Patient Care Coordination (PCC) Implementation Guide
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Patient Care Coordination (PCC) Implementation Guide, published by Virtually Healthcare. This guide is not an authorized publication; it is the continuous build for version 0.1.1-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Virtually-Healthcare/R4/ and changes regularly. See the Directory of published versions

Clinical Assessment [ACDC]

References

Actors and Transactions

Actor Definition
Clinical Data Repository The system holding the patients provider health record
Clinical Decision Support  
Personal Health Record (PHR) Citizen held records, e.g. Apple Health and Google Health Connect
Personal Health Device (PHD) A device capturing health related data, e.g. Oura Ring, FitBit, etc

Overview

Device Data CaptureAssessmentDiagnosisTriagePlanInterventionnoEvaluate (still a problem?)yes

Remote Patient Monitoring Overview


Remote Patient Monitoring Process

Remote Patient Monitoring Process


Event ServiceClinical Assessment ServiceClinical Data Extraction Service[X] Clinical Knowledge ServiceClinical Data RepositoryEvent ServiceClinical Assessment ServiceClinical Data Extraction Service[X] Clinical Knowledge ServiceClinical Data Repositoryevent feed(FHIR Observation)This is probably a rules engine e.g.if X is higher than normal X then trigger Yopt[if a triggering event]This service performs the clinical assessment, this may be an external API or application.See alsoIHE Assessment Curation and Data Collection (ACDC)andHL7 Clinical AssessmentAssess Patient [PCC-X3]Assessment (FHIR QuestionnaireResponse)This is the same service used in SDCSee alsoHL7 SDC Form PopulateGet Assessment (automatically populated from existing data)Assessment (FHIR QuestionnaireResponse?)alt[if clinical assessment was complete]Clinical Assessment(FHIR ClinicalImpression and Observations (Calculated Scores))Store Clinical Assessment[Clinical Assessment not completed]Issues(FHIR OperationOutcome)Request Assessment (Data Capture) to be performed(FHIR Task)

Clinical Assessment


Pre Conditions

Data is entered into the Clinical Data Repository via Apple HealthKit/Google Health/Hl7 Personal Health Device integration or Structured Data Capture. This data is also sent to an Event Service, this emits the data as an event feed.

Event Feed

The Clinical Assessment Service inspects the event feed for triggering events. This is a series of rules such as (these have not been clinically verified):

  • if resting heart (LOINC 55425-3) is 10 beats higher than average resting heart rate for last two weeks then call Does Patient have COVID Clinical Knowledge Sevice
  • if body weight (SNOMED 27113001) recorded then perform Calculate BMI
  • if vital signs recorded and patient has active episode then perform NEWS2 Risk Calculations

Assess Patient

This performs the clinical assessment, to perform this assessment this may need to retrieve assessments from the Clinical Data Repository, these may be autopopulated from a combination of data entered an application (structured data capture) or data sourced from personnel health devices.

Clinical Assessment

Clinical Assessment Performed

If the clinical assessment can be performed then a FHIR ClinicalImpression and Risk Scores are returned. These should be stored in the Clinical Data Repository.

Not Performed

If clinical assessment can't be performed such as Obesity which requires a Waist Circumference measurement (SNOMED 276361009) or Height (SNOMED 50373000), then a request to perform an Assessment can be made.