CapabilityStatement prototype for MHV as a FHIR Server exposing PHR data

A profile on the DocumentReference resource that covers all uses of FHIR DocumentReference in the MyHealtheVet FHIR API. This includes Physician Notes, Discharge Summary, and ECG/EKG reports.

This defines the use for Chem-Hem and DiagnosticReport, with contained Observation and Specimen as needed.

A profile on the AllergyIntolerance resource for MHV PHR exposing Allergies using FHIR API.

A profile showing how HDR labTests.chemistryResults will be exposed using FHIR API to MyHealtheVet PHR.

One Observation holds one labTests.chemistryResults

• This profile is based on US-Core Lab
  • category must have http://terminology.hl7.org/CodeSystem/observation-category#laboratory
• .subject must be the patient from the DiagnosticReport
• valueInterpretation -> .interpretation
• testIdentifier -> .code – where LN is Loinc
• referenceRange -> .referenceRange.text – dont try to break out further as there is little use of this value
• labCommentEvents -> .note.text
• value[x] either String or Quantity with units
• observationValue -> .valueQuantity.value
• observationUnits.unit -> .valueQuantity.unit
• observationUnits.code -> .valueQuantity.code - likely need to adjust some
• observationUnits.codingSystem -> .valueQuantity.system
• performingOrganization -> .performer
• labCommentEvents -> '.note`
• effective[x] is same as the DiagnosticReport
• issued is same as the DiagnosticReport
• specimen = specimen
• basedOn = ServiceRequest
• ObservationStatus' -> [concept map translation](ConceptMap-VF-ChemistryResult-ObservationStatus.html) -> .status`

A profile showing how HDR labTests.orderedTestCode (Order) using FHIR API to MyHealtheVet PHR.

One ServiceRequest holds one labTests.orderedTestCode. Where multiple orderedTestCode elements exist, multiple ServiceRequest are used.

• .subject must be the patient from the DiagnosticReport
• code = {labTests.orderedTestCode}
• status = unknown
• intent = order
• category = SCT#108252007 Laboratory procedure
• specimen = specimen
• not populating US-Core must support as we dont have the values
  • occurrence[x], authoredOn
• requester is the requesting provider
• facility is the requesting facility
• no other elements are populated

A profile on the DocumentReference resource for MHV PHR exposing ECG/EKG (ClinicalProcedureTO) using FHIR API.

A profile showing how the labTestPromises.specimen is mapped into a FHIR Specimen.

• This is usually a contained resource, contained in the Lab Report. The use of contained is for simplicity sake and to limit the need to manage Specimen resource instances
• must have a type
  • Specimen.type.text <- labTestPromises.specimen.specimenSource
• should have a collectedDateTime derived from labTestPromises.specimen.specimenTakenDate

Profile on DiagnosticReport for Chem-Hem lab report.

A profile on the DiagnosticReport resource for MHV PHR exposing Imaging Report (ImagingExamTO) using FHIR API.

A profile showing how ImagingExamTO.order (Order) using FHIR API to MyHealtheVet PHR.

One ServiceRequest holds one ImagingExamTO.order. Where multiple order elements exist, multiple ServiceRequest are used.

• .subject must be the patient from the DiagnosticReport
• code.text = {imagingExamTO.order.type.name1}
• status = unknown
• intent = order
• category = SCT#363679005 Imaging
• not populating US-Core must support as we dont have the values
  • occurrence[x], authoredOn
• requester is the requesting provider
• facility is the requesting facility
• no other elements are populated

A profile on the Immunization that declares how MHV will expose PHR immunization.

A profile for the contained Observation indicating an immunization reaction

• status final
• code.text ImmunizationTO.reaction
• valueCodeableConcept - SNOMED#401515003 Known present
• effectiveDateTime from ImmunizationTO.administeredDate if known
• subject - the patient
• performer - migth come from ImmunizationTO.encounter.provider but can't have contained resources in a resource that will be contained.

A profile showing how the Microbiology and Pathology LabSpecimenTO is mapped into a FHIR Specimen.

A profile on the Location resource for MHV PHR exposing Location using FHIR API.

