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 - Search

Introduction

 

Actors

The following actors and FHIR interactions are part of this Use Case:

  • Wound Assessment Registry (and Repository)
    • FHIR Interactions from other EHR actors:
      • read and search of WATT data
  • EHR - Example: Primary Care Physician (PCP)
    • FHIR Interactions to Registry:
      • read and search of WATT data

 

Summary Workflow

This use case defines one or more FHIR search operations initiated by the EHR actor to the Wound Assessment Registry actor. The workflow is outlined in the following figure.

Use Case Search
UseCase_Search.jpg

 

FHIR Search Interactions

The first search interaction for the WATT retrieval will be based on the WATT profiled Condition resource type where the following search parameters will be incorporated:

  • _profile - The value will be fixed to the WATT profiled Condition resource type canonical URI “http://hl7.org/fhir/us/lower-extremity-skin-wound-assessment/StructureDefinition/WoundAssert”
  • asserted-date - Default to today’s date
    • Specific date, default can be current date; or,
    • Date range where one or two instances of the search parameter are given with either the ‘ge’ (greater than or equal) or ‘le’ (less than or equal) prefixes
  • patient - (Optional, if known) Specific Patient.id reference

The second search interaction for the WATT retrieval will be on the WAT profiled related Observation(s) referenced from the returned WATT Condition resources in the first search interaction where the follow search interactions will be incorportated:

  • _id - The WAT related Observation wound panel resource id(s) returned from the first search
  • _include:recurse (WoundRelatedObservationsPanel) - Observation:related-target

 

Examples

Specific date search

GET [base]/Condition?_profile=http://hl7.org/fhir/us/lower-extremity-skin-wound-assessment/StructureDefinition/WoundAssert&asserted-date=2019-04-19&patient=1234

Date range search

GET [base]/Condition?_profile=http://hl7.org/fhir/us/lower-extremity-skin-wound-assessment/StructureDefinition/WoundAssert&asserted-date=ge2019-04-18&asserted-date=le2019-04-20&patient=1234

 

Implementation Details

EHR search for WATT data from Wound Assessment Registry (WAR)

The process of a single EHR actor retrieving existing specific Lower Extremity Skin Wound Assessment data from the Wound Assessment Registry (WAR) is done via a FHIR GET search operation that targets the Lower Extremity Skin Wound Assessment conformant (profiled) Condition resource type. The search criteria will consist at a minimum of the Condition.meta.profile equal to the Lower Extremity Skin Wound Assessment IG WoundAssert profile canonical URL and a targeted datetime range. An additional search result parameter for inclusion of the WoundRelatedObservationsPanel profiled Observation Resources will also be defined in the search criteria parameters. This _include result parameter will also have the :recurse modifier in insure all related Observations in the panel are returned.

The expectation is that the WAR will manage the wound data to insure there is no duplication of data. For example, if the targeted datetime ranges for muliple search interactions overlap, the WAR will examine each Resource returned to determine if that Resource has already been received from a prior search interaction. If a Resource is received and matches an existing Resource previously received, the WAR will either replace that Resource or perform a FHIR update (preferred) of the existing Resource.

The WAR will manage the retrieved data to insure there is no loss of data. For example, the WAR will insure the targeted datetime ranges between search interaction executions do not have any datetime gaps, or provide a degree of datetime period overlap where duplication of data is handled (see above).

Test Definition

Actors: Origin - EHR actor, or Test Platform; Destination - Wound Assessment Registry (WAR) (Note: Origin and Destination cannot be the same actor)

Test Data: See Use Case - Originate and Retain (null), then Amend (populate with clinical content) See Use Case - Receive and Retain

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 Lower Extremity Skin Wound Assessment Condition(s) matching a specific date and optional Patient to the destination system, or

GET [base]/Condition?_profile=http://hl7.org/fhir/us/lower-extremity-skin-wound-assessment/StructureDefinition/WoundAssert&asserted-date=[YYYY-MM-DD]{&patient=[Patient id]}

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

Action 1b (Test Step): Origin system executes a FHIR Search Interaction for the WATT Condition(s) within a specific date range and optional Patient to the destination system

GET [base]/Condition?_profile=http://hl7.org/fhir/us/lower-extremity-skin-wound-assessment/StructureDefinition/WoundAssert&asserted-date=ge[YYYY-MM-DD]&asserted-date=le[YYYY-MM-DD]{&patient=[Patient id]}

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 all returned Bundle.entry.resource contents declare profile conformance to Lower Extremity Skin Wound Assessment IG
  • 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)

Action 2 (Test Step): Origin system executes a FHIR Search Interaction for the WATT related Observation(s) for a WATT Condition retrieved in Action 1a or 1b to the destination system

GET [base]/Observation?_include:recurse=Observation:related-target&_id=[WATT Condition id]

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

Request Success Criteria 2 (Asserts): (for peer-to-peer)

  • 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 all returned Bundle.entry.resource contents declare profile conformance to Lower Extremity Skin Wound Assessment IG
  • 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)