Details
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Change Request
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Resolution: Persuasive with Modification
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Medium
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US Da Vinci HRex (FHIR)
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current
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Clinical Interoperability Council
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HRex Coverage Profile
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Bob Dieterle / Jay Lyle : 13-0-0
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Correction
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Non-compatible
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Yes
Description
Issues:
- Coverage.payer is 1... It's not clear why we'd *ever have more than 1 payer for a single coverage
- Coverage.beneficiary is 1..1 and US Core Patient, which it resolves to says Patient.identifier is 1..1. However, we won't always have an identifier for the beneficiary, sometimes we've only got an identifier for the member
- Patient.identifier says that Identifier.system is mandatory, but in general we'll have no clue what the system is for a particular member or subscriber identifier
- With beneficiary, we'd be having both Patient.identifier and subscriberId, which presumably would be the same thing.
- Insurance cards typically capture the notion of 'Group' so you know what plan is being talked about, but that's supposed to go in Coverage.class.value, and neither class nor value are even mustSupport.
- Coverage.identifier is 0..*, with no constraints - it's not clear why there'd ever be more than one, and we need to make clear that .value is mandatory but we might not have the rest
After talking things over with Bob, my recommendation is as follows:
Coverage.payer becomes 1..1
Coverage.beneficiary changes the target profile from US Core Patient to hrex-patient-demographics which will be based on core patient and will have mandatory gender, birth date, family name and 1..* given names as well as must support address (with same mustSupport elements as US-core)
Coverage.identifier becomes 0..1 with Coverage.identifier.value being 1..1, mustSupport
Coverage.class will have a (?1..1?) mustSupport slice by class.type, where class.type is set to 'group' and value is mandatory mustSupport
We'll add an invariant requiring either identifer.value or subscriberId