Examining Model / Workflow Variations in the use of FHIR Resources for SANER

 

In working through how to automate measure computation for SANER, I've encountered some interesting (or not so interesting) variations in organizational representation and/or workflow which impacts how different information is captured.

These variations may depend on EHR implementation of the FHIR Standard, or US Core or other national guide, or may simply depend on which components of an EHR a provider users or doesn't use to track some forms of activity.

Some examples:

Why did this encounter occur?  This question can be answered in various ways:

1. The encounter has an admission diagnosis of X
2. The encounter has a reason code of X
3. The encounter references a Condition coded with X
4. The encounter references an Observation coded with X having value Y
5. There is a condition recorded during the encounter with a code of X
6. There is an observation recorded during the encounter with a code of X having a value of Y

The patient has deceased:

1. The patient is discharged with a disposition indicating deceased.
2. The patient is identified as having died.
3. The patient has a deceased date.
4. The patient is discharged to a location that indicates the patient is deceased.

Medication (in hospital) was started on day X, and finished on day Y

1. Request date has X, last administration referencing order has Y.
2. Timing in order represents X and Y, order is updated after a discontinuation order (e.g., for cases like "until the patient is better").
3. Simply look at medication administration records.
4. Look at medication statement records.
5. Other combinations of 1-4 above.

Until such representations become standardized, systems which are trying to automate around some of these questions will have to look down a number of different pathways to address these differences.