HL7.FHIR.US.PHYSICAL-ACTIVITY\Scenario 2 - Provider to Personal Trainer Post-Rehabilitation Referral

Physical Activity Implementation Guide
1.0.0 - STU Release 1 United States of America flag

This page is part of the U.S. Physical Activity IG (v1.0.0: STU 1.0) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

ExampleScenario: Scenario 2 - Provider to Personal Trainer Post-Rehabilitation Referral

Official URL: http://hl7.org/fhir/us/physical-activity/ExampleScenario/Scen2ProviderToPersonaltrainerReferral				Version: 1.0.0
Standards status: Informative				Computable Name: ProviderToPersonalTrainerReferral

This scenario provides an example of the types of data exchanges that are described in the Provider Refers to Personal Trainer Post-Rehabilitation scenario from the Scenarios page.

The scenario shows the flows of information between the different systems and the various FHIR calls involved, as well as what the data might have looked like in each of the exchanges. There are detailed tables below that provide details on each of the steps in the exchange as well as the types of data being shared. From the instances table, it's possible to navigate to sample XML and JSON instances.

Actors

Name	Type	Description
Good Health Cardiology	System	EHR that records patient's exercise plan
Get Fit Training	System	'Light' service provider'
Fit 4 Life	System	'Full' service provider'
Service Registry	System	Registry of candidate service providers - outside the scope of this IG

Diagram

Processes

Process: Subscription Establishment

Pre-conditions:

Good Health Cardiology, Fit 4 Life, and Get Fit training have established legal and technical arrangements for interoperability

Post-conditions:

Subscriptions are successfully created allowing Good Health Cardiology to monitor Fit4Life-assigned Tasks and GetFit to monitor Tasks assigned to it hosted on Good Health Cardiology

Step	Name	Description	Initator	Receiver	Request	Response
1	Create service provider-monitoring Subscription - create	EHR posts Subscription to Fit 4 Life to monitor Tasks. Request: `POST https://fit4life.example.org/fhir/Subscription` Response: `201 Created`	Good Health Cardiology	Fit 4 Life	Subscription from EHR
2	Create EHR-monitoring Subscription - create	Get Fit Training posts Subscription to EHR to monitor Tasks. Request: `POST https://goodCardio.example.org/fhir/Subscription` Response: `201 Created`	Get Fit Training	Good Health Cardiology	Subscription from Get Fit Training

Process: 1 Hour after appointment

Pre-conditions:

EHR has completed the appointment with the patient

Post-conditions:

EHR has retrieved list of personal trainers and notified GetFit of new Task

Step	Name	Description	Initator	Receiver	Request	Response
3	Retrieve service provider list - search-type	Search to retrieve list of Service Providers for personal trainers near Mrs. Johansson.	Good Health Cardiology	Service Registry	Query for personal trainers near Mrs. Johansson	Searchset Bundle returning list of personal trainers
4	Subscription notification of new Task - create	Service provider is notified of new Task via subscription. Request: `POST https://fit4life.example.org/fhir/Subscription` Response: `201 Created`	Good Health Cardiology	Get Fit Training	Subscription notification indicating new Task

Process: 1 Day after appointment

Pre-conditions:

GetFit has received the notification of new Task

Post-conditions:

GetFit has queried Task, associated ServiceRequest and Patient; and updated Task to refused

Step	Name	Description	Initator	Receiver	Request	Response
5	Getfit retrieves referral - search-type	GetFit retrieves the referenced Task and its associated ServiceRequest and Patient.	Get Fit Training	Good Health Cardiology	Query for Get Fit assigned referrals	Search-set Bundle returning referenced Task
6	GetFit refuses task - update	GetFit updates the Task status to 'refused' with a reason. Request: `PUT https://goodCardio.example.org/fhir/Task/Scen2TaskGetFitV1` Response: `200 Ok`	Get Fit Training	Good Health Cardiology	Updated GetFit Task

Process: An Hour later

Pre-conditions:

EHR has a Task seeking fulfillment of ServiceRequest for Fit4Life

Post-conditions:

Fit4Life has retrieved ServiceRequest, Patient, Conditions, Observations, and updated Task

