[Openid-specs-heart] Current Medications on FHIR

Wed Dec 14 21:39:30 UTC 2016

All,

Please read this short thread that directly addresses some of the resource
naming and patient-friendly naming issues we have talked about. Definitely
follow the link that Grahame posts at the end.  http://build.fhir.org/
lifecycle.html#current

My conclusion is that HEART cannot and should not play at this game in the
first release. All we can do is wait for HL7 / FHIR to do it's work and
follow suit. Anything else will simply add confusion to an already
difficult problem.

A second gem is embedded in this thread and Grahame's link: The problem of
curation in a FHIR-enabled EHR. Most institutional EHRs are very reluctant
to open their FHIR API to write for obvious and justifiable reasons. How
then do we create a curated longitudinal health record?

The suggestion I have is to use HEART to enable a patient-centered health
record like HIE of One which is designed to be written to by anyone with a
medical license that is also a member of the care team. This record
demonstrated a pNOSH in the videos and code at http://hieofone.org/ and is
FHIR accessible under control of the HEART authorization server.

Any EHR vendor can play this game to the extent they want to set up a
separate writeable place and manage who gets to access and how it relates
to the institutional EHR. The difference is whether the operator of the
separate writeable place is willing to accept that liability. It's much
cheaper and less risky to let the patient themselves host their HEART AS
and patient-centered FHIR health record. The liability then rests with the
individual licensed providers that curate the patient-centered record but
they're already being paid to be part of the care team.

Adrian

Forwarded conversation
Subject: active medication list
------------------------

From: <howard.strasberg at wolterskluwer.com>
Date: Wed, Dec 14, 2016 at 12:45 PM
To: argonaut-project <argonaut-project at googlegroups.com>

Has Argonaut agreed on a common FHIR representation for a patient's active
medication list?  If so, would it based on MedicationOrder (now
MedicationRequest) or MedicationStatement?  Which FHIR search parameters
would return this list?  If it's based on MedicationStatement, would it be
status=active?  If it's based on MedicationOrder (or MedicationRequest),
would it also be status=active, or might it be status=completed (meaning
the order was completed)?  On the other hand, we wouldn't want to include
old orders for medications that the patient is no longer taking.  Would app
developers have to look at both MedicationOrder (MedicationRequest) and
MedicationStatement?  Retrieving the active medication list is such a
common use case that there should be a simple approach on which everyone
agrees.

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----------
From: Brett Marquard <brett at riverrockassociates.com>
Date: Wed, Dec 14, 2016 at 3:15 PM
To: "howard.strasberg at wolterskluwer.com" <howard.strasberg at wolterskluwer.com>,
argonaut-project <argonaut-project at googlegroups.com>

Hi, Howard,

This seemingly innocent question is tricky to nail down.

We have discussed this within several projects and have agreed it’s
combination of MedicationRequest/MedicaitonStatement – in order to finalize
approach we included a specific scenario in the FHIR Mature Medications
Connectathon Track
<http://wiki.hl7.org/index.php?title=201701_Medication_Track> for the San
Antonio WG (see Patient and Provider access to a patient’s active and
historical medication list). We have also included this in the Pharmacy
FHIR Maturity ballot. <http://hl7.org/fhir/us/meds/>

You should join us!

Best,

Brett

*From:* argonaut-project at googlegroups.com [mailto:argonaut-project@
googlegroups.com] *On Behalf Of *howard.strasberg at wolterskluwer.com
*Sent:* Wednesday, December 14, 2016 12:45 PM
*To:* argonaut-project <argonaut-project at googlegroups.com>
*Subject:* active medication list
To view this discussion on the web visit https://groups.google.com/d/
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----------
From: Grahame Grieve <grahame at healthintersections.com.au>
Date: Wed, Dec 14, 2016 at 3:41 PM
To: Brett Marquard <brett at riverrockassociates.com>
Cc: "howard.strasberg at wolterskluwer.com" <howard.strasberg at wolterskluwer.com>,
argonaut-project <argonaut-project at googlegroups.com>

Also, note this: http://build.fhir.org/lifecycle.html#current

Grahame

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Adrian Gropper MD

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