Multiple referring pratictioners in an FHIR Encounter

Question

I want to express the following use case :

A patient is pregnant. She's seen by two specialists : an endocrinologist and an obstetric gynecologist. The gynecologist sends her to the hospital, for a care he can't give.

The patient has then :

• a family doctor
• a referring doctor (obstetric gynecologist)
• a specialist (endocrinologist)

The family doctor is referenced in the Patient Resource, by the generalPractitioner element.

But I want to reference the two others practitioners in the Encounter Resource. I'm ok with the first (the referring), but I don't know where to reference the second.

<?xml version="1.0" encoding="UTF-8"?>
<Encounter xmlns="http://hl7.org/fhir">
    <id value="99289910"/>
    <contained>
        <ReferralRequest>
            <id value="p1"/>
            <status value="active"/>
            <category value="request"/>
            <requester>
                <reference value="Practitioner/99003499686"/>
                <identifier>
                    <type>
                        <coding>
                            <system value="http://hl7.org/fhir/v2/0443"/>
                            <code value="RP"/>
                            <display value="Referring Provider"/>
                        </coding>
                        <text value="Referring doctor"/>
                    </type>
                    <system value='urn:oid:1.2.250.1.71.4.2.1'></system>
                    <value value='99003499686'/>
                    <assigner><display value="RPPS"/></assigner>
                </identifier>
            </requester>
        </ReferralRequest>
    </contained>
    <status value="finished"/>
    <class>
        <system value="http://hl7.org/fhir/v3/ActCode"/>
        <code value="IMP"/>
    </class>
    <patient>
        <reference value="/patient/3803218"/>
    </patient>
    <incomingReferral>
        <reference value="#p1"/>
    </incomingReferral>
    <period>
        <start value="2016-09-07T15:39:00"/>
        <end value="2016-09-11T16:35:00"/>
    </period>
    <location>
        <location>
            <reference value="/uf/1835"/>
        </location>
        <status value="completed"/>
        <period>
            <start value="2016-09-07T15:39:00"/>
            <end value="2016-09-08T00:28:00"/>
        </period>
    </location>
    <location>
        <location>
            <reference value="/uf/3650"/>
        </location>
        <status value="completed"/>
        <period>
            <start value="2016-09-08T00:28:00"/>
            <end value="2016-09-11T16:35:00"/>
        </period>
    </location>
    <serviceProvider>
        <reference value="/uf/2407"/>
    </serviceProvider>
</Encounter>

Where can I reference the specialist (endocrinologist) in the Encounter ?

Answer 1

If I understand correctly, the first would be identified as the referring practitioner, but the other is essentially just an "interested party" - someone who should be notified of the admission, the discharge and presumably should receive a copy of the discharge summary.

The concept of "interested party" isn't part of the value set for Encounter.participant.type, but the value set is extensible, so you're free to define your own code for that concept. It seems like a generally useful idea, so I'd encourage you to submit a change request (propose a change link at the bottom of each page in the spec) for us to add that to the specification for everyone.