[Openid-specs-heart] Current Medications on FHIR

Thu Dec 15 01:28:03 UTC 2016

I see that the UMA profile from HEART can facilitate creating a longitudinal health record, in a variety of use cases, but I do not see the implementation of it within the profile’s scope.  What would a trial use demonstration of the profile be to show that it can generally facilitate an abstract family of longitudinal health record use cases?  This would be something that could participate in an HL7 FHIR Connectathon, although the January one is likely too soon for it.

Glen F. Marshall
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________________________________
From: Openid-specs-heart <openid-specs-heart-bounces at lists.openid.net> on behalf of Adrian Gropper <agropper at healthurl.com>
Sent: Wednesday, December 14, 2016 16:39
To: openid-specs-heart at lists.openid.net
Cc: Josh Mandel; Grahame Grieve
Subject: [Openid-specs-heart] Current Medications on FHIR

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<mailto:howard.strasberg at wolterskluwer.com>>
Date: Wed, Dec 14, 2016 at 12:45 PM
To: argonaut-project <argonaut-project at googlegroups.com<mailto: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<mailto:brett at riverrockassociates.com>>
Date: Wed, Dec 14, 2016 at 3:15 PM
To: "howard.strasberg at wolterskluwer.com<mailto:howard.strasberg at wolterskluwer.com>" <howard.strasberg at wolterskluwer.com<mailto:howard.strasberg at wolterskluwer.com>>, argonaut-project <argonaut-project at googlegroups.com<mailto: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 at googlegroups.com> [mailto:argonaut-project at googlegroups.com<mailto:argonaut-project at googlegroups.com>] On Behalf Of howard.strasberg at wolterskluwer.com<mailto:howard.strasberg at wolterskluwer.com>
Sent: Wednesday, December 14, 2016 12:45 PM
To: argonaut-project <argonaut-project at googlegroups.com<mailto:argonaut-project at googlegroups.com>>
Subject: active medication list
To view this discussion on the web visit https://groups.google.com/d/msgid/argonaut-project/CY1PR07MB21659AA0E9B98788A684D14FA89A0%40CY1PR07MB2165.namprd07.prod.outlook.com<https://groups.google.com/d/msgid/argonaut-project/CY1PR07MB21659AA0E9B98788A684D14FA89A0%40CY1PR07MB2165.namprd07.prod.outlook.com?utm_medium=email&utm_source=footer>.

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From: Grahame Grieve <grahame at healthintersections.com.au<mailto:grahame at healthintersections.com.au>>
Date: Wed, Dec 14, 2016 at 3:41 PM
To: Brett Marquard <brett at riverrockassociates.com<mailto:brett at riverrockassociates.com>>
Cc: "howard.strasberg at wolterskluwer.com<mailto:howard.strasberg at wolterskluwer.com>" <howard.strasberg at wolterskluwer.com<mailto:howard.strasberg at wolterskluwer.com>>, argonaut-project <argonaut-project at googlegroups.com<mailto:argonaut-project at googlegroups.com>>

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

Grahame

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http://www.healthintersections.com.au / grahame at healthintersections.com.au<mailto:grahame at healthintersections.com.au> / +61 411 867 065<tel:+61%20411%20867%20065>

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Adrian Gropper MD

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