Lower Extremity Skin Wound Assessment Implementation Guide STU1 CI Build

Lower Extremity Skin Wound Assessment - IG, published by HL7 International - Electronic Health Records Work Group. This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of https://github.com/HL7/fhir-skin-wound-ig/ and changes regularly. See the Directory of published versions

Use Case - Originate then Amend

Introduction

Wound Assessment and Treatment Template (WATT) Scenario - Use Case - Originate and Retain (null), then Amend (populate with clinical content).

Demonstrate how an EHR actor incorporates the FHIR Record Lifecycle Event (RLE) Implementation Guide (IG) processing of the Originate/Retain and Amend Record Content events when first recording the Wound Assessement Template data.

The focus of this use case is the verification and validation of recording and storage of the FHIR Record Lifecycle Event data represented by the FHIR Resource Types of AuditEvent and US Core Provenance (R4).

  • This represents the first trial definition of incorporating the RLE Originate and Retain event and RLE Amend event into the the WATT data creation. This is the simplest way for the local system to demonstrate that the “populate with clinical content” step began from an “all null clinical content” state. This also establishes that the null-state template may pre-exist on the local system for any interval (seconds to years) prior to its “Amend” to add an instance of assessment.
  • For future work, we may identify the complexity of demonstrating that the null-state version could be empty also of patient demographics, thus the null state could be used as the initial state for all subsequent patient-specific captures as Amend events to the all-null original.

 

Actors

The following actor and FHIR RLE events are part of this Use Case:

  • EHR - Example: Primary Care Physician (PCP)
    • FHIR RLE Events (internal):
      • Originate/Retain Record Entry
      • Evidence of Originate/Retain Record Entry
      • Amend Record Entry Content
      • Evidence of Record Entry Ammendment Event

 

Summary Workflow

This use case defines the FHIR Record Lifecycle Event processes performed by an EHR actor when first recording the Wound Assessment Template data for a given Patient encounter. The workflow is outlined in the following figure. Please note that although there are two separate workflows represented, both are executed in support of the first recording of the Wound Assessment Template data.

Use Case Originate and Amend
UseCase_Originate.jpg

 

Expected Behavior

The following is the expected behavior of the EHR actor system when implementing the FHIR RLE Events when first recording the Wound Assessment Template data:

1. Originate/Retain Record Entry The creation of the the Wound Assessment and Treatment Template (WATT) data as empty FHIR resource instances of

  • The WoundAssert Condition (R4) profiled Condition
  • The WoundRelatedObservationsPanel Observation (R4) profiled Observation
    • The various Wound profiled related Observations
  • Clarification - the empty WATT FHIR resource are expected to be minimally populated where only mandatory/required elements are assigned with known or default values. Please see the example resources in the section 1. Originate/Retain Record Entry below.

2. Evidence of Originate/Retain Record Entry The creation of the corresponding FHIR RLE AuditEvent and US Core Provenance (R4) resources related to #1.

3. Amend Record Entry Content The update of the initial data contents in the Wound Assessment Template data FHIR resource instances created in #1 of

4. Evidence of Record Entry Ammendment Event The creation of the corresponding FHIR RLE AuditEvent and US Core Provenance (R4) resources related to #3.

 

WATT Data Storage

The expectation for the EHR actor system is that all of the above RLE processes will be implemented as a single transaction. This will result in the EHR actor’s (FHIR) data repository storing two (2) versions the WATT data FHIR resources:

  • #1 - empty created version 1 instances, then
  • #3 - the updated current version 2 instances

 

RLE Data Storage

The expectation here is that the generated RLE data FHIR instances will be:

 

Data Examples

Example FHIR resource instances illustrating the expected contents of the WATT and RLE data (FHIR resource instances) the EHR actor system will store after each of the FHIR RLE Events:

1. Originate/Retain Record Entry

2. Evidence of Originate/Retain Record Entry

3. Amend Record Entry Content

4. Evidence of Record Entry Ammendment Event

 

Validation Test Details

Validation of Wound Assessment and Treatment Template (WATT) data

See Use Case - Search: Query and retrieval of the Wound Assessment and Treatment Template (WATT) data

Validation for Evidence of FHIR Record Lifecycle Event data

The EHR actor will provide standard FHIR GET search operation support for query and retrieval of the AuditEvent and US Core Provenance (R4) resource instances created from the RLE Evidence events #2 and #4.

AuditEvent

The search criteria will consist at a minimum of the AuditEvent patient parameter equal to the known Patient id and the date parameter set to a targeted datetime range. Additional optional search parameters could include the entity-type parameter equal to ‘Condition’ or ‘Observation’, and the type parameter equal to ‘C’ for Create or ‘U’ for Update.

Provenance

The search criteria will consist at a minimum of the Provenance patient parameter equal to the known Patient id and the recorded parameter set to a targeted datetime range. Additional optional search parameters could include the target parameter equal to the known ‘Condition’ or ‘Observation’ resource references.

Test Definition

Actors: Origin - External client system, or Test Platform; Destination - EHR actor (Note: Origin and Destination cannot be the same actor)

Test Data: See Data Examples above

Setup: If the destination system is pre-populated prior to the test execution with known test data, the setup step can be skipped. Otherwise, for automated testing, the testing platform can send the known test data to the destination system.

Action 1a (Test Step): Origin system executes a FHIR Search Interaction for the RLE AuditEvent or US Core Provenance (R4) resources matching a specific Patient id and date to the destination system

GET [base]/AuditEvent?patient=[Patient id]&date=[YYYY-MM-DD]

Accept: application/fhir+xml or application/fhir+json
GET [base]/Provenance?patient=[Patient id]&recorded=[YYYY-MM-DD]

Accept: application/fhir+xml or application/fhir+json

Action 1b (Test Step): Origin system executes a FHIR Search Interaction for the RLE AuditEvent or US Core Provenance (R4) resources matching a specific Patient id, date and WATT resource type to the destination system

GET [base]/AuditEvent?patient=[Patient id]&date=[YYYY-MM-DD]&entity-type=Condition

Accept: application/fhir+xml or application/fhir+json
GET [base]/Provenance?patient=[Patient id]&recorded=[YYYY-MM-DD]&target=Observation

Accept: application/fhir+xml or application/fhir+json

Request Success Criteria 1 (Asserts):

  • HTTP Accept header contains valid FHIR mime-type
  • GET URL - verify expected search parameters in path
  • HTTP response code is 200 (OK)
  • HTTP response body is a FHIR Bundle Resource Type
  • Validate the returned Bundle.entry.resource contents include the expected matching AuditEvent and/or Provenance instances
  • Validate returned Bundle against base FHIR specification Bundle profile (FHIR Validation Engine will perform individual validation of each Bundle.entry.resource using their declared profile conformance)

 

Summary of FHIR Artifacts

FHIR Resource Overview

Resources supported for this use case:

Resource Type Profile Name Link to R4 Profile
Patient US Core Patient Profile US Core Patient (R4)
Practitioner US Core Practitioner Profile US Core Practitioner (R4)
Encounter US Core Encounter Profile US Core Encounter (R4)
Condition WoundAssert Condition Profile WoundAssert Condition (R4)
Observation WoundRelatedObservationsPanel Observation Profile WoundRelatedObservationsPanel Observation (R4)
AuditEvent FHIR AuditEvent Profile FHIR AuditEvent (R4)
Provenance US Core Provenance Profile US Core Provenance (R4)