Overview of Automated Processing in the InfrastructureThis section provides an overview of automated processing in the Infrastructure. The details of the automated processing are described below. The automated processing is either triggered by some event or actions in the Infrastructure, to timer based meaning the processing takes place at certain intervals. Scheduled processing*) When there is a timezone change (to daylight saving time, DST), the execution is still at local Danish time. Event-based processingAutomated processing of … | Triggering event | More info … |
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Library rule evaluation for submitted measurements | Measurement submitted | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-AutomatedProcessingofSubmittedMeasurement | Check if the measurement submitted at an unexpected time. | Check and handling of measurements to be automatically approved for document sharing | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140/Automated+Processing#AutomatedProcessing2550661140#AutomatedProcessing-AutomatedApprovalofDocumentSharing | Validation of SSL orders | CarePlan activated | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-ValidationofSSLorderswhenactivatingaCarePlan | Handling of creation of EpisodeOfCare and CarePlan | EpisodeOfCare and CarePlan created | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-HandlingofEpisodeOfCareandCarePlanCreated | Handling of change of EpisodeOfCare status, CareTeam, scheduled status and/or scheduled CareTeam | EpisodeOfCare status, CareTeam, scheduled status and/or scheduled CareTeam changed | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-HandlingofChangeofEpisodeOfCareandCarePlanStatus,CareTeam,ScheduledStatusand/orScheduledCareTeam | Handling of Change of CarePlan status, CareTeam, scheduled status and/or scheduled CareTeam | CarePlan status, CareTeam, scheduled status and/or scheduled CareTeam changed | Handling of Automatic NemSMS Notification | | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-HandlingofAutomaticNemSMSNotificationonCreationofCommunicationofTypemessage | Create Tasks and Reminders when a citizen has not submitted measurement within time. | Resolved timings for effectively active ServiceRequests are continuously monitored. The event that triggers the creation of Tasks and Reminders are the passing of the end time of resolved timings. | https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-AutomatedProcessingofMissingMeasurements |
Automated Processing of Submitted MeasurementThe Clinical Administrator can set u a PlanDefinition, which includes activities defined in an ActivityDefinition Info |
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With release 2024.2, the check for missing measurements is changed to be event driven (passing end time of occurrences). Previously, the check was scheduled to check for missing measurements for a time interval. The event driven check will cause Tasks and Communications to be created immediately (or within a few minutes) after the end time of an occurrence timing has passed. |
Automated Processing of Submitted MeasurementThe Clinical Administrator can set up a PlanDefinition, which includes activities defined in an ActivityDefinition. They can also include a Questionnaire to be answered, and add one or more Library resources, each containing a rule. Their Libraries are specifically for automated processing and are linked to a plan that has received a measurement. In the following, a measurement resource denotes an Observation, QuestionnaireResponse or Media which has been submitted either by itself or along with other measurement resources in a call of the submit-measurement operation. All the measurement resource(s) submitted together are denoted as measurement. Overall, the automated processing of a submitted measurement is asynchronous and constitutes the following handling as a response to a submitted measurement event (which contains a reference to a Provenance resource referencing the measurement resources): Info | Before release 2024.1With release 2024.1 For each measurement resource in the order Observation, QuestionnaireResponse and Media resources in the measurement: For Observations and QuestionnaireResponses an approval of document sharing is For each measurement resource in the order Observation, QuestionnaireResponse and Media resources in the measurement:
The timing of the measurement resource is examined to see if was submitted timely, as described in Automated Processing of Measurements Submitted at Unexpected Time. The automated processing rule(s) are evaluated, as described in Automated Processing of Library Rules
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For Observations and QuestionnaireResponses an approval of document sharing is automatically generated if the ServiceRequest.sharingApprovalPolicy is set to automatic . The timing of the measurement resource is examined to see if was submitted timely, as described in Automated Processing of Measurements Submitted at Unexpected Time. The automated processing rule(s) are evaluated, as described in Automated Processing of Library Rules
The automated processing of submitted measurements is shown in the sequence diagram Automated Processing of Measurements. Automated Approval of Measurement for Document SharingApproval of document sharing a measurement, that is, registering a measurement in national document sharing infrastructure, is considered an assessment of the measurement and comes in the form of a ClinicalImpression resource. Whether a measurement is eligible for automated approval is evaluated by using the ServiceRequest referenced by the measurement. If the ServiceRequest.sharingApprovalPolicy is set to automatic at the time of processing, an approval for document sharing is automatically created by the infrastructure with contents as described in the table below. ClinicalImpression Element | Value |
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.decision
| Coding with code =approved-for-sharing and system = http://ehealth.sundhed.dk/cs/clinicalimpression-decision-codes | .code
| Coding with code =MeasurementAssessment and system = http://ehealth.sundhed.dk/cs/clinicalimpression-codes | .status
| completed
| .carePlan
| References the CarePlan that has the ServiceRequest as an action. | .episodeOfCare
| References the EpisodeOfCare from CarePlan.episodeOfCare | .assessor
| Not set. For manual approvals the assessor would be the practitioner performing the approval, however, for automatic approval, there is no assessor. | .assessorOrganization
| The organization from CarePlan.author is used if present. Otherwise the EpisodeOfCare.careManagerOrganization is used. | .investigation
| Is set to contain a versioned and a versionless reference for the measurement in question, as described in Assessing Measurements. |
Automated Processing of Measurements Submitted at Unexpected TimeThe Infrastructure validates the measurement time of a submitted measurement for compliance with the resolvedTiming period provided in the measurement. An unexpected measurement is determined as a submitted measurement having either: Measurement time outside of the resolvedTiming period. Measurement time within the resolvedTiming period but, in case of the measurement being associated with a ServiceRequest defined with occurrenceTiming, the measurement time is not within the repeat.boundsPeriod of the occurrenceTiming.
