Definition of health program participation observation (summary information)

[dtr-agency]

Information about participation in a health program is an observation with component observations - design decision as outcome from clinical information architecture workshop .

Solution options proposed in early design workshop 27/01/202: Observation, Procedure, Extension (complex), Encounter-grouped, Composition-grouped, List-grouped. Follow-up design workshop 01/02/22 to walkthrough solution options selected Observation to pursue.

Originally posted by @dtr-agency in https://github.com/AuDigitalHealth/ci-fhir-r4/issues/126#issuecomment-1057416718

[dtr-agency]

To support key strategic objectives in Australia in support of digital health and interoperable data standards developed in collaboration with our partners we will propose a national data model for health program participation information that is realised as HL7 AU FHIR materials published in the HL7 AU Australian Base Implementation Guide (AU Base 2) and governed by the HL7 AU standards process.

Outcomes of the design working group session 09/02/2022 Health Program Participation Information Architecture -> FHIR:

• Data model is program participation information – this will be handled by an Observation of program participation
  • HL7 AU profile proposed
  • ADHA profile will derive and constrain to support NCSR to MHR integration requirements
• It will be composite observation with the Observation.code scoping an observation of type of program participation information to a meaningful set of information – preferred to be handled by SNOMED CT-AU concepts that support typing program participation:
• Specific requirements to support cancer screening program participation with children as:
  • National bowel cancer screening program participation
  • National cervical cancer screening program participation
  • National breast cancer screening program participation
• Other expected needs include concepts like
  • Weight management program participation
  • Alcohol twelve step program participation

The composite observation parts of the program participation Observation are proposed to be the following with each needing a concept identifier - this list is expected to be winowed later on: 1. Program participation status : as CodeableConcept with binding to a preferred value set 2. Program participation status validity period : as DateTime | Period 3. Suspension of program participation : as Boolean

4. Reason for suspension of program participation : as CodeableConcept with binding to a preferred value set
5. Suspension of program participation period : as Period
6. Opted off of program participation : as Boolean
7. Reason for opting off of program participation : as CodeableConcept with binding to a preferred value set
8. Opting off of program participation period : as DateTime
9. Last program participation action : as CodeableConcept
10. Last program participation action date : as DateTime | Period
11. Next program participation action : as CodeableConcept
12. Next program participation action date : as DateTime | Period 13. Forecast status : as CodeableConcept 14. Forecast status period : as DateTime | Period

In the above list the DoH data model items requested to be shared with MHR system are in bold.

Terminology needs assessment

Forecast status First assessment of 'next screening actions’ (i.e. forcecast status in the above model) is that this looked to be multi-axial and incredibly targeted to only the national cancer screening programs – for now to be supported by text in the NCSR to MHR integration exchange. If any reusable national pieces of structure or terminology are identified then this decision can be revisited as needed.

Program participation observation types Request for Terminology to develop, if possible, a set of concepts to identify the type of observation of program participation status including:

• Cancer screening program participation:
  • National bowel cancer screening program participation
  • National cervical cancer screening program participation
  • National breast cancer screening program participation
• Other expected needs include concepts like
  • Weight management program participation
  • Alcohol twelve step program participation

Of interest is https://www.nhs.uk/conditions/nhs-screening/ for a list of the NHS screening programs.

Program participation status values Request for Terminology to investigate and develop if possible an appropriate set of concepts to indicate program participation status. The requirements from Dept of Health are expected to be only a subset of these concepts – and are scoped towards their reporting requirements.

The semantic meaning of the program participation values will be achieved by understanding what the participation status value means in the context of a particular program e.g. may understand that an individual is ‘actively screening’ if the program is a screening program and the status is a value of active involvement.

Dept of Health preliminary requirements for participation status that are of interest to the cervical and bowel national cancer screening programs: Never Responder | Overdue for Screening | New to Screening | Actively Screening | Not Eligible | Excluded | Age Exited

Reason for suspension of program participation / opt off of program participation Request for Terminology to investigate and identify/develop a set of concepts to support the reason for suspension of program participation. Also think a constrained set for disease screening program participation seems relevant.

Available reference material (but specific to disease or cancer screening): https://meteor.aihw.gov.au/content/index.phtml/itemId/568098, https://meteor.aihw.gov.au/content/index.phtml/itemId/568086, https://www.ncsr.gov.au/content/ncsr/en/contact-us.html?category=bowelScreening&enquiryType=reqDeferScreening.

