How should the role of the author be represented in a document reference?


#1

In general EHR classification, recognised in both XDS & FHIR, there an assumption that the type of document is orthogonal to the role of the creator, so for instance a “report” could generated by a doctor or physio, or a “prescription” could be generated by a doctor or nurse etc. However it is reasonable for those trawling though extensive notes to wish to identify the source of the documents - e.g. to locate “physio notes” or “nursing notes” etc. In the XDS metadata scheme, the “author” attribute has a “role” which can be used for this (not ideal, as it is not server searchable and needs client side filtering, but at least it is there!). When doing an XDS <=> FHIR mapping I cannot identify any equivalent in the DocumentReference resource. The closest I can find are the qualifications of the practicationer - which is rather indirect and in any case a property of the practitioner not of the encounter/document or the PractitionerRole which has the same limitations. Am I missing something? What should be the quick way to retrieve only references to documents created by physiotherapsists?


#2

Most typically, the DocumentReference.type will pre-coordinate the kind of author where this is considered relevant. For example “Nurse note” as opposed to “General Medicine” note. Barring that, you’d need to look at the Practitioner. (In R4, there will also be a choice of PractitionerRole which will allow you to know what specific role was in play (GP, surgeon, dentist, etc.) when document was written - if that information happens to be known by whoever records the DocumentReference.


#3

Dave,

This is a known issue with DocumentReference. See http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=13266&start=0. The suggestion is to add PractitionerRole. I recall a discussion about whether the roles should be in relation to the clinical event (attending physician, etc.) or to the document (author, custodian), but don’t remember where that landed.


#4

Elliot & Lloyd,

Thanks for the feedback - this would definitely be worth adding for the “event” in my opinion.