#FHIR - still a long way to go yet

Feb 18, 2014

While working with one of my Customers (NEHTA), this diagram went past, a powerpoint mock-up of a GP system went past. They’ve given me permission to take it out of it’s context, and use it for something else (thanks). So here’s the GP system mock-up:

 

What I thought I’d do with this image is indicate which fields on here correspond to existing resources, and which don’t. That would be helpful to implementers, and also give some ideas as to where the project team needs to go yet.

So, in this image:

  • The top banner: Name, DoB, Gender, the first two panels (address, phone, work, mobile) and (identifiers, marital status, email address), indigenous status (race, for non-Australians), and the image are all from the patient resource
  • “Known Allergies and Adverse Reactions” - a set of AllergyIntolerance resources
  • Past Medical Hx - a set of Conditions and Procedures
  • Medicines - probably a mix of MedicationPrescription and MedicationStatement, but it would depend on the application (this one is fictional, so we can make up whatever answer we want)
  • Investigations - a set of DiagnosticReports and possible some DiagnosticOrders - depends on the application, again
  • Immunisation - a set of Immunization resources
  • Correspondence - a list of Document or DocumentReferences. Possibly a reference into an XDS. Or maybe just a list of emails (for which there is no resource, nor would we plan one)
  • Observations/Examinations (on the right side) - a list of Observation Resources, some of which would be simple, and some could be pretty complex

That leaves a number of things for which there’s no immediately obvious answer.

  • There’s a number of observations - Social History, and the Smoking/Alcohol ones, which are simple observations, but they are part of a curated list of observations (not just the most recent observation of a particular type plucked out of a big bucket of observations). We have the List resource for this, but we really need to start maintaining a fixed list of special list codes so that it can be used in an organised manner
  • The financial standing - we haven’t got anything in the financial space yet, though we’re starting to work on this now
  • Follow up date and time - is this an appointment? I think that’s overkill, but what is it if it isn’t? that’s an open question
  • The actual progress notes - what are these? we don’t know yet. We haven’t got a resource for this. Do we need one? We are arguing about that now
  • And finally, the whole thing - is this an Encounter? or something else?

So the 1st DSTU was just a starting point: there’s plenty of work for us to do yet (and this is a simple case single screen from fictional example).