PACIO Personal Functioning and Engagement Implementation Guide
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PACIO Personal Functioning and Engagement Implementation Guide, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 3.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pacio-pfe/ and changes regularly. See the Directory of published versions

Extension:

Official URL: http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-clinical-justification Version: 3.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: PFEDeviceRequestClinicalJustification
Other Identifiers: OID:2.16.840.1.113883.4.642.40.67.42.8

Groups information that supports the clinical justification for the device request. These can include assessment findings, and goals that may influence fulfillment of the device request.

  • assessments documenting the patient’s ability to use/interact with the device related to:
    • Cognition: If the patient has the cognitive capacity to use the device via the Brief Cognitive Assessment Tool (BCAT®) short form (LOINC 95872-8)
    • Physical Functioning: If the patient is physically able to use the device via the 9-Hole Pegboard Dexterity Test (LOINC 83141-2)
    • Vision: If the patient's visual capabilities are aligned with the device features via the Motor Free Visual Perception test (MFVP) (SNOMED-CT 396216003)
    • Health Literacy: If the patient has the ability learn how to use the device via the BRIEF health literacy screening tool (LOINC 95866-0)
    • Disability: If the patient has a disability that would need to be accommodated in the selection of a device via an indication in the patient’s demographic record of having a disability (ICD-10 Z73.6)
  • Documented observation of the patient’s usage of the requested device during an assessment that may influence the fulfillment of the device.
    • Example: A patient at a long-term care facility uses a cane to complete a walking assessment (e.g., the Centers for Medicare & Medicaid Services [CMS] Minimum Data Set [MDS] section GG items on walking distance) that is captured as observation data (via the derivedFrom data element within the PFE Use of Device profile).
  • Supporting information about the patient's goals that may influence fulfillment of the device request.
    • Example: A patient at an inpatient rehabilitation facility has a goal of living independently at home after knee surgery, which requires limiting the range of motion of their knee. To support this goal, the physical therapist overseeing their rehab submits device requests for a knee brace that limits range of motion and a grabbing tool to help compensate for limited mobility due to the brace. Supporting information related to the goal can include: Independent daily dressing assessment (e.g., items GG0130.F and G from the MDS captured in the LOINC panel 108256-9) and a pain assessment (e.g., section J from the MDS captured in the LOINC panel 108256-9) that are completed by the patient while wearing a knee brace and while using a grabbing tool (captured in the PFE Goal profile via an Observation under the “addresses” data element).
    • Example: A patient in a skilled nursing facility has a goal to gain weight and maintain it. The patient’s dietitian orders an enteral nutrition-related device. Supporting information related to the goal can include: Vital sign data regarding weight to assess gain/maintenance (captured in the PFE Goal profile via LOINC code 29463-7 under the “measure” data element), Nutrition orders (captured in the PFE Goal profile via a NutritionOrder under the “addresses” data element)

Context of Use

    This extension may be used on the following element(s)

Usage info

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Extension
... Slices for extension Content/Rules for all slices
.... extension:note 0..* Extension Clinical justification note
..... extension 0..0 Extension
..... url 1..1 uri "note"
..... value[x] 0..1 Value of extension
...... valueString string
...... valueAnnotation Annotation
.... extension:assessment 0..* Extension Supporting assessment information
..... extension 0..0 Extension
..... url 1..1 uri "assessment"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Clinical Test Observation | Personal Functioning and Engagement Collection | Personal Functioning and Engagement Single Observation) Value of extension
.... extension:use-of-device 0..* Extension Supporting device usage information
..... extension 0..0 Extension
..... url 1..1 uri "use-of-device"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Use of Device) Value of extension
.... extension:goal 0..* Extension Supporting goal information
..... extension 0..0 Extension
..... url 1..1 uri "goal"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Goal Profile) Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-clinical-justification"
... value[x] 0..0 Value of extension

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Extension
... id 0..1 string Unique id for inter-element referencing
... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... extension:note 0..* Extension Clinical justification note
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "note"
..... value[x] 0..1 Value of extension
...... valueString string
...... valueAnnotation Annotation
.... extension:assessment 0..* Extension Supporting assessment information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "assessment"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Clinical Test Observation | Personal Functioning and Engagement Collection | Personal Functioning and Engagement Single Observation) Value of extension
.... extension:use-of-device 0..* Extension Supporting device usage information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "use-of-device"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Use of Device) Value of extension
.... extension:goal 0..* Extension Supporting goal information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "goal"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Goal Profile) Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-clinical-justification"

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression

Summary

Complex Extension: Groups information that supports the clinical justification for the device request. These can include assessment findings, and goals that may influence fulfillment of the device request.

