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I'm making a web tool that shows FHIR Observation resources. These are for example measurements taken at home (blood pressure, weight etc) by the patient themselves. Then I want a health worker to look at the graph and be able to comment it. I guess the comment could be linked to invididual observations, or be a general comment about the patient.

Which resource should I use for this comment?

Larsie
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  • Is the comment rather trivial or more of an assertion in its own right? If the latter, we create another observation and use provenance to establish dependence. – Chris Grenz Oct 21 '15 at 14:22
  • OK, thanks... I need to look more at the use case I guess. – Larsie Oct 22 '15 at 15:25

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At the moment, there isn't a good answer to this question. There's an expectation that the Observation.comments element will change in the next release to have a type of Annotation. I also expect an operation to be defined that would allow a new annotation to be added without needing to do a full update on the content of the resource. Until that happens, you could mirror that behavior using a custom operation and an extension.

Lloyd McKenzie
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  • Thanks. Comment won't tell me who wrote it, right? Could I use DiagnosticReport? If we're saying that it's really an e-encounter that the doctor looks at the graph and reports on it?? – Larsie Oct 20 '15 at 13:05
  • Or could ClinicalImpression be used? And then link it to the Observation somehow? – Larsie Oct 20 '15 at 16:44
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    comment will be changed to "note" which will have a type of Annotation - which identifies the comment text plus when it was written and who did it. Clinical impression is possible, though that resource is in considerable flux right now. And it's a bit heavy when all you want to do is add some notes. – Lloyd McKenzie Oct 20 '15 at 17:41
  • I think maybe the permission to post (and edit) and observation may be different from the permission to comment on it. For example, if an observation has been uploaded by a patient or a practitioner, other practitioners may be able to comment on it, but not actually change the observation itself. So I'm not sure how this could be handled easily. It may be better to have a separate comment-resource refering to the Observation rather than embedding it in the Observation? – Larsie Oct 24 '15 at 21:12
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    That's one of the reasons for having a distinct operation - the operation would manage the permissions issue. Having a distinct Annotation resource was considered, but the complexity there is that when you query a record, you'd only get the base resource and not the annotations unless you specifically queried for them. There'd also be the possibility of annotations getting stored on a variety of servers - and needing to query all of those servers to find them. – Lloyd McKenzie Oct 25 '15 at 01:07