[dtr-agency]

Table x. Example scenarios as FHIR Observation (with Patient, Organisation)

The table below that shows which examples include an instance of a component observation by marking an X for inclusion. The key is pretty basic, e.g. NBCSP-01 is NBCSP Participation Scenario 1. The hyperlinks go the html friendly pages not the master ADHA Confluence pages (NCSR Example Scenarios & Other Program Participation Example Scenarios).

Component	Included in Example FHIR Observation
	NCSR to MHR integration							Other
	NBCSP-01	NBCSP-02	NBCSP-03	NBCSP-04	NCSP-01	NCSP-02	NCSP-03	BCSP-01	BCSP-02	12alcohol-01
1. Program participation status	x	x	x	x	x	x	x	x	x	x
2. Program participation status validity period	x	x	x	x	x	x	x	x	x	x
3. Suspension of program participation	x	x	x	x	x	x	x		x
4. Reason for suspension of program participation									x
5. Suspension of program participation period									x
6. Opted off of program participation								x
7. Reason for opting off of program participation								x
8. Opting off of program participation period								x
9. Last program participation action
10. Last program participation action date
11. Next program participation action
12. Next program participation action date
13. Forecast status	x	x	x	x	x	x	x
14. Forecast status period			x							dtr-agency commented 2 years ago Clinical information model design normalisation Post normalisation proposal moves the separate data items for suspension of program participation (flag, period, reason) and opted off of program participation (flag, date, reason) into program participation (status, period, reason). This move requires that suspension and opt out be available as status concepts in the program participation status value set: **1. Program participation status : as CodeableConcept with binding to a preferred value set Program participation status validity period : as DateTime | Period** Reason for not participating (i.e. in FHIR element names 'status reason') : CodeableConcept Last program participation action : as CodeableConcept Last program participation action date : as DateTime | Period Next program participation action : as CodeableConcept Next program participation action date : as DateTime | Period **8. Forecast status : as CodeableConcept (maps NCSR next screening action) Forecast status period : as DateTime | Period (maps to NCSR next screening action date)** For discussion at design meeting 04/03/2022. See program participation status page here: https://confluence.hl7australia.com/display/PA/Program+Status dtr-agency commented 2 years ago DESIGN QUERY: Observation.category - current discussion indicates that ‘therapy’ or ‘social history’ are closest fit from existing Observation Category Codes but these are not ideal. Proposal is to extend the HL7 Int set of concepts with a localised concept for health programs including treatment programs and prevention programs. Proposed concept is ‘program’ with definition ‘Observations that describe an individual’s participation in one or more health programs such as treatment or prevention or public health (e.g. disease screening or substance use therapy)’. dtr-agency commented 2 years ago Post normalised design proposal in agreed with the following comments: Requirements for terminology to support typing the observation, i.e. enable indication of the type of information being shared - information on an individual's participation in a program. with the set of values supporting distinguishing between an individual's participation in a broad range of health programs, is well enough understood to submit a terminology request no use case for subject to be a Group at this time; restrict to Patient Participation status is 1..1. Requirements for terminology worked through and amendments made here: https://confluence.hl7australia.com/display/PA/Program+Status only minor changes made. This is ready to be submitted as a terminology request participation status validity period is appropriate reasons to not participate are well understood enough to be submitted as a terminology request discussion and agreement that the reason for enrollment in the health program is not to be captured in this observation this is an administrative observation not a clinical observation - there are a number of context elements, and this observation may be referenced by other structures when sharing that information reasons to not participate to be 0..* the other elements were not substantially changed and were confirmed as ok to move forwards into HL7 AU Post normalisation design review approved this design to progress to draft build and submission of PR to AU FHIR Base for adoption into Australian Base Implementation Guide (AU Base 2) subject to WG Approval and entry into HL7 AU Governance. dtr-agency commented 2 years ago Table x. Example scenarios as FHIR Observation (with Patient, Organisation) - WIP changes now to match post normalised structure. The table below that shows which examples include an instance of a component observation by marking an X for inclusion. The key is pretty basic, e.g. NBCSP-01 is NBCSP Participation Scenario 1. The hyperlinks go the html friendly pages not the master ADHA Confluence pages (NCSR Example Scenarios & Other Program Participation Example Scenarios). Element NBCSP-01 NBCSP-02 NBCSP-03 NBCSP-04 NCSP-01 NCSP-02 NCSP-03 BCSP-01 BCSP-02 12alcohol-01 Program participation status x x x x x x x x x x Program participation status validity period x x x x x x x x x x Reason for not participating               x x   Last program participation action                     Last program participation action date                     Next program participation action                     Next program participation action date                     Forecast status x x x x   x x x     Forecast status period x x       Suspension Flag (Potential for ADHA Profile only) x x x x x x x       dtr-agency commented 2 years ago Proposed concepts, definitions, data types, approved for progression. Below request sent to ADHA Terminology, managed by FHIR Terminology Requests FTR-1498. Please identify (or create if not available and it is possible to do so) matching SNOMED CT-AU terms that for the 14 concepts listed below. This request is in the context of sharing health program participation information. A mock-up of the information structure with this content including definitions is here https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/StructureDefinition-dh-observation-programparticipation-1.html. These concepts will be used as the 'name' in a name/value pair providing identification of the concept being valued when exchanged in a HL7 format (FHIR / CDA / V2). Concept list Name of concept for matching Program participation status Description of concept for matching Represents the current state of an individual's participation in a program. This status is only representative at the time this observation is asserted and may also represent participation exception states including exclusion or ineligibility. When this concept is valued in an instance, the element identified with the concept may have values such as: active, inactive, never participated, ineligible, new, planned, completed, suspended, excluded, cancelled. When used together the information structure becomes the equivalent of 'program participation status is active' Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation status, program participation status, or just participation status. Name of concept for matching Program participation status period Description of concept for matching The validity period associated with the program participation status. This may be a date where the status is meaningful when described by a point in time, e.g. date of death. This may be a period when associated with a status that can have a start and end date e.g. suspended. Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation period, program participation period, or just participation period. Name of concept for matching Suspension indicator / flag Description of concept for matching An indicator of whether a individual has suspended participation from a program, e.g. deferred an appointment or treatment action. The value is 'true' when the individual has suspended participation. Potential matches (if known) When valued for a disease screening program this concept is equivalent to Australian Institute of Health and Welfare data element 568068 Person—suspended participation from a disease screening program indicator. The AIHW concept is narrower in meaning than the target concept to match. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation suspension indicator, program participation suspension indicator, or just participation suspension indicator. Name of concept for matching Reason for not participating Description of concept for matching The reason why an individual is not actively participating in a program. This may be the reason why an individual's participation is suspended or stopped participating prior to completion. Potential matches (if known) When participation status is suspended and the health program is a disease screening program this concept is equivalent to Australian Institute of Health and Welfare data element 568096 Person—reason for suspending disease screening participation and data element 568098 Person—reason for suspending disease screening participation, code N. When participation status is opted off and the health program is a disease screening program this concept is equivalent to Australian Institute of Health and Welfare data element 568084 Person—reason for opting off a disease screening program and data element 732523 Person—reason for opting off a disease screening program, code N. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia. This concept may be matched to health program participation suspension reason, program participation suspension reason, or just participation suspension reason. Name of concept for matching Most recent action taken / last action taken Description of concept for matching The last action taken, with reference to a subject that is the focus of the action. This element may be used to indicate progress with reference to a particular protocol or pathway. Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to last action / most recent action. Name of concept for matching Date of most recent action taken / last action taken Description of concept for matching The time or time period of the last action taken, often with reference to a set of actions defined by a particular protocol or pathway. Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to most recent / last action date. Name of concept for matching Next action Description of concept for matching The next action expected or scheduled, often in reference to a particular protocol or pathway. Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to next action. Name of concept for matching Date of next action Description of concept for matching The time or time period of the next action. Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to next action date. Name of concept for matching Program forecast status Description of concept for matching Represents the most clinically relevant state at the time of assertion of this observation for future program participation, e.g. overdue or eligible at 25, and may repeat exception states relevant to forecasting program participation. This may be used in conjunction with reporting against an immunisation program.When this concept is valued in an instance, the element identified with the concept may have values such as: overdue, due now, eligible at (date), eligible at (age), completed, ineligible, completing at (age), completing at (date), exited at diagnosis, referral recommended. When used together the information structure becomes the equivalent of 'program forecast status is overdue' Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation status, program participation status, or just participation status. Name of concept for matching Program forecast status period Description of concept for matching The time or time period associated with 'forecast status'. When used together the information structure becomes the equivalent of 'program forecast status is overdue as at 19/01/2021' or 'program forecast status is eligible at (date) 03/04/22' Potential matches (if known) None known. Requested Terminology to find a match SNOMED CT Business Reason for Request To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation status, program participation status, or just participation status. dtr-agency commented 2 years ago Agency Terminology have advised the initial set of SNOMED CT-AU concepts that will be published to support this request are: 1603781000168102|Program participation status| 1603791000168104|Program participation status period| 1603871000168108|Program participation suspension indicator| 1603991000168102|Reason for program non participation| 1604001000168105|Most recent action taken| 1604011000168108|Date of most recent action taken| 1604021000168101|Next action| 1604031000168103|Date of next action| 1604041000168107|Program forecast status| 1604051000168109|Program forecast status period| Publication planned for the April 2022 release. dtr-agency commented 2 years ago Requested concepts published in the National Clinical Terminology Service in the SNOMED-CT AU 30 Apr 2022 release accessible via https://www.healthterminologies.gov.au/access/snomed-ct-au/snomed-ct-au-releases/ dtr-agency commented 2 years ago Development and internal design architecture review is complete, clinical Informatics peer review is underway via [AN-24] (https://jira.digitalhealth.gov.au/browse/AN-24) and AN-23. This is a review activity to close off internal development against the existing requirements and design before putting this work on hold. The NCSR to MHR integration project has been de-prioritised by Dept of Health so this work will go on hold. A complete, correct draft set of materials is intended to be handed over to the project on completion of this review activity. Temporary branch for review: http://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/NCSRIntegrationDraft/ dtr-agency commented 2 years ago Clinical Informatics peer review and limited testing complete via AN-24 and AN-23: Fix to typo in Composition.section.mode fixed value Improvement to Observation definition Added missing Must Support to Observation.component:participationStatus.code Removed erroneous Must Support from Observation.component:forecastStatus.code.text Other changes introduced via whole-sale enhancement to StructureDefinitions: Addition of condition attribute to element definitions Addition of XPath expression to invariants dtr-agency commented 2 years ago The NCSR to MHR Integration FHIR payload materials have completed development of this material including HL7 AU Base content, SNOMED CT-AU content, clinical Informatics peer review and limited testing, FHIR Architecture review, and Terminology review. This work is now on hold until progressed as part of a work program. Product realisation of NCSR concept (as part of integration with MHR) #130 remains open until the infrastructure identifiers for the NCSR (PAI-D, PAI-O, etc.) are registered. © Githubissues. Githubissues is a development platform for aggregating issues.

