AU Core PractitionerRole Consensus Discussion

[dt-r]

Check out AU Core PractitionerRole, noting the draft general conformance and Must Support data obligations.

To see the full constraints inherited from AU Base view the Key Elements Table

AU Core PractitionerRole should support the minimum requirements to record, search, and fetch basic demographics and other administrative information about an individual practitioner in a role, associated with a patient.

Comment on:

• If this profile was mandated tomorrow, what problems would that cause for your organisation?
• What's missing?
• Should any other identifier besides HPI-I and Medicare Provider Number be supported in AU Core? What about Employee Identifier?
• Should anything change?

[heathfrankel]

Please allow active value of false to support cases when clinical resource reference a PractitionerRole that is no longer active within an organization

HPI-I should NOT be provided on PractitionerRole since it is associated with the individual, not on each role or at each location the practitioner operates.

The Employee Identifier would be nice to have given that the My Health Record allows this as an alternative identifier to the HPI-I (or is this no longer allowed).

A mandatory identifier may also be problematic for scenarios when staff do not have a provider number and employee numbers are not used.

[kimberley-hilton]

Agreed re HPI-I

[utsavigajjar]

Agree re HPI-I

[dt-r]

Discussed in 2023-09-28 AU Core TDG Agenda/Minutes.

• Motion to remove support for HPI-I on PractitionerRole passed. Change tracked via AU Core PractitionerRole remove support for HPI-I from PractitionerRole #58.
• Support for Employee identifier (which is supported by My Health Record) be used instead?
  • Outcome: Agreement that Employee identifier is useful, is allowed but the profile, no interest in explicit must support in the profile
• Motion to remove the mandatatory cardinality on PractitionerRole.identifier passed. Change tracked via AU Core PractitionerRole: PractitionerRole.identifier to be 0..* #57

NOTE: Outcome of the two above changes is that no specific type of identifier is supported for this resource type and identifier is not mandatory.

Discussed in 2023-10-19 AU Core TDG Agenda/Minutes

• Motion to remove PractitionerRole.active passed. Change tracked via Agreed change PractitionerRole.active to be unconstrained #61

[dt-r]

From @ir4y

I have a question about the fixed value for the active field in Patient, Practitioner, PractitonerRole, and Organization.
Could you please share a bit more details on why it is a fixed true value?

There are multiple use cases when you need to make a resource inactive. @heathfrankel mentioned some of them in the GitHub discussion (please check related topics for dedicated resources) and all of them make sense to me.

Originally posted by @ir4y in #43

[dt-r]

Discussed in 2023-10-19 AU Core TDG Agenda/Minutes

Motion to remove PractitionerRole.active passed. Change tracked via #61

[dt-r]

PractitionerRole.healthcareService should be 0..* in AU Core PractitionerRole.

What is being defined by that cardinality is: is it meaningful to limit the set of services provided by a practitioner in a role at a location for an organisation to only one? Effectively saying that we

• treat a practitioner in a role at a location for an organisation as providing a single service and by unique it has it’s own record and identifier that are managed. Thus 0..1.
• treat a practitioner in a role at a location for an organisation as providing more than one service, and these would have a meaningful record and identifier that goes across the set of services. Thus we should allow 0..*

I think this should be 0..*.

[dt-r]

I'd count HealthcareService as in the hot list. It wasn't raised in the very first TDG meeting when asked to list their top 10, but it's currently number 11 in terms of up votes to be in R1.

[dt-r]

I think don't think Provider Directory is the more abstract case. I think that's AU Core. Provider Directory necessarily needs to support some specific constraints to drive that use case.

[mmalc]

@heathfrankel Is it worth noting that the Location should be [0..1] if the identifier is AUMedicareProviderNumber
If the provider role identifier is HPI-I, I'm assuming the "Id of a practitioner at a particular practice" rule doesn't apply.
Or are we thinking to constrain the use of PractitionerRole to infer the use if a Medicare Provider ID?

[dt-r]

I think we are moving to the position that PractitionerRole.location isn't core of the core and we want to be silent on in AU Core. We didn't quite finish that discussion previously and should look at this, maybe in the October 19 meeting.

[dt-r]

Discussed in 2023-10-19 AU Core TDG Agenda/Minutes

Motion to remove must support and constraints on PractitionerRole.healthcareService. Change tracked via #56

[heathfrankel]

Mandatory Search parameter for practitioner by reference I suspect is unuseful, the chained practitioner.identifier would be more likely.
If HPI-I is removed from the PractitionerRole, then it should be removed from the identifier search parameter.
Providing a code only in an identifier search parameter is ambiguous. If allowed, I would suggest stating a single (or explicit list) type of identifier that will be used in the search.
a chained organization.identifier may be better or additional search parameter than the organization reference.
I suggest removing the mandatory requirement to support _revinclude of provenance until we at least have a profile for it.

[nielmdrec]

We use PractitionerRole for our Contacts (e.g. Health Professionals) and it's possible that some Contacts don't have identifiers.
This will be an issue because AU Core PractitionerRole requires at least 1 (1..*) identifier.

Also, Contacts can be inactivated in our system, so we need support for PractitionerRole.active = false

[dt-r]

If systems are missing supported AU Core data, then the AU Core definition of Missing Data would apply. That's something we need to look at with the context of how elements are interpreted through Must Support and Conformance Requirements.

[utsavigajjar]

Even if a practitioner does not have a national identifier, when we persist their information in our system, we must assign them some form of identifier, can that be used as an identifier (although may not be of much value if its an internal org. specific identifier).

[dt-r]

To be progressed via #80 and #70

[dylan-jf7]

If Identifier is not made mandatory can we add an additional conformance requirement that at least one of Organisation, Healthcare Service, or Location(maybe) mandatory

[dt-r]

Agreed. This already exists for Organization, Location, HealthcareService. For profile of an entity type resource (Patient, Organization, etc.) if identifier isn't mandatory then we need a constraint that says that one of the accepted identifying elements need to be supplied e.g. name or identifier or ...

For PractitionerRole my preference is:
The practitioner role shall at least have a valid identifier or practitioner or code

We should discuss this. Maybe in the October 19 zoom call.

[dt-r]

To be progress via #79

[dt-r]

This discussion is now closed. Feedback on AU Core should be raised using GitHub issues. Feedback might be suggesting a feature, pointing out a place where a specification is unclear or over-restrictive, identifying a spelling or grammar issue, identifying a defect, or suggesting that an entire area needs to be rethought.

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