FHIR DeviceRequest Resource - Healthcare Interoperability

The Fast Healthcare Interoperability Resources (FHIR) standard has emerged as a pivotal framework in modern healthcare to enhance the exchange and management of health-related data. Within the expansive realm of FHIR resources, the DeviceRequest resource occupies a crucial role by facilitating the seamless communication and coordination between healthcare providers and medical devices.

Table of content

Introduction

The FHIR DeviceRequest resource encapsulates a request made by a clinician, care provider, or authorized personnel for a specific medical device-related action or procedure. This might encompass a broad spectrum of actions, ranging from the initiation of diagnostic tests through specific devices, adjustments to device settings, or even the cessation of a device’s functionality. The resource not only encapsulates the core request but also encompasses ancillary information like timing, priority, and specific details about the intended action, thereby ensuring comprehensive communication between different healthcare entities.

Incorporating the principles of FHIR, the DeviceRequest resource adheres to a structured data model, fostering interoperability and efficient data exchange across disparate systems. The resource encapsulates essential metadata, including patient information, encounter context, and the associated clinical context. This comprehensive packaging of data promotes a holistic understanding of the patient’s situation, enabling more informed decision-making by both requesting and responding parties.

In the broader landscape of healthcare information exchange, the DeviceRequest resource synergizes with other FHIR resources, such as Observation and Device, to offer a cohesive and comprehensive view of the patient’s medical journey. For instance, a DeviceRequest for a specific diagnostic test can subsequently link with the corresponding Observation resource containing the test’s results, yielding a dynamic narrative of the patient’s care trajectory.

Ultimately, the FHIR DeviceRequest resource emerges as a linchpin in the orchestration of medical devices within the evolving landscape of digital healthcare. By standardizing the way medical device-related actions are requested and communicated, this resource streamlines care processes reduces errors arising from miscommunication, and propels healthcare systems toward a more integrated and patient-centric future.

Structure of FHIR DeviceRequest Resource

Here is the structure of the FHIR DeviceRequest resource in JSON format along with an explanation of each element. Other format like XML and Turtle is also present, but for simplicity here we will take the example of JSON format. The complete structure details can be found here.

{
  "resourceType": "DeviceRequest",
  "id": "example-device-request",
  "status": "active",
  "intent": "original-order",
  "priority": "routine",
  "codeReference": {
    "reference": "CodeSystem/device-codes#blood-pressure-monitor",
    "display": "Blood Pressure Monitor"
  },
  "subject": {
    "reference": "Patient/example-patient"
  },
  "encounter": {
    "reference": "Encounter/example-encounter"
  },
  "authoredOn": "2023-08-15T10:30:00Z",
  "requester": {
    "reference": "Practitioner/example-practitioner"
  },
  "performerType": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/performer-role",
        "code": "manufacturer"
      }
    ]
  },
  "performer": {
    "reference": "Organization/example-device-manufacturer"
  },
  "reasonCode": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/reason-medication-given",
          "code": "therapy"
        }
      ],
      "text": "Management of hypertension"
    }
  ],
  "note": [
    {
      "text": "Please ensure accurate calibration."
    }
  ]
}

Explanation of the JSON elements:

resourceType: Indicates the type of FHIR resource, which is “DeviceRequest” in this case.
id: A unique identifier for the DeviceRequest resource.
status: The status of the device request, which can be “active,” “completed,” etc.
intent: Describes the intent of the device request, such as “original-order,” “reflex-order,” etc.
priority: Indicates the priority of the request, like “routine,” “urgent,” etc.
codeReference: The medical device being requested, specified by a reference to a coding system and a display name.
subject: Reference to the patient for whom the request is being made.
encounter: Reference to the encounter context in which the request is made.
authoredOn: The date and time when the request was authored.
requester: Reference to the practitioner making the request.
performerType: Describes the type of entity that will perform the requested action, using coding from a performer role code system.
performer: Reference to the organization or entity that will perform the action (e.g., the manufacturer).
reasonCode: The reason for the device request, with coding indicating the purpose and an accompanying text description.
note: Additional notes or comments associated with the request.

