A patient goes into hospital for a day procedure to remove a mole

In FHIR terms, this is a LOT more complicated that a simple GP visit. Here’s how it might look.

First, the scenario. Our patient, Leopold Bloom, was referred to a plastic surgeon at a major Dublin hospital to have a mole removed from the top of his ear.

The mole was identified as suspicious by a dermatologist a few weeks earlier, and her suspicion was confirmed after a biopsy.

Leo arrives at the hospital in the early hours of Monday morning, undergoes the procedure without sedation, and is discharged in the afternoon.

Here’s the sequence of events as they might occur in FHIR.

FHIR resources that may already exist
– Patient
– Organization (the hospital)
– Practitioner [n] (the surgeon, the dermatologist, the GP, and the many nurses)
– PractitonerRole [n] (the various roles each Practitioner fills)
– Location (the operating theatre)

FHIR resources created in advance of the procedure
– ServiceRequest (the order for the procedure, probably initiated by the dermatologist)
– Appointment (Monday morning, 7am, the hospital)

FHIR resources created as the patient checks in at reception
– Encounter
– RelatedPerson (next of kin)
– AllergyIntolerance (any allergies the patient has)
– Flag (significant allergies that need to flagged — latex gloves, for example)
– Coverage (Insurance details)
– CoverageEligibilityRequest (what’s covered by insurance)
– CoverageEligibilityResponse

Resources created pre-procedure, as the patient is made ready
– MedicationStatement (list of meds the patient is taking)
– Observation [n] (BP, pulse, etc.)
– Consent (patient signs consent form for the procedure)

Resources created during the procedure
– Procedure (might or might not be created earlier)
– Medication (to numb the ear and surrounding areas)
– MedicationAdministration (what was administered)
– Specimen (sent to pathology for analysis)
– Observations [n] (BP and other readings taken throughout the procedure)

Resources created post-procedure
– MedicationRequest – (prescription for pain killers if required)
– Appointment (for the bandages to be removed a week later)
– DiagnosticReport (post-pathology, sent to the GP and patient)
– Claim (Insurance)
– ExplanationOfBenefit (details of the claim)
– PaymentReconciliation (what was paid)

As you can see, even a minor day procedure where the patient is not sedated can lead to a host of FHIR resources.

If I’ve left out or misused any, please leave a comment.

* Thanks to Neeraj Shrivastava for help with expanding out the Insurance and Claim resources.



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