1. Outstanding Design Considerations

1. For ED Notes, the main procedure can have multiple step procedures. The current design is to use partOf element in the step procedure to reference the main procedure. The alternative design is to create an extension in the main procedure to reference all the step procedures. Read more here EDNotes.

2. Dispensed medications are modelled using MedicationDispense resource. However there are no suitable elements to store the medication start and end date times and the clinician who authorized the medication. The current design is to store both fields in MedicationRequest resource, using effectiveDosePeriod element to store the medication start and end date times and authorizer extension element to store the authorizing clinician. MedicationDispense resource will reference MedicationRequest resource using authorizingPrescription element. Another design consideration is to create two extension elements in MedicationDispense resource to store both data points. Read more here DispensedMedications

2. Fine-grained vs Coarse grained API design

1. Current position is to use coarse grained API (use default CRUD first, and create extended operation unless it is necessary)
   1. 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
   2. 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.