Step	Name	Description	Initator	Receiver	Request	Response
7	Create Task on Fit4Life - create	New Task is created directly on Fit4Life's server. Request: `POST https://fit4life.example.org/fhir/Task` Response: `201 Created`	Good Health Cardiology	Fit 4 Life	Initial Fit4Life Task
8	Fit4Life retrieves referral - search-type	Fit4Life retrieves the ServiceRequest and Patient referenced by the Task.	Fit 4 Life	Good Health Cardiology	Query for Referral & Patient for retrieved Task	ServiceRequest search response for Fit4Life
9	Fit4Life retrieves conditions - search-type	Fit4Life retrieves the physical-activity related Conditions associated with the patient.	Fit 4 Life	Good Health Cardiology	Query for patient physical activity conditions	Condition response for Fit 4 Life
10	Fit4Life retrieves referral - search-type	Fit4Life retrieves the physical-activity related Observations associated with the patient. (In practice there would typically be more than are shown here, and some might not be for profiles defined in this IG.)	Fit 4 Life	Good Health Cardiology	Query for patient physical activity observations	Observation response for Fit 4 Life
11	EHR gets referral acceptance - create	A subscription notification to the EHR is triggered when Fit4Life changes the prescription status to 'accepted'. Request: `POST https://goodCardio.example.org/mySubscriptions` Response: `200 Ok`	Fit 4 Life	Good Health Cardiology	Subscription Notification that Task has updated
12	EHR retrieves accepted Task - search-type	EHR retrieves the Task referenced by the subscription notification	Good Health Cardiology	Fit 4 Life	Query for EHR-issued task based on notification	Accepted Task search response for EHR

Process: 2 Months Later

Pre-conditions:

Fit4Life has updated the Task

Post-conditions:

EHR has retrieved the completed Task, DiagnosticReport, and associated Observations

Step	Name	Description	Initator	Receiver	Request	Response
13	EHR gets referral acceptance - create	A subscription notification to the EHR is triggered when Fit4Life changes the Task status to 'completed'. Request: `POST https://goodCardio.example.org/mySubscriptions` Response: `200 Ok`	Fit 4 Life	Good Health Cardiology	Subscription Notification that Task has completed
14	EHR retrieves completed Task - search-type	EHR retrieves the Task referenced by the subscription notification	Good Health Cardiology	Fit 4 Life	Query for EHR-issued task based on notification	Completed Task search response for EHR
15	EHR retrieves report - search-type	EHR retrieves the Fit4Life DiagnosticReport using the id provided in the Task. It also uses _include to retrieve referenced observations	Good Health Cardiology	Fit 4 Life	Query for report and referenced observations	DiagnosticReport response for EHR

