needs to be addressed as feedback to DSTU materials, at least to have the use case in place and explanation.

Additional solutions with current material are: refer to the same class in definition mood with a different ID. It can be done with the care plan material, but that is not pulled through to DSTU. In the current care statement however, there is an Act Definition relationship to ActDefinition. The immunization could be in definitionmood there and get a real id. However, I cannot say it helps, immunization might be many, but it can be done via multiple instantiations of act definition to care statement class.

Hope this helps.

Sincerely yours,

dr. William TF Goossen

discussion Tom and Keith:

rom: Tom de Jong [1] Sent: Wednesday, May 28, 2008 6:51 PM To: Boone, Keith W (GE Healthcare); pher@lists.hl7.org Cc: patientcare@lists.hl7.org Subject: RE: careProvisionReason

Hi Keith,

I believe that querying for immunizations should result in a list of…immunizations (not a care record).

I have copied the PHER Work Group, who maintain the Immunization domain with HL7.

Best,

Tom

Keith anwswer: Tom,

Thanks for forwarding, as it is relevant in both places. The reason that I asked Patient Care is because IHE has profiled Care Record query as a generalized mechanism to query a source of Clinical data, which could include immunization information. The use case for Immunizations can be applied to other cases that would also show up in that domain.

keith

Subj: Re: careProvisionReason Date: 29-5-2008 4:59:13 W. Europe Daylight Time From: kevin.coonan@gmail.com To: lloyd@lmckenzie.com, patientcare@lists.hl7.org, pher@lists.hl7.org, keith.boone@ge.com Received from Internet: click here for more information

Who issues the id element? Seems that we need a general solution to this problem which vocabulary is in part responsible. We have some easy ID's to specify, but this requires that the issuer be given a OID by HL7 or someone else (at least to use the II datatype). There needs to be an easier way to say that X authority issued Y an identifier and Y issues Z individual identifiers. This requires knowledge of X, but you don't need to know all that much about Y (e.g. an organization) other than its identity. There are plenty of "X" authorities we could use, rather than having X=HL7 for all these use cases.

For example, each state has a licensing authority. I would like to be able to indicate which state medical board issued a medical license with a specific value. I don't see much use in having each medical board obtain (if they were willing) an OID from HL7 for this use (which they may or may not care about).

For this specific use case isn't the information in the scoping organization of the individual who administered the vaccination and/or the care delivery location and/or some account (health clinics may be giving vaccinations on behalf of multiple programs) related to the SubstanceAdministration act? The program wouldn't be just an ID but rather an entity, right?

Kevin

Subj: Re: careProvisionReason Date: 29-5-2008 5:06:15 W. Europe Daylight Time From: lloyd@lmckenzie.com To: kevin.coonan@gmail.com CC: patientcare@lists.hl7.org, pher@lists.hl7.org, keith.boone@ge.com Received from Internet: click here for more information

Hi Kevin,

Whether you're talking code or id, you need an OID. And it doesn't require that you know anything about the issuing organization at all. In fact, for the id you could use a simple GUID if you prefer.

The state medical board doesn't need to get an OID themselves, but someone needs to register with HL7.org the OID for "[state x] medical license number". That's true for every single license number and other public identifier type used in v3 messages.

A program is an Act, never an entity. It might be authored or supervised by an entity, but the id for the entity would be a completely separate thing. If you don't want to communicate an id, you could skip that and just include the author participation to say something like "This immunization was done as part of a program created by XYZ Health Authority".

Lloyd

Subj: Re: careProvisionReason Date: 29-5-2008 9:43:22 W. Europe Daylight Time From: Williamtfgoossen@cs.com To: kevin.coonan@gmail.com, lloyd@lmckenzie.com, patientcare@lists.hl7.org, pher@lists.hl7.org, keith.boone@ge.com Received from Internet: click here for more information

In a message dated 29-5-2008 4:59:13 W. Europe Daylight Time, kevin.coonan@gmail.com writes:

Who issues the id element?

Simply the application in which the care record / care provision is documented.

Sincerely yours,

dr. William TF Goossen

Subj: Re: careProvisionReason Date: 29-5-2008 15:17:07 W. Europe Daylight Time From: dmead@comcast.net To: Williamtfgoossen@cs.com, keith.boone@ge.com, patientcare@lists.hl7.org Received from Internet: click here for more information

This is perhaps a related required.

In current Vaccine Adverse Event Reporting, there is an item labeled "Vaccine Purchased With". The choices are: private funds, public funds, military funds, other.

Today, in the ICSR, we are addressing this as an observation associated with a supply act for the vaccination.

Mead

From: Williamtfgoossen@cs.com [2] Sent: donderdag 29 mei 2008 9:36 To: keith.boone@ge.com; tom@nova-pro.nl; pher@lists.hl7.org Cc: patientcare@lists.hl7.org Subject: Re: careProvisionReason

Tom is right that there is an option to have the list of immunizations. The list is modelable in the LIST R-MIM called statement collecter, which is DSTU at this stage.

William

In a message dated 29-5-2008 2:30:17 W. Europe Daylight Time, keith.boone@ge.com writes:

Subj: RE: careProvisionReason Date: 29-5-2008 22:36:37 W. Europe Daylight Time From: tdejong3@xs4all.nl To: Williamtfgoossen@cs.com, keith.boone@ge.com, pher@lists.hl7.org CC: patientcare@lists.hl7.org Received from Internet: click here for more information

Hi William,

Actually, I meant a query response that has nothing to do with a Patient Care model. The statement collector is a universal construct for making a list of clinical statements, but we seem to forget that a domain (like Immunization) can still just define a query interaction that returns all Immunizations that match certain criteria (just like Pharmacy does).

Best,

Tom