[dtr-agency]

Clinical information model design normalisation

Post normalisation proposal moves the separate data items for suspension of program participation (flag, period, reason) and opted off of program participation (flag, date, reason) into program participation (status, period, reason).

This move requires that suspension and opt out be available as status concepts in the program participation status value set: **1. Program participation status : as CodeableConcept with binding to a preferred value set

2. Program participation status validity period : as DateTime | Period**
3. Reason for not participating (i.e. in FHIR element names 'status reason') : CodeableConcept
4. Last program participation action : as CodeableConcept
5. Last program participation action date : as DateTime | Period
6. Next program participation action : as CodeableConcept
7. Next program participation action date : as DateTime | Period **8. Forecast status : as CodeableConcept (maps NCSR next screening action)
8. Forecast status period : as DateTime | Period (maps to NCSR next screening action date)**

For discussion at design meeting 04/03/2022.

See program participation status page here: https://confluence.hl7australia.com/display/PA/Program+Status

[dtr-agency]

DESIGN QUERY: Observation.category - current discussion indicates that ‘therapy’ or ‘social history’ are closest fit from existing Observation Category Codes but these are not ideal. Proposal is to extend the HL7 Int set of concepts with a localised concept for health programs including treatment programs and prevention programs. Proposed concept is ‘program’ with definition ‘Observations that describe an individual’s participation in one or more health programs such as treatment or prevention or public health (e.g. disease screening or substance use therapy)’.

