Mongolian HDIT Implementation guide
1.0.0 - Review
Mongolian HDIT Implementation guide
1.0.0 - Review
Mongolian HDIT Implementation guide - Local Development build (v1.0.0). See the Directory of published versions
To describe a healthcare process with the related activities and outcomes, many factors need to be taken into account. James Grier Miller defined eight levels of organizational complexity in living systems, spanning from cellular to super-societal, all of which can have an impact on healthcare and treatment. Adding the dimension of time and requirements of supporting information longevity of a patients lifespan, patient mobility, linguistic complexities, multiple sources of data, changes of requirements following new evidence based treatment practices and knowledge, the domain complexity expands additionally.
To model the complete domain with all dimensions and complexities is an undertaking no one has managed so far, so simplifications must be made.
Here FHIR provides us with a good basic framework for a simplified representation of information and entities which can be expanded and customized for regional purposes, while still providing interoperability on a national and international level. The philosophy is to model the relevant parts of the domain, as needed, adding models in an iterative and implementable manner.
For the Mongolian national Implementation guide, we have made a major division of profiles into 4 main categories:
The administrative profiles are a bridge to real world concepts within healthcare. These include, but are not limited to, the patient, the practitioner, organizations and locations.
A starting point of describing healthcare data is the entities involved. In order to describe the healthcare process, the “who” and “where” must be well defined.
In the administrative profiles we define the actors involved in the care process, the organizations responsible for the care process and the structure of the organizations.
We have also included the Encounter as an administrative resource since it connects the who and where of the meeting between a patient and a medical professional.
The clinical profiles handle the issue of what has happened within the care process. They are the central element of the data exchange and documenting data known about the patient and the activities that have been performed on, with or for the patient as a part of a care process.
This data is used to monitor progress, support diagnosis, identify patterns, capture demographic characteristics and improve patient care.
Focus for the clinical profiles is keeping records of and exchanging data concerning the health care process.
During a healthcare process it is common that a patient is handled or treated by several parties, a fact that puts emphasis on a good process for handing over information and directives from one party to another. The workflow profiles aim to meet these demands by supplying means to communicate what activity is to be performed, for which patient, and for what reason. This can be a request for diagnostic testing, procedure or another activity to be performed or medication to be handed over to the patient.
In addition to the actual request profiles, some supporting profiles have also been included to handle the logistics of requests and activities. These supporting profiles are mainly related to scheduling.
While tracking details about a patient is both relevant and meaningful, it must also be possible to represent a set of healthcare related information with a singular context.
In order to achieve this, the composition is used, detailing which information can and should be included, which entities were involved. A choice of which composition is to be used is dependent on the context in which the data is passed from system to system.
This guide details four compositions corresponding to the requirements set in the mongolian national standards, but compositions are expected to be added locally as experience of exchanging health data increases and demands & requirements change over time.
When compositions are communicated between systems, they are seen as FHIR Documents, an immutable, coherent set of information that is a statement of healthcare information. The composition is wrapped in a Bundle resource with Bundle.type=document, where the composition is the first entry with any other resources referenced to from the composition included as subsequent entries in the bundle. This applies to both clinical data as well as entities such as Patient, Practitioner, Encounter etc.