Define exchange of patient's registered GP practice and practitioner - MyGP

[dtr-agency]

Prerequisites

• I have searched open and closed issues to make sure it isn't already requested or reported
• I have written a descriptive issue title

The feature

Define representation of registration information from MyGP - Medicare / DVA healthcare recipients voluntary registration of their regular General Practice. Support exchange GP practice registration information for a patient from MyGP for the electronic exchange of health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.

What it actually enables people to do

TBD

Mockups

TBD

How awesome would it be?

TBD

Workarounds

TBD

Additional context

https://www1.health.gov.au/internet/main/publishing.nsf/Content/primary-health-care-reform
https://www.health.gov.au/resources/publications/australias-primary-health-care-10-year-plan-2022-2032

[dtr-agency]

Preliminary MyGP FHIR R4 payload design overview

The MyGP GP practice registration data is to be sent in a FHIR Bundle of type collection. This bundle is constructed as follows:

• A Bundle resource to hold the collection of resources, conforming to the profile ADHA Payload Bundle.
• An EpisodeOfCare resource for the registration details, conforming to the profile ADHA GP Practice Registration Entry.
• An Organization resource for the GP Practice, conforming to the profile ADHA Core Organization.
• A Patient resource for the patient, conforming to the profile ADHA Core Patient.

Future enhancement support:

• Additional GP Practice information (e.g. HPI-O) is supported by this approach.
• Additional practitioner information can be supported with a PractitionerRole resource conforming to ADHA Core PractitionerRole and Practitioner resource conforming to ADHA Core Practitioner.
• This design pattern also supports additional registrations (e.g. registered pharmacy) if voluntary patient registration information is extended to additional services.

Figure 1. MyGP GP practice registration data Set FHIR Bundle structure

Profiles that make up MyGP Registered Practice Information:

1. ADHA Payload Bundle
2. ADHA GP Practice Registration Entry
3. ADHA Core Patient
4. ADHA Core Organization

Data Mapping

Data Item	Cardinality	Target FHIR Element
Registration Start date	1..1	EpisodeOfCare.period.start
Registered GP Practice Name	1..1	Organization.name
Practice Address	1..1	Organization.address
Preferred GP name	0..1	Patient.generalPractitioner.display

Additional items of interest to the Agency that can be supported but are not in current
scope of VPR.

Data Item	Cardinality	Target FHIR Element	Notes
GP Practice HPI-O	TBD	Organization.identifier	Shall conform to the profile AU HPI-O
GP Practice phone number	TBD	Organization.telecom

Bundle samples – demonstrate detailed implementation requirements

Examples are starting as maximal to help guide implementation, and have additional items of interest that can be removed as scope of implementation is clarified:

• Patient has both IHI and Medicare number - remove Medicare number if this will not be provided by Services Australia
• Patient.identifier IHI contains verification data - remove if this cannot be sent by Services Australia (check with Architecture first)
• Organization samples contain telecom - remove this data is telecom cannot be sent by Services Australia

Scenario	Links
GP practice only	Narrative | XML | JSON
GP practice & practitioner name registered	Narrative | XML | JSON
History - current registration and historical registration	Narrative | XML | JSON

[dtr-agency]

To do

Resource type	To dos
Bundle	Unclear on the need for Bundle.identifier to support current architecture requirements for a document id - to be determined. Query architect. Query need for timestamp to be mandatory - my view is that this is critical metadata for currency and should be made mandatory. Query @oridashi & architect.
EpisodeOfCare	Profile supports current and historical - reflects current CDT discussions.  If support for historical is to be removed the following actions are required: Remove inv-dh-epoc-03 Remove inv-dh-epoc-04 Place a fixed value constraint on EpisodeOfCare to be 'active' Prohibit EpisodeOfCare.period.end Make the necessary informative material updates incl examples
Organization	None.
Patient	None. Note1: A complete core Patient resource with identifier, name, gender, birthdate is required to be returned by Services Australia in the Bundle - necessary patient matching and identification data. Note2: practitioner name is to be implemented as Patient.generalPractitioner.display with Patient.generalPractitioner.type=PractitionerRole
Other	getDocument needs type code | class code definition. To be defined in NCTIS Data Components code system. Current thinking is "Patient GP Registration Information" or "MyGP Registered Practice Information". @dbojicic-agency  to progress concept design and implementation of record type & class with Terminology team Concept, ensuring that all change proposals for the NCTIS Data Components code system go through the CI - NCTIS Data Components JIRA project and governance process – and if needed OID registration for record type.

[dtr-agency]

Out of FHIR Architect review 14 Oct:

1. Bundle.timestamp now mandatory
2. EpisodeOfCare.period.start now mandatory

[dtr-agency]

CDT design walkthrough held 17 Oct:

1. Confirmed no requirement for Bundle.identifier
2. Confirmed support for Bundle.timestamp
3. Clarification provided that only current and not historical to be supported - action on @dtr-agency to update EpisodeOfCare profile to reflect this scope
4. Clarification that IHI verification information not required

Changes have been made via 1bb9c38

Notes on design of historical entry that can be supported (but is in current scope of VPR)
Some discussion in CDT that historical entries would be of interest. The below sample shows how this could be supported with a current entry and historical entry.

