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  1. FHIR Specification Feedback
  2. FHIR-30490

clinician burden reduction

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    • Change Request
    • Resolution: Persuasive with Modification
    • Highest
    • US Da Vinci CDex (FHIR)
    • current
    • Patient Care
    • (NA)
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      1) There has been no formal cost and benefit assessment performed although is based on the basic premise of medical informatics that health information technology will improve quality, reduce costs, and increase access to care.  This guide refers to the HREX guide which discusses both costs and patient safety 

      1. FHIR-28828
      2.  FHIR-30936

      2) Basic Provenance will be addressed based on the related tracker FHIR-30489 

      3) Will clarify the clinical safety section in HREX which this guide references FHIR-30936

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      1) There has been no formal cost and benefit assessment performed although is based on the basic premise of medical informatics that health information technology will improve quality, reduce costs, and increase access to care.  This guide refers to the HREX guide which discusses both costs and patient safety  FHIR-28828   FHIR-30936 2) Basic Provenance will be addressed based on the related tracker FHIR-30489   3) Will clarify the clinical safety section in HREX which this guide references  FHIR-30936
    • Eric Haas/Jay Lyle: 5-0-8
    • Enhancement
    • Compatible, substantive

    Description

      1) We reviewed the ballot material with an eye to ascertain whether this specification is advantageous, disadvantageous or neutral with regard to clinician burden reduction and patient safety assurance. Have clinician burden and patient safety been considered? Is there any formal documentation of this analysis? Are there specific points of guidance which might be included to show how this specification can be used to enhance front-line clinician practice, reduce burden and ensure patient safety?

      2a) Not clear if/how provenance is captured, represented and persisted (over time) in this specification. Knowing who did what when were and why is essential. Capture points include: i) point of origination (at the source, for newly captured content), ii) point of update (for newly updated content whilst preserving previous content and its provenance).

      Who = subject of care/information (typically the patient)
      Who = participant in action taken, including role (e.g., performer, assistant, observer) and credentials (e.g., MD, RN, PharmD, therapist, MA...)
      Who = author of information captured or updated
      Who = organization
      What = action taken
      When = date/time of action taken
      When = date/time of information capture or update
      Where = physical location of action taken
      Where = physical location of information capture or update
      Where = network address and/or device ID where information captured or updated
      Why = rationale, purpose of action taken

      2b) Provenance elements, if not captured at the point of origination or point of update, are often forever lost beyond that moment.

      2c) Granularity of provenance (e.g., binding authorship to content) may be at the dataset or element level, as appropriate.

      2d) Provenance elements are intrinsic to what the source system or device already “knows” at the point of origination or update and thus should not increase burden by requiring extra input on the part of the entering author (clinician or other end user).

      3) For FHIR IGs, please include reference to Clinical Safety - FHIR Implementer’s Safety Checklist: http://hl7.org/fhir/safety.html

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              Unassigned Unassigned
              gdickinson Gary Dickinson
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