I am a FHIR novice, so i may have missed it, but i do not see any Resources related to Inventory management and/or Procurement/Purchasing (similar to CXML)?
Is Procurement out-of-scope for FHIR? If not, are there any existing Resources for those usecases?
Thank you.
Marko.
.
We have SupplyRequest which allows items to be requested and we have Claim which can seek reimbursement. We don’t yet have BillableItem which can be used to associate a cost with an item, but will for release 4. At the moment, we don’t see a strong need to expand into general purchasing/procurement capability, though if there’s a significant desire for it, we could theoretically bring it into scope.
Thanks for the getting back Lloyd!
we don’t see a strong need to expand into general purchasing/procurement capability, though if there’s a significant desire for it, we could theoretically bring it into scope.
I would humbly suggest that there is broad desire (motivated by cost pressure and revenue opportunities) for Health Care Orgs to streamline the Procurement of Facility Supplies as well as directly filling Patient Orders or Referrals that are Reimbursed via Patient Insurance and/or out-of-pocket.
I have worked for a number of Medical Supply Distributors that are also under pressure to provide Automated/Electronic integration for Ordering Supply Products, DME, Prescribed Products, etc…
EHR/EMR, Practice Mgt Software, Procurement Hubs, are all being enhanced to support Procurement workflows for Facility Supplies, Patient Products, and Insurance Billing.
So i definitely see desire to standardize this type of integration/workflow.
I’m currently part of a team for a Medical Supply Org, and i have been asked to create a REST(ish) API for these usecases.
Previously we have used EDI and CXML for the Facility Supplies scenarios, and a combination of Custom-XML/CSV-Protocols and HL7 for the Insurance Billable ordering (HL7 segments we use include ORC, PID, RQD, IN1, DG1, ZW1, etc…).
Looking forward, i would really prefer if our new REST API was either conformant to FHIR, or easily mapped to FHIR, or at the very least i would like our API to be semantically consistent with the FHIR model where there is overlap.
Question?
As i move forward to spec an API to handle these usecase, if i intend to be consistent with the current FHIR model, would this Forum be the appropriate place to post work-in-progress for feedback (even if FHIR decides that Procurement will remain out-of-scope for the official API)?
Maybe you guys could consider a “sandbox” for API Vendor Extensions?
Thank you for your help.
Marko.
.
The desire to standardise the procurement workflow makes sense. The question is whether FHIR is the right vehicle to do this. It’s possible for us to do it, but in order for us to do it, we’d need to have the following:
In terms of Forums:
For the first, it would be useful to ask the fhir email list (see http://wiki.hl7.org/index.php?title=FHIR_email_list_subscription_instructions) and the implementers stream on chat.fhir.org to find out whether there’s interest in this. for #2, what SDOs are we concerned with? GS1, ISO HL7 has contact with, but what others are there? For detailed technical work… chat.fhir.org is probably best, if there’s the drive to go ahead
I will ask for comments on here from some of the contacts
Pinging a few of the regulators indicated that they doubt that this is something that makes sense for HL7 to take on. Most are focused on GS1xml
Hi Grahame.
Thanks for the feedback.
Pinging a few of the regulators indicated that they doubt that this is something that makes sense for HL7…
Are you saying these usecases feel out of scope for FHIR in general, or are you saying there appears to be no energy/resources to do this work for FHIR today?
Thank you for the reference to GS1, i was not aware of that standard. Do you think that is the most applicable standard that exists today for the usecases i’m concerned about?
I only took a quick look, but i did not see anything obvious in GS1 that covers procurement of health products that are paid for by Patient insurance (Medicare/caid and Private Insurance)?
For that scenario do you think GS1 or HL7 (or something else) is the best fit?
Thank you Grahame.
Marko.
.
The regulators felt that the use cases are outside HL7’s scope in general. I would have thought that products paid for a 3rd party is not an unusual situation in the supply chain space.
Thx Grahame.
I would have thought that products paid for a 3rd party is not an unusual situation in the supply chain space.
At least in my experience it’s not unusual.
If you have any insight on any standard that would best accommodate the usecase of Medical Facility Procurement paid-for using Patient Insurance, then please let me know:-)
Marko.
.
In the US X12 is the supply chain standards body, GS1 has similar standards which are used outside of the US. HL7 doesn’t typically touch the supply but has materials addressing from inventory through consumption and billing.
When you say “the usecase of Medical Facility Procurement paid-for using Patient Insurance”, do you mean that the facility purchases supplies and then resells to the patient(s), perhaps with little or no markup, or that the facility is just facilitating the patient’s order, where the patient, or their insurance, directly reimburses the product seller?
