How to deal with encounter (visit) information in BICEPS

[PeterKranich]

Section Number

This relates to @MartinKasp comment in IHE/sdpi-fhir#288. B.3.4.4.4 PV1-19 Visit Number

Priority

• High: Important issue where there is major issue to be resolved. Requires discussion and debate.

Issue

The issue surfaced in the IHE HL7 V2 gateway section but is a general issue about how to deal with patient encounters (alias visits).

Proposed Change

R8114 states:
"A SOMDS DEC Gateway / SOMDS ACM Gateway shall set the PV1-19 field to the patient’s visit identifier.
If the SDC patient identifier element pm:PatientContextState/pm:Identification contains more than one patient
identifier, only the unique identifier assigned to the patient’s visit is mapped according to the Table TF-2:B.3.4.4.4-75. PV1-
19 Visit Number Mapping table.
When there is no unique visit identifier assigned to the patient’s visit, the field is left empty."

@MartinKasp recommended to use the MDIB WorkflowContext for this concept, but from the BICEPS definition it is not clear how to use it in real clinical workflows. FHIR has a good decription for the Encounter conecpt (http://hl7.org/fhir/administration-module.html). The WorkflowContext has a WorkflowDetail element which has elements for patient, AssignedLocation, VisitNumber, etc. but how does this relate to the existing PatientContextState and LocationContextState?
Use case need to be defined and mapped to the SDPi requirements for the WorkflowContext.

This also relates to
R8115
"A SOMDS DEC Gateway / SOMDS ACM Gateway shall set the PV1-44 field to the patient’s admission date/time.
The SDC data model does not support the concept of an admission date/time. There are also different types of admissions;
e. g. hospital admission, care unit admission, etc.
This said, it is up to the SOMDS DEC Gateway / SOMDS ACM Gateway to figure out the admission date/time to be set in the
PV1-44 field. If the gateway is not able to determine the admission date/time, the field is left empty."
@MartinKasp : Suggested covering the admission date/time using the workflow context. If we do this, SDPi needs to define how to model this in SDC.

Table 35 also needs to be considered
According to table 35 there is more than one valid identifier type code for the visit number. R8114 says only the unique identifier assigned to the patient’s visit is mapped.
@riechkathrin commented: From my experience, limit the visit identifier only to the Visit Number (VN) is not appropriate. Often the Account Number (AN) is used for identifying a visit. Some EMRs also have their own visit identification types e. g. Cerner uses FIN for the visit/encounter identification (https://fhir.cerner.com/millennium/dstu2/encounters/encounter/).

[AnnaFeiler]

Hi @PeterKranich , I agree that this requires more discussion. But since we have postponed developing a concept how to build patient/location based ensembles from patient and location contexts for the different use cases as well as how to get patient data distributed at a workplace (share at point of care vs. import fropm hospital information systems), it might be difficult to solve right now. All of those topics are at the top of my (currently not aligned) to do list for version 1.1. Could we solve this as part of this bigger discussion once SDPi 1.0 is done?
Is this related to IHE/sdpi-fhir#258?

[AnnaFeiler]

Added a related issue to have all information in one place.

[riechkathrin]

This also has an effect on: IHE/sdpi-fhir#258

[PeterKranich]

Discussed at the SDPi workshop on 20-Jul-2023 in Luebeck:

• add encounter id (visit number, account number, etc.) to the PatientContext/Identification
• shall requirement in SDPi
• Use HL7 table for the Identifier Type Code

[ToddCooper]

@riechkathrin - Check to see if this resolution has been completed already.