type: resourceresource: PractitionerRole

PractitionerRole

Introduction

[%stu-note dstu%] The display property has been added as a denormalized representation of the various core properties of this resource. The expected usage would be for easily populating the display field in references to this resource. We request feedback on whether implementers have a need for this property and if that need aligns with the proposed element definition.

Feedback is welcome here. [%end-note%]

Scope and Usage

The PractitionerRole describes the types of services that practitioners provide for an organization at specific location(s).

The PractitionerRole resource can be used in multiple contexts including:

Provider Registries where it indicates what a practitioner can perform for an organization (may indicate multiple healthcareservices, locations, and roles)
In a Clinical system where it indicates the role, healthcareservice and location details associated with a practitioner that are applicable to the healthcare event (e.g. Observation, Appointment, Condition, CarePlan)
In a Clinical system as a point of reference rather than an event, such as a patient's preferred general practitioner (at a specific clinic)

The role, specialty, Location telecom and HealthcareService properties can be repeated if required in other instances of the PractitionerRole. Some systems record a collection of service values for a single location, others record the single service and the list of locations it is available. Both are acceptable options for representing this data.
Where availability, telecom, or other details are not the same across all healthcareservices, or locations a separate PractitionerRole instance should be created.

Many resource types have a choice of a reference to either a Practitioner resource or a PractitionerRole resource. The latter provides organizational context for the practitioners participation when it is required, otherwise a direct reference to the practitioner may be used.
Many implementations may choose to profile the PractitionerRole to a single location/role/healthcareservice for their specific usage.
As the property that references a PractitionerRole typically has a specific context, the code on the PractitionerRole having duplicate code values is not a big concern (and is used for discovery where required).
e.g. These references are all very context specific: Patient.GeneralPractitioner, CarePlan.reported, CarePlan.contributor, Appointment.participant (through the participant.role), Immunization.informationSource, Immunization.performer (through the performer.function property)

For use cases where an organization has activities where a practitioner is not defined/pre-allocated for a specific role (e.g. an un-named surgeon at XYZ Hospital), a PractitionerRole resource can be used with an empty Practitioner property, and the other relevant role properties populated - i.e. code, organization.

Boundaries and Relationships

Qualifications (from the Practitioner resource) do not imply a Role, but might be considered when an Organization allocates practitioners to roles within their organization, and could provide useful information (such as expiry information) which could need to be tracked in some situations to ensure they continue to be eligible for a specific role.

The CareTeam resource is also often used to provide details of a role that a practitioner is allocated to perform, but is usually scoped to a much finer granularity of care, and often within the specific context of a Patient, or functional role (e.g. Crisis planning team). In contrast the PractitionerRole is used in a more general sense to cover all the places that the practitioner is allocated to work (and specific details relevant to that role - such as a specific contact number, or electronic services endpoint).

When referencing a practitioner from clinical (or other) content where the organization and role are important to the context of the reference to the practitioner, then a reference to the PractitionerRole should be used.

Background and Context

Practitioner performs different roles within the same or even different organizations. Depending on jurisdiction and custom, it may be necessary to maintain a specific Practitioner Resource for each such role or have a single Practitioner with multiple roles. The role can be limited to a specific period, after which authorization for this role ends. Note that the represented organization need not necessarily be the (direct) employer of a Practitioner.

Notes

There is no address on the PractitionerRole as the location that is defined here contains the address.
This prevents having to duplicate the address values across multiple resources.
As briefly noted in the boundaries and relationships section the PractitionerRole resource can be used to represent multiple locations in the one resource instance, however this should be done with care. When representing multiple locations in an instance, and/or multiple specialties, all details apply to all locations. Using that approach you cannot differentiate a different contact number, different availabilities, or different services at each location.
Hence maintaining these records needs to ensure that when changing a value, such as availability, it applies to all locations. If different values are required for the different locations, then a new instance will need to be created, and then split as appropriate. Existing resources referencing the original PractitionerRole instance will need to be updated to refer to the appropriate record.
For this reason we expect that it will be common to profile the location element down to a single location, simplifying overall usage, and the availabilities are clear that they apply to this location, and any referenced healthcare services.