If the former then I expect the common 'supply chain in and patient bills/claims" to recover costs would apply, if the latter then the same model could apply but where the facility would be the “ship to” for the goods and the order/payment/claim would be between the product seller and the patient (the facility would not intermediate the business flow but may facilitate the order process on behalf of the patient).
Thx for the feedback Paul.
…or that the facility is just facilitating the patient’s order, where the patient, or their insurance, directly reimburses the product seller?
Yes, this is mostly the scenario we are dealing with (when i’m speaking as being part of a med product distributor).
…if the latter then the same model could apply but where the facility would be the “ship to” for the goods and the order/payment/claim would be between the product seller and the patient (the facility would not intermediate the business flow but may facilitate the order process on behalf of the patient).
The facility is involved to mostly place the Product Order and to help resolve issues that are preventing the Supplier from having an accepted claim (eg. if the claim info is incorrect or incomplete then the Facility would help resolve that).
Product is mostly around DME or Patient Med Supplies, not usually pharma.
For a fully electronic Order, the Facility EHR (or Practice Mgt Software) would be used to place orders.
The electronic Product Order would include Product info + all info need for the Supplier to submit a good Claim for Payment.
** Do you know of any standard that handles this usecase (X12, HL7, …)? Where a transaction includes not only a Product Order intended for a Patient, but also bundles all insurance information needed for the Supplier to successfully submit a Claim and receive Payment? The Order may request the Product be shipped to the Facility (eg. long-term care facility), or shipped directly to the Patient shipto.
Some particular examples might be:
A Dr. creating a referral for a breast-pump (expectant mother), then the Facility placing an electronic order for the Breast Pump, including all referral, order, dr/patient, insurance information. Supplier ships the BreastPump to the patient, and then files a claim against the Patients insurance.
A similar workflow could happen when a Dr. diagnoses a patient with a chronic condition (eg. Diabetes) and places an order/referral to the Supplier (eg. Diabetes strips). The Product Order would also include all necessary claim information. Patient is shipped the product, Supplier deals with insurance and facilitates any additional information needed from the facility/provider.
A nursing home may electronically order wound-care supplies for a resident patient. The Facility electronically sends the Product Order to the Supplier, including Dr. info (NPI,etc), Patient Demo, Referral/Order info (ICD codes, DWO, etc…), Insurance information, etc… Supplier sends the Product to the Patient (care-of the Facility). Supplier files the claim/invoice.
In all cases when a Product and required claim info is electronically submitted, the Supplier system attempts to validate all info before Shipping and Submitting a Claim. If the validation fails, then there a call-back workflow is used to resolve validation issues. The API also includes Order Status, Shipping info/status.
The API will also allows for creating recurring Product Orders (eg. chronic care supplies).
In some cases the Facility system supports integration of the Supplier Product Catalog (and Order Product from the Catalog).
I know I’m responding to an old thread about this, but there doesn’t seem to be any newer communication on this kind of topic. I’m in the process of evaluating and mapping my company’s data model to the FHIR specification for the purpose of communicating implant-related information between us and hospitals (who are our clients on our software). We also communicate purchase order information (essentially a list of Devices for a manufacturer that constitute a purchase order requisition). I understand that there was intent to provide the ability to do something akin to this kind of request and response in version 4, but thus far I’ve yet to see any movement on that.
We’re trying to standardize our communication format to FHIR and not having a model that represents a purchase order request and response will require us to either a) use some other model like SupplyRequest or Claim which isn’t really the intent of those models; or b) mix standards (such as using X12 850). In dealing with hospital IT, it is never a good idea to propose implementations that use too many different formats (assuming they can even handle standards such as FHIR in the first place, but we’re trying to push it).
Is it the community’s suggestion that a best practice here is to use SupplyRequest or Claim/ClaimResponse as a way to solve this for now? Or is it a better practice to simply mix standards (use JSON [or XML] FHIR for everything we can, but use X12 850 for Purchase Order Integration (https://www.1edisource.com/resources/edi-transactions-sets/edi-850/) ?
Thanks in advance.
So far, we’ve limited ourselves to resources that are in some way specific to healthcare. General procurement processes don’t really fit into that space. For the same reason, FHIR doesn’t support user/access control management, resources related to equipment maintenance, etc. You could handle purchasing/procurement using Basic if you wanted to.
That’s a good compromise, thanks so much @lloyd. We may try to go that route. I’m new to FHIR so I didn’t realize Basic existed for purposes such as this.
Much appreciated!
X12 850 would be appropriate as HL7 doesn’t do supply chain management.