  • assessments documenting the patient’s ability to use/interact with the device related to:
    • Cognition: If the patient has the cognitive capacity to use the device via the Brief Cognitive Assessment Tool (BCAT®) short form (LOINC 95872-8)
    • Physical Functioning: If the patient is physically able to use the device via the 9-Hole Pegboard Dexterity Test (LOINC 83141-2)
    • Vision: If the patient's visual capabilities are aligned with the device features via the Motor Free Visual Perception test (MFVP) (SNOMED-CT 396216003)
    • Health Literacy: If the patient has the ability learn how to use the device via the BRIEF health literacy screening tool (LOINC 95866-0)
    • Disability: If the patient has a disability that would need to be accommodated in the selection of a device via an indication in the patient’s demographic record of having a disability (ICD-10 Z73.6)
  • Documented observation of the patient’s usage of the requested device during an assessment that may influence the fulfillment of the device.
    • Example: A patient at a long-term care facility uses a cane to complete a walking assessment (e.g., the Centers for Medicare & Medicaid Services [CMS] Minimum Data Set [MDS] section GG items on walking distance) that is captured as observation data (via the derivedFrom data element within the PFE Use of Device profile).
  • Supporting information about the patient's goals that may influence fulfillment of the device request.
    • Example: A patient at an inpatient rehabilitation facility has a goal of living independently at home after knee surgery, which requires limiting the range of motion of their knee. To support this goal, the physical therapist overseeing their rehab submits device requests for a knee brace that limits range of motion and a grabbing tool to help compensate for limited mobility due to the brace. Supporting information related to the goal can include: Independent daily dressing assessment (e.g., items GG0130.F and G from the MDS captured in the LOINC panel 108256-9) and a pain assessment (e.g., section J from the MDS captured in the LOINC panel 108256-9) that are completed by the patient while wearing a knee brace and while using a grabbing tool (captured in the PFE Goal profile via an Observation under the “addresses” data element).
    • Example: A patient in a skilled nursing facility has a goal to gain weight and maintain it. The patient’s dietitian orders an enteral nutrition-related device. Supporting information related to the goal can include: Vital sign data regarding weight to assess gain/maintenance (captured in the PFE Goal profile via LOINC code 29463-7 under the “measure” data element), Nutrition orders (captured in the PFE Goal profile via a NutritionOrder under the “addresses” data element)

  • note: string, Annotation: Captures the clinical justification or rationale for the medical necessity of a device request. Complements the DeviceRequest.reasonCode and DeviceRequest.reasonReference data elements.
  • assessment: Reference: Supporting information about patient assessments that may influence fulfillment of the device request. This includes assessments documenting the patient's ability to use/interact with the device related to:

    • Cognition: If the patient has the cognitive capacity to use the device (e.g., via cognitive test/scale)
    • Physical Functioning: If the patient is physically able to use the device (e.g., assessment)
    • Vision: If the patient's visual capabilities are aligned with the device features (e.g., via ICD code)
    • Health Literacy: If the patient has the ability learn how to use the device (e.g., via health literacy scale)
    • Disability: If the patient has a disability that would need to be accommodated in the selection of a device (e.g., via an demographic disability item)
  • use-of-device: Reference: Supporting information about the patient's usage of the requested device during an assessment that may influence fulfillment of the device request.
  • goal: Reference: Supporting information about the patient's goals that may influence fulfillment of the device request.

Maturity: 3

Differential ViewDifferential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Extension
... Slices for extension Content/Rules for all slices
.... extension:note 0..* Extension Clinical justification note
..... extension 0..0 Extension
..... url 1..1 uri "note"
..... value[x] 0..1 Value of extension
...... valueString string
...... valueAnnotation Annotation
.... extension:assessment 0..* Extension Supporting assessment information
..... extension 0..0 Extension
..... url 1..1 uri "assessment"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Clinical Test Observation | Personal Functioning and Engagement Collection | Personal Functioning and Engagement Single Observation) Value of extension
.... extension:use-of-device 0..* Extension Supporting device usage information
..... extension 0..0 Extension
..... url 1..1 uri "use-of-device"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Use of Device) Value of extension
.... extension:goal 0..* Extension Supporting goal information
..... extension 0..0 Extension
..... url 1..1 uri "goal"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Goal Profile) Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-clinical-justification"
... value[x] 0..0 Value of extension

