NHSDigital-Task
FHIR Task usage and scope is defined as
A task resource describes an activity that can be performed and tracks the state of completion of that activity. It is a representation that an activity should be or has been initiated, and eventually, represents the successful or unsuccessful completion of that activity. Note that there are a variety of processes associated with making and processing orders. Some orders may be handled immediately by automated systems but most require real world actions by one or more humans. Some orders can only be processed when other real world actions happen, such as a patient presenting themselves so that the action to be performed can actually be performed. Often these real world dependencies are only implicit in the order details.
Within NHS Digital this resource will often be associated with workflow management.
Similar concepts exist outside of NHS Digital for example a GP system has the concept of Task and this includes:
- telephone patient
- form to complete
- prescription
- referral
- book appointment
- medication review
These are complemented with more detailed Task management around:
- pathology
- medicine management and also includes EPS
- Rejected Prescriptions
- Cancelled Prescriptions
- Subsequent cancellation rejections
- referrals
NHS App also includes the ability to order repeat prescriptions which relates to the GP systems prescriptions.
reasonCode
In FHIR Task these types of workflow would be represented via reasonCode and/or reasonReference
For medication this is probably SNOMED CT based using codes under the SNOMED CT 182832007 Medication management and includes codes such as:
| SNOMED CT | Display |
|---|---|
| 182836005 | Review of medication |
| 430193006 | Medication Reconciliation |
| 103742009 | Renewal of prescription |
| 33633005 | Prescription of drug |
For referral management
| SNOMED CT | Display |
|---|---|
| 3457005 | Patient Referral |
| 185499000 | Expedite appointment |
code
The reasonCode's are complemented with task-code which indicates the type of action to be performed.
For example:
The code fulfil used with 182836005 | Review of medication means a task to review medication.
The code approve used with 103742009 | Renewal of prescription is a task for a clinician to approve the issue of a repeat medication.
status
These workflow tasks have status which indicates the Task status.
The following diagram reflects the "typical" state machine for Task. Note that not all states will be supported by all workflows and that some workflows may support additional transitions, including transitions from terminal states (e.g. back to "in-progress" from "failed" or "completed").
For example:
A patient requesting a repeat prescription would ask for task with code fulfil used with 103742009 | Renewal of prescription and a status of requested.
Once reviewed (by a clinician), the task status would be changed to accepted. When the task is then picked up (in-progress) and the related MedicationRequest is sent, the status would change to completed.
focus
Tasks are often generated as a consequence of other workflows or relate to FHIR Workflow resources. For example a repeat medication request will be related to a previous MedicationRequest or a medication reconciliation may relate to a hospital admissions Encounter/EpisodeOfCare. This is carried in the focus element.
focus can be omitted. For example if an ED generated a Medication Review as a result of COPD Emergency encounter they may chose to include a reference to the Encounter but they may decide instead to use a more specific reasonCode such as 394720003 | Asthma medication review.