• based on US-Core for Location
• identifier
  • system = urn:oid:2.16.840.1.113883.4.349
• name is the name as known
• always a contained resource, so not exposed RESTfully

NOT USING Mapping to VIA HospitalLocationTO.

A profile showing how Microbiology LabReportTO is mapped into a FHIR DiagnosticReport, Observation, and Specimen.

A profile on the DocumentReference resource for MHV PHR exposing Notes (NoteTO) using FHIR API.

A profile on the Organization resource for MHV PHR exposing Organization using FHIR API.

• based on US-Core for Organization
  • must have a status
  • must have a name
  • there are other things us-core defines that are not manditory (NPI, CLIA)
• two identifier types defined TOid and HDRid
• used for Lab Site. In FHIR R4, the Lab site needs to go into .performer which can't take a Location. (TechnicalDebt)
• always a contained resource, so not exposed RESTfully

Map to VIA labSiteID

Map to HDR PerformingOrganization

HDR IntoleranceCondition has an element recordSource with the identifier of the facility the allergy was recorded. Given that this does not include a friendly name, but MHV has a manually managed table with this, then we will populate the Organization.name with the value from that table (when it is available) - MHV FACILITY_INFO table {FACILITY_INFO.NAME}

A profile on the Patient resource for MHV PHR exposing Patient using FHIR API.

• based on US-Core for Patient
• mapping from patient details in eVault (not from VIA/HDR transaction)
  • all elements populated from eVault PHR patient service
  • phrVPRDAO.fetchDetailPatientInfo(icn)
• identifier
  • value = GetPatientId
  • system = urn:oid:2.16.840.1.113883.4.349
  • not using ICN but rather the id value known to eVault. There is concern the ICN is not unique enough.
• name - First and Last Name
• gender
• birthDate
• active = true

mapping concerns - TODO

• The Identifier for the ICN is still being discussed
• identifer.use is not being populated so can't use slicing
• name seems to only populate first and last, but puts them both in given
• populating identifier with GetPatientId() - the MHV patientId (jwt subjectId)
  • TODO: the system value should not be the generic VA oid, but rather some URI identifying MHV as this is where these id values are unique.
  • TODO: John is requesting an assigned OID for the MHV patientId system
    • Historically 200MH was used as an assigning authority USVHA identifier type (e.g., H7 v2 Identifier)
  • FHIR database will likely need to have the current Patient resources updated. Updating the FHIR database first will continue to work with current client.
  • MHV-54036
  • TODO: client will need to change to be specific to the new system value - https://github.com/department-of-veterans-affairs/vets-api/blob/f2733b21112f94c90dae618f0420d712f01cdf49/lib/medical_records/client.rb#L75
• eVault also has, but are not being used in the FHIR Patient
  • MiddleName
  • Ssn
  • Email
  • Icn
• set .meta.profile
• Would be even better if we could use a common Patient registry.
• The Patient resource can hold much more such as religion, birth place, other identifiers, etc…
• Integration with Cerner will force even more federation of identities
• Not mapping PatientTO

A profile on the Practitioner resource for MHV PHR exposing Practitioner using FHIR API.

• NOT based on US-Core for Practitioner, as that makes slicing on VA OID pattern impossible
• used for VIDF UserTO, and AuthorTO
• used for HDR PractitionerLite
• might be used for PersonTO or is that RelatedPerson?
• always a contained resource, so not exposed RESTfully

Mapping to VIA UserTO and VIA AuthorTO

Mapping to HDR PractitionerLite

A profile on the Observation resource for MHV PHR exposing Pluse Oximetry Vital-Signs using FHIR API.

Note that VIA does not provide us the supplemental O2 concentration or flowrate

A profile showing how SP LabReportTO is mapped into a FHIR DiagnosticReport, Observation, and Specimen.

A profile on the Observation resource for MHV PHR exposing Vital-Signs using FHIR API.

A profile on the Observation resource for Blood Pressure

A profile on the Observation resource for Pain

Not drived from us-core vitals, us-core does not have Pain and forbids valueInteger.

