ArgonautProfiles and Cerner

Overview of the Argonaut "CCDS" profiles and Document reads, as well as Cerner's Compliance or gaps with these profiles

Transcript

1. FHIR AND THE ARGONAUTS JENNI SYED PRINCIPAL ARCHITECT, CERNER @JENNISYED
2. JASON TASK FORCE REPORT
3. USE CASES • Patient accessing their data from a web/mobile app • Provider accessing patient data from a web/mobile app
4. AUTHORIZATION
5. MEANINGFUL USE STAGE 3 I wonder if I can get my health record printed on papyrus…
6. THE COMMON CLINICAL DATA SET • Allergies • Assessment and Plan of Treatment • Care Team Member(s) • Implantable Device UDI • Goals • Health Concerns • Immunizations • Labs • Medications • Patient Demographics • Problems • Procedures • Smoking Status • Vitals
7. AND C-CDA • Request for all data
8. FHIR VERSIONS • DSTU 2: Argonaut Implementation Guide • http://www.fhir.org/guides/argonaut/r2/index.html • STU 3: US-Core • http://hl7.org/fhir/us/core/STU1/index.html • http://hl7.org/fhir/us/core/STU1/us-core-vitalsigns.html
9. ALLERGIES: ALLERGYINTOLERANCE • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- allergyintolerance.html • Required: patient, substance, status • No Known: substance with appropriate SNOMED negation code • Substance: NDFRT, RxNorm, SNOMED • GET /AllergyIntolerance?patient=[id]
10. http://fhir.cerner.com/millennium/dstu2/general-clinical/allergy-intolerance/
11. ASSESSMENT AND PLAN OF TREATMENT: CAREPLAN • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo-careplan.html • Required: narrative, subject (patient), status, category • category = assess-plan • GET /CarePlan?patient=[id]&category=assess-plan • (optional) GET /CarePlan?patient=[id]&category=assess-plan&date=[date] (date would include le/ge qualifier) • (optional) GET /CarePlan?patient=[id]&category=assess- plan&status=active&date=[date] (date would include le/ge qualifier)
12. CARETEAM MEMBER(S): CAREPLAN… • (CareTeam in STU 3/US Core) • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- careteam.html • Required: subject (patient), status, category, participant.role, participant.member display/name • role: NUCC, SNOMED (extensible) • GET/CarePlan?patient=[id]&category=careteam&status=active
13. http://fhir.cerner.com/millennium/dstu2/care-provision/care-plan/ And Category … but no status yet
14. IMPLANTABLE DEVICE UDI: DEVICE • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- device.html • Required: type, udi, patient • type: SNOMED (extensible) • GET /Device?patient=[id]
15. http://fhir.cerner.com/millennium/dstu2/devices/device/
16. GOALS: GOAL • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- goal.html • Required: patient, description, status • GET /Goal?patient=[id] • GET /Goal?patient=[id]&targetdate=[date]{&targetdate=[date]} (targetdate would include le/ge qualifier)
17. http://fhir.cerner.com/millennium/dstu2/care-provision/goal/
18. HEALTH CONCERNS & PROBLEMS: CONDITION • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo-condition.html • Required: patient, code, category, clinicalStatus, verificationStatus • code: SNOMED • category: problem OR health-concern • GET /Condition?patient=[id] • Note: may return other types of Conditions! • (optional) GET /Condition?patient=[id]&clinicalstatus=active,relapse,remission • (optional) GET /Condition?patient=[id]&category=problem • (optional) GET /Condition?patient=[id]&category=health-concern
19. http://fhir.cerner.com/millennium/dstu2/general-clinical/condition/
20. IMMUNIZATIONS: IMMUNIZATION • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- immunization.html • Required: status, date, vaccineCode, patient, wasNotGiven, reported • vaccineCode: CVX & should include NDC translation • GET /Immunization?patient=[id]
21. http://fhir.cerner.com/millennium/dstu2/medications/immunization/
22. LABS: DIAGNOSTICREPORT & OBSERVATION • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- diagnosticreport.html • Required: status, category, code, subject (patient), effective[x], issued, performer • AND either a result (reference to 1 or more Observations), image, or presentedForm • code: LOINC (extensible) + additional • category: LAB + additional
23. DIAGNOSTICREPORT CONT… • GET [base]/DiagnosticReport?patient=[id]&category=LAB • GET [base]/DiagnosticReport? patient=[id]&code=[LOINC{,LOINC2,LOINC3,…}] • GET [base]/DiagnosticReport? patient=[id]&category=LAB&date=[date]{&date=[date]}
24. http://fhir.cerner.com/millennium/dstu2/diagnostic/diagnostic-report/ Radiology Only - Lab Reports pending
25. LABS: DIAGNOSTICREPORT & OBSERVATION • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- observationresults.html • Required: status, category, code, subject (patient), value[x] (or dataAbsentReason) • code: LOINC (plus additional) • category: laboratory (plus additional)
26. OBSERVATION CONT… • GET [base]/Observation?patient=[id]&category=laboratory • GET [base]/Observation? patient=[id]&code=[LOINC{,LOINC2,LOINC3,…}] (multiple code search is optional, must support at least one) • GET [base]/Observation? patient=[id]&category=laboratory&date=[date]{&date=[date]}
27. http://fhir.cerner.com/millennium/dstu2/diagnostic/observation/ And category
28. MEDICATIONS: MEDICATIONORDER AND MEDICATIONSTATEMENT • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- medicationorder.html • Required: status, patient, prescriber, dateWritten, medication[x] • medication code: RxNorm • GET /MedicationOrder?patient={id} • (optional for server, required for client) GET /MedicationOrder? patient={id}&_include=MedicationOrder:medication
29. http://fhir.cerner.com/millennium/dstu2/medications/medication-order/
30. MEDICATIONS: MEDICATIONORDER AND MEDICATIONSTATEMENT • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- medicationstatement.html • Required: patient, dateAsserted, status, medication[x] • medication code: RxNorm • GET /MedicationStatement?patient={id} • (optional for server, required for client) GET /MedicationStatement? patient={id}&_include=MedicationStatement:medication
31. http://fhir.cerner.com/millennium/dstu2/medications/medication-statement/
32. PATIENT DEMOGRAPHICS: PATIENT • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- patient.html • Required: identifier, name, gender • Must Support: birthDate, race, ethnicity, birth sex, communication.language • race and ethnicity: V3 value sets, based on CDC race and ethnicity • birth sex: V3 administrative gender
33. PATIENT CONT… • GET [base]/Patient/[id] • GET [base]/Patient?identifier=[system]|[code] • GET [base]/Patient?name=[string]&birthdate=[date] • GET [base]/Patient?name=[string]&gender=[code] • (optional) GET [base]/Patient?family=[string]&gender=[code] • (optional) GET [base]/Patient?given=[string]&gender=[code]
34. http://fhir.cerner.com/millennium/dstu2/individuals/patient/ This will change >
36. PROCEDURES: PROCEDURE • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- procedure.html • Required: subject (patient), status, code, performed[x] • code: SNOMED, CPT-4, may also provide ICD-10-PCS • GET /Procedure?patient=[id] • GET /Procedure?patient=[id]&date=[date]{&date=[date]}
37. http://fhir.cerner.com/millennium/dstu2/general-clinical/procedure/
38. SMOKING STATUS: OBSERVATION • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- smokingstatus.html • Required: status, code, subject (patient), issued, valueCodeableConcept (or dataAbsentReason) • code: 72166-2 (Tobacco smoking status) • valueCodeableConcept: SNOMED (subset of 8 specific codes) • GET [base]/Observation?patient=[id]&code=72166-2
39. http://fhir.cerner.com/millennium/dstu2/diagnostic/observation/ Note: adding support to query by specific loinc for Smoking Status
40. VITALS: OBSERVATION • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo-vitalsigns.html • Required: status, category, code, subject (patient), effective[x], valueQuantity • category: vital-signs • code: LOINC (specific requirements) - can provide translations • GET [base]/Observation?patient=[id]&category=vital-signs • GET [base]/Observation?patient=[id]&code=[vital sign LOINC{,LOINC2,LOINC3,…}] • GET [base]/Observation?patient=[id]&category=vital-signs&date=[date]{&date=[date]}
42. http://fhir.cerner.com/millennium/dstu2/diagnostic/observation/ And category
43. ALL DATA: DOCUMENTREFERENCE • http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo- documentreference.html • Required: subject (patient), type, indexed, status, content.attachment.contentType (eg: application/xml), content.attachment.url, content.attachment.format (eg: urn:hl7- org:sdwg:ccda-structuredBody:1.1) • type: LOINC (required)
44. DOCUMENTREFERENCE CONT… • If support “pre-indexed” queries: • GET [base]/DocumentReference?patient=[id • (optional) GET [base]/DocumentReference? patient=[id]&type=[type]&period=[date] • If support “on the fly” queries: • GET [base]/DocumentReference/$docref?patient=[id] • (optional) GET [base]/DocumentReference? patient=[id]&type=[type]&start=[date]&end=[date]
45. http://fhir.cerner.com/millennium/dstu2/infrastructure/document-reference/#operation-docref
46. BEYOND ARGONAUT All About Sparta
47. CURRENT FUNCTIONALITY • AllergyIntolerance: update and create • Appointment • Binary (both DocumentReference/CCDA and DiagnosticReports reference) • Condition: update and create • Condition: diagnoses • Contract (Authorized rep) • DiagnosticReport: Radiology (and more in the future) • DocumentReference: write XHTML Note • Encounter • MedicationStatement: update and create • Observation: All social history, all measurements • OperationDefinition (custom operations) • Person • Practitioner (very soon!) • RelatedPerson • StructureDefinition (custom extensions)
48. HOPEFUL ROADMAP (FORWARD LOOKING AND MAY CHANGE) • Location • MedicationAdministration • MedicationDispense • Organization • ProcedureRequest (diagnostic and procedure orders) • Schedule • Slot • More Writes! • Observation • Patient • Native Documents
49. REFERENCES • Argonaut Zulip Channel: https://chat.fhir.org/#narrow/stream/argonaut • Argonaut IG (DSTU 2): http://www.fhir.org/guides/argonaut/r2/ index.html • US Core (STU 3): http://hl7.org/fhir/us/core/STU1/index.html • Cerner Open Developer Experience: https://code.cerner.com/ • Cerner Google Group: https://groups.google.com/forum/#!forum/ cerner-fhir-developers
50. QUESTIONS?