Outstanding Design Considerations

ED Notes

• Triage and consultation to be modelled using Observation or QuestionnaireResponse?
• MedicationRequest with self contained MedicationAdministration vs an extension administerLog with 4 fields: administeredBy, checkedBy, adminsteredDateTime, remarks?
• Medical certificate as DocumentReference under EDNotes vs an extension in Encounter.admission.dischargeDisposition?
• step procedures to be modelled as extension in main procedure to contain the ProcedureStep?

Summary Notes

• Store creator as extension in Composition or in author but reference PractitionerRole to differentiate author and creator?

Radiology Report/Lab Result

• Currently DiagnosticReport.status only stores: final, amended, corrected, cancelled. How about "final with correction"?

Ordered Medications

• Store authorizer as extension in MedicationRequest or use recorder?

Dispensed Medications

• 'Medication administered start/end date time' and 'authorized by' to be stored in MedicationRequest or MedicationDispense?
• Reason for changes in medication item to be stored in MedicationDispense.notPerformedReason?

Patient Medication List

• For medicationManagementIssues, need to store code instead of string, create extension under List.note? Or store in DetectedIssue.evidence.code and link it to List.entry.item?

Fine-grained vs Coarse grained API design

• Current position is to use coarse grained API (use default CRUD first, and create extended operation unless it is necessary)
  • for document related composition eg discharge summary, ED notes and OT notes, create generic option such as $submit and use Meta.profile to indicate the resource profile
  • for other discrete data submission, such as Ordered Meds and Prescribed Meds, use default CRUD for submission and update, and possibly introduce new extended operation if current NEHR supports delta update for meds, lab results, events etc.