A profile showing how Microbiology and Pathology LabTestTO and LabResultTO will be exposed using FHIR API to MyHealtheVet PHR.

• This profile is based on US-Core Lab Observation

A profile on the Condition resource for MHV PHR exposing Problems using FHIR API.

Maps to Vista 120.8 (Allergy) - (6) OBSERVED/HISTORICAL 'o' FOR OBSERVED; 'h' FOR HISTORICAL; LAST EDITED: DEC 07, 1990 DESCRIPTION:
Indicates whether this allergy/adverse reaction has been observed by some personnel, or if it is historical data gathered about the patient. RECORD INDEXES: AHDR (#482)

Notes

DateTime of when the authentication happened

The codes for Allergy Observed vs Historic

Specific kind of Pathology or Microbiology mapped from labReportTO/type

DocumentReference types

Lab Report types

Note types

not all of them

Not all of them

not all of them

The codes for Allergy Observed vs Historic

Map between ChemistryResult.ObservationStatus and FHIR Observation.status code.

Map between ChemistryResult.valueInterpretation and FHIR Observation.interpretation.coding.

Map between VitalSignTO.type(ObservationTypeTO.name) VUID/string and LOINC code.

Vista units are close but often not exactly correct. This map gives the proper formal UCUM code.

• DrugUcum.csv - 11/08/2021, vhaislstewar, VHAT 325

Map between VitalSignTO.qualifier VUID/string and SNOMED code for Observation.extension[observation-deviceCode].valueCodeableConcept

Map between VitalSignTO.qualifier VUID/string and SNOMED code for Laterality Observation

Map between VitalSignTO.qualifier VUID/string and SNOMED code for Observation.method

Map between VitalSignTO.qualifier VUID/string and SNOMED code for Observation.extension[bodyPosition].valueCodeableConcept

Map between VitalSignTO.qualifier VUID/string and SNOMED code for Observation.bodySite

Map between VitalSignTO.qualifier VUID/string when a units of measure should be dropped

IntoleranceCondition record identity 53495 from a mock ProblemTO

IntoleranceCondition record identity 53495 from a mock ProblemTO

IntoleranceCondition record identity 69075 from a mock ProblemTO

IntoleranceCondition record identity 69092 from a mock ProblemTO

IntoleranceCondition record identity 69093 from a mock ProblemTO

IntoleranceCondition record identity 69123 from a mock ProblemTO

IntoleranceCondition record identity 69124 from a mock ProblemTO

IntoleranceCondition record identity 69129 from a mock ProblemTO

IntoleranceCondition record identity 67933 from a mock ProblemTO

IntoleranceCondition record identity 67934 from a mock ProblemTO

IntoleranceCondition record identity 69066 from a mock ProblemTO

IntoleranceCondition record identity 69067 from a mock ProblemTO

IntoleranceCondition record identity 69071 from a mock ProblemTO

IntoleranceCondition record identity 69072 from a mock ProblemTO

IntoleranceCondition record identity 69073 from a mock ProblemTO

IntoleranceCondition record identity 69074 from a mock ProblemTO

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PODIATRY - CONSULT REQUESTED

COMMUNITY CARE-CONSULT RESULT NOTE

COMMUNITY CARE-CONSULT RESULT NOTE

CLINICAL PHARMACY - MENTAL HEALTH E-CONSULT

WOUND - E-CONSULT

PULMONARY - LUNG CANCER SCREENING CONSULT

CLINICAL PHARMACY - E-CONSULT

ANESTHESIA - E-CONSULT

CARDIOLOGY - E-CONSULT

Example from a mock labTestPromises (1110200002)

Example from a mock labTestPromises (1110200002) with a secondary kind of identifier

Example from a mock labTestPromises (1103030001)

Example from a mock labTestPromises (1103030002)

Example from a mock labTestPromises (1190370002)

Example from a mock labTestPromises (1190530001)

Example from a mock labTestPromises (1190530002)

Example from a mock labTestPromises (1190740001)

