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  1. FHIR Specification Feedback
  2. FHIR-20635

Improve definition of PractitionerRole

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • FHIR Core (FHIR)
    • STU3
    • Patient Administration
    • PractitionerRole
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      Change the short description from:
      "A specific set of Roles/Locations/specialties/services that a practitioner may perform at an organization for a period of time."

      to

      "A specific set of Roles/Locations/specialties/services that a practitioner may perform, or has performed at an organization during a period of time."

      Change the Scope and usage section to this:

      The PractitionerRole describes the types of services that practitioners provide for an organization at specific location(s).

      The PractitionerRole resource can be used in multiple contexts including:

      * Provider Registries where it indicates what a practitioner can perform for an organization (may indicate multiple healthcareservices, locations, and roles)

      * In a Clinical system where it indicates the role, healthcareservice and location details associated with a practitioner that are applicable to the healthcare event (e.g. Observation, Appointment, Condition, CarePlan)

      _* In a Clinical system as a point of reference rather than an event, such as a patient's preferred general practitioner (at a specific clinic) _

      The role, specialty, Location telecom and HealthcareService properties can be repeated if required in other instances of the PractitionerRole. Some systems record a collection of service values for a single location, others record the single service and the list of locations it is available. Both are acceptable options for representing this data.
      Where availability, telecom, or other details are not the same across all healthcareservices, or locations a separate PractitionerRole instance should be created.

      Many resource types have a choice of a reference to either a Practitioner resource or a PractitionerRole resource. The latter provides organizational context for the practitioners participation when it is required, otherwise a direct reference to the practitioner may be used.

      Many implementations may choose to profile the PractitionerRole to a single location/role/healthcareservice for their specific usage.

      As the property that references a PractitionerRole typically has a specific context, the code on the PractitionerRole having duplicate code values is not a big concern.

      e.g. These references are all very context specific: Patient.GeneralPractitioner, CarePlan.reported, careplan.contributor, apppointment.participant (through the participant.role), Immunization.informationSource, Immunization.performer (through the performer.function property)

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      Change the short description from: "A specific set of Roles/Locations/specialties/services that a practitioner may perform at an organization for a period of time." to "A specific set of Roles/Locations/specialties/services that a practitioner may perform, or has performed at an organization during a period of time." Change the Scope and usage section to this: The PractitionerRole describes the types of services that practitioners provide for an organization at specific location(s). The PractitionerRole resource can be used in multiple contexts including: * Provider Registries where it indicates what a practitioner can perform for an organization (may indicate multiple healthcareservices, locations, and roles) * In a Clinical system where it indicates the role, healthcareservice and location details associated with a practitioner that are applicable to the healthcare event (e.g. Observation, Appointment, Condition, CarePlan) _* In a Clinical system as a point of reference rather than an event, such as a patient's preferred general practitioner (at a specific clinic) _ The role, specialty, Location telecom and HealthcareService properties can be repeated if required in other instances of the PractitionerRole. Some systems record a collection of service values for a single location, others record the single service and the list of locations it is available. Both are acceptable options for representing this data. Where availability, telecom, or other details are not the same across all healthcareservices, or locations a separate PractitionerRole instance should be created. Many resource types have a choice of a reference to either a Practitioner resource or a PractitionerRole resource. The latter provides organizational context for the practitioners participation when it is required, otherwise a direct reference to the practitioner may be used. Many implementations may choose to profile the PractitionerRole to a single location/role/healthcareservice for their specific usage. As the property that references a PractitionerRole typically has a specific context, the code on the PractitionerRole having duplicate code values is not a big concern. e.g. These references are all very context specific: Patient.GeneralPractitioner, CarePlan.reported, careplan.contributor, apppointment.participant (through the participant.role), Immunization.informationSource, Immunization.performer (through the performer.function property)
    • Craig Newman/Cooper Thompson: 3-0-0
    • Enhancement
    • Non-substantive
    • R5

    Description

      The definition says that it indicates "roles", when in fact it represents a single role. The usage notes also don't make it clear that one of the intended uses of this resource is to allow identifying a Practitioner "in a particular capacity and on behalf of a particular organization". That's how the resources is most commonly referenced, so the description should call out that it can be used to refer to "Dr. Smith, chief cardiologist at Hospital X" or "Dr. Smith at Hospital X" or "Chief cardiologist at Hospital X" or "Dr. Smith, as chief cardiologist" and similar combinations of the 3 primary elements of practitioner, organization & role.

      We should be specific that if you point to PractitionerRole, the assertion is that the individual is acting "in that capacity". I.e. If you point to the PractitionerRole linked to Hospital X, that means they're acting on behalf of Hospital X. If you want to record that they are acting on behalf of a different organization, it must use a different PractitionerRole.

      Finally, the change of PractitionerRole.code to 0..* is problematic because if multiple codes are specified, how can you tell what "capacity" the individual was acting in? It's not ok to say they were acting in capacity A or B. We could allow for them to be acting in both capacities simultaneously, or we would have to have a distinct PractitionerRole for each capacity so that when a linkage is made it's clear which capacity is relevant.

      In general, need to clarify the use of this resource when it's identifying an actor as opposed to when it's just appearing in a registry and identifying relationships. The work group needs to recognize that most systems will only deal with PractitionerRole as an actor, not as a registry entry and take this usage into account when making changes to the resource.

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            brian.postlethwaite Brian Postlethwaite
            lloyd Lloyd McKenzie
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              Updated:
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