AuDigitalHealth/ci-fhir-r4

My Health Record Other Diagnostic Report usage scenario - changes to align to CURRENT (Path & DI) approach to My Health Record diagnostic reporting

dtr-agency opened this issue · 2 comments

dtr-agency commented

Prerequisites

  • I have searched open and closed issues to make sure it isn't already requested or reported
  • I have written a descriptive issue title

The issue

As part of the forthcoming piece of work Clinical Document Categorisation (CDC) the Agency intends to complete a My Health Record Other Diagnostic Report clinical document capability in CDA; leveraging the recently completed project Diagnostics in FHIR R4 that established establish of a suite of profiles to support diagnostics reporting in FHIR R4 including pathology reports, diagnostic imaging reports, and specialist and other diagnostics reports.

The released Diagnostic Report FHIR implementation guide for stakeholder feedback included some forward thinking materials that proposed improvements based on lessons learned from currently supported Pathology Reports and Diagnostic Imaging Reports available in the My Health Record system.

The initial directive in progressing a My Health Record Other Diagnostic Report is to be consistent with the approach and architecture of the currently supported MHR Pathology Report and MHR Diagnostic Imaging Report clinical document specification packages. To that end a number of changes are needed ASAP to trim back the design to be consistent with the initial directive.

Change description

Identified changes required to move the designs and the implementation guide to be consistent with the approach and architecture of the currently supported MHR Pathology Report and MHR Diagnostic Imaging Report clinical document specification packages are described below.

HOME page

Changes required to make obvious the direction change from early models of all three domains for stakeholder engagement to maturing the model for Specialist and Other Diagnostic Report to the MHR:
• Introduction
• How to read this document
• Roadmap portion of known issues
• References

Profiles pages

Changes required to keep only the profiles referenced using the Composition (Other Diagnostic Report) profile as the starting point.

Composition (Other Diagnostic Report)

Changes:

  1. Add short to Composition.type of “Document sub-type, also referred to as document category”
  2. Add Must Support to Composition.category 1..1 and to fix to the type for ‘Diagnostic Report’ or ‘Specialist and Other Diagnostic Report’. For now fix to 47045-0 LOINC Study report is the highest possible level of catch-all but that includes all reports generated in response to a request – truly the generic Diagnotic Report type rather than ‘Specialist and Other Diagnostic Report’.
  3. Add short to Composition.category of “Document type”
  4. Change Composition.author to 1..*
  5. Known Issues changes:
    a. Remove the closed known issues
    b. Add known issue for Composition.category (document type) Need to put known issue that this is likely too generic to support requirements for the CDC project – as part of the piece of work to determine types and sub-types a suitable type needs to be defined and agreed
    c. Update known issue Composition.type (document subtype) – required development of the set of sub-types for this, often referred to as ‘Clinical Document Categories’

Patient (My Health Record Patient)

Changes:

  1. Rebase to work off latest AU Base – fix slicing on Patient.identifier by moving slicing into our profile. Slice by Identifier.type pattern

DiagnosticReport (My Health Record Other Diagnostic Report)

Changes:

  1. DiagnosticReport.category remove from diff
  2. DiagnosticReport.result restrict to only Simple Other Diagnostic Observation
  3. DiagnosticReport.code – bind the Evaluation Procedure value set as extensible
  4. Known Issues changes:
    a. Remove the closed known issues
    b. Add known issue to table, and raise in GitHub for URI of location of referred to content for Other Diagnostic Report (go off of the same issue for My Health Record Pathology Report – but we want a separate one for Other Diagnostics as these are different use cases so different choices may be made).
    c. Add known issue to table to argue for inclusion of DiagnosticReport.category as 1..*
    d. Add known issue on ServiceRequest.requester (Organization) to argue for allowing an organization and not just a practitioner. YES on this profile page – due to inv-dh-dir-03
    e. Update known issue on code – basically the outstanding requirement is to validate the value set and its usability now that its available
    f. Add known issue that DiagnosticReport.category may be required to enable system processing differentiation between path, di, and other – as in a Path diagnostic report has a fixed value of pathology for DiagnosticReport.category and a DI report has a fixed value of ‘imaging’ for DiagnosticReport.category, etc.

ServiceRequest (Order Details for Other Diagnostic Report)

Changes:

  1. ServiceRequest.category remove from diff
  2. ServiceRequest.code - bind the Evaluation Procedure value set as extensible
  3. Known Issues changes:
    a. Remove the closed known issues
    b. Update known issue on code – basically the outstanding requirement is to validate the value set and its usability now that its available

Observation (Simple Other Diagnostic Observation)

Changes:

  1. Observation.partOf remove from diff
  2. Observation.category make 1..1
  3. Observation.code – bind the Evaluation Procedure value set as extensible
  4. Known Issues changes:
    a. Remove the closed known issues
    b. Add known issue to table, and raise in GitHub for Simple Other Diagnostic Observation inclusion of value[x] to argue for its inclusion but get stakeholder and business agreement as Path & DI don’t support this element but we think its relevant for this domain
    c. Add known issue to table to argue for inclusion of Observation.performer as organization – essentially the lab
    d. Update known issue on code – basically the outstanding requirement is to validate the value set and its usability now that its available.

Other:

  1. Go through all profile pages that remain in the IG and update the known issues – at least remove the issues that are closed
    b. Go through all profile pages that remain in the IG and update the ‘this profile is referenced by’

What it actually enables people to do

TBD

Mockups

N/A

How awesome would it be?

TBD

Workarounds

N/A

Additional context

The Clinical Document Categorisation (CDC) work package is intended to:

  • Improve the ability of clinicians to discover clinical documents relevant to particular health care scenarios.
  • Support additional types of clinical documents to capture greater share of available health information.

My Health Record Other Diagnostic Report usage scenario is one of several streams of work that are part of the CDC work package.

dtr-agency commented

@davidmckillop, isn't this complete? Can this be closed?

dtr-agency commented

Proof of concept work is now closed.