Commonly used fields in FHIR DeviceRequest Resource

Here are some of the most commonly used fields in the FHIR DeviceRequest resource along with explanations for each:

status: Indicates the current status of the device request, such as “active,” “completed,” or “cancelled.” It provides insights into the progress of the request.
intent: Describes the intent of the device request, conveying the purpose or reason behind it. Examples include “original-order” for the initial request and “reflex-order” for a follow-up request triggered by a previous result.
priority: Specifies the urgency or importance of the device request, with values like “routine,” “urgent,” or “stat.” This helps in prioritizing actions and responses.
codeReference: Refers to the specific medical device being requested, using a reference to a coding system along with a display name that provides clear identification.
subject: Points to the patient for whom the device request is made, ensuring that the request is linked to the correct individual’s care.
encounter: References the encounter or clinical context in which the device request is being made, establishing the broader context of the request.
authoredOn: Records the date and time when the device request was created or authored, enabling chronological tracking of requests.
requester: Specifies the practitioner or person who initiated the device request, providing accountability and facilitating communication.
performerType: Describes the type of entity that will perform the requested action, utilizing coding from a performer role code system. For instance, it might indicate if the performer is the “manufacturer” or “clinician.”
performer: Refers to the organization or entity that will execute the requested action, offering clarity on who will carry out the device-related task.
reasonCode: Specifies the reason for the device request using coded values that denote the purpose or context of the request, such as “therapy,” “diagnostic,” or “monitoring.”
note: Allows for the inclusion of additional free-text comments or notes relevant to the device request, aiding in communication and clarifications.

These commonly used fields within the FHIR DeviceRequest resource collectively contribute to a well-defined and structured representation of medical device-related requests. They serve to enhance the interoperability and comprehensibility of healthcare data, promoting efficient and informed decision-making across various healthcare contexts.

A use case where FHIR DeviceRequest Resource can be utilized

Use Case: Monitoring Glucose Levels in a Diabetic Patient

Description: A diabetic patient requires continuous monitoring of their glucose levels to manage their condition effectively. The healthcare provider wants to initiate a device request for a glucose monitoring device that will allow real-time tracking of the patient’s blood sugar levels and provide timely alerts for potential complications.

Solution:

DeviceRequest Creation: The healthcare provider, a physician, creates a new DeviceRequest resource in the EHR system for the patient. They set the status to “active,” indicating an ongoing request. The intent is set to “original-order” to signify the initial prescription of the device.
Device Selection: The provider specifies the requested device in the codeReference field, referencing the appropriate coding system and display name for a glucose monitoring device. The patient’s information is linked via the subject field, and the current encounter is referenced using the encounter field to provide context.
Authorship and Reasoning: The authoredOn field records the timestamp of the request. In the requester field, the provider’s reference is added to indicate their role in initiating the request. The reasonCode field is populated with the coding for “monitoring” and a text description explaining that the device is required for continuous glucose level tracking.
Priority and Performer: The priority is set to “routine” as glucose monitoring is a regular aspect of the patient’s care. The performerType is set to “manufacturer” to indicate that the device’s manufacturer will fulfill the request. The specific manufacturer is then referenced in the performer field.
Notes: A note is added in the note field to request accurate calibration of the device.

By utilizing the FHIR DeviceRequest resource in this use case, the healthcare provider ensures that the request for a glucose monitoring device is communicated accurately and comprehensively. The standardized structure of the resource allows for clear documentation of the patient’s needs, the specific device requested, the rationale behind the request, and the responsible parties involved. This promotes seamless coordination between healthcare professionals and device manufacturers, ultimately aiding in the effective management of the patient’s diabetic condition.

Here are a few general or interview questions related to the DeviceRequest resource, which aims to gauge your knowledge about the resource, its practical application, and your understanding of healthcare interoperability principles.