StructureDefinition

Elements (Simplified)

PractitionerRole [0..*]: - Roles/organizations the practitioner is associated with
PractitionerRole.identifier [0..*]: Identifier Identifiers for a role/location
PractitionerRole.active [0..1]: boolean Whether this practitioner role record is in active use
PractitionerRole.period [0..1]: Period The period during which the practitioner is authorized to perform in these role(s)
PractitionerRole.practitioner [0..1]: Reference(Practitioner) Practitioner that provides services for the organization
PractitionerRole.organization [0..1]: Reference(Organization) Organization where the role is available
PractitionerRole.network [0..*]: Reference(Organization) The network in which the PractitionerRole provides the role's services (if defined) at the indicated locations (if defined)
PractitionerRole.code [0..*]: CodeableConcept example:practitioner-role Roles which this practitioner may perform
PractitionerRole.display [0..1]: string Denormalized practitioner name, role, organization and location
PractitionerRole.specialty [0..*]: CodeableConcept example:c80-practice-codes Specific specialty of the practitioner
PractitionerRole.location [0..*]: Reference(Location) Location(s) where the practitioner provides care
PractitionerRole.healthcareService [0..*]: Reference(HealthcareService) Healthcare services provided for this role's Organization/Location(s)
PractitionerRole.contact [0..*]: ExtendedContactDetail Official contact details relating to this PractitionerRole
PractitionerRole.characteristic [0..*]: CodeableConcept example:service-mode Collection of characteristics (attributes)
PractitionerRole.communication [0..*]: CodeableConcept required:all-languages A language the practitioner (in this role) can use in patient communication
PractitionerRole.availability [0..1]: Availability Times the Practitioner is available at this location and/or healthcare service (including exceptions)
PractitionerRole.endpoint [0..*]: Reference(Endpoint) Endpoints for interacting with the practitioner in this role

Mappings

PractitionerRole Mappings — 36 mapping entries

Implementation Guide

implementationguide-PractitionerRole-core.xml

<?xml version="1.0" encoding="UTF-8"?>

<ImplementationGuide xmlns="http://hl7.org/fhir">
  <id value="PractitionerRole-core"/>
  <version value="0.01"/>
  <name value="PractitionerRoleHL7Extensions"/>
  <title value="Practitioner Role  H L7  Extensions"/>
  <status value="draft"/>
  <date value="1970-01-01T10:00:00+10:00"/>
  <publisher value="HL7"/>
  <description value="Defines common extensions used with or related to the PractitionerRole resource"/>
</ImplementationGuide>

Resource Packs

list-PractitionerRole-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../publish/List.xsd">
  <id value="PractitionerRole-packs"/>
  <status value="current"/>
  <mode value="working"/>
  <entry>
    <item>
      <reference value="ImplementationGuide/PractitionerRole-core"/>
    </item>
  </entry>
</List>

Search Parameters

active — token — Whether this practitioner role record is in active use — PractitionerRole.active
characteristic — token — One of the PractitionerRole's characteristics — PractitionerRole.characteristic
date — date — The period during which the practitioner is authorized to perform in these role(s) — PractitionerRole.period
email — token — A value in an email contact — PractitionerRole.contact.telecom.where(system='email')
endpoint — reference — Technical endpoints providing access to services operated for the practitioner with this role — PractitionerRole.endpoint
identifier — token — A practitioner's Identifier — PractitionerRole.identifier
location — reference — One of the locations at which this practitioner provides care — PractitionerRole.location
organization — reference — The identity of the organization the practitioner represents / acts on behalf of — PractitionerRole.organization
phone — token — A value in a phone contact — PractitionerRole.contact.telecom.where(system='phone')
practitioner — reference — Practitioner that is able to provide the defined services for the organization — PractitionerRole.practitioner
role — token — The practitioner can perform this role at for the organization — PractitionerRole.code
service — reference — The list of healthcare services that this worker provides for this role's Organization/Location(s) — PractitionerRole.healthcareService
specialty — token — The practitioner has this specialty at an organization — PractitionerRole.specialty
telecom — token — The value in any kind of contact — PractitionerRole.contact.telecom
communication — token — One of the languages that the practitioner can communicate with — PractitionerRole.communication
network — reference — Health insurance provider network in which the PractitionerRole provides the role's services (if defined) at the indicated locations (if defined) — PractitionerRole.network

Full Search Parameters

Examples

3ad0687e-f477-468c-afd5-fcc2bf897808 — practitionerrole-examples-general — HL7 Defined Practitioner Role examples
example — practitionerrole-example — Dr Adam Careful's role at the Acme Hospital
practitionerrole-example — practitionerrole-example
practitionerrole-examples-general — practitionerrole-examples-general
practitionerrole-examples-header — practitionerrole-examples-header

Full Examples

FiveWs.status → PractitionerRole.active

Unmapped Elements

FiveWs.what — Unknown
FiveWs.recorded — Unknown
FiveWs.author — Unknown
FiveWs.actor — Unknown
FiveWs.cause — Unknown
FiveWs.version — Unknown
FiveWs.witness — Unknown
FiveWs.class — Unknown
FiveWs.context — Unknown
FiveWs.init — Unknown
FiveWs.why — Unknown
FiveWs.source — Unknown
FiveWs.who — Unknown
FiveWs.grade — Unknown
FiveWs.planned — Unknown
FiveWs.subject — Unknown