This page is part of the PACIO Personal Functioning and Engagement Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

Domains

Note to Commenters: The PACIO Personal Functioning and Engagement IG replaces the previously published PACIO Functional Status and PACIO Cognitive Status FHIR IGs as well as the PACIO SPLASCH IG that was under development. This decision was made because the observation profiles created for these IGs all had very similar structures with differences only in the vaocabulary used for the category tied to the profile and the value set from which the code was to be pulled. The use of health domains based on ICF categories and corresponding value sets of observation codes for each domain replaces this approach, allowing this IG to define only a single set of profiles that cover all domains.

The intent of the Personal Functioning and Engagement IG is to provide a framework for communicating and understanding observations related to an individual’s functioning in terms of body functions, activities, and participation. The profiles defined within this IG provide a structure that can be used to represent functioning observations from many different domains. In each case, the domain is associated with specific observation codes reprenting questions, tools, instruments, and measurements within that domain.

This IG provides examples of some potential domains and some associated codes. However, the complete list of domains and the associated domain lives in an external supplemental guide maintained by the PACIO project. Use of the supplemental guide is optional, but highly recommended.

Use

The supplemental guide provides a mapping of health and health-related domains that fall under the personal functioning and engagement umbrella. Implementers of this IG SHOULD include at least one category from the Domain Category value set on each observation instance conformant to this guide. Additionally, the code of the instance SHOULD come from the value set associated with the indicated category or categories.

Motivation and Approach

Standards designers and implementers face many challenges when attempting to enable scalable and meaningful interoperability between health IT systems. Two specific ones that this IG engages with are

• Low Friction Communication: How to generate agreement and consensus about the structure of and terminology used to communicate data so that implementers can adopt the IG consistently enough to support exchange with minimal partner-specific handling and thus realize a reduction in the administrative overhead associated with communication of this information.
• Understanding and Use: How to support the effective use of the data by clinicins and other users so the system can realize the intended benefits of the shraing of this data, namely improved care and reduced costs.

Categorization of observations into health domains based on International Classification of Functioning, Disability and Health (commonly known as ICF) categories provides opportunities to address these challenges.

Low Friction Communication

Categorization of functioning and engagement observations into health domains reduce the set of conformant data by allowing categories to be tied to specific value sets that limit the set of valid observation codes. This mechanism supports the development of consistent implementation of the standards, which in turn enables interoperability, by

• clearly defining a subset of codes that must be understood and accepted by the system that is much smaller than typical general requirements (e.g., all of LOINC)
• supporting validation of inbound data and rejection of messages that do not conform

Understanding and Use

The collection of person’s functioning and engagement varies between care settings. Comprehension and use of information communicated from one setting to another should not require a detailed understanding of the collection mechanisms. By categorizing observations into health domains, health IT systems can organize received data in a clinically relevant way.

Supplemental Guide Development and Maintenance

Development and maintenance of the supplemental guide will be done by the PACIO project. Expected activities include

• Definition of additional domains
• Creation, publication, and maintenance of value sets containing codes for use within each domain
• Additional guidance and support for implementers