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 Electronic Long-Term Services & Supports (ELTSS) (FHIR)
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2.0.0-ballot [deprecated]
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Human and Social Services
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All Eltss Careplan
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Artifacts Summary
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Profiles
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Bret Heale / Brian Handspicker : 7 - 0 - 0
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Enhancement
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Compatible, substantive
Description
The 2.0.0-ballot eLTSS IG defines a number of profiles base on US Core 3.1.1. US Core 3.1.1 is quite old now and lacks many of the data elements that have been added for post-acute care from more recent releases of USCDI. eLTSS is designed to exchange long-term care plans, so this is an issue for PACIO, which is designing IGs to leverage the many additions (e.g., Functional Status, Mental Status, Advance Directives, etc.) in US Core 6.1.0 that have been added since 3.1.1.
The balloted eLTSS IG has many specific references to eLTSS profiles (it actually creates quite a web of these references). The PACIO Personal Functioning and Engagement IG, for STU2 development, is adding Condition, ServiceRequest, and other profiles beyond just the Observation focus in STU1, similar to what was done for the published SDOH-CC and Physical Activity IGs.
The web of references between eLTSS profiles based on US Core 3.1.1 makes it very difficult for PACIO to integrate (or anyone else wanting to leverage the newer US Core profiles) with the eLTSS IG and take advantage of the new data elements in US Core. Indeed, PACIO had to get a waiver from using a US Core 3.1.1 profile since it did not cover our needs. That has since been fixed in subsequent US Core releases.
All of this will also impact implementations and potentially raise a lot of confusion. Mismatched US Core lineages would be an issue, but creating duplicate sets of profiles in various places (like in PACIO) beyond what is defined in eLTSS to leverage the latest additions in US Core doesn’t seem like a great solution either.
eLTSS should consider at least the following alternatives:
1) If sticking with US Core 3.1.1, relax references to not just refer to eLTSS profiles. If they wish, they could still promote the use of their profiles, but add a slice that also references base FHIR resources so that other profiles based on newer US Core releases to be used as well. This is similar to what the SDOH-CC and Physical Activity IGs did with references in the “addresses” data element within their Goal profiles.
2) Base eLTSS profiles off of a newer version of US Core (e.g., 6.1.0).
Attachments
Issue Links
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