Short Description

Help test the new HL7 FHIR Physical Activity implementation guide

Long Description

The Physical Activity project is a new effort to develop standards around helping patients improve and sustain their levels of physical activity.  The guide focuses on standardizing 3 things:

• observations about physical activity level (primary and supporting observations)
• plans, goals and orders related to physical activity
• interfaces for exchanging all of those between clinical and other 'ordering' systems, patient-facing applications, and systems used by physical activity service providers

Assessing physical activity is currently listed in the draft release of USCDI

Type

Test an Implementation Guide

Related Tracks?

2023 - 05 Gravity SDOH Exchange - Our IG aligns closely with Gravity's architectural approach.  We may sit in on some of their break-out sessions

2023 - 05 Patient Track - If you've never done any FHIR work before, the patient track acts as an on-ramp/tutorial

2023 - 05 FAST National Directory of Healthcare & Da Vinci Plan Net - We will eventually need to leverage directory information for providers, organizations and other entities

2023 - 05 Bidirectional Services e-Referrals (BSeR) IG - Alternative mechanism to manage referrals that we might explore

2023 - 05 Coordinating Care for Patients with Chronic Conditions - Physical activity is impacted by chronic conditions, and the assess/plan/goal/referral approach envisioned by this IG is similar to our IG

Call for participants

We are looking for:

• EHRs or other systems that capture clinical concerns about patient physical activity levels and order interventions
• Applications used by physical activity service providers (personal trainers, fitness centers, etc.) that will participate in the referral process and support patients.  (Note, these might be web-based or mobile applications.)
• Patient-facing applications that help patients monitor their physical activity levels and exchange information with EHRs and service provider applications
• Technical individuals with domain expertise interested in helping test out the specification

Ideally, systems will have done some development in advance of the connectathon, but given that we're in the early stages of IG design, most implementations won't be terribly far along, so planning to "develop as part of the event" is completely fine.  If you aren't prepared to write software, but you're willing to help create JSON or XML example instances and run them through a validator or manually submit them to systems, that's welcome too, especially if you have knowledge about the domain.

If you don't have time to participate in person, but have a server that satisfies some of the requirements, let us know and we'll happily do some testing with it!

Track Prerequisites

Track Lead(s)

Lloyd McKenzie

Track Lead Email(s)

lloyd@dogwoodhealthconsulting.com

Specification Information

Draft IG: build.fhir.org/ig/HL7/physical-activity

Reference Implementation: https://paaapp.azurewebsites.net/

Zulip stream

https://chat.fhir.org/#narrow/stream/327137-Physical-Activity

Track Kick off Call

Scheduled Tuesday Apr. 11, 2:30-3:30 Eastern.

Recording: Link to recording

Testing Scenario:

System roles

Physical Activity Care Manager: an EHR or other system involved in reviewing patient physical activity levels, that may receive activity level observations from other systems, and that will coordinate the creation of an intervention plan, goals, exercise prescriptions, and referrals.  These systems will primarily act as servers, hosting data for access by external systems and accepting submissions from other systems.  Standing up a server will require advance development, though you could use one of the existing open-source servers and focus on configuring/customizing it to meet track-specific use-cases

Physical Activity Referral Recipient: any system that supports physical activity professionals - individuals who can help a patient to improve or maintain their levels of physical activity.  These may be web-based applications, mobile applications, or traditional software.  These systems will primarily act as FHIR clients, though sophisticated ones might also act as FHIR servers to receive patient-reported data.  Advanced prep is ideal, though coming with just a dev environment or a willingness to work on examples is welcome

Physical Activity Patient Engagement: any system that allows patients and their caregivers (family members, etc.) to capture and share information about their physical activity, integrate device-provided data, and receive and to  supports physical activity professionals - individuals who can help a patient to improve or maintain their levels of physical activity.  These may be web-based applications, mobile applications, or traditional software.  These systems will primarily act as FHIR clients, though sophisticated ones might also act as FHIR servers to receive patient-reported data.  Advanced prep is ideal, though coming with just a dev environment or a willingness to work on examples is welcome

Scenarios

There are three main scenarios we're trying to test, listed in order of complexity (and likelihood participants will be ready...)