ChemHem mock 9952

ChemHem mock 9953

ChemHem mock 9954

ChemHem mock 9955

ChemHem mock 9956

ChemHem mock 9957

ChemHem mock 9958

ChemHem mock 9959

ChemHem mock 9960

ChemHem mock 9961

ChemHem mock 9962

ChemHem mock 9963

ChemHem mock 9964

ChemHem mock 9965

ChemHem mock 9966

ChemHem mock 9967

ChemHem mock 9968

ChemHem mock 9969

ChemHem mock 9970

ChemHem mock 9971

ChemHem mock 9972

ChemHem mock 9973

ChemHem mock 9974

ChemHem mock 9975

ChemHem mock 9976

ChemHem mock 9977

ChemHem mock 9978

ChemHem mock 9979

ChemHem mock 9980

ChemHem mock 9981

ChemHem mock 9982

ChemHem mock 9983

ChemHem mock 9984

ChemHem mock 9985

ChemHem mock 9986

ChemHem mock 9987

ChemHem mock 9988

COR ATHEROSCL UNSP TYP-VES (ICD-9-CM 414.00)

Restless Legs (ICD-9-CM 333.99)

Benign Prostatic Hypertrophy (ICD-9-CM 799.9)

Hypertrophy (Benign) of Prostate without Urinary obstruction (ICD-9-CM 600.00)

Lumbago (ICD-9-CM 724.2)

Cardiomegaly (SCT 8186001)

Chronic Kidney Disease Stage 2 (SCT 431856006)

Retained Dental Root (SCT 66569006)

Proliferative Diabetic Retinopathy (SCT 59276001)

Rash (SCT 271807003)

Atrial Flutter (SCT 5370000)

Defective Dental Restoration (SCT 109728009)

Benign Neoplasm of Skin (SCT 92384009)

History of Alcohol Abuse (SCT 371434005)

Angina Pectoris (SCT 194828000)

Chest Pain (SCT 29857009)

Acute Deep Vein Thrombosis Of Lower Limb (SCT 651000119108)

Exposure to Agent Orange (SCT 718016003)

Acute posttraumatic stress disorder following military combat (SCT 446175003)

AF- Atrial Fibrillation (SCT 49436004)

Alcohol Abuse (SCT 15167005)

CAD - Coronary Artery Disease (SCT 53741008)

Abnormal cardiotochogram tracing (SCT 735205007)

SCREENING FOR ALCOHOLISM (ICD-9-CM V79.1)

SCREENING FOR OTHER SPECIFIED MENTAL DISORDERS AND DEVELOPMENTAL HANDICAPS (ICD-9-CM V79.8)

Hypertension (ICD-9-CM 401.9)

Hypertension (ICD-9-CM 401.9)

Anxiety Neuroses (ICD-9-CM 300.00)

Glaucoma (ICD-9-CM 365.9)

ENDOCARDITIS NOS (ICD-9-CM 424.90)

Discharge Summary

Discharge Summary

Discharge Summary

Discharge Summary

Discharge Summary

Derived from the a mock ClinicalProcedureTO:

Derived from the a mock ClinicalProcedureTO:

Derived from the a mock ClinicalProcedureTO:

Derived from the a mock ClinicalProcedureTO:

Derived from the a mock ClinicalProcedureTO:

Derived from the a mock ClinicalProcedureTO:

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Derived from the a mock ImagingExamTO:

SPINE LUMBOSACRAL MIN 2 VIEWS

CHEST 2 VIEWS PA&LAT

SPINE LUMBOSACRAL MIN 2 VIEWS

MYOCARDIAL PERFUSION (SPECT), EX/REDIST, W/ W/O PHARM INTER

J1245 DIPYRIDAMOLE INJECTION

J1245 DIPYRIDAMOLE INJECTION

CARDIOVASCULAR STRESS TEST (TECH)

