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 Baltimore 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/ clinFHIR tool]

- 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.
The project:

- plans to define services and profiles that allow care coordination across clinical teams for a patient (e.g. manage teams, care plans, etc) - expects to use FHIR resources, profiles, operations etc to define a "Care Coordination Service" - has use cases, and some preliminary architecture - plans to hold a connectathon track at the January meeting - is working towards an initial submission date of Feb 2017, and is being lead by AllScripts

The project is seeking participation from the FHIR community, including all those that are already working on (or have in production) solutions around coordinated care, both inside USA and outside as well.

A proposal has been initiated for a Care Plan track to be run at the Jan FHIR connectathon (technical connectathon) that would focus on testing CarePlan, CareTeam, and Goal. And any any profiles that are available or proposed at that time, e.g. US-Core profiles and the IHE Dynamic Care Plan IG.

More details about the proposal can be found at this link:

http://wiki.hl7.org/index.php?title=201701_Care_Plan

Resource subscription function may be useful in care planning collaboration:

http://wiki.hl7.org/index.php?title=201701_Resource_Subscription_Track

Appendix

Allergy/Intolerance and Adverse Reaction

• Discussed on 8 November 2016 conference call
  

Allergy/Intolerance track to be incorporated into Emergency Care track

Contents set aside for future use

Goals/Objectives

- To test changes to the Allergy/Intolerance resource since the last Clinician-on-FHIR event

- To assess the clinical usability and quality of the Allergy/Intolerance resource (and as potential candidate for Level 3 maturity)

Lessons from previous Clinician-on-FHIR

Use cases / Scenarios

(1) Documenting patient allergy/intolerance histories on:

- allergic reaction to a penicillin drug during a previous healthcare encounter

- parent assertion of history of allergy to a sulphur drug when patient was a child

- allergic reaction to ionized particles from a cobalt-chromium alloy knee prosthetic implant

- allergic reaction to an environmental agent (e.g. Fel d 1 (a secretoglobin) and Fel d 4 (a lipocalin))

- allergic reaction to seafood

- adverse reactions after a meal at an Asian restaurant

(2) negation examples:

- no known allergy

- allergy to tree nuts but no known allergy to peanut

(3) generating an allergy/intolerance list from allergy/intolerance and adverse reaction history

(4) Decision support scenario

- Scenario 1: patient allergy/intolerance list shows previous mild allergic reaction to oral amoxicillin (e.g. rash, diarrhoea)

* patient is scheduled for prosthetic knee replacement

o Pre-operative prophylactic antibiotic prescription by junior registrar as per hospital protocol: cefuroxine 1.5g IV 60 min before surgery

o DSS returns a caution/low criticality alert on cross sensitivity - patient has allergy to amoxcillin with previous mild allergy reaction

- Scenario 2: patient allergy/intolerance list shows previous severe allergic reaction to oral amoxicillin (e.g. severe rash, swelling of tongue, difficulty in breathing)

* patient is scheduled for prosthetic knee replacement

o Pre-operative prophylactic antibiotic prescription by junior registrar as per hospital protocol: cefuroxine 1.5g IV 60 min before surgery

o DSS returns a high criticality alert on cross sensitivity - patient has allergy to amoxcillin with previous severe allergy reaction, cefuroxine is contraindicated