High-level design of the FHIR® Reasonable Adjustments API

FHIR® Reasonable Adjustments API

Design Decisions

Initial Design

Reasonable Adjustments initial design followed the architectural principles outlined. This was a simple ReSTful design, based on loosely coupled resources aligned with the units of exchange within the API Operations.

  • Adjustments are modelled as Flag resources
  • Impairments are modelled as Condition resources
  • Consent is modelled as a Consent resource

As Adjustments and Impairments are optional, the presence, or not, of an active Consent resource for a given Patient can stand for presence or absence of the Reasonable Adjustment Flag.

Details of the practitioner recording the Reasonable Adjustment information are required for all items.

  • Practitioner details are modelled as Provenance resources
  • As Provenance is only relevant in the context of the parent resource, the API design contains the Provenance of the resource author or updater within the parent Flag, Condition or Consent resource

Standard Create, Read and Update operations are used to write, read and soft delete the Reasonable Adjustment resources.

INTEROPen Curation

Reasonable Adjustments underwent INTEROPen curation in April 2018. The initial design used the .category element to identify resources that are part of a Reasonable Adjustment Flag.

Curation recommended use of a List resource to identify Conditions that are part of a Reasonable Adjustment Flag in order to:

  • limit .category valueset to clinical categories, protecting against category proliferation
  • conform to a pattern established in GPConnect and Transfer of Care programmes

Further design constraints recommended an approach where Reasonable Adjustment Condition resources are exchanged as a unit, by containing the Conditions as elements withina single List per patient. This List to be managed client-side, and to contain the relevant Provenance information.

Reasonable Adjustments API has incorporated the recommended changes.