We would like to use FHIR to notify providers about gaps in care for particular patients. For example, a gap in care could be a failure to administer a flu vaccine to an elderly patient or lack of a foot exam in the past year for a diabetic patient. If I understand correctly those should use the Flag resource. However I don’t see an obvious way to indicate which Practitioner is responsible for closing the gap.
Would it make sense to add a new Flag element named something like “responsible
”? The Type would be something like Reference (Practitioner | Organization | Group)
.
Have you looked at DetectedIssue?
Flag is more like a sticky-note on the front of a patient’s file. Agree that DetectedIssue sounds more appropriate for this scenario.
I had looked at the DetectedIssue resource but it seemed inappropriate due to this statement.
This resource only applies to documenting a risk associated with a specific planned or ongoing action, not a general propensity to risk.
Gaps in care generally do indicate only general propensities to risk. For example, if a diabetic patient hasn’t had a recent foot exam (nothing specific planned or ongoing) that increases the risk of a future amputation but doesn’t guarantee a bad outcome.
Have I misinterpreted the definition? Or should we consider expanding the definition for DetectedIssue to explicitly cover gaps in care? I am approaching the issue from the perspective of a payer sending a message to a provider organization asking them to take better care of one of our members.
It’s still applicable. Alert wasn’t intended to meet the use-case for DetectedIssue.
That language is intended to say that DetectedIssue isn’t intended to say something like “Drug A is contraindicated if a patient is on Drug B”, but rather “Drug A which is currently being prescribed is contraindicated with this patient’s existing Drug B medication”. I.e. It’s capturing patient-contextual and time-contextual risk manifestations, not generic knowledge statements about risks that can exist.
In your case, you’re dealing with a specific risk at a specific time to a specific patient related to ongoing action. You’re not trying to say “diabetic patients should have regular foot exams”, you’re trying to say “this patient is diabetic and has not had a recent foot exam”. The former would not be a candidate for DetectedIssue. The latter definitely is.
If you have recommendations about how we can make the description clearer, we would certainly welcome a change request (link at the bottom of any page in the spec).