Wednesday, November 29, 2017

The subtle differences between data needed for different use cases

As a patient, I want to be able to look back at my medical history and understand what the situation was as I saw it at the time.  When I'm referred to another provider, I really only want to talk to them about the situation that I'm experiencing in the now, and for the most part, they only want to see the relevant and pertinent parts of my historical situation as it relates to now.

This creates subtle differences in the views needed to create clinical documents for these two use cases.  The HL7 Continuity of Care Document using CCDA 2.1 can work for both use cases, but the content to include varies.  Preset document formulations will almost always break for some use case.  Customization is essential.

Resolved issues and completed medications are LESS likely to be relevant in the referral case, than the historical view. In the historical view, I want to see the medications that were being used at that time (e.g., metaprolol).  In the referral case, we are likely to only be talking about my current medications (amlodipine/benzapril).  In the historical view, I'll be looking at resolved problems (cervical radiculopathy) as well as those that are still currently active (e.g., my hypertension), but for the referral, we'll probably only be discussing what is current.

What is relevant and pertinent? It depends on your use case, and it means that you have to pay attention to it closely.  It even varies according to the reason for referral.

It gets even more challenging once you start to bring payers into the picture.  What can you share with a payer?  While minimum necessary is the guard rail, there's NO crisp white line.  Can historical data be shared that preceded the payer's relationship with the patient?  I've heard arguments for both sides of that case.

Dynamic query through FHIR based interfaces can help a great deal in these scenarios.  The requester can simply ask the questions (remember Query Health?) they need answered.



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