[dtr-agency]

Post normalised design proposal in agreed with the following comments:

• Requirements for terminology to support typing the observation, i.e. enable indication of the type of information being shared - information on an individual's participation in a program. with the set of values supporting distinguishing between an individual's participation in a broad range of health programs, is well enough understood to submit a terminology request
• no use case for subject to be a Group at this time; restrict to Patient
• Participation status is 1..1. Requirements for terminology worked through and amendments made here: https://confluence.hl7australia.com/display/PA/Program+Status only minor changes made. This is ready to be submitted as a terminology request
• participation status validity period is appropriate
• reasons to not participate are well understood enough to be submitted as a terminology request
• discussion and agreement that the reason for enrollment in the health program is not to be captured in this observation this is an administrative observation not a clinical observation - there are a number of context elements, and this observation may be referenced by other structures when sharing that information
• reasons to not participate to be 0..*
• the other elements were not substantially changed and were confirmed as ok to move forwards into HL7 AU

Post normalisation design review approved this design to progress to draft build and submission of PR to AU FHIR Base for adoption into Australian Base Implementation Guide (AU Base 2) subject to WG Approval and entry into HL7 AU Governance.

[dtr-agency]

Table x. Example scenarios as FHIR Observation (with Patient, Organisation) - WIP changes now to match post normalised structure.

The table below that shows which examples include an instance of a component observation by marking an X for inclusion. The key is pretty basic, e.g. NBCSP-01 is NBCSP Participation Scenario 1. The hyperlinks go the html friendly pages not the master ADHA Confluence pages (NCSR Example Scenarios & Other Program Participation Example Scenarios).

Element	NBCSP-01	NBCSP-02	NBCSP-03	NBCSP-04	NCSP-01	NCSP-02	NCSP-03	BCSP-01	BCSP-02	12alcohol-01
Program participation status	x	x	x	x	x	x	x	x	x	x
Program participation status validity period	x	x	x	x	x	x	x	x	x	x
Reason for not participating								x	x
Last program participation action
Last program participation action date
Next program participation action
Next program participation action date
Forecast status	x	x	x	x		x	x	x
Forecast status period			x		x
Suspension Flag (Potential for ADHA Profile only)	x	x	x	x	x	x	x

[dtr-agency]

Proposed concepts, definitions, data types, approved for progression. Below request sent to ADHA Terminology, managed by FHIR Terminology Requests FTR-1498.

Please identify (or create if not available and it is possible to do so) matching SNOMED CT-AU terms that for the 14 concepts listed below. This request is in the context of sharing health program participation information.

A mock-up of the information structure with this content including definitions is here https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/StructureDefinition-dh-observation-programparticipation-1.html.

These concepts will be used as the 'name' in a name/value pair providing identification of the concept being valued when exchanged in a HL7 format (FHIR / CDA / V2).

Concept list

Name of concept for matching	Program participation status
Description of concept for matching	Represents the current state of an individual's participation in a program. This status is only representative at the time this observation is asserted and may also represent participation exception states including exclusion or ineligibility. When this concept is valued in an instance, the element identified with the concept may have values such as: active, inactive, never participated, ineligible, new, planned, completed, suspended, excluded, cancelled. When used together the information structure becomes the equivalent of 'program participation status is active'
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation status, program participation status, or just participation status.

Name of concept for matching	Program participation status period
Description of concept for matching	The validity period associated with the program participation status. This may be a date where the status is meaningful when described by a point in time, e.g. date of death. This may be a period when associated with a status that can have a start and end date e.g. suspended.
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation period, program participation period, or just participation period.

Name of concept for matching	Suspension indicator / flag
Description of concept for matching	An indicator of whether a individual has suspended participation from a program, e.g. deferred an appointment or treatment action. The value is 'true' when the individual has suspended participation.
Potential matches (if known)	When valued for a disease screening program this concept is equivalent to Australian Institute of Health and Welfare data element 568068 Person—suspended participation from a disease screening program indicator. The AIHW concept is narrower in meaning than the target concept to match.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation suspension indicator, program participation suspension indicator, or just participation suspension indicator.

Name of concept for matching	Reason for not participating
Description of concept for matching	The reason why an individual is not actively participating in a program. This may be the reason why an individual's participation is suspended or stopped participating prior to completion.
Potential matches (if known)	When participation status is suspended and the health program is a disease screening program this concept is equivalent to Australian Institute of Health and Welfare data element 568096 Person—reason for suspending disease screening participation and data element 568098 Person—reason for suspending disease screening participation, code N. When participation status is opted off and the health program is a disease screening program this concept is equivalent to Australian Institute of Health and Welfare data element 568084 Person—reason for opting off a disease screening program and data element 732523 Person—reason for opting off a disease screening program, code N.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia. This concept may be matched to health program participation suspension reason, program participation suspension reason, or just participation suspension reason.