Scenario	Links
History - current registration and historical registration	Narrative | XML | JSON

In support of a historical entry the profile ADHA GP Practice Registration Entry would need a minor update to:

1. Remove the fixed value constraint on EpisodeOfCare.status and replace with invariant e.g. inv-dh-epoc-04 

<constraint>
        <key value="inv-dh-epoc-03"/>
        <severity value="error"/>
        <human value="status shall be active or finished"/>
        <expression value="(status='active') or (status='finished')"/>
        <xpath value="(f:status/@value = 'active') or (f:status/@value = 'finished')"/>
        <source value="http://ns.electronichealth.net.au/fhir/StructureDefinition/dh-episodeofcare-mygp-1"/>
</constraint>

2. Make informative update to EpisodeOfCare.status short and comment
3. Make informative update to EpisodeOfCare.period short and comment

[dtr-agency]

Delivery partner (NIO, Services Australia, Deloitte) design walkthrough held 18 Oct: no changes out of this walkthrough.

[dtr-agency]

VPR: release of ADHA FHIR NPM package v1.1.0-qa-preview1 for assurance

An initial submission of the Australian Digital Health Agency FHIR implementation guide v1.1.0 for internal and external assurance.

In addition to the attachments on collaborate, a temporary web version of the implementation guide is available from https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/2022Oct/ for the next 30 days.

Internal testing is being undertaken via AN-533, peer review via AN-534, internal and external assurance via the collaborate page.

Changes from v1.0.0 and v1.1.0-qa-preview2 :

• Added ADHA Payload Bundle ci-medicare-records #153
• Added ADHA GP Practice Registration Entry ci-medicare-records #153
• Inclusion of change log

ADHA FHIR IG & NPM package
The ADHA FHIR implementation guide defines profiles that may be used by systems to represent clinical information in the electronic exchange of health information between individuals, healthcare providers, and the My Health Record system infrastructure in Australia.

Each profile defines the FHIR structures required, the data element definitions, their associated rules of usage including the use of extensions and terminology, and references the additional profiles necessary to assert conformance.

The FHIR profiles are also published in a FHIR NPM package for use with FHIR and FHIR-aware tools. The package contains the validation form (JSON + SCH) of the conformance artefacts (i.e. StructureDefinitions) for direct use in validation operations and example resource instances that demonstrate use cases and conformance requirements.

[dbojicic-agency]

Proposed type code | class code

Terminology	NCTIS Data Components
Reason	New concept
Concept arc	Data Components (101) > Structured Documents (100) OID Sub-Register
Concept	100.32048
Suggested Display	MyGP Registered Practice Information
Detailed Description	A record of information for an individual about their usual General Practitioner (GP) and GP practice registered with the MyGP system.
Business Reason for Request	To support the current work plan initiative: Voluntary Patient Registration VPR (myGP)

Concepts reviewed and approved by Terminology Analyst, Lead Clinical Information Modeller, Clinical Information Modeller. Feedback opportunity provided to Product Owner, Business Analyst, Solution Architect - no feedback provided. Documentation available on internal ADHA JIRA CI - NCTIS Data Components DATA-281.

Publication in NCTIS Data Components https://healthterminologies.gov.au/fhir/CodeSystem/nctis-data-components-1 scheduled for February 2023. Publication will be managed by internal ADHA JIRA FHIR Terminology Request FTR-1623.

[dbojicic-agency]

VPR: release of ADHA FHIR NPM package v1.1.0-qa-preview2 for assurance

Feedback raised during the assurance period from internal testing and CI SME design review. Temporary web version of the implementation guide was available from https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/2022Nov/.

Changes include:

• Fixed typo in guidance in ADHA GP Practice Registration Entry AN-540
• Removed broken hyperlinks to unrelated examples in ADHA Payload Bundle AN-541
• Fixed typo in guidance in ADHA Core Patient AN-542
• Fixed typo in guidance in ADHA Core Practitioner AN-544
• Linked two VPR examples from ADHA Payload Bundle AN-545

[dbojicic-agency]

VPR: release of ADHA FHIR NPM package v1.1.0-qa-preview3 for assurance

The Agency branding and style changes and the change of the implementation guide copyright year to 2023 for the completion of assurance activities.

In addition to the attachments on collaborate, a temporary web version of the implementation guide is available from https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/2023Feb/ for the next 30 days.

Internal testing is being undertaken via AN-533, peer review via AN-534, internal and external assurance via the collaborate page.

Changes from 1.1.0-qa-preview3 :

• Apply the Agency style and branding changes AN-598
• Update implementation guide copyright year to 2023 AN-597

[dbojicic-agency]

Concept 100.32048 MyGP Registered Practice Information has now been made available in the February update to the NCTIS Data Components code system via the National Clinical Terminology Service.