1. What is the purpose of the FHIR DeviceRequest resource?

The FHIR DeviceRequest resource serves as a standardized representation of requests for medical devices or device-related actions within the Fast Healthcare Interoperability Resources (FHIR) framework. It enables healthcare providers to communicate their requirements for specific devices or procedures seamlessly, ensuring clear and structured data exchange between different healthcare systems.

2. Explain the key elements of an FHIR DeviceRequest resource.

The key elements of a FHIR DeviceRequest resource include:

status: Indicates the current status of the device request, such as “active,” “completed,” or “cancelled.”
intent: Describes the purpose or intent behind the device request, like “original-order” or “reflex-order.”
priority: Specifies the urgency of the request with values such as “routine” or “urgent.”
codeReference: References the requested device using a coding system and display name.
subject: Links the device request to the patient for whom it’s intended.
encounter: Provides context by referencing the clinical encounter associated with the request.
authoredOn: Captures the date and time when the request was authored.
requester: Identifies the practitioner or entity initiating the request.
performerType: Specifies the type of entity that will perform the requested action.
performer: References the organization or entity responsible for executing the request.

3. How does the status field in the FHIR DeviceRequest resource reflects the progress of a device-related request?

The status field in the DeviceRequest resource indicates the current stage of the device request’s lifecycle. It evolves as the request progresses from creation to fulfillment. For instance, it can start as “active” when the request is initiated, transition to “completed” when the action is carried out and change to “cancelled” if the request is terminated before completion. This field provides real-time insights into the state of the request.

4. What is the significance of the intent field in the context of a FHIR DeviceRequest resource?

The intent field in the DeviceRequest resource outlines the purpose or intent behind the device request. It categorizes the request based on its context, which can include actions like “original-order” for initial requests, “reflex-order” for actions triggered by results, and “order” for general orders. This field aids in understanding the clinical reasoning behind the request and helps automate workflows.

5. In a FHIR DeviceRequest resource, how is the urgency of a request indicated? Provide examples of possible values for the priority field.

The urgency of a request is indicated using the priority field in a DeviceRequest resource. This field determines the level of urgency with which the requested action should be performed. Examples of possible values priority include:

“routine”: Indicates a standard level of urgency for routine requests.
“urgent”: Specifies a higher level of urgency for actions that require immediate attention.
“asap”: Denotes that the action should be performed as soon as possible, but not necessarily immediately.
“stat”: Signifies an urgent request that requires immediate action.

6. Describe the role of the codeReference field in a FHIR DeviceRequest resource.

The codeReference field in a DeviceRequest resource plays a crucial role in specifying the requested medical device or action. It references a coding system, such as a standardized code set for medical devices, and provides a display name that identifies the requested device. This ensures accurate and unambiguous communication of the desired device or action between healthcare systems.

7. Why is the subject field important in a FHIR DeviceRequest resource, and how is it typically populated?

The subject field in a DeviceRequest resource is vital because it links the device request to the patient for whom the action is intended. It establishes the context of the request within the patient’s medical history and care plan. The field is populated with a reference to the specific patient using a unique identifier, allowing for accurate tracking and coordination of patient-specific device requests.

8. Explain how the encounter field is used to provide the context within a FHIR DeviceRequest resource.

The encounter field in a DeviceRequest resource references the clinical encounter during which the request is made. It offers additional context by indicating the setting, location, and circumstances under which the device-related action is being requested. This field helps healthcare providers better understand the clinical scenario surrounding the request and ensures accurate communication between various entities involved.

9. What purpose does the authoredOn field serve in a FHIR DeviceRequest resource, and what kind of information does it capture?

The authoredOn field in a DeviceRequest resource captures the date and time when the request was created or authored. It provides a chronological reference point for when the request was initiated. This information is valuable for tracking the timeline of the request, ensuring accountability, and maintaining an accurate historical record of device-related actions.