• transmitting physical activity-related observations
• transmitting and updating physical activity goals and plans
• retrieving physical activity orders

NOTE: for this connectathon, no test scripts are in place.  Future tracks may provide more support for automated testing

Submit Physical Activity Observation

Action:

A Patient Engagement system POSTs an Observation conformant with the Physical Activity Vital Sign profile to a Care Manager (or possibly a Referral Recipient)

Precondition: 

• Client system has permission to POST Observations to server system
• Client has determined the server identity of the patient and any other entities

Success Criteria:  

Observation exists on the target server and is available for query

Bonus point:

• Post a 'supporting' observation instead of a physical activity vital sign
• Post a physical activity vital sign with links to multiple supporting observations
• Post a physical activity observation and set of supporting observations via a transaction
• As part of accepting the observation, validate that it complies with the profile

Query Physical Activity Observations

Action:

A Patient Engagement or Referral Recipient queries for physical activity-related observations residing on a Care Manager, filtering by patient and category

Precondition: 

• Client system has permission to query Observations from server system
• Client has determined the server identity of the patient
• (ideally) Patient has physical activity observations available on the server

Success Criteria:  

Client system has received a list of physical activities-related observations for the specified patient

Bonus point:

• Filter to only include specific types of observations
• Filter to only include observations in a specific time-range

Create Physical Activity Goal

Action:

A Patient Engagement or Referral Recipient POSTs a physical activity-related Goal to a Care Manager

Precondition: 

• Client system has permission to create goals from server system
• Client has determined the server identity of the patient

Success Criteria:  

Goal exists and is queriable on the Care Manager system

Bonus point:

• Update an existing goal

Query Physical Activity Goals

Action:

Patient Engagement or Referral Recipient queries physical activity-related Goals from a Care Manager based on patient id and category

Precondition: 

• Client system has permission to query Goals from server system
• Client has determined the server identity of the patient
• (ideally) Patient has physical activity goals available on the server

Success Criteria:  

Client system has a local copy of the patient's physical-activity related goals

Bonus point:

• Filter to only include goals in a specific time-range
• Filter goals by status (in-progress, completed, etc.)
• Try for a patient who has no goals

Update Physical Activity Plan

Action:

A Patient Engagement or Referral Recipient PUTs changes a physical activity-related CarePlan on a Care Manager

Precondition: 

• Client system has permission to update physical activity care-plans on the server system
• There is a current CarePlan with a category of 'physical-activity' on the server for the patient

Success Criteria:  

The CarePlan on the Care Manager reflects the changes

Bonus point:

• none

Query Physical Activity Plans

Action:

Patient Engagement or Referral Recipient queries physical activity-related CarePlans from a Care Manager based on patient id and category

Precondition: 

• Client system has permission to query CarePlans from server system
• Client has determined the server identity of the patient
• (ideally) Patient has physical activity care plans available on the server

Success Criteria:  

Client system has a local copy of the patient's physical-activity related care plan(s)

Bonus point:

• Filter care plans by status (in-progress, completed, etc.)
• Try for a patient who has no care plans

Query Exercise Prescriptions

Action:

Patient Engagement or Referral Recipient queries exercise prescriptions from a Care Manager based on patient id and category

Precondition: 

• Client system has permission to query ServiceRequests from server system
• Client has determined the server identity of the patient
• (ideally) Patient has exercise prescriptions available on the server

Success Criteria:  

Client system has a local copy of any patient's exercise prescriptions

Bonus point:

• None

Query Exercise Referral Tasks

Action:

Referral Recipient queries Tasks assigned to them from a Care Manager based on owner and status, with an _include to retrieve the associated ServiceRequest

Precondition: 

• (ideally) There are tasks assigned to the Organization, Practitioner, CareTeam or HealthcareService associated with the ReferralRecipient

Success Criteria:  

Referral Recipient has a list of Tasks and associated ServiceRequests assigned to it

Bonus point:

• Filter by status

Security and Privacy Considerations:

At this stage, security and privacy are not a focus.  The objective is to test the data structures and workflows and get implementers comfortable using FHIR.  Security layers will be folded in as part of future events..