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  1. FHIR Specification Feedback
  2. FHIR-36078

CareTeam for a patient is not the same thing as "a random collection of Providers that treated the patient once"

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci PDex (FHIR)
    • 2.0.0-ballot
    • Financial Mgmt
    • PdexServerCapabilityStatement [deprecated]
    • Payer-to-Payer Exchange [deprecated]
    • 4.3.3
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      The EpisodeOfCare Resource, that is not a part of US Core, references the CareTeam Resource but US Core Encounter and Procedure do not reference the profile..

      If the providers engaged in an Encounter can be derived from a claim and represented in the Encounter resource then they can be recorded there, rather than in a discrete CareTeam resource.

      Propose adding the following text above the CPCDS mapping table:

      Claims information typically represents a particular event, such as a procedure or encounter. The CareTeam resource is intended to represent the parties involved in supporting a subject/patient. Where a claim represents an Episode of Care it may be appropriate to record the parties involved in the claim as members of the CareTeam involved in that EpisodeOfCare. For discrete procedures or encounters it *MAY* not be appropriate to create a CareTeam record from the claims information.

       

      The essential fields to be provided in the CareTeam resource from the CPCDS file, where appropriate, are:

       

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      The EpisodeOfCare Resource, that is not a part of US Core, references the CareTeam Resource but US Core Encounter and Procedure do not reference the profile.. If the providers engaged in an Encounter can be derived from a claim and represented in the Encounter resource then they can be recorded there, rather than in a discrete CareTeam resource. Propose adding the following text above the CPCDS mapping table: Claims information typically represents a particular event, such as a procedure or encounter. The CareTeam resource is intended to represent the parties involved in supporting a subject/patient. Where a claim represents an Episode of Care it may be appropriate to record the parties involved in the claim as members of the CareTeam involved in that EpisodeOfCare. For discrete procedures or encounters it * MAY * not be appropriate to create a CareTeam record from the claims information.   The essential fields to be provided in the CareTeam resource from the CPCDS file, where appropriate, are:  
    • Bob Dieterle / Celine Lefebvre: 21-0-1
    • Clarification
    • Compatible, substantive
    • Yes
    • 2.0.0-ballot

    Description

      This page states that care team resources should be created from the participant list of a claim. This is not what a care team is. A care team is "The CareTeam includes all the people, teams, and organizations who plan to participate in the coordination and delivery of care for a single patient or a group (such as a married couple in therapy or a support group)." 

       

      Just because a group of people treated me one time does not make them a care team. As a patient, I may choose to never interact with any of these providers again. Assuming that they are on my care team is invalid.

      Additionally, to make an instance of a care team for every claim submitted would be a significant amount of duplication. Take for instance if I have dialysis 3 times a week and the facility submits a claim for each visit. Does that mean I 156 care teams each existing for 1 day last year alone?

      I can certainly understand that you might use information gleaned from claims as a starting point to have a conversation with the patient as to who will be the care team going forward. But to use CareTeam as a "this group of people were involved in your care on a given day", is not a care team. Leave that data on the claim where it belongs.

       

      Corollary: You can derive a patients conditions from examining claims, but you wouldn't create a new "Kidney failure" condition resource every time a claim was filed. You'd use that information to compile a single condition resource that has as much accurate information possible. And if you only saw that diagnosis 1 time in the history of claims, you might have a conversation with the patient, "Do you really have Kidney failure or was that an incorrect filing?"

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            dventon Daniel Venton
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