Name of concept for matching	Most recent action taken / last action taken
Description of concept for matching	The last action taken, with reference to a subject that is the focus of the action. This element may be used to indicate progress with reference to a particular protocol or pathway.
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to last action / most recent action.

Name of concept for matching	Date of most recent action taken / last action taken
Description of concept for matching	The time or time period of the last action taken, often with reference to a set of actions defined by a particular protocol or pathway.
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to most recent / last action date.

Name of concept for matching	Next action
Description of concept for matching	The next action expected or scheduled, often in reference to a particular protocol or pathway.
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to next action.

Name of concept for matching	Date of next action
Description of concept for matching	The time or time period of the next action.
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia. This concept is not specific to the concept of program participation, it may be matched to next action date.

Name of concept for matching	Program forecast status
Description of concept for matching	Represents the most clinically relevant state at the time of assertion of this observation for future program participation, e.g. overdue or eligible at 25, and may repeat exception states relevant to forecasting program participation. This may be used in conjunction with reporting against an immunisation program.When this concept is valued in an instance, the element identified with the concept may have values such as: overdue, due now, eligible at (date), eligible at (age), completed, ineligible, completing at (age), completing at (date), exited at diagnosis, referral recommended. When used together the information structure becomes the equivalent of 'program forecast status is overdue'
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation status, program participation status, or just participation status.

Name of concept for matching	Program forecast status period
Description of concept for matching	The time or time period associated with 'forecast status'. When used together the information structure becomes the equivalent of 'program forecast status is overdue as at 19/01/2021' or 'program forecast status is eligible at (date) 03/04/22'
Potential matches (if known)	None known.
Requested Terminology to find a match	SNOMED CT
Business Reason for Request	To support the exchange of health program participation information in Australia as part of the the current work plan initiative: NCSR integration with MHR system. This concept may be matched to health program participation status, program participation status, or just participation status.

[dtr-agency]

Agency Terminology have advised the initial set of SNOMED CT-AU concepts that will be published to support this request are: 1603781000168102|Program participation status| 1603791000168104|Program participation status period| 1603871000168108|Program participation suspension indicator| 1603991000168102|Reason for program non participation| 1604001000168105|Most recent action taken| 1604011000168108|Date of most recent action taken| 1604021000168101|Next action| 1604031000168103|Date of next action| 1604041000168107|Program forecast status| 1604051000168109|Program forecast status period|

Publication planned for the April 2022 release.

[dtr-agency]

Requested concepts published in the National Clinical Terminology Service in the SNOMED-CT AU 30 Apr 2022 release accessible via https://www.healthterminologies.gov.au/access/snomed-ct-au/snomed-ct-au-releases/

[dtr-agency]

Development and internal design architecture review is complete, clinical Informatics peer review is underway via [AN-24] (https://jira.digitalhealth.gov.au/browse/AN-24) and AN-23.

This is a review activity to close off internal development against the existing requirements and design before putting this work on hold. The NCSR to MHR integration project has been de-prioritised by Dept of Health so this work will go on hold. A complete, correct draft set of materials is intended to be handed over to the project on completion of this review activity.

Temporary branch for review: http://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/NCSRIntegrationDraft/

[dtr-agency]

Clinical Informatics peer review and limited testing complete via AN-24 and AN-23:

1. Fix to typo in Composition.section.mode fixed value
2. Improvement to Observation definition
3. Added missing Must Support to Observation.component:participationStatus.code
4. Removed erroneous Must Support from Observation.component:forecastStatus.code.text

Other changes introduced via whole-sale enhancement to StructureDefinitions:

1. Addition of condition attribute to element definitions
2. Addition of XPath expression to invariants

[dtr-agency]

The NCSR to MHR Integration FHIR payload materials have completed development of this material including HL7 AU Base content, SNOMED CT-AU content, clinical Informatics peer review and limited testing, FHIR Architecture review, and Terminology review.

This work is now on hold until progressed as part of a work program.

Product realisation of NCSR concept (as part of integration with MHR) #130 remains open until the infrastructure identifiers for the NCSR (PAI-D, PAI-O, etc.) are registered.