The ADI Track will test the exchange of patient authored advanced directive information and build upon the prior testing done in the January 2021 and May 2021 Connectathons. The additional focus will be on the use cases of updating content [4] and verifying the current version of advanced directive content [5].
Focus areas include:
- Portable Medical Order - (FHIR Document or Scanned)
- Person Authored Data - Personal Advance Care Plan (PACP)
- Document Sharing
- Authenticated/authorized access (security)
ADI Document Types
Scenes
Scene 1: Create Portable Medical Order (PMO)
- The Primary Care Physician (PCP), consulting with the patient, creates Portable Medical Order (PMO) in digital form
- The PMO Document may be made available in the source system through a FHIR Server (e.g. an EHR with a FHIR Server)
Scene 2: Share a Portable Medical Order
- The source system of the PMO send the data to an external registry or repository
- There are several technical architectures that exist throughout the US.
- This document may be pushed out directly to a portable medical order registry or be shared with a state HIE. This HIE may act as a PMO registry or a conduit for an external registry.
- The exact architecture tested will depend on the participants testing.
Scene 3: Query and access of the Portable Medical Order
- The patient wants to review their active Portable Medical Orders
- The patient using a client facing app queries for their Portable Medical Order documents.
- During an appointment with a specialist provider, there is a review of the Portable Medical Orders.
- The practitioner, using an EHR, queries for active Portable Medical Orders
Scene 4: Updating the Portable Medical Order
- During the review of the Portable Medical Orders for the patient, it is determined that a change needs to be made to the active Portable Medical Order
- In consultation with the patient, the specialist creates a new Portable Medical Order
Scene 5: Sharing the updated Portable Medical Order
- The source system of the PMO send the data to an external registry or repository
- The source system marks the replaced Portable Medical Order as superseded with a reference to the new Portable Medical Order
Scene 6: Query and access of the updated PMO (with additional clients)
- The patient wants to review their active Portable Medical Orders
- The patient using a client facing app queries for their Portable Medical Order documents.
- During an emergency encounter another provider, which can be EMS, retrieves the active Portable Medical Order to determine what the order specifies for medical interventions
- The provider, or EMS, using their EHR/EMR/clinical record system, queries for active Portable Medical Orders to guide care delivery
Bonus Scenes (Separate Patient)
Bonus Scene 1: Revoke Portable Medical Order
- A provider determines, in consultation with the patient, that the information in a Portable Medical Order was issued in error or that having a Portable Medical Order for the patient is no longer appropriate
- The provider marks the Portable Medical Order as revoked or voided and updates the source registry or repository
- There are several technical architectures that exist throughout the US.
- This document may be revoked in the provider's EHR/EMR/clinical record system or a registry/repository which, depending on the architecture may be propagated to other systems
Bonus Scene 2: Query and access of the Portable Medical Order
- A provider at a skilled nursing facility needs to review the patients Portable Medical Orders as part of their standard policy.
- The practitioner, using an EHR, queries for active Portable Medical Orders, and will not see the revoked or voided portable medical order.
- The practitioner can query for revoked or voided orders and will be able to see the inactive order.
System Roles
AD Information Creator (Client)
- A system that creates an ADI IG Conformant set of FHIR resources, stores, and pushes to another system (An ADI Information Receiver)
- Advance Preparation: The system will be able to create portable medical order documents (FHIR Document Reference) and send them through a FHIR interface.
AD Information Receiver (Server)
- A system, acting as a FHIR Server, receives an ADI IG Conformant set of FHIR resources.
- These resources may be utilized for display only or enable them to be made available for query (Acting as an ADI Information Repository or Portable Medical Order Registry)
- Advance Preparation: The system will be able to receive and store AD DocumentReference resources through a FHIR interface.
AD Information Repository (Server)
- A system that stores ADI documents and makes them available for query, ADI IG Conformant FHIR resources.
- Advance Preparation: The system will be able to store AD DocumentReference resources and make them available for query through a FHIR interface.
AD Information Requester
- A system that queries an AD Information Repository for advance directive FHIR resources and displays or otherwise uses the information contained within.
- Advance Preparation: The system will have the ability to query for AD DocumentReference resources through a FHIR interface.
