Reporting death of a patient

Legacy openhie-shr
1

Hello,

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.

Thanks,

Monika.

2

Looping in the Shared Health group.

···

On Tuesday, September 2, 2014 2:25:17 PM UTC+5:30, Monika Ramesh wrote:

Hello,

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.

Thanks,

Monika.

3

Hi Monika.

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.

Warmest regards,

Derek.

···

On Tuesday, 2 September 2014 04:55:17 UTC-4, Monika Ramesh wrote:

Hello,

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.

Thanks,

Monika.

4

Hi Derek,
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
1) a custom profile
2) a "other" resource.
3) 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.
Thanks again
regards
~angshu

···

On Tue, Sep 2, 2014 at 6:08 PM, derek.ritz wrote:

Hi Monika.

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
.

Warmest regards,

Derek.

On Tuesday, 2 September 2014 04:55:17 UTC-4, Monika Ramesh wrote:

Hello,

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.

Thanks,
Monika.

5

Hi Angshu / Derek,

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).

Cheers

-Justin

···

From: Derek Ritz [mailto:ops_djritz@hotmail.com]
Sent: Friday, September 05, 2014 7:56 AM
To: Angshuman Sarkar; derek.ritz; justin.fyfe@ecgroupinc.com
Cc: openhie-shr@googlegroups.com; sharedhealth@googlegroups.com
Subject: RE: Reporting death of a patient

Hi Angshu.

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,

Derek.

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
From: angshus@thoughtworks.com
To: derek.ritz@ecgroupinc.com
CC: openhie-shr@googlegroups.com; sharedhealth@googlegroups.com

Hi Derek,

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

  1. a custom profile

  2. a “other” resource.

  3. 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.
Thanks again
regards

~angshu

On Tue, Sep 2, 2014 at 6:08 PM, derek.ritz wrote:

Hi Monika.

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.

Warmest regards,

Derek.

On Tuesday, 2 September 2014 04:55:17 UTC-4, Monika Ramesh wrote:

Hello,

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.

Thanks,

Monika.

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6

Hi Justin,Derek

Thanks for your responses.

We could always send observations with a specific coding (like in smomed indicating a death event http://www.snomedbrowser.com/Codes/Details/419620001)

As I understand, as part of a death note, its common to capture “cause of death” and “circumstances”.

for example, if death happened while in hospital cause of death could be linked to a coded system like ICD10. Wherein in case a death is reported by a CHW, it is likely the cause of death is unknown, but circumstances are filled in.

Same can be said about birth registration, which can be quite complicated considering that a baby may not be identified as a patient, and all care is given from mother’s perspective or part of her care plan.

Currently, I am thinking that either FHIR document (a composition) or a specific profile would be appropriate for death reporting. Since the death note can be country specific, I am not thinking of mapping to exactly like a VRDR IHE profile. So, maybe we will take some inspiration from it, but keep it flexible using a custom FHIR composition or profile.

I will check with the FHIR list and update what they recommend.

thanks a ton.
regards

~angshu

···

On Fri, Sep 5, 2014 at 5:19 PM, Justin Fyfe justin.fyfe@ecgroupinc.com wrote:

Hi Angshu / Derek,

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).

Cheers

-Justin

From: Derek Ritz [mailto:ops_djritz@hotmail.com]
Sent: Friday, September 05, 2014 7:56 AM
To: Angshuman Sarkar; derek.ritz; justin.fyfe@ecgroupinc.com
Cc: openhie-shr@googlegroups.com; sharedhealth@googlegroups.com
Subject: RE: Reporting death of a patient

Hi Angshu.

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,

Derek.

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
From: angshus@thoughtworks.com
To: derek.ritz@ecgroupinc.com
CC: openhie-shr@googlegroups.com; sharedhealth@googlegroups.com

Hi Derek,

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

  1. a custom profile
  1. a “other” resource.
  1. 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.
Thanks again
regards

~angshu

On Tue, Sep 2, 2014 at 6:08 PM, derek.ritz wrote:

Hi Monika.

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.

Warmest regards,

Derek.

On Tuesday, 2 September 2014 04:55:17 UTC-4, Monika Ramesh wrote:

Hello,

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.