10. How does the requester field identifies the initiator of a device-related request in a FHIR DeviceRequest resource?

The requester field in a DeviceRequest resource specifies the practitioner or entity that initiated the device-related request. It is populated with a reference to the relevant practitioner or entity using a unique identifier. This field ensures that the person responsible for requesting the device action is accurately documented, facilitating communication and accountability throughout the care process.

11. Explain the significance of the performerType field in a FHIR DeviceRequest resource and how it can be used to differentiate between different entities.

The performerType field in a DeviceRequest resource defines the type of entity that will carry out the requested action. It utilizes coding from a predefined performer role code system to categorize the performing entity. This field is instrumental in distinguishing between various roles or organizations involved in fulfilling device-related requests. For instance, it can differentiate whether the performer is a “manufacturer,” “clinician,” or “laboratory,” thereby clarifying the responsible party’s role and aiding in efficient coordination.

12. Describe the role of the performer field in a FHIR DeviceRequest resource and provide an example of its usage.

The performer field in a DeviceRequest resource specifies the organization or entity that will execute the requested action. It is populated with a reference to the performing entity using a unique identifier. For instance, in the context of a device request for a diagnostic test, the performer field might refer to a medical laboratory that conducts the test. This field ensures that the correct entity is aware of and carries out the device-related action.

13. Explain the significance of the reasonCode field in a FHIR DeviceRequest resource. How does it contribute to effective communication?

The reasonCode field in a DeviceRequest resource denotes the reason behind the device-related action using coded values. It allows for standardized communication of the purpose or context of the request. By including a specific code, such as “therapy,” “diagnostic,” or “monitoring,” healthcare professionals can swiftly understand the underlying objective of the request. The accompanying text description further enhances clarity, ensuring effective communication between different stakeholders.

14. In the context of a FHIR DeviceRequest resource, what is the purpose of the note field? Give an example scenario where it might be used.

The note field in a DeviceRequest resource provides an avenue for including additional free-text comments or notes relevant to the request. It serves to offer supplementary information that might not fit within the structured fields. For instance, a note might be used to emphasize the importance of accurate calibration for a requested medical device, ensuring that this detail is not overlooked during the fulfillment process.

15. Give an example use case where the DeviceRequest resource could be applied to streamline a healthcare process.

Imagine a scenario where a physician wants to initiate a DeviceRequest for a patient who needs a cardiac monitor. By creating a DeviceRequest with the relevant patient’s information, specifying the type of device needed, and including the reason for monitoring, the physician ensures that all necessary information is accurately conveyed to the appropriate parties. This streamlines the process of acquiring the cardiac monitor and provides a clear record of the request for future reference.

Conclusion

In conclusion, the FHIR DeviceRequest resource stands as a pivotal cornerstone within the realm of modern healthcare data exchange. By encapsulating crucial information related to medical device requests and actions, it addresses the need for standardized and structured communication between healthcare providers, patients, and device manufacturers. This resource not only streamlines the process of requesting, performing, and tracking device-related actions but also ensures a clear and comprehensive representation of the patient’s care journey. With its standardized elements, including status, intent, priority, requester details, performer information, and more, the DeviceRequest resource fosters interoperability and effective collaboration in an increasingly digital healthcare landscape.

The adoption of the FHIR DeviceRequest resource holds immense promise for enhancing patient-centered care, minimizing errors arising from miscommunication, and promoting seamless integration of medical devices into the broader healthcare ecosystem. By facilitating accurate and unambiguous communication, bolstering data sharing, and enabling streamlined workflows, the DeviceRequest resource is a testament to the FHIR standard’s commitment to advancing healthcare data interoperability, ultimately leading to improved patient outcomes and more efficient care delivery.

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Introduction

Structure of FHIR DeviceRequest Resource

Commonly used fields in FHIR DeviceRequest Resource

A use case where FHIR DeviceRequest Resource can be utilized

General (interview) questions related to FHIR DeviceRequest Resource

Conclusion