InterweaveObservation
FHIR Profile
The Notts Care Record will use the InterweaveObservation Resource Profile as published in the Interweave Implementation Guide
Note: The Interweave Observation resource profile link is not working - see CareConnect-Observation-1 which it is based on
NottsCR Observation Category
The FHIR Observation resource is very flexible, and can be used to support multiple use cases within the Notts Care Record, including:
- End of Life Preferences/EPaCCS Information
- Frailty Risk
- Care Co-ordinator Case Notes
The nature of each of these data types will be different, please see the sections below for the relevant guidance.
In order to support the retrieval, grouping and reporting of data within the Notts Care Record, a CodeSystem has been created to represent the different categories/use cases.
Note: Obervation.category has a cardinality of "0../*", so can support multiple categorisations
End Of Life (EoL)
In Phase 1, the Notts Care Record End of Life requirements will mirror the types of information currently available in the eHealthscope register:
The Notts Care Record will use the FHIR Observation Resource Type to share EoL information for a specific patient, the key elements will be
| FHIR Element | GPRCC | Notes |
|---|---|---|
| Observation.tag | system=https://fhir.nottscr.nhs.uk/CodeSystem/GPRCC-ResourceType code=EOL |
|
| Observation.id | FHIREventID + FHIReAttribute | Used to update or delete a specific record in the future |
| Observation.status | Fixed value = final | |
| Observation.category[0] | Fixed value = social-history | All Observations MUST have a category from the required binding |
| Observation.category[1] | Fixed value = end-of-life | Will be used to distinguish observations that relate to EoL from all other categories, e.g. Frailty, Care Co-ordinator Case Notes, Legal Status, etc) |
| Observation.code | system = https://fhir.nottscr.nhs.uk/CodeSystem/GPRCC-FHIReAttribute code = FHIReAttribute display = FHIReAttributeFriendlyName |
Used to identify the specific type of observation that the value relates to. This equates to the columns in the table above, e.g. 'Resuscitation status', 'Preferred place of Death', etc. |
| Observation.valueCodeableConcept | system = CodeSystem code = Code display = Description |
The actual value / recorded finding, e.g. "Home" for an observation which relates to 'Preferred place of Death' (i.e. Observation.code) |
| Observation.effectiveDateTime | EventDate in GPRCC | When the information was recorded or asserted as being true |
| Observation.subject | "Patient/" + PatientID | Local GPRCC id for the Patient which the observation is for |
Example
Click here to see an example of an End of Life Observation for a Patient's Preferred Place of Death
Frailty
The Phase 1 NCR Requirements are to mirror the types of information currently available in the eHealthscope frailty register:
| FHIR Element | GPRCC | Notes |
|---|---|---|
| Observation.tag | system=https://fhir.nottscr.nhs.uk/CodeSystem/GPRCC-ResourceType code=Frailty |
|
| Observation.id | FHIREventID + FHIReAttribute | Used to update or delete a specific record in the future |
| Observation.status | Fixed value = final | |
| Observation.category[0] | Fixed value = social-history | All Observations MUST have a category from the required binding |
| Observation.category[1] | Fixed value = frailty | Will be used to distinguish observations that relate to Frailty from all other categories, e.g. EoL, Care Co-ordinator Case Notes, Legal Status, etc) |
| Observation.code | system = https://fhir.nottscr.nhs.uk/CodeSystem/GPRCC-FHIReAttribute code = FHIReAttribute display = FHIReAttributeFriendlyName |
Used to identify the specific type of observation that the value relates to. This equates to the columns in the table above, e.g. 'Ability to Drink', 'Ability to Eat', etc. |
| Observation.valueCodeableConcept | system = CodeSystem code = Code display = Description |
The actual value / recorded finding, e.g. "Able to use toilet" for an observation which relates to 'Toilet use' (i.e. Observation.code) |
| Observation.effectiveDateTime | EventDate in GPRCC | When the information was recorded or asserted as being true |
| Observation.subject | "Patient/" + PatientID | Local GPRCC id for the Patient which the observation is for |
Example
Click here to see an example of a Frailty Observation for a Patient's Ability to use the Toilet
Care Co-ordinator Case Notes
The Phase 1 NCR Requirements are to mirror the case notes currently viewable in eHealthscope:
| FHIR Element | GPRCC | Notes |
|---|---|---|
| Observation.tag | system=https://fhir.nottscr.nhs.uk/CodeSystem/GPRCC-ResourceType code=Care Plan |
|
| Observation.id | FHIREventID | Used to update or delete a specific record in the future |
| Observation.status | Fixed value = final | |
| Observation.category[0] | Fixed value = social-history | All Observations MUST have a category from the required binding |
| Observation.category[1] | Fixed value = case-note | Will be used to distinguish observations that relate to Care Co-ordinator Case Notes from all other categories, e.g. Frailty, End of Life, Legal Status, etc) |
| Observation.code | Fixed value = http://snomed.info/sct|37331000000100 - Comment note (record artifact). | |
| Observation.comment | String with the care plan case note as recorded in eHealthscope (i.e. Description) | |
| Observation.effectiveDateTime | EventDate in GPRCC | When the information was recorded or asserted as being true |
| Observation.subject | "Patient/" + PatientID | Local GPRCC id for the Patient which the observation is for |
Note - unlike the poposed view in the MIG, the initials of the HCP (Health Care Practitioner), will not be shown in the Notts Care Record
Example
Click here to see an example of a Case Note Observation for a Patient
Diabetes
The Phase 1 NCR Requirements are to mirror the types of information currently available in the eHealthscope diabetes register:
| FHIR Element | GPRCC | Notes |
|---|---|---|
| Observation.tag | system=https://fhir.nottscr.nhs.uk/CodeSystem/GPRCC-ResourceType code=Diabetes |
|
| Observation.id | FHIREventID + FHIReAttribute | Used to update or delete a specific record in the future |
| Observation.status | Fixed value = final | |
| Observation.category[0] | Fixed value = social-history | All Observations MUST have a category from the required binding |
| Observation.category[1] | Fixed value = diabetes | Will be used to distinguish observations that relate to Diabetes from all other categories, e.g. EoL, Care Co-ordinator Case Notes, etc) |
| Observation.comment | FHIReAttributeFriendlyName | Text denoting the Event Concept in GPRCC, e.g. Latest HbA1c |
| Observation.code | system = CodeSystem code = Code display = Description |
Used to identify the specific coding of what was measured (SNOMED or READ code). |
| Observation.valueQuantity | value = NumericValue unit = Units |
Where the observation has a numeric value the quantity and units will also be available. Note some diabetes observations will not have a value, for these the code will provide all the details of the observation, such as the specific diagnosis for the individual, e.g. Diabetes mellitus type 2 (disorder). Where there is no NumbericValue/Units, the cardinality of the valueQuantity element will be zero |
| Observation.effectiveDateTime | EventDate in GPRCC | When the information was recorded or asserted as being true |
| Observation.subject | "Patient/" + PatientID | Local GPRCC id for the Patient which the observation is for |
Example
Click here to see an example of a Diabetes Observation for a Patient's Haemoglobin A1c level