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Tue Jan 23 18:01:42 UTC 2024 (#1922)
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Co-authored-by: Workflows.Backup <[email protected]>
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github-actions[bot] and Workflows.Backup authored Jan 23, 2024
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2 changes: 1 addition & 1 deletion GPConnectDirectCareAPIs-STU3/README.md
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Expand Up @@ -5,4 +5,4 @@ It was created on 29/09/2023 and has been set up to run every 1 month.

## Last Updated

Updated at: Mon Jan 22 18:01:54 UTC 2024
Updated at: Tue Jan 23 18:01:50 UTC 2024
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Expand Up @@ -100,15 +100,9 @@ The logical structure of a Consultation is reflected in FHIR using the `Encounte
</tr>
</table>

<a href="images/access_structured/Consultation_FHIR_Resource_Model.png"><IMG src="images/access_structured/Consultation_FHIR_Resource_Model.png" alt="Consultation FHIR Resource Model" style="max-width:100%;max-height:100%;"></a>
{{ render: Consultation_FHIR_Resource_Model1.png }}

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>

<a href="images/access_structured/Consultation_Stucture.png"><IMG src="images/access_structured/Consultation_Stucture.png" alt="Consultation Structure" style="max-width:100%;max-height:100%;"></a>

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>
{{ render: Consultation_Stucture2.png }}

## Consultation notes

Expand All @@ -120,42 +114,25 @@ There are two primary ways that consultation notes are recorded on native GP sys

- Consultation notes for a heading are recorded as a single piece of free text. Any clinical coded information under the same heading is associated to that text as a whole.

<a href="images/access_structured/Consultation_text_1a.png"><IMG src="images/access_structured/Consultation_text_1a.png" alt="Free text with multiple clinical codes" style="max-width:100%;max-height:100%;"></a>

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>
{{ render: modelOnev1.png }}

- Consultation notes for a heading are recorded as a collection of observations, each with a clinical code and or text. When read together in order they produce the consultation notes.
Note – this may be entering free text format dynamically identifying codes or through forms where there are specific fields for codes and free text.

<center>
<a href="images/access_structured/Consultation_text_1b.png"><IMG src="images/access_structured/Consultation_text_1b.png" alt="Clinical code and text" style="max-width:40%;max-height:40%;"></a>
</center>
&nbsp;
Note – this may be entering free text format dynamically identifying codes or through forms where there are specific fields for codes and free text.

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>
{{ render: modelTwov1.png }}

When reflecting these in FHIR it is important they these two methods are represented in a way that retains the structural information they contain, does not create any unintended clinical meaning and can be viewed / imported. This is done by taking any free text in model one and representing it as uncategorised data and positioning it as the first clinical item under the heading.

<a href="images/access_structured/Consultation_text_2.png"><IMG src="images/access_structured/Consultation_text_2.png" alt="Consultation text in FHIR" style="max-width:100%;max-height:100%;"></a>

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>
{{ render: bothModels.png }}

While there are differences between the two outputs, the consultation notes can be derived from both by reading through each clinical item in order and merging the Term Text, Clinical Code, Values and Comment into a single narrative.

<a href="images/access_structured/Consultation_text_3.png"><IMG src="images/access_structured/Consultation_text_3.png" alt="Reconstituted Consultation Text" style="max-width:100%;max-height:100%;"></a>

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>
{{ render: bothModels2.png }}

## Example

<a href="images/access_structured/Consultation_Example_v6.png"><IMG src="images/access_structured/Consultation_Example_v6.png" alt="Sequence diagram for retrieving a patient record" style="max-width:100%;max-height:100%;"></a>
{{ render: Consultation_Example.png }}

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>

## Clinical item references ##

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Expand Up @@ -111,10 +111,8 @@ For example, if four items of uncategorised data are recorded under the investig
Direct references to all four items will be populated in the `List(Heading)` profile.
If all four items are linked to a problem then all four items will be populated in the `ProblemHeader (Condition)` profile.

<a href="images/access_structured/Uncategorised_Structure_v2.png"><IMG src="images/access_structured/Uncategorised_Structure_v2.png" alt="Uncateogirsed Structure" style="max-width:100%;max-height:100%;"></a>
{{ render: Uncategorised_Structure_v2.png }}

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix link above<br/> </div>

## Representing inbound referrals ##

Expand Down Expand Up @@ -159,17 +157,17 @@ The way standard blood pressures are recorded in different clinical systems vari

* Recorded as the following triple in the below structure and using any of the codes from the table below,

<a href="images/access_structured/BP_Diagram.png"><IMG src="images/access_structured/BP_Triple.png"></a>
{{ render: BP_Triple1.png }}

* Recorded as 2 individual readings that are grouped together with no panel code using any of the systolic and diastolic codes from the table below,

<a href="images/access_structured/BP_Diagram.png"><IMG src="images/access_structured/BP_ComponentCodes.png"></a>
{{ render: BP_ComponentCodes2.png }}

Where there is no panel code then '163020007 On examination - blood pressure reading (finding)' **MUST** be used in the GP Connect triple.

* Recorded using a panel code with two readings but no systolic and diastolic codes. This may be recorded as either of the 2 panel codes from the table below,

<a href="images/access_structured/BP_Diagram.png"><IMG src="images/access_structured/BP_HeaderCodeNoComponent.png"></a>
{{ render: BP_HeaderCodeNoComponent3.png }}

Where there is only a panel code the following codes **MUST** be used to complete the triple for export in GP Connect,
- 163020007 On examination - blood pressure reading (finding) and 386534000 Arterial blood pressure (observable entity)
Expand All @@ -178,10 +176,7 @@ In GP Connect we have decided that all of these variations will be represented u

Following the guidance above to determine the appropriate codes for the triple will result in the following structure which may contain any of the codes from the table below,

<a href="images/access_structured/BP_Diagram.png"><IMG src="images/access_structured/BP_Diagram.png"></a>

<div class="alert alert-warning nhsd-t-body" role="alert">
<i class="fa fa-exclamation-triangle"></i> <b>Important:</b> - Fix the 4 links above<br/> </div>
{{ render: BP_Diagram4.png }}

The triple may contain any combination of the following SNOMED codes for the panel, systolic and diastolic components,

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