How to to Construct a Clinical Workflow within a FHIR Bundle For a Shared Health Record

Architecture & Standards
1

Hello Community,

We have a clinical workflow for which we’d like to build a FHIR Bundle to capture all the events happening at different stages. Could you guide us on how the FHIR Bundle will handle updates to resources since these events occur at different intervals? Additionally, which FHIR resources would be suitable for constructing this bundle?

Here’s the workflow:

  • A patient arrives at the health facility and is registered in the system.
  • A nurse records the patient’s vital signs (e.g., height, weight, blood pressure).
  • The patient meets with the doctor for a consultation.
  • The doctor orders lab tests for the patient.
  • The patient completes the lab tests and provides the results to the doctor.
  • The doctor makes a diagnosis and prescribes medications for the patient.
  • The patient visits the pharmacy to collect the prescribed medications.
  • The pharmacy dispenses the medications to the patient.
  • The patient’s visit ends.

Looking forward to your suggestions and best practices. Thank you!

2

Hi Frank.

The care-continuity use case is one of the most impactful ones supported by a Health Information Exchange (HIE). :slightly_smiling_face: :+1: The long-running workflow you have described can be supported by a 1-2-3-4 pattern of health summary exchange:

  1. identify the patient
  2. retrieve the patient’s health summary from the HIE
  3. based on the health summary, provide necessary care
  4. update the health summary with details of the encounter and post this updated summary back to the HIE

This approach is illustrated in a short video from the World Bank Digital Health Blueprint Toolkit (found here: Digital Health Blueprint Toolkit). The video illustrates the arc of patient care (including the use of an MOH-hosted Patient Health Record) supported by this 1-2-3-4 pattern of exchange; it is found, here. The national data model for a patient summary can be based on the FHIR IPS. That’s the approach that Canada (my home country) is using, and it is also being used by the EU, Sri Lanka, Botswana, NZ and others.

Warmest wishes,
Derek