Instances

Name	Type	Content	Description
Query for personal trainers near Mrs. Johansson	Binary		Search to retrieve list of Service Providers for personal trainers near Mrs. Johansson: `GET https://registry.example.org/fhir/PractitionerRole?role=228239008\|http%3A//snomed.info/sct&location.near=37.8393\|84.2700\|20\|[mi_us]&_include=PractitionerRole:practitioner`
Query for Get Fit assigned referrals	Binary		Query Task and associated ServiceRequest and Patient: `GET https://goodCardio.example.org/fhir/Task?status=requested&owner=https%3A//registry.example.org/fhir/Organization/Scen2OrgGetFitTraining&_include=Task:patient&_include=Task:focus`
Query for Referral & Patient for retrieved Task	Binary		Search to retrieve ServiceRequest and Patient for specified Task: `GET https://goodCardio.example.org/fhir/ServiceRequest?_id=Scen2ServiceRequest&_include=ServiceRequest:patient`
Query for patient physical activity conditions	Binary		Search to retrieve Conditions: `GET https://goodCardio.example.org/fhir/Condition?patient=Scen2PatientJohansson&category=http:%3A//hl7.org/fhir/us/physical-activity/CodeSystem/PATemporaryCodesorary-codes\|PhysicalActivity`
Query for patient physical activity observations	Binary		Search to retrieve Observations: `GET https://goodCardio.example.org/fhir/Observation?patient=Scen2PatientJohansson&category=http:%3A//hl7.org/fhir/us/physical-activity/CodeSystem/PATemporaryCodesorary-codes\|PhysicalActivity`
Query for EHR-issued task based on notification	Binary		Search to retrieve Task: `GET https://fit4life.example.org/fhir/Task?_id=Scen2TaskFit4Life`
Query for report and referenced observations	Binary		Search on referenced Observations: `GET https://fit4.life.example.org/fhir/DiagnosticReport?id=Scen2DiagnosticReport&_include=DiagnosticReport:result`
Mrs. Johansson Patient Record	Patient	here	Demographics and contact information
Mr. Matthews Registry Entry	Practitioner	here	Practitioner details for personal trainer Mr. Matthews
Ms. Wang Registry Entry	Practitioner	here	Practitioner details for personal trainer Ms. Matthews
Mr. Matthews Registry Entry	PractitionerRole	here	Practitioner organization details for personal trainer Mr. Matthews
Ms. Wang Registry Entry	PractitionerRole	here	Practitioner organization details for personal trainer Ms. Matthews
Subscription from EHR	Subscription	here	Establishes the subscription for the EHR to monitor tasks it's created
Subscription from Get Fit Training	Subscription	here	Establishes the subscription for the service provider to monitor tasks created for it
Searchset Bundle returning list of personal trainers	Bundle	here	In practice, the set of candidates would likely be longer. Note that this functionality is outside the scope of this IG. Contains: Mr. Matthews Registry Entry
Low physical activity condition	Condition	here	New condition added to chart
Hypertension condition	Condition	here	Older condition
Initial days per week of activity	Observation	here	Exercise of once per week
New days per week of activity	Observation	here	Exercising 5 times per week
Initial minutes per day of activity	Observation	here	15 minutes per day
New minutes per day of activity	Observation	here	32 minutes per day
Information about a run	Observation	here	Collection of sub-observations about a single run
Type of activity - run	Observation	here	Indicates that the activity performed was a run
Duration of run	Observation	here	Run was 30 minutes
Average heart rate during run	Observation	here	Average heart rate of 132 bpm
Peak heart rate during run	Observation	here	Peak heart rate of 177 bpm
Experience of run by patient	Observation	here	Experience of run was positive
Calories burned during run	Observation	here	517 calories burned during run
Report from personal trainer	DiagnosticReport	here	Letter to provider indicating how the consultation went
Referral for support	ServiceRequest	here	Indicates what is to be done and when - but not by whom
Task seeking GetFit to fulfill referral	Task		This is the initial Task seeking fulfillment
Initial GetFit Task		here	This is the initial Task seeking fulfillment
Updated GetFit Task		here	This is the initial Task seeking fulfillment
Subscription notification indicating new Task	Bundle	here	Points to the initial 'requested' version of the Task
Search-set Bundle returning referenced Task	Bundle	here	Returns Task referenced in subscription notification. Includes associated ServiceRequest and Patient Contains: Initial GetFit Task
Task seeking FitLife to fulfill referral	Task		This is the second Task seeking fulfillment (after the first was rejected)
Initial Fit4Life Task		here	This is the second Task seeking fulfillment (after the first was rejected)
Updated Fit4Life Task		here	This is the second Task seeking fulfillment (after the first was rejected)
Completed Fit4Life Task		here	This is the second Task seeking fulfillment (after the first was rejected)
ServiceRequest search response for Fit4Life	Bundle	here	Search-set Bundle returning ServiceRequest and Patient for the Task posted to Fit4Life Contains: Mrs. Johansson Patient Record
Accepted Task search response for EHR	Bundle	here	Search-set Bundle returning 'accepted' Task with id based on subscription notification Contains: Updated Fit4Life Task
Completed Task search response for EHR	Bundle	here	Search-set Bundle returning 'completed' Task with id based on subscription notification Contains: Completed Fit4Life Task
Condition response for Fit 4 Life	Bundle	here	Search-set Bundle containing the patient's Conditions (that Fit 4 Life has access to) Contains: Hypertension condition
Observation response for Fit 4 Life	Bundle	here	Search-set Bundle containing the patient's Observations (that Fit 4 Life has access to) Contains: Initial minutes per day of activity
Subscription Notification that Task has updated	Bundle	here	Pointer to the Task that has been updated
Subscription Notification that Task has completed	Bundle	here	Pointer to the Task that has been updated
DiagnosticReport response for EHR	Bundle	here	Search-set Bundle returning DiagnosticReport and the Observations it references Contains: Calories burned during run

IG © 2022+ HL7 International - Patient Care WG. Package hl7.fhir.us.physical-activity#1.0.0 based on FHIR 4.0.1. Generated 2023-08-25
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