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Scenario (simplified) for purposes of supporting Sept. 2020 ballot and next Connectathon.
June 29, 2020
Introduction to the Lower Extremity Skin Wound Assessment (LE-SWA or SWA) FHIR IG (links below)
This introduction includes a few key points that will greatly enhance understanding of this first instance of the IG and the initial scenario it is intended to support.

  1. Developed concurrently with a method of testing conformance of an instance of the FHIR object to enable evaluation and verification of conformance with the IG.
  2. Version 1 of the IG supports a "minimum useful" data object, suitable for production use by one or more of our current known implementers
  3. Future versions of the IG will support additional data points to allow for a more robust exchange of information on Assessment and Treatment of wounds. It incorporates an initial "ease of use" 2-step process that considers the nearly infinite variability in EHR systems:
    1. Step 1: The EHR initially originates (creates) the data object as a null (empty) clinical data set.
    2. Step 2: The EHR populates the patient care event-specific data set as an AMENDMENT to the initial null data set. (This is akin to a launching a blank form then populating the form at the point of care.)


The purpose of the two-step process is to:

  1. Ensure that all data for each encounter is developed 'de novo' and
  2. Differentiate instances where EHR systems populate a data set using "brought forward", previously authored or other non-original data elements
  3. These provide affirmation that all data reflects current encounter conditions consistent and in conformance with data quality specifications including end-use requirements for "accurate" and "complete".

At this time the specification does not cover, and therefore does not directly address representation of (data) absence. It does directly address assurance of intent for all populated data elements.
The basic scenario undertaken:

  • A clinician* evaluates a wound (initial or follow-up), their system generates an instance of the Assessment. The event record differentiates device-originated data vs. clinician originated data.
  • The newly generated Assessment populates the local system, also populating a Registry (which validates the Assessment's conformance with the FHIR IG's specifications).
  • The Registry manages responses to calls for Assessments and manages the diverse exports to different end-users (including, hypothetically, payers).

*Clinician = Community clinical resource (Ex: Primary care including Podiatry, Emergency Dept., Home Care, Orthotics, Prosthetics)
Example Use Case:

  • The patient is referred to a Wound Care clinic (or other different authorized PCP).
  • The Clinic executes a Call for the patient's existing Assessment(s). Finding that it exists, then
  • The Clinic Receives and Retains the prior instance(s) of Assessment. (Clinician views for past state of the wound)
  • The Clinic evaluates the wound anew, generating another instance of Assessment, which also populates the Registry (for subsequent calls to identify the existence of all Assessment instances).

Continuing, ongoing visits with members of the care team treating the wound will be captured and managed to conform with the specification, assuring consistency in information capture and high interoperability via compliance with the specification.
Conclusion:
This initial FHIR IG and its "initial lift" scenario represents the first step in developing a method of collecting and exchanging information on wounds that meets the needs of clinicians, payors, and patients to reduce clinician burden, enhance access to care, and ensure that care provided is appropriate and cost effective resulting in optimal patient outcomes.
Next Steps in the LE-SWA FHIR IG's extension: Our workplan extends the Assessment "payloads" to also capture treatment, if any, at the point of care. However, our immediate priority is to address the "fitness for use" requirements for Anthem's PriorAuth DaVinci project and other invested stakeholders in addition to our extraordinary network of clinicians in practice.
Regards,
RDGelzer
Trustworthy EHR, LLC
Co-Facilitator, LE-SWA + T working group
As of June 29, 2020
Link to current build: https://build.fhir.org/ig/HL7/fhir-skin-wound-ig/branches/master/index.html
Link to current PSS: https://confluence.hl7.org/display/EHR/2020-02-19+Lower+Extremity+Skin+Wound+Assessment+FHIR+IG
Link to posted FHIR IG Proposal: https://confluence.hl7.org/display/FHIR/Lower+Extremity+Skin+Wound+Assessment+FHIR+IG

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