Atomic Unit to capture the advance treatment preferences for a patient.

Advance Treatment Preferences

The following FHIR profiles are used to form the Advance Treatment Preferences Atomic Unit:

Advance Treatment Preferences data item mapping to FHIR profiles

The Advance Treatment Preferences data items are fulfilled by elements within the FHIR resources listed below:

EOL Data Item FHIR resource element Mandatory/Required/Optional
Date of Change in List EOL-ATP-ProblemList-List.date Mandatory
Problem or Condition EOL-ATPProblemList-List.entry.item.reference Optional
Details of Problem or Condition EOL-ATPProblemHeader-Condition-1.code.text Mandatory
Treatment Level EOL-ATP-CarePlan-1.activity.detail.code.text Optional
Intervention EOL-ATP-CarePlan-1.activity.detail.description Optional
ReSPECT Care Priority   Optional
  Extension.respectPriorityScale.valueInteger Mandatory
  Extension.respectPriorityScaleStatement.valueString Optional
Professional recording changes to List of Problems and Interventions EOL-ATP-ProblemList-1.source Mandatory
Advance Decision to Refuse Treatment Coded EOL-ADRT-Flag-1.code Optional
Advance Decision to Refuse Treatment Additional Notes EOL-ADRT-Flag-1.code.text Mandatory
Date of Advance Decision to Refuse Treatment EOL-ADRT-Flag-1.period.start Mandatory
Issue of Anticipatory Medicines Code CareConnect-EOL-Procedure-1.code Optional
Issue of Anticipatory Medicines Additional Notes CareConnect-EOL-Procedure-1.code.text Mandatory
Location of Anticipatory Medicines CareConnect-Location-1.name Optional

EOL-ADRT-Flag-1.code and CareConnect-EOL-Procedure-1.code (codeableConcept) Guidance

Where the sending system supports a terminology system:

  • The codeableConcept.coding element MUST be populated with:
    • system: identity of the terminology system (e.g. SNOMED-CT)
    • code: symbol in syntax defined by the system
    • display: representation defined by the system
  • the codeableConcept.text field MUST be populated with the display value from the codeableConcept.coding.display element e.g. ‘Asthma (disorder)’
  • the codeableConcept.text field MAY contain free text to capture more detail associated with the codeableConcept.coding.code e.g. ‘Patient uses blue inhaler to relieve symptoms’

Where the sending system does not support a terminology system:

  • the codeableConcept.text field MUST be populated with a text description of the concept as a human readable narrative e.g ‘Asthma’.
  • the codeableConcept.text field MAY contain free text to capture more detail associated with the concept e.g. ‘Patient uses blue inhaler to relieve symptoms’

Advance Treatment Preferences ERD

Problem List Example XML

Problem Header Condition Example XML

Care Plan Example XML

Flag Example XML

Care Connect Profiles

Where possible, Care Connect profiles have been used to develop the End of Life API. On this occasion it has not been possible to do this. The table below highlights the Care Connect profile(s) replaced with a bespoke version and the rationale behind this.

Care Connect Profile Rationale for Change New Component Required
CareConnect-List-1 and ReSPECT scale complex extension required extension.resPECTScale
CareConnect-ProblemList-1    
CareConnect-Condition-1 and Problem description is mandatory Change of cardinality to ‘code’ element from 0..1 to 1..1
CareConnect-ProblemHeader-Condition-1    

End of Life will engage with the healthcare community and INTEROPen in the future to propose these changes to the Care Connect profiles(s).