An implementation guide for representation of the schedule of visits and other activities that take place in a clinical trial. Includes necessary extensions and profiles.
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General Comment Visits/Encounter - Definitional vs. Execution #28
URL: https://build.fhir.org/ig/HL7/Vulcan-schedule-ig/unscheduled-activities.htmlComment: Since the SoA itself is definitional, the execution of that plan may or may not align according to the plan. The mechanism which, for example, an EHR is to execute depends not solely on the CarePlan, but rather the logistical/administrative procedures. For CarePlan to occur, there must be an Appointment and corresponding AppointmentResponse, after which an Encounter goes into effect. This is the way my appointment process works via primary care EHR.
Therefore, the primary mechanism to execute a CarePlan and corresponding Encounter is scheduling (Schedule + Slots) to create an Appointment and trigger the AppointmentResponse. The workflow (Appointment, Schedule, Slot) + management (Encounter) + care provision (CarePlan) must be orchestrated during that execution phase. Note: This is a high-level detail of the components involved in the execution of the SoA.
Furthermore, there are different considerations concerning EHRs vs. ePROs vs. DHTs. Therefore, the delivery and location factors can change the prescriptive actions. For example, a ResearchSubject acts upon an ActivityDefinition using a virtual Encounter triggered via Subscription (vis-a-vis SubscriptionTopic) to notify them to use their home Device (DeviceUsage) to obtain a measurement (Observation).
In general, we should simply state that the SoA FHIR IG assumes that how activities/tasks get executed is dependent on their respective services, procedures, and administrative mechanisms. As mentioned, it will vary dependent on the scenario and how each system, application, device, etc. are setup.
Final note, we have not, to-date, tested this in an originating system (e.g., an EHR) to demonstrate how those factors are applied.
Example Scenario: A Patient visits their CVS (Clinical Trial Site) for an Unscheduled Walk-in Appointment [ref]
fhir:Appointment.appointmentType [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0276" ];
fhir:Coding.code [ fhir:value "WALKIN" ];
fhir:Coding.display [ fhir:value "A previously unscheduled walk-in visit" ]
]
];
URL: https://build.fhir.org/ig/HL7/Vulcan-schedule-ig/unscheduled-activities.html Comment: Since the SoA itself is definitional, the execution of that plan may or may not align according to the plan. The mechanism which, for example, an EHR is to execute depends not solely on the CarePlan, but rather the logistical/administrative procedures. For CarePlan to occur, there must be an Appointment and corresponding AppointmentResponse, after which an Encounter goes into effect. This is the way my appointment process works via primary care EHR.
Therefore, the primary mechanism to execute a CarePlan and corresponding Encounter is scheduling (Schedule + Slots) to create an Appointment and trigger the AppointmentResponse. The workflow (Appointment, Schedule, Slot) + management (Encounter) + care provision (CarePlan) must be orchestrated during that execution phase. Note: This is a high-level detail of the components involved in the execution of the SoA.
Furthermore, there are different considerations concerning EHRs vs. ePROs vs. DHTs. Therefore, the delivery and location factors can change the prescriptive actions. For example, a ResearchSubject acts upon an ActivityDefinition using a virtual Encounter triggered via Subscription (vis-a-vis SubscriptionTopic) to notify them to use their home Device (DeviceUsage) to obtain a measurement (Observation).
In general, we should simply state that the SoA FHIR IG assumes that how activities/tasks get executed is dependent on their respective services, procedures, and administrative mechanisms. As mentioned, it will vary dependent on the scenario and how each system, application, device, etc. are setup.
Final note, we have not, to-date, tested this in an originating system (e.g., an EHR) to demonstrate how those factors are applied.
Example Scenario: A Patient visits their CVS (Clinical Trial Site) for an Unscheduled Walk-in Appointment [ref] fhir:Appointment.appointmentType [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0276" ]; fhir:Coding.code [ fhir:value "WALKIN" ]; fhir:Coding.display [ fhir:value "A previously unscheduled walk-in visit" ] ] ];
Resource References: CarePlan.activity CarePlan.encounter Encounter.appointment Appointment.replaces Appointment.originatingAppointment Appointment.occurrenceChanged Appointment.start Appointment.end Schedule.serviceType Slot.serviceType Slot.appointmentType