Submitted by HCapon on
PACIO Comments on Provenance
The PACIO Project workgroup offers the following comments on the USCDI V4:
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Data Class: Provenance (Draft V4)
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Data Elements: Author (Level 2), Signature (Comment), Author Roles (Comment), and Purpose of Capture (Comment)
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Recommendation: Include data element “Author” in USCDI V4 and advance data elements, “Signature,” “Author Roles,” and “Purpose of Capture” to level 1.
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Rationale: The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange. The PACIO Community recommends the following data elements that are currently at other levels should be upgraded.
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Author (currently on level 2) - Author time and organization is not going to have a lot of meaning without the author particularly in non-institutional data sources. As we move to more patient centered care, there will be other contributors of data including patients and non-clinician Caregivers
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Signature (Currently Comment) – Some documents and other information, such as end of life, like POLST, orders need to be signed in order to trusted and used. Without a signature there is no way to validate the veracity of data that may not be coming from a direct trusted source.
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Author Role(s) (Currently Comment) – The role in which data is captured is important to more fully understand data. It is important to know not only what organization or author created the data but the capacity in which they were operating under in order to properly understand the data.
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Purpose of Capture (Currently Comment) – Information is gathered from numerous sources for their own specific purposes. The level of detail, completeness, and quality of the information is going to be highly dependent on the interests of those capturing the information. This is important to understand more about the data and how it can be further used for things such as population and public health.
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Submitted by a_davis on
Provenance Use Cases
Provenance was a field added to USCDI with a lot of hope. Unfortunately the role out of the fields have not added a lot of value as they remain lacking the specificity to truly understand the provenance of a given field/item. I think the problem may be that the important components of provenance may differ with different types of health care data. For example author may be critical for a note but may not make sense for a vital sign or an immunization. Provenance for a problem list item that has been updated over time may be much tougher to understand than it would be for an immunization that was given once.
I would recommend shifting the provenance paradigm and rather than focusing on a singular model for all data types, focus more deeply on a given data type and solve it for that type and then advance to the next priority. USCDI should move the data provenance to the data fields it applies to and then solve for that use case. Perhaps first start with clinical notes and immunizations. They have different provenance needs but both are solvable. Then once that is demonstrated can continue to other pami data or vital signs for example.