[dbojicic-agency]

There is a requirement to update VPR (MyGP) FHIR design to provide for success, failure or informative responses:

API outcome	Response
Success (i.e. no functional or technical errors); Patient is actively registered for MyGP with Services Australia	The patient’s MyGP practice registration information – i.e. Practice name, Practice address, Preferred GP (if provided), Registration start date (for MyGP)
Success (i.e. no functional or technical errors); Patient is not actively registered for MyGP	An informational message stating that the patient is not actively registered for MyGP
Functional error (a list to be specified); e.g. where Services Australia do not have an active MHR registration	An informational message including the relevant error code and perhaps a short description of the error.
Technical error ( a list to be specified)	An informational message containing the relevant error code and perhaps a short description.

[dbojicic-agency]

MyGP FHIR R4 payload design overview - providing for success, failure or informative responses

If the outcome of the operation to retrieve the MyGP GP practice registration data is successful, i.e. patient is currently registered for MyGP, the MyGP GP practice registration data is to be sent in a FHIR Bundle. Please refer to Preliminary MyGP FHIR R4 payload design overview above.

If the outcome of the operation to retrieve the MyGP GP practice registration data is successful but there is no data data to be returned (i.e. patient is not currently registered for MyGP) or an error, an OperationOutcome resource that conforms to ADHA Core OperationOutcome is sent as a direct response.

Figure 1. Overview of VPR (MyGP) interactions

OperationOutcome samples

Scenario	Links
Patient not registered for MyGP	Narrative | XML | JSON
MyGP functional error	Narrative | XML | JSON
Technical error	Narrative | XML | JSON

[dbojicic-agency]

Delivery partner (Services Australia, Deloitte) design walk-through held 24 Feb: no changes out of this walk-through.

[dbojicic-agency]

VPR: release of ADHA FHIR NPM package v1.1.0-qa-preview5 for assurance

An updated submission of the Australian Digital Health Agency FHIR implementation guide v1.1.0 for internal and external assurance. This submission includes support for informational and error messages exchange.

Internal testing is being undertaken via AN-533, peer review via AN-534, internal and external assurance via the collaborate page.

Changes from v1.1.0-qa-preview4 and v1.1.0-qa-preview5:

• Added ADHA Core OperationOutcome ci-fhir-r4 #153

Changes from internal assurance between v1.1.0-qa-preview4 and v1.1.0-qa-preview5:

• Improved wording in ADHA Payload Bundle description and intro AN-599
• Added must support to entry.resource in ADHA Payload Bundle AN-600
• Relaxed cardinality of entry.fullURL in ADHA Payload Bundle AN-601
• Typo in ADHA Core Practitioner intro page post-publication ADHA FHIR IG v1.0.0
• Typo in ADHA Core Patient intro page post-publication ADHA FHIR IG v1.0.0

ADHA profiles amended:

• ADHA Payload Bundle

[dbojicic-agency]

VPR: release of ADHA FHIR NPM package v1.1.0-qa-preview6 for assurance

This version incorporates changes for the feedback raised from internal testing and IA SME design review and implements the tooling patch for the examples display.

The package and implementation guide are available from:

• Temporary public link active for the next 30 days: https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/2023Mar/
• Collaborate page: https://collaborate.digitalhealth.gov.au/pages/editpage.action?pageId=156897792

Changes from internal assurance between v1.1.0-qa-preview5 and v1.1.0-qa-preview6:

• Improved invariant expression in ADHA GP Practice Registration Entry AN-618
• Fixed typo in ADHA Core Practitioner description AN-604
• Added Examples menu

ADHA profiles amended

• ADHA GP Practice Registration Entry
• ADHA Core Practitioner

[dbojicic-agency]

Department of Health announced the new name for 'MyGP' to 'MyMedicare' in early May 2023. Agency project team together with NIO, Deloitte and other delivery partners decided to incorporate name change into the project including all conformance and informative artefacts that define the FHIR payload from Services Australia and are used by the MHR backend.

type code | class code update
NCTIS Data Components code system concept 100.32048 MyGP Registered Practice Information to be updated:

concept	old concept name	synonym	old definition	new concept name	new definition
100.32048	MyGP Registered Practice Information		A record of information for an individual about their usual General Practitioner (GP) and GP practice registered with the MyGP system.	MyMedicare Registered Practice Information	A record of information for an individual about their usual General Practitioner (GP) and GP practice registered with the MyMedicare system.
Code system update is requested via https://jira.aws.tooling/browse/FTR-1669.

[dbojicic-agency]

VPR: release of ADHA FHIR NPM package v1.1.0-qa-preview8 for assurance

The package and implementation guide are available from:

• Temporary public link active for the next 30 days: https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/branches/2023May/
• Collaborate page: https://collaborate.digitalhealth.gov.au/pages/editpage.action?pageId=156897792

Changes from internal assurance between v1.1.0-qa-preview7 and v1.1.0-qa-preview8:

• ADHA GP Practice Registration Entry update for the system name change from MyGP to MyMedicare
• Typo fixes AN-630, AN-628, AN-632

ADHA profiles amended:

• ADHA GP Practice Registration Entry

[dbojicic-agency]

Release readiness and regression testing AN-533 completed with no issues.
Publication readiness review AN-625 completed with informative documentation updates now complete.

Now progressing to publication in the Australian Digital Health Agency FHIR Implementation Guide v1.1.0.