Queries regarding FHIR Bundle Creation and Comprehending it as User

ABDM FHIR Resources
#1

Queries related to FHIR Profiles by NDHM

Hi NDHM Team,
Following are some of the queries related to FHIR Profiles and FHIR Bundle Comprehending.

  1. What is the difference between the profiles Prescription and OPConsultation? And when to use which one?
  2. Do we need to send the coding for Medicines, Prescribed Tests and Symptoms as Coding Objects?
    Can we send it as free text?
    If not, how should we manage a new or previously unknown entry?
  3. Can a media object (Document) like Pdf, Jpg, image be considered as a complete Profile without other metadata, like medication request etc.?
  4. Any prescription or other document can be converted to FHIR Document in multiple ways (Like Medicine can be added as Medication Request or Medication Statement)?
    How an HIU should comprehend the FHIR Document to use it?

@sukreet Kindly look into these issues?

Thanks and Regards,
Arvind Singh Rawat

1 Like
#2
  1. What is the difference between the profiles Prescription and OPConsultation? And when to use which one?
  • These are two different profiles created for two different type of clinical records. In an OPD visit, if only prescription record has been generated (which covers more than 60% of the cases), then it is preferred to share the record adhering to Prescription profile. In case, the visit involve other care activities performed such as immunization, clinical observations, some interventions, orders, etc., then such data combined may be shared through the OPConsultation.
  1. Do we need to send the coding for Medicines, Prescribed Tests and Symptoms as Coding Objects?
    Can we send it as free text?
    If not, how should we manage a new or previously unknown entry?
  • It is expected that, if a system supports standardized coding of clinical information (as required in the profile definition), then the coded data may be shared. If you refer the profile definition, currently the coded data is marked as MUST SUPPORT and not mandatory to take care of legacy data as well as systems which are still in-process of moving to standardized data entry. In some cases free text may also be needed to document some clinical terms which are not found in clinical terminologies. The implementers are also expected to keep both the options for the users (clinicians). Please see the structure and description of ‘coding’ element (especially coding.text).
  1. Can a media object (Document) like Pdf, Jpg, image be considered as a complete Profile without other meta-data, like medication request etc.?
  • If you are referring to Prescription profile, the MedicationRequest is a structured resource that has the list of medications and its not the meta-data element. The use case is, if its the legacy data then a pdf/image may be shared. Any one of them are expected. Please see the optionality at the ‘entry’ element in Prescription Record.
  1. Any prescription or other document can be converted to FHIR Document in multiple ways (Like Medicine can be added as Medication Request or Medication Statement)?
    How an HIU should comprehend the FHIR Document to use it?
  • MedicationRequest is referred as Prescription Order while MedicationStatment is the log of medicines given/taken to/by the patient. The have a different meaning.

I hope this clarifies. Please let me know if any further information is needed.

3 Likes
#3

Hey @Manisha ,

Thank you for your response. This helps us a lot for the implementation.
For now, I think this explains the most. If we face any other issue while implementing, we will post the same in this thread.

Thanks and Regards
Arvind

#4

Hello,

We have some follow-up questions related to these initial questions regarding how to include certain kinds of content in OPConsultRecord/DischargeSummary FHIR bundles.

  1. From the profile for OPConsultRecord, for example, the following composition sections appear to be the only ones permitted: ChiefComplaints, PhysicalExamination, Allergies, MedicalHistory, FamilyHistory, InvestigationAdvice, Medications, FollowUp, DocumentReference, Procedure.

    1. In our system, there is presently no semantic way of knowing which of our EHR entries belong in which of these categories; it is currently all done via human interpretation (though this will change over time as more semantic capabilities are added). What is the correct way in this case to convey EHR data values to HIUs without systematically knowing exactly in which of the aforementioned composition sections they belong? We have tried simply conveying the raw data using HTML in the narrative text section of the composition, but this narrative text does not appear to be displayed by either the NDHM Health Records reference application nor the HIU online consent request application. It has been stated that plain text representations of data is supported, but where can this plain text go if not into one of these pre-defined sections?

    2. Along the same lines as question 1.1, where would EHR entries go that don’t fit into any of the pre-defined sections, even if semantic coding and resolution were present? Is it acceptable to add arbitrary additional sections (as the base FHIR profile would suggest)?

  2. From the profile it is clear that DocumentReference is 0…1; meaning, the bundle can optionally contain a single PDF- or other format representation of the structured data conveyed in the bundle. There does not appear to be any place in the bundle, however, to include additional arbitrary documents that may have been generated during a patient encounter and have clinical relevance, such as forms, certificates, diagrams, reports, etc. It seems desirable also to include such documents in the data bundles being sent to HIUs, so, where would these documents be conveyed?

Thanks,
SnapRx Team

#5

Hello @Snaprx team,

Sorry, I somehow missed your post.

1 & 1.1 FHIR is all about data sharing in a systematic manner.
All the clinical artifacts / HI types have a defined structure so that every system over NDHM should be able to process and infer the information from the records.

Specifically, for OP Consult Record, all the sections are designed in such as way that one can provide one or more list of relevant FHIR resources (Observation, Condition, History, etc.). You will have to analyze the structure of your existing data and map the contents accordingly.

1.2 In case there are any data structures/elements that you could not map and you feel that they are missing in the OPConsultRecord, then you can always share the feedback so that we can collectively work to improve the record structure. You may post the request at this forum or directly send an email to NRCeS at nrc-help@cdac.in

  1. There are specific resources to include Diagnostic Reports (in form of Media as well as DICOM) which should be used instead of Document Reference. The forms & questionnaires are currently not there in the scope. Again, if there is any clear use-case of data sharing of a specific format, please let us know or write to us at nrc-help@cdac.in
#6

@Arvind can you guide me how do i create a FHIR document and link it to patient care context ? Can you share me apis please