Multiple referring pratictioners in an FHIR Encounter

Question

I want to express the following use case :

A patient is pregnant. She's seen by two specialists : an endocrinologist and an obstetric gynecologist. The gynecologist sends her to the hospital, for a care he can't give.

The patient has then :

a family doctor
a referring doctor (obstetric gynecologist)
a specialist (endocrinologist)

The family doctor is referenced in the Patient Resource, by the generalPractitioner element.

But I want to reference the two others practitioners in the Encounter Resource. I'm ok with the first (the referring), but I don't know where to reference the second.

<?xml version="1.0" encoding="UTF-8"?>
<Encounter xmlns="http://hl7.org/fhir">
    <id value="99289910"/>
    <contained>
        <ReferralRequest>
            <id value="p1"/>
            <status value="active"/>
            <category value="request"/>
            <requester>
                <reference value="Practitioner/99003499686"/>
                <identifier>
                    <type>
                        <coding>
                            <system value="http://hl7.org/fhir/v2/0443"/>
                            <code value="RP"/>
                            <display value="Referring Provider"/>
                        </coding>
                        <text value="Referring doctor"/>
                    </type>
                    <system value='urn:oid:1.2.250.1.71.4.2.1'></system>
                    <value value='99003499686'/>
                    <assigner><display value="RPPS"/></assigner>
                </identifier>
            </requester>
        </ReferralRequest>
    </contained>
    <status value="finished"/>
    <class>
        <system value="http://hl7.org/fhir/v3/ActCode"/>
        <code value="IMP"/>
    </class>
    <patient>
        <reference value="/patient/3803218"/>
    </patient>
    <incomingReferral>
        <reference value="#p1"/>
    </incomingReferral>
    <period>
        <start value="2016-09-07T15:39:00"/>
        <end value="2016-09-11T16:35:00"/>
    </period>
    <location>
        <location>
            <reference value="/uf/1835"/>
        </location>
        <status value="completed"/>
        <period>
            <start value="2016-09-07T15:39:00"/>
            <end value="2016-09-08T00:28:00"/>
        </period>
    </location>
    <location>
        <location>
            <reference value="/uf/3650"/>
        </location>
        <status value="completed"/>
        <period>
            <start value="2016-09-08T00:28:00"/>
            <end value="2016-09-11T16:35:00"/>
        </period>
    </location>
    <serviceProvider>
        <reference value="/uf/2407"/>
    </serviceProvider>
</Encounter>

Where can I reference the specialist (endocrinologist) in the Encounter ?

You say she's seen by two specialists. The second one sends her to the hospital. It's not clear from your description what relationship the endocrenologist has to the encounter at all. Can you explain why a linkage is needed? That may help figure out where/how the linkage should be conveyed. — Lloyd McKenzie, Dec 30 '16 at 18:41
Both are concerned by the hospitalization of the patient, because they have different but complementary specialties. A long-term concern for the endocrinologist (for diabetes problems) and a short-term concern for the gynecologist (for pregnancy). By querying the Encounter Resource and having links to both, a process can send information (hospital note) to them, for instance. — Fred Laurent, Dec 30 '16 at 22:58

score 0 · Answer 1 · answered Dec 31 '16 at 20:39

0

If I understand correctly, the first would be identified as the referring practitioner, but the other is essentially just an "interested party" - someone who should be notified of the admission, the discharge and presumably should receive a copy of the discharge summary.

The concept of "interested party" isn't part of the value set for Encounter.participant.type, but the value set is extensible, so you're free to define your own code for that concept. It seems like a generally useful idea, so I'd encourage you to submit a change request (propose a change link at the bottom of each page in the spec) for us to add that to the specification for everyone.

answered Dec 31 '16 at 20:39

Lloyd McKenzie

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You understood my use case. But the partcipant element doesn't seem to match. According to the doc : Encounter.participant = The list of people responsible for providing the service. In that case, the endocrenologist doesn't "provide" anything. The ReferralRequest container could possibly be augmented by adding another link (like requester), like participant (0..*) or contact (0..*). – Fred Laurent Jan 03 '17 at 13:51
Yeah, it looks like the full definition is inconsistent with the short definition. Looking at the list of particiapation types involved, they're certainly not all involved in "providing the service". I'd submit a change to get the definition fixed. – Lloyd McKenzie Jan 03 '17 at 17:48

Multiple referring pratictioners in an FHIR Encounter

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