Minutes - Referral WG 2021-01-04

Attendees

• 7
• Erwin Bellon
• José Costa Teixeira
• Karen Anthonissen
• Karlien Erauw
• Nick Hermans
• Pieter Devolder
• Robin Bosman
• Sander Van den Wyngaert

Excused

• Andries Nelissen
• Arnaud Lippert
• Bruno Casneuf
• Elfi Goessaert
• Jean-Michel Polfliet
• Katleen Smedts
• Robin Decoster
• Tom Deprez
• Wouter Huysse

Agenda

• Closure of medical imaging referral
• Next steps
• Review of the updated datamodel and technical FHIR artefact
• Review of example on modalities
• Further take-up in other organisations

Minutes

• Closure of medical imaging referral

• last update:

• add supporting information, only when relevant; see Guidance in 2.4.3: "The profile contains a few elements that can contain supporting information. It SHALL be clear, these elements are there to only include information that is considered relevant within the context of this prescription. These elements are not to be used to construct an exhaustive dossier of the patient." and in be-ext-supporting-info (Relevant clinical information in the context of this prescription concerning for example allergies, kidney function, diabetic. This extension allows the use of a codeableConcept or Annotation but when more detailed information can be given, it is RECOMMENDED to express it as structured as possible using the appropriate elements (for general relevant supporting information, this means the use of the .supportingInfo element.) ContraIndications SHALL be expressed using the contraIndication modifierExtension.) and supportingInfo (that is part of the basic profile ; Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements)
• addition in orderDetail (part of basic profile): modality to put acquisition modalities, with slicing ; in this case you have to use the dicom nema coding system
• examples are available

• Way to evolve to federal standard: following the governance as published last year. Sponsor needs to initiate the project through a form/document "FHIR project proposal". This form is being circulated and ends up at the WGSE that does a quality control. It helps if documents outlines that work has already been done with different stakeholders/domain experts present. Afterwards it moves on to the Program Board that advises that a federal profile would be good or not. IF the advice is negative, it can be published as HL7 Belgium standard. If the advice is positive, it is published as Belgium federal standard.

• Robin presents the

• modifierExtension: obligatory to pass on, v3-NullFlavor can be given, example of null flavor: asked but unknown (ASKU)

• Null Flavors is HL7 concept, see values: https://terminology.hl7.org/2.1.0/CodeSystem-v3-NullFlavor.html

• modifierExtension BeContrastFluidUse, see http://build.fhir.org/ig/hl7-be/hl7-be-fhir-referral-prescription/ValueSet-be-contrastfluid-use.html having 2 values
• reasonCode element
• see examples: http://build.fhir.org/ig/hl7-be/hl7-be-fhir-referral-prescription/ServiceRequest-diagnostic-imaging-basic-example-concreteWithDetails.xml.html

• the Belgian FHIR profile for vaccination has been used to influence the FHIR profile at European level

• Erwin has composed a list with questions that mainly need to be answered by the politics
• Review of the updated datamodel after the discussion in the previous WG ; unfortunately there was a technical issue with the publication

• logical model has been cleaned, heritage from BeReferralPrescription
• diagnostic questioning
• extension for codeable concept
• modifier extension for contra indication as it is important ; with its own structure and preferrably expressed as a structure
• supporting info: goal is that only relevant information is sent in the referral

• Should/shall we enforce for Acquisition Modality: http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html

• Clarification by RIZIV: the referrals will be active and identical intramuros and extramuros

• however if intramuros there are additional requests, it would be fine as long as it fits in the general model
• for complex cases it might be difficult to capture all the details in the referral (f.e. 3D modelling for surgery)
• intramuros there are detailed modules for medical imaging
• a good balance will have to be sought here to avoid that we keep discusssing for years

• Robin will finalise the technical structure to finish the medical imaging referral

• can we move to a federal standard ? We will have to go through a formal request, then through the WGSE (WG Structural Elements) and the eHealth Program Board

Date Next Meeting : April 15 at 4PM which will on a new referral: kine or nursing Action point:

• Karlien should ask for 45/60minute slot to present to 3 associations: BVR, Belg vereniging voor Nuclaire geneeskunde, BELMIP ?Karlien to take action here
• Karlien to reach out to stakeholders