Support for practitioner qualification information

[dbojicic-agency]

Prerequisites

• [x] I have searched open and closed issues to make sure it isn't already requested or reported
• [x] I have written a descriptive issue title

The issue / feature

Change description

Determine what kind of support and related terminology is needed for practitioner's qualification information. Practitioner.qualification.code has an example binding to v2 table 0360, Version 2.7 value set which does not include some key Australian qualifications. HL7 AU Base Practitioner defines a slice for recording Australian Health Practitioner Regulation Agency (AHPRA) qualification details (as text) only. We might need a broader value set that includes a set of codes which represent the possible qualifications, licences or registrations that a practitioner may hold in Australia.

What it actually enables people to do

Enables the use of standard terminology for the practitioner qualification in the electronic exchange between healthcare providers, and between healthcare providers and the My Health Record system infrastructure in Australia.

Mockups

If applicable, add screenshots or mockups to help explain the issue / feature.

How awesome would it be?

Pretty awesome - management by terminology binding is the preferred means in CI Agency profiles of specifying more than one allowed values for an element. This contributes to minimising the risk of inappropriate, invalid or obsolete clinical content.

Workarounds

Additional context

• Legacy Agency CDA specifications support capturing qualification as a text field in CDA schema data element of //assignedPerson/ext:asQualifications/@classCode="QUAL", where the qualification or list of qualifications is entered in //assignedPerson/ext:asQualifications/ext:code/originalText

• FHIR-driven CDA specifications support capturing qualification as a complex structure or as a text list:

  • as a text field in CDA schema data element of //assignedPerson/ext:asQualifications/@classCode="QUAL", where the qualification or list of qualifications is entered in //assignedPerson/ext:asQualifications/ext:code/originalText
  • as a complex structure ext:coverage2[prac_qual], where the qualification is represented in the CDA schema element of ext:coverage2[prac_qual]/ext:entitlement/ext:code as a code value (ext:code/@code) or as text (ext:code/originalText), or both. This element is bound to http://hl7.org/fhir/STU3/v2/0360/2.7/index.html with the strength of 'example'.

• AU Base GitHub #314 for discussion in HL7 AU PA work group

• Internal terminology ticket to author and publish the resulting healthterminologies ValueSet in NCTS FTR-776

Reference material

• SNOMED: Closest content in SNOMED is Occupation hierarchy, however this is occupation only and does not indicate qualification.

• AHPRA published data: AHPRA has advised that there is no national list of recognised health related qualifications/licences/certificates etc. This information may be available through each of the individual national boards that feed to AHPRA,

  • Data tool
  • Approved programs of study

• AIHW METeOR relating to qualification:

  • Provider academic qualification cluster
  • Healthcare provider qualification and registration cluster
  • Individual service provider—professional qualification title, text X[X(99)], Individual service provider—name of institution awarding qualification, text X[X(49)], Individual service provider—country of institution awarding qualification, code (SACC 2016) NNNN, Individual service provider—year professional qualification was awarded, YYYY
  • Individual service provider—provider's clinically proficient language, code (ASCL 2011) NN{NN}
  • Provider professional board cluster, Provider registration cluster, Provider extensions or restrictions to practice cluster
  • Individual service provider—provider registration sequence number, identifier NNN, Individual service provider—registration division, code (ANZSCO 2013 Version 1.2) N[NNN]{NN}, Individual service provider—registration type, code N, Individual service provider—registration subtype, code NN, Individual service provider—registration status, code N, Individual service provider—current registration substatus, code N, Individual service provider—registration start date, DDMMYYYY, Individual service provider—registration end date, DDMMYYYY, Individual service provider—specialty name, code (ANZSCO 2013 Version 1.2) N[NNN]{NN}, Individual service provider—field of specialty practice, code (ANZSCO 2013 Version 1.2) N[NNN]{NN}

• ABS Classification of Qualifications (ABSCQ) (https://www.abs.gov.au/AUSSTATS/abs@.nsf/5e3ac7411e37881aca2568b0007afd16/c0fa9a3d3b020826ca25697e00184be6!OpenDocument)

• Australian Qualification Framework

• Qualification Recognition: Overseas qualification recognition in Australia

[dbojicic-agency]

Looking for information requirements related to a practitioner qualifications in Agency specifications.

What is the use case for including practitioner qualification in patient-focused document/record exchange scenario? The concept of a practitioner in our exchange-specific specifications is within the context of a practitioner role, as the person acting in the role (on behalf of an organisation). The practitioner's qualifications are acquired by the practitioner independent of any organization or role. The qualifications may be irrelevant for the role that the practitioner is performing.

The practitioner qualification is not used for identifying practitioners in an exchange scenario either.

How is it used in common practice?

What are the rules associated with each qualification type (formal qualification, registration, licence etc), some types won't have an identifier? Is is important to specify the type - qualification, registration, licence etc? Do some qualification types have other attributes such as status/other conditions imposed on the specific type? How to record international qualifications? How to provide better terminology support for qualification - slice by qualification peak body?

[dbojicic-agency]

Checked with @davidmckillop, practitioner qualification information is not transmitted in v2 messages.

[dbojicic-agency]

Could not find any requirements related to practitioner qualification in any of the legacy Agency information requirements documents or any related use cases.

Emailed Agency BAs with a request for more information; response from GC:

It’s not used in MHR and to my knowledge – not used in P2P – until recently.

In MHR, we need to know the surname and HPII (where possible) and the role, as you mentioned. In the P2P world, I would not be surprised to see brief details about qualifications becoming important. There is an acknowledged use case for PSML where a role is: NURSE and the qualification is: MEDICINES COMPETENT. This signals that this nurse specialises in medicines and as such, is not a regular nurse. The precises details around the qualification are less important.

Electronic Prescribing has something called “Specialty”. Not all prescribers were created equal. For most, the role is PRESCRIBER and the speciality is “GENERAL PRACTITIONER”. There are other specialties that apply to the prescribing role and these are incredibly important to the PBS scheme.

https://meteor.aihw.gov.au/content/index.phtml/itemId/600681

(That link also doesn’t describe “VETINARY” speciality – which is recognised by the states)

To answer your question – qualification hasn’t been important in the past but it is an ‘emerging attribute’ that will become increasingly important as the Agency moves into the P2P world. I don’t think a lot of details are required as the author including the qualification in a document vouches for the accuracy and currency of that information.

[dbojicic-agency]

From the email above it seems evident Agency CI Practitioner models should keep must support flag on the qualification element. We don't have clear requirements around support for practitioner qualification including related terminology bindings. Until the use case and terminology requirements are better understood practitioner qualification can be supported as a text field, e.g.

FHIR:

<qualification>
      <code>
         <text value="CHC33015 Certificate III in Individual Support"/>
    </code>
</qualification>

CDA:

<ext:asQualifications classCode="QUAL">
   <ext:code>
      <originalText>CHC33015 Certificate III in Individual Support</originalText>
   </ext:code>
</ext:asQualifications>

[dtr-agency]

Queries on qualification

**1. How is it used in common practice?

2. What are the categories or qualification types of interest?
3. What are the rules associated with each qualification type (formal qualification, registration, licence etc), some types won't have an identifier?
4. Is is important to specify the type - qualification, registration, licence etc?
5. Do some qualification types have other attributes such as status/other conditions imposed on the specific type?
6. How to record international qualifications?
7. Is it meaningful to tag the region qualification was issued and more specifically if it is recognised in Australia?
8. How to provide better terminology support for qualification - slice by qualification peak body?**