Measurement time is captured in: In case a measurement has been submitted at an unexpected time, automated processing produces: Note that most of the above details do not constitute guaranteed content that can be used for searching for or determining whether unexpected measurement(s) has been submitted for a particular Patient. The guaranteed elements are Tasks.category (withTask.episodeOfCare ) and Communication.reasonCode (with Communication.subject and Communication.episodeOfCare ). Automated Processing of Library RulesWhen a measurement is submitted to the infrastructure, it triggers the automated processing of rules described in the following. Each submitted measurement is related to an activity in a citizen plan represented as a CarePlan where each activity is a ServiceRequest. Which rule or rules are involved depends on the PlanDefinition and its comprised ActivityDefinition resources referenced from the CarePlan and ServiceRequest resources, see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1661141027/Creating+Care+Plans#Applying-a-PlanDefinition-to-create-CarePlan(s). The Library rules eligible for automated processing for a particular ServiceRequest are: Library resources where the Library.type is automated-processing . Library resources (zero, one, or more) related to the ActivityDefinition referenced by the ServiceRequest
Situation | Overrides Eligible Library? | Automated Processing Rules | Processing |
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Submitted measurement is an Observation with no value (.dataAbsentReason is present) ServiceRequest references ActivityDefinition with no reference to Library or reference to any other than Null-rule Library | Yes | All Library are ignored and processing is performed as described | A Task is created with the Task.category set to Coding MeasurementForAssessmentAbsentValue | Submitted measurement is an Observation with no value (.dataAbsentReason is present) ServiceRequest references ActivityDefinition concerning Null-rule Library | No | Null-rule Library is evaluated and processing is performed as described | No Task is created. | ServiceRequest references ActivityDefinition concerning Null-rule Library | No | ServiceRequest references ActivityDefinition with no Library references | Yes | The Fallback Library is evaluated and processing is performed as described | A Task is created with the Task.category set to Coding MeasurementForAssessment | ServiceRequest references ActivityDefinition concerning Fallback Library | No | ServiceRequest references ActivityDefinition concerning one or more other Library | No | Each Library is evaluated | Depends on the Library. |
One (or at least one) of the automated-processing type Library resources associated with an ActivityDefinition should create a Task that can draw adequate attention to a submitted and automatically processed measurement. The Null-rule Library is the one exception to this guideline/recommendation. The evaluation of automated-processing type Library resources is described in https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2727247913/Managing+and+Using+Library+Rules#Library-Rule-Evaluation-in-Automated-Processing-in-the-Infrastructure . Automated Processing of Action Triggers and Trigger ConditionsEach submitted measurement references a ServiceRequest. As part of the automated processing of a submitted measurement, the infrastructure examines whether the measurement constitutes fulfilment of trigger conditions that may be defined as action trigger for one or more of its sibling ServiceRequest. In each case where trigger conditions are met, the defined action trigger reaction is performed. Trigger evaluation is skipped if the submitted measurement is an Observation with .dataAbsentReason . This means that an Observation with .dataAbsentReason will not fire any action triggers. In the example below, the PlanDefinition contains an action trigger where activity “action[2]” has dependencies to “action[0]” and “action[1]”. Compared to the same setup at the time of PlanDefinition$apply (see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/1661141027/Creating+Care+Plans#Trigger-Actions-and-Trigger-Conditions), the CarePlan and triggering ServiceRequest (SR0 and SR1 in the figure below) now have status set to active , presumably because all necessary adjustments and delivering of device etc. have been performed and