Thanks,

Monika.

–
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To unsubscribe from this group and stop receiving emails from it, send an email to openhie-shr+unsubscribe@googlegroups.com.
For more options, visit https://groups.google.com/d/optout.

–

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7

Hello Monika,

I have been working – in the US – on developing an HL7 implementation for reporting death information from an EHS. The content of the specifications are based on the US standard death certificate. I would be happy to provide you with the draft specifications if you think they would be useful.

I also noted a comment from Derek Ritz in response to – I think – another inquiry. I agree with him that there is a substantial difference between simply noting that a person has died, and supplying the information needed for death registration. In particular, death cause information is likely to be needed for death registration. It may also only be available sometime after the actual death. For one thing, a death case may need to be referred to a medical examiner (coroner) to determine the actual cause of death.

I think providing more details regarding the use case here would be helpful. Do you simply need to note that the patient has died? So as, for example, to cancel health insurance, to avoid use of a passport. Or, is the interest more along the lines of filing a death certificate.

If I were to dip into FHIR for a minute, I think you would want a “death report document” that would include the basic information. You might want to rebrand “cause of death” as “preliminary impressions as to death cause”.

Mead Walker

···

From: openhie-shr@googlegroups.com [mailto:openhie-shr@googlegroups.com] On Behalf Of monikar@thoughtworks.com
Sent: Tuesday, September 02, 2014 6:15 AM
To: openhie-shr@googlegroups.com
Cc: sharedhealth@googlegroups.com
Subject: Re: Reporting death of a patient

Looping in the Shared Health group.

On Tuesday, September 2, 2014 2:25:17 PM UTC+5:30, Monika Ramesh wrote:

Hello,

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.

Thanks,

Monika.

–
You received this message because you are subscribed to the Google Groups “Shared Health Record (OpenHIE)” group.
To unsubscribe from this group and stop receiving emails from it, send an email to openhie-shr+unsubscribe@googlegroups.com.
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8

Hello,

Thank you Mead, Derek and Justin for your inputs.

@Mead - The usecase here, is to capture the details of a patient’s death, including time/date, cause and circumstance as a death note in the hospital system and communicate the same with the Shared Health Resource. This may trigger further action items like informing the National Registry of the person’s death.

For now, we might go ahead with a FHIR Profile and structure it as per the requirements.

Thank you all again for the helpful responses!

Regards,

Monika.

···

On Fri, Sep 5, 2014 at 7:29 PM, Mead Walker dmead@comcast.net wrote:

Hello Monika,

I have been working – in the US – on developing an HL7 implementation for reporting death information from an EHS. The content of the specifications are based on the US standard death certificate. I would be happy to provide you with the draft specifications if you think they would be useful.

I also noted a comment from Derek Ritz in response to – I think – another inquiry. I agree with him that there is a substantial difference between simply noting that a person has died, and supplying the information needed for death registration. In particular, death cause information is likely to be needed for death registration. It may also only be available sometime after the actual death. For one thing, a death case may need to be referred to a medical examiner (coroner) to determine the actual cause of death.

I think providing more details regarding the use case here would be helpful. Do you simply need to note that the patient has died? So as, for example, to cancel health insurance, to avoid use of a passport. Or, is the interest more along the lines of filing a death certificate.

If I were to dip into FHIR for a minute, I think you would want a “death report document” that would include the basic information. You might want to rebrand “cause of death” as “preliminary impressions as to death cause”.

Mead Walker

From: openhie-shr@googlegroups.com [mailto:openhie-shr@googlegroups.com] On Behalf Of monikar@thoughtworks.com
Sent: Tuesday, September 02, 2014 6:15 AM
To: openhie-shr@googlegroups.com
Cc: sharedhealth@googlegroups.com
Subject: Re: Reporting death of a patient

Looping in the Shared Health group.

On Tuesday, September 2, 2014 2:25:17 PM UTC+5:30, Monika Ramesh wrote:

Hello,

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.

Thanks,

Monika.

–
You received this message because you are subscribed to the Google Groups “Shared Health Record (OpenHIE)” group.
To unsubscribe from this group and stop receiving emails from it, send an email to openhie-shr+unsubscribe@googlegroups.com.
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