I am not that familiar with death reporting, however I am sure that there are some FHIR resources that could be profiled to capture the type of information that you’re looking for.
As Derek noted, in FHIR we can record the date/time or indication that a patient is deceased via the Patient resource. Per the death report, or issuance of a death certificate, there are a couple of FHIR resources which may be of use. You could bundle a series of Observation resources related to the death report as a logical FHIR document (see http://hl7.org/implement/standards/fhir/documents.html).
There is also the DiagnosticReport resource which could be profiled to support what you’re looking for (I’m not as familiar with this resource).
From: Derek Ritz [mailto:email@example.com]
Sent: Friday, September 05, 2014 7:56 AM
To: Angshuman Sarkar; derek.ritz; firstname.lastname@example.org
Cc: email@example.com; firstname.lastname@example.org
Subject: RE: Reporting death of a patient
I’m a bit out of my depth re: FHIR (I’ve not got much more than a surface familiarity with it). My colleague, Justin Fyfe, however, is quite expert and so I’m drawing him into this thread, too.
One word of caution – FHIR isn’t fully baked yet so planning to build production systems using just those interfaces is risky. A lot of good “profiling” work is underway and, helpfully, Justin is doing some of it so I think he can shed some light on what might be a useful approach.
Justin, do you have any immediate “gut instinct” thoughts on what might be a good way to proceed?
Thanks and warmest regards,
PS: Justin – the thread (below) explains a bit more of the underlying use case.
Date: Tue, 2 Sep 2014 19:32:10 +0530
Subject: Re: Reporting death of a patient
CC: email@example.com; firstname.lastname@example.org
Thanks for your response.
We haven’t found any specific resource in FHIR corresponding to DR. (or in upcoming DSTU).
Even without a specific resource, there are ways to model that in FHIR using
a custom profile
a “other” resource.
a composition/bundle resource
I am thinking - if we should model as part HL7 v3 VR DAM? which I think IHE profile you mentioned also caters too.
My only apprehension would be that from the example in the VRDR profile, it seemed too US specific.
One thing for us to figure out: how in Facilities, this would be recorded - as a Death Note, as observation recording, a disposition, or something like a death certificate issuance.
Whatever be the case in EMRs, while communicating to the SHR, we can adopt a specific message resource (preferably). But if that’s not possible, an option is to go with specific bundle approach, which SHR can interpret using registered “processors” for bundles. While thats technically possible, we would like to get the semantics right.
I will check with HL7 FHIR list.
Please let us know your thoughts.
On Tue, Sep 2, 2014 at 6:08 PM, derek.ritz wrote:
There may be a benefit to de-coupling the reporting of a death event with the reporting of the cause of death. As you’ve noted, the reporting of a person’s death may be captured as an update to their demographic record with the date (and time) of their death. There are IHE profiles for doing this and there is a FHIR message, too. By capturing this event, even without “verbal autopsy” or other cause-of-death information, we are able to satisfy a wide array of important use cases and workflows – including raising the alert that we should seek to establish cause of death for this person.
Capturing the cause of death can be a different workflow fro capturing the death event. As you’ve noted, we will want to log coded information as well as (potentially) free text information about the death. There is an IHE profile describing a process for doing this as well as the profiled data content (in CDA format): Vital Records Death Reporting (VRDR). The profile may be found here: ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/QualityResearchPublicHealth/IHE_QRPH_Suppl_VRDR.pdf. I will leave it with others to say whether there is an equivalent FHIR message; my sense is that a “health summary” message could be used as that is what underlies the IHE profile (it profiles the generic XDS-MS content specification).
De-coupling the death event and cause of death may help get the necessary information more quickly and more readily. A community health worker or village elder may be able to log rudimentary “death event” information using a mobile phone, for example. The cause of death information may require a skilled practitioner and could potentially require a larger data communication pattern not as easily accomplished using mobile phones (altho anything we do to ensure we can leverage these devices will be effort well spent!).
I hope this is helpful. As a note, it may be worth investigating how this was approached in the recently published RSA national eHealth standards framework; this issue came up during the development of the RSA framework. The RSA document can be found here: http://hufee.meraka.org.za/Hufeesite/staff/the-hufee-group/paula-kotze-1/hnsf-complete-version.
On Tuesday, 2 September 2014 04:55:17 UTC-4, Monika Ramesh wrote:
As you all may know, we are building a Health Information Exchange(HIE) for Bangladesh. One component of the system is Shared Health Record (SHR), which captures health data for all the patients. As part HIE, we are using FHIR standard to exchange data between a facility and SHR.
We are now trying to capture death of a patient in a hospital system and communicate the same with SHR. However, there do not seem to be any dedicated resource in FHIR to send the details of death.
The details we would like to capture are -
Time of death
Date of death
Cause of death (coded concepts)
Circumstance of death (non coded / notes)
The FHIR resource for patient has a field, ‘deceased’ which will help us send the time and date of death. But it does not allow us to send cause and circumstance.
Any comments on how to report the death of a patient will be very helpful.
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