Map [Subjective Objective Assessment Plan] SOAP to HL7 - FHIR

Hello I am new to HL7 and FHIR , I am currently trying to find best resources to map SOAP [Subjective Objective Assessment Plan] documents into FHIR.

I have attached the example sample of SOAP document :

Key pieces are -> Patient Info, Clinic info, initial examination, goals, objective, assessment, Plan, Patient Problems , Procedures and Consent.

One of the idea is to use ClinicalImpression to do [Subjective, Objective, Assessment, Plan] but the maturity level is 0, are there more mature models that can be used instead? Or any examples on how it is solved at other places?

Also are there any mapping tools or other resources available that can be utilized for this issue?

Sample Document

Appreciate your help.

ClinicalImpression is the right place to look. FHIR tries hard to make sure we don’t have multiple places for the same information, so you won’t find a more mature alternative. The maturity of the ClinicalImpression resource is tied to the fact that it’s relatively new and also to the fact it hasn’t been well exercised yet. In terms of mapping tools, lots of interface engines now have FHIR capabilities. As well, you might look at StructureMap.

Thanks @lloyd for your prompt response and guidance, I wanted to make sure we look at appropriate resources before we start mapping exercise.

With the process of maturity will it mean there is possibility there is a risk of our mapped data getting obsolete and might require lots of rework, or does the data elements stay the same ?

can you recommend any tool to help us with this exercise?

There’s no guarantee of the data elements staying the same for any resource until it becomes normative. (A small number of resources may become normative in the R4 release at the end of 2018, but most clinical resources won’t be candidates for normative until 2020 or later.) The odds of change are higher the lower the FMM level is. FMM 0 means that the work group doesn’t consider the design “finished” yet so it may not be suitable for production use. You’re free to use it, but you may find some aspects don’t work well and you may find extensions are necessary.

In terms of tooling, the first question is whether you’re going to support only JSON, only XML or both. Also, does your organization already have an integration engine that you use?

Thanks @lloyd for the explanation of maturity level’s in depth and that makes me feel that it might not be a good choice for the organization, what is your opinion if I use following set of resources to solve same problem - Procedures, Condition, carePlan, goal, consent.

We are using json for new architecture but would like to expose both options for api.

Currently we use Mirth as integration engine.

Using the wrong resources will mean even greater migration in the future. If you’re not comfortable building in a layer to support transformation and accomodation of future changes in the specification, it may be that FHIR itself isn’t the right solution for your organization. Several of the resources you identified don’t have super-high maturity levels either. And realistically, a full SOAP solution would have likely included both ClinicalAssessment and several of those other resources.

At this point, thousands of organizations have implemented FHIR even though it is not yet locked down and substantive changes are still being made to resources between versions. The belief of these implementers is that their savings in being able to easily communicate with other systems through the user of a “standard” interface as opposed to building their own custom interface, together with the ability to leverage the though, expertise and considerable implementation experience that’s gone into FHIR together outweigh the cost of accomodating future changes to the specification. You’ll need to determine based on your implementation space whether that cost-benefit evaluation holds the same for your organization - it won’t for everyone.

Thanks @lloyd I really appreciate your time and guidance in helping me identifying best solution for my organization.

1 last question - do you think ClinicalAssessment applies to Physical Therapy SOAP notes also?

Yes. The principle action is the same regardless of medical discipline.

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FYI - There has been recent discussion about using the Composition resource for unstructured SOAP notes (there can be structured data, such as patient, encounter, author, date, chief complaint, note type, status, but the main content of note, itself, is textual narrative).

The Structured Document work group owns the Composition resource and their Dec 14 meeting minutes captures some of the discussion as well as the next steps to clarify the Composition documentation and test the proposal at a Connectathon:

Thank you so much @michellemiller, I was looking for a container to hold SOAP notes but I probably did not frame my question properly. We will continue our design with Composition as the container, and closely follow the progress of “Clinical Note” and also the examples that work group is planning to release.

Really appreciate your help and direction.