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  1. FHIR Specification Feedback
  2. FHIR-43030

Information Origin Extension challenged to be supported by SMART

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci DTR (FHIR)
    • current
    • Clinical Decision Support
    • Information Origin
    • (NA)
    • 10.1.18.1.1
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      The misalignment between what the extension expects and what's defined in U.S. core is an error.  We will make a technical correction that:

      a) changes the cardinality of the 'role' component extension to have a cardinality of 0..* instead of 1..1 to align with the cardinality of PractitionerRole.code in U.S. core

      b) changes the value set binding and strength to be the same as that used for PractitionerRole.code in 3.1.1

       

      Also, because some EHRs consider transmitting PractitionerRole as part of SMART App Launch to be a breaking change (from SMART App Launch 1.0) we will define an extension on Practitioner (0..* with same binding as PractitionerRole.code) that allows those EHRs to transmit the role using Practitioner rather than PractitionerRole.  We will indicate in the specification that DTR clients SHALL either provide a PractitionerRole in SMART App launch of DTR or SHALL support transmitting the role in the extension.  Because it's not possible to implement DTR without doing one of these two things, we believe that this can also be considered a technical correction.

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      The misalignment between what the extension expects and what's defined in U.S. core is an error.  We will make a technical correction that: a) changes the cardinality of the 'role' component extension to have a cardinality of 0..* instead of 1..1 to align with the cardinality of PractitionerRole.code in U.S. core b) changes the value set binding and strength to be the same as that used for PractitionerRole.code in 3.1.1   Also, because some EHRs consider transmitting PractitionerRole as part of SMART App Launch to be a breaking change (from SMART App Launch 1.0) we will define an extension on Practitioner (0..* with same binding as PractitionerRole.code) that allows those EHRs to transmit the role using Practitioner rather than PractitionerRole.  We will indicate in the specification that DTR clients SHALL either provide a PractitionerRole in SMART App launch of DTR or SHALL support transmitting the role in the extension.  Because it's not possible to implement DTR without doing one of these two things, we believe that this can also be considered a technical correction.
    • Lloyd Mackenzie / Bob Dieterle: 14-0-0
    • Correction
    • Non-compatible

    Description

      This extensions is intended to identify the origin of information for an answer in a QuestionnaireResponse.  The following rule is defined; dtrx-1: If source is 'override' or 'manual' then an author SHALL be supplied, otherwise author is prohibited.  We have been exploring the scenario where a Practitioner overrides the answer provided via CQL, where in this case, source would be 'override'.  The challenge we encountered was that the author extension has a mandatory cardinality (1..1) for PractitionerRole but an optional cardinality (0..1) for Practitioner.  As this is in the context of a DTR SMART app, PractitionerRole is not a paramter provided in context, only the FHIRUser which can be mapped to Practitioner.  Unfortunately there is no accurate way to determine PractitionerRole given only the Practitioner.  Further investigation into the business use case around this suggests that PractitionerRole is not in fact used in this context.  Possible options to resolve include switching the cardinalities around between these two attributes, or simply removing Role and making Practitioner 1..1.

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        1. 2023-10-30 10_51_53-Information Origin - Da Vinci - Documentation Templates and Rules v2.0.0.png
          2023-10-30 10_51_53-Information Origin - Da Vinci - Documentation Templates and Rules v2.0.0.png
          39 kB

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            tkakanowski Tom Kakanowski
            Tom Kakanowski
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              Created:
              Updated:
              Resolved: