I outline in the last article that a Document Sharing "document" does not need to be a "Document". I propose that there might be a set of documents that are very focused on specific concepts, or Document sections. I think we have a ready structure for this in the current International Patient Summary (IPS). This is a real Document, but it is made up of sections that are interesting on their own. So, I suggest that we take the sections of the IPS and declare a way for that section to be made available as a "document" in Document Sharing.Here is the diagram from IPS, the BLUE (header) stuff is already handled by the DocumentReference (XDS DocumentEntry)., so each of the Red, Orange, and Green blocks could be a standalone "document".
Following are the profiles that have been defined for each section. (R) denotes a required section (i.e. must be present in an IPS), (S) denotes a recommended section, the others are optional:
- Medication Summary (R) [ Medication Statement (IPS) | Medication (IPS) ]
- Allergies and Intolerances (R) [ Allergy Intolerance (IPS) ]
- Problem List (R) [ Condition (IPS) ]
- Immunizations (S) [ Immunization (IPS) ]
- History of Procedures (S) [ Procedure (IPS) | Organization (IPS) | Device (performer, observer) ]
- Medical Devices (S) [ Device Use Statement (IPS) | Device (IPS) ]
- Diagnostic Results (S) [ Observation (Results) | DiagnosticReport (IPS) | Organization (IPS) ]Laboratory results [ Observation (Results: laboratory) | Specimen (IPS) | Media observation (Results: laboratory, media) ]
- Radiology results [ Observation (Results: radiology) | Device (performer, observer) | Imaging Study (IPS) | Practitioner (IPS) ]
- Pathology results [ Observation (Results: pathology) | Specimen (IPS) | Media observation (Results: laboratory, media) ]
- Vital Signs [ Vital Signs ]
- Past history of illnesses [ Condition (IPS) ]
- Pregnancy (status and history summary) [ Observation (Pregnancy: EDD) | Observation (Pregnancy: outcome) | Observation (Pregnancy: status) ]
- Social History [ Observation (SH: alcohol use) | Observation (SH: tobacco use) ]
- Functional Status (Autonomy / Invalidity) [ Condition (IPS) | Clinical Impression ]
- Plan of care [ Care Plan ]
- Advance Directives [ Consent ]
So we just need (a small Implementation Guide written)
- A formatCode defined for each of the above.
- A constrained DocumentReference to make sure that it is covering all that is in the Blue section of the IPS. Mostly this is just a use of the IPS Composition profile applied to the DocumentReference (see FHIR core mapping between Composition and DocumentReference).
- Additional requirements on DocumentReference based on the Composition.section details for that type of content. This likely sets the typeCode, classCode, etc.
- The Bundle profiled. I propose a search set Bundle, but am not sure that is the right Bundle type. I prefer it as that type of a bundle is well supported today, and realistically this whole concept could be seen as a search result.
- Define if this is only available as a On-Demand? Should this allow snapshot, or forbid? Is there a Transforms relationship to the full IPS, or is that through referenceIdList?