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..* Extension Extension
... id 0..1 string Unique id for inter-element referencing
... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... extension:note 0..* Extension Clinical justification note
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "note"
..... value[x] 0..1 Value of extension
...... valueString string
...... valueAnnotation Annotation
.... extension:assessment 0..* Extension Supporting assessment information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "assessment"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Clinical Test Observation | Personal Functioning and Engagement Collection | Personal Functioning and Engagement Single Observation) Value of extension
.... extension:use-of-device 0..* Extension Supporting device usage information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "use-of-device"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Use of Device) Value of extension
.... extension:goal 0..* Extension Supporting goal information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "goal"
..... value[x] 0..1 Reference(Personal Functioning and Engagement Goal Profile) Value of extension
... url 1..1 uri "http://hl7.org/fhir/us/pacio-pfe/StructureDefinition/pfe-device-request-clinical-justification"

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression

Summary

Complex Extension: Groups information that supports the clinical justification for the device request. These can include assessment findings, and goals that may influence fulfillment of the device request.

  • assessments documenting the patient’s ability to use/interact with the device related to:
    • Cognition: If the patient has the cognitive capacity to use the device via the Brief Cognitive Assessment Tool (BCAT®) short form (LOINC 95872-8)
    • Physical Functioning: If the patient is physically able to use the device via the 9-Hole Pegboard Dexterity Test (LOINC 83141-2)
    • Vision: If the patient's visual capabilities are aligned with the device features via the Motor Free Visual Perception test (MFVP) (SNOMED-CT 396216003)
    • Health Literacy: If the patient has the ability learn how to use the device via the BRIEF health literacy screening tool (LOINC 95866-0)
    • Disability: If the patient has a disability that would need to be accommodated in the selection of a device via an indication in the patient’s demographic record of having a disability (ICD-10 Z73.6)
  • Documented observation of the patient’s usage of the requested device during an assessment that may influence the fulfillment of the device.
    • Example: A patient at a long-term care facility uses a cane to complete a walking assessment (e.g., the Centers for Medicare & Medicaid Services [CMS] Minimum Data Set [MDS] section GG items on walking distance) that is captured as observation data (via the derivedFrom data element within the PFE Use of Device profile).
  • Supporting information about the patient's goals that may influence fulfillment of the device request.
    • Example: A patient at an inpatient rehabilitation facility has a goal of living independently at home after knee surgery, which requires limiting the range of motion of their knee. To support this goal, the physical therapist overseeing their rehab submits device requests for a knee brace that limits range of motion and a grabbing tool to help compensate for limited mobility due to the brace. Supporting information related to the goal can include: Independent daily dressing assessment (e.g., items GG0130.F and G from the MDS captured in the LOINC panel 108256-9) and a pain assessment (e.g., section J from the MDS captured in the LOINC panel 108256-9) that are completed by the patient while wearing a knee brace and while using a grabbing tool (captured in the PFE Goal profile via an Observation under the “addresses” data element).
    • Example: A patient in a skilled nursing facility has a goal to gain weight and maintain it. The patient’s dietitian orders an enteral nutrition-related device. Supporting information related to the goal can include: Vital sign data regarding weight to assess gain/maintenance (captured in the PFE Goal profile via LOINC code 29463-7 under the “measure” data element), Nutrition orders (captured in the PFE Goal profile via a NutritionOrder under the “addresses” data element)

  • note: string, Annotation: Captures the clinical justification or rationale for the medical necessity of a device request. Complements the DeviceRequest.reasonCode and DeviceRequest.reasonReference data elements.
  • assessment: Reference: Supporting information about patient assessments that may influence fulfillment of the device request. This includes assessments documenting the patient's ability to use/interact with the device related to:

    • Cognition: If the patient has the cognitive capacity to use the device (e.g., via cognitive test/scale)
    • Physical Functioning: If the patient is physically able to use the device (e.g., assessment)
    • Vision: If the patient's visual capabilities are aligned with the device features (e.g., via ICD code)
    • Health Literacy: If the patient has the ability learn how to use the device (e.g., via health literacy scale)
    • Disability: If the patient has a disability that would need to be accommodated in the selection of a device (e.g., via an demographic disability item)
  • use-of-device: Reference: Supporting information about the patient's usage of the requested device during an assessment that may influence fulfillment of the device request.
  • goal: Reference: Supporting information about the patient's goals that may influence fulfillment of the device request.

Maturity: 3

 

Other representations of profile: CSV, Excel, Schematron