#PROVISION OF DIAGNOSTIC RADIONUCLIDES

MYOCARDIAL PERFUSION STUDY WITH EJECTION FRACTION

J1245 DIPYRIDAMOLE INJECTION

A9505 THALLOUS CHLORIDE TL 201/MCI

A9505 THALLOUS CHLORIDE TL 201/MCI

A9505 THALLOUS CHLORIDE TL 201/MCI

MYOCARDIAL PERFUSION STUDY WITH WALL MOTION

J1245 DIPYRIDAMOLE INJECTION

CHEST 2 VIEWS PA&LAT

CT THORAX W/CONT

FOOT 3 OR MORE VIEWS

CHEST 2 VIEWS PA&LAT

FOOT 3 OR MORE VIEWS

RIBS BILAT+CHEST 4 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

CHEST 2 VIEWS PA&LAT

FOOT 3 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

FOOT 3 OR MORE VIEWS

CHEST 2 VIEWS PA&LAT

FOOT 3 OR MORE VIEWS

CHEST 2 VIEWS PA&LAT

UROGRAM IV W NEPHROTOMOGRAMS

ImmunizationTO.125286

ImmunizationTO.125285

ImmunizationTO.124694

ImmunizationTO.124695

ImmunizationTO.124696

ImmunizationTO.124697

ImmunizationTO.125307

ImmunizationTO.125308

ImmunizationTO.124684

This is derived from ImmunizationTO.124684, with a diffent identifier (ImmunizationTO.1), and marked as entered-in-error

ImmunizationTO.124685

ImmunizationTO.124685

Immunization given in 1980

Immunization given in 2012-01-02

Example from a mock labReportTO

Example from a mock labReportTO

Example from a mock labReportTO

Example from a mock labReportTO

Example from a mock labReportTO

Example from a mock labReportTO

Example from a mock labReportTO

Example from a mock labReportTO

Derived from the a mock NoteTO:

Derived from the a mock NoteTO:

This is replicated from ex-MHV-note-1, with change of identifier (NoteTO.5), and marked as entered-in-error

Derived from the a mock NoteTO:

Note dropped cosigner

Derived from the a mock NoteTO:

Note has an unsigned addenda

Derived from the a mock NoteTO:

Note has a signed addenda

This is a sample of a "Compensation and Pension Examination" (aka, "C & P") note. These notes will be held by notes business rules for 30 days past the signature.

This is a sample of a "Compensation and Pension Examination" (aka, "C & P") note. These notes will be held by notes business rules for 30 days past the signature.

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SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

PSYCHIATRY - ATTENDING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

MENTAL HEALTH SECURE MESSAGING

PRIMARY CARE SECURE MESSAGING

MOVE SECURE MESSAGING

ENDOCRINOLOGY SECURE MESSAGING

MENTAL HEALTH SECURE MESSAGING

MENTAL HEALTH SECURE MESSAGING

PROCEDURE - INTRAOSSEOUS VASCULAR ACCESS

MHD - MHICM PROGRESS NOTE

INPAT - MED - ATT - ADMIT

MENTAL HEALTH SECURE MESSAGING

VIRTUAL EMERG MGMT PHARM

PC - FOLLOW UP

PC - AFTERVISIT SUMMARY

SECURE MESSAGING

NEUROLOGY SECURE MESSAGING

SECURE MESSAGING

SECURE MESSAGING

TLH - PORTLAND/VANCOUVER

PC - NEW

PC - AFTERVISIT SUMMARY

AVS STUB NOTE

SECURE MESSAGING

CCC: CLINICAL TRIAGE

MENTAL HEALTH SECURE MESSAGING

MENTAL HEALTH SECURE MESSAGING

EYE - AFTERVISIT SUMMARY SPECTACLE RX

UROLOGY SECURE MESSAGING

WOUND - SECURE MESSAGING

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This example is derived off of a mock PatientTO

This example is derived off of a mock PatientTO

This example is derived off of a mock patient

This example is derived off of a mock PatientTO. It shows where everything that could be in a VIA PatientTO could go. This is not an example of what MHV will populate the Patient like.

This example is derived off of a mock PatientTO

This example is derived off of a mock PatientTO

This example is derived off of a mock patient

This example is derived off of a mock patient

This example is derived off of a mock PatientTO

Used in testing environment

Only values from eVault

Immunization testng patient

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Example from a mock VitalSignTO

Example from a mock VitalSignTO

holding typical values

Heart Rate holding typical values

Heart Rate holding typical values

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