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 Core (FHIR)
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7.0.0-ballot
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Cross-Group Projects
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US Core Care Experience Preference Profile
US Core Treatment Intervention Preference Profile -
Background
The commenter is referencing this bullet in the US Core Care Experience Preference Profile and the corresponding bullet in the US Core Treatment Intervention Preference Profile:
Decision
1) For the US Core Care Experience Preference Profile:
a) Change the Implementer Specific Guidance from:
*Care experience preferences are patient-authored information used to share an individual’s goals, preferences, and priorities for overall experiences during their care and treatment. They guide caregivers and medical personnel about what is important to them. The preferences may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer.
to:
Care experience preferences expressed by a patient may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer.
b) Update the profile description from:
"This profile represents a person’s care preferences during their care and treatment. Examples include, but are not limited to religious preferences, dislikes and fears, and thoughts and feelings to be shared. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient’s care experience preferences. This profile identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases."
to:
The profile provides guidance on how to record a care experience preference expressed by the patient regarding their care and treatment. Examples include, but are not limited to religious preferences, dislikes and fears, and thoughts and feelings to be shared. This profile does not represent an actual order, but it can guide caregivers and medical personnel about what is important for the person.
To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient’s care experience preferences. This profile identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases
2) Make similar changes to the US Core Treatment Intervention Preference Profile
3) (note for this tracker, not the US Core Spec) The addition of this profile does not introduce a new requirement that servers support direct Patient Authored:- US Core Care Experience Preference
- US Core Treatment Intervention Preference Profile.
Some servers may implement Patient Authored: - US Core Care Experience Preference
- US Core Treatment Intervention Preference Profile.
Background The commenter is referencing this bullet in the US Core Care Experience Preference Profile and the corresponding bullet in the US Core Treatment Intervention Preference Profile: Decision 1) For the US Core Care Experience Preference Profile: a) Change the Implementer Specific Guidance from: *Care experience preferences are patient-authored information used to share an individual’s goals, preferences, and priorities for overall experiences during their care and treatment. They guide caregivers and medical personnel about what is important to them. The preferences may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer. to: Care experience preferences expressed by a patient may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer. b) Update the profile description from: "This profile represents a person’s care preferences during their care and treatment. Examples include, but are not limited to religious preferences, dislikes and fears, and thoughts and feelings to be shared. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient’s care experience preferences. This profile identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases." to: The profile provides guidance on how to record a care experience preference expressed by the patient regarding their care and treatment. Examples include, but are not limited to religious preferences, dislikes and fears, and thoughts and feelings to be shared. This profile does not represent an actual order, but it can guide caregivers and medical personnel about what is important for the person. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient’s care experience preferences. This profile identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases 2) Make similar changes to the US Core Treatment Intervention Preference Profile 3) (note for this tracker, not the US Core Spec) The addition of this profile does not introduce a new requirement that servers support direct Patient Authored: US Core Care Experience Preference US Core Treatment Intervention Preference Profile. Some servers may implement Patient Authored: US Core Care Experience Preference US Core Treatment Intervention Preference Profile. -
Brett Marquard / Lisa Nelson : 21-1-2
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Clarification
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Non-substantive
Description
The Treatment Intervention/Care experience preferences are modeled using the Observation. IF the intent is to capture the clinician's documentation of the patient's ADI verbally or transcribed interpretation, then the Observation is a reasonable resource to use. A subsequent clinician's Care Plan would use one or more of these observations to create appropriate Goals and/or ServiceRequests (of type plan) to address those preferences that the clinician can address. But if the preferences are in a truly patient authored document, the FHIR based model for that ADI should be based on CarePlan as well: the patient's authored careplan. Upon intake the clinician would review that (with the patient/caregiver) and make their observations, that in combination with the patient's authored documentation (if in computable form using the care pan structure) would yield a clinician authored care plan using the CarePan constructs.
USCDI US Core does not indicate the preferences are patient authored, rather patient expressed, which can be verbally and/or sharing a document in some form. Thus using Observation in FHIR US Core for the clinician to reflect their documentation and impressions of the patient's preferences is fine. But that means that the statement *Care experience preferences are patient-authored information used to share an individual’s goals, preferences, and priorities for overall experiences during their care and treatment. " is incorrect as that would require the use of CarePlan, using Goals and ServiceRequests where the author is the patient or their caregive, not Observation. And it is not what USCDI states.
We suggest that the profiles clearly state that these are clinician documented reflections of what the patient expressed, specifically, replace "*Care experience preferences are patient-authored information used to share an individual’s goals, preferences, and priorities for overall experiences during their care and treatment. " with "*Care experience preferences are patient expressed, clinician documented information about an individual’s goals, preferences, and priorities for overall experiences during their care and treatment." and similarly replace "*Treatment intervention preferences are patient-authored information used to share an individual’s medical treatment and intervention goals, preferences, and priorities. They guide caregivers and medical personnel when the patient cannot communicate." with "*Treatment intervention preferences are patient expressed, clinician documented information about individual’s medical treatment and intervention goals, preferences, and priorities. They guide caregivers and medical personnel when the patient cannot communicate."
Introducing the CarePlan to truly and properly express a patient's authored preferences in a structured, computable format would be a substantial step and is not what we understand the scope of USCDI to be.
Attachments
Issue Links
- is voted on by
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BALLOT-57991 Negative - Hans Buitendijk : 2024-Jan-FHIR US CORE E7 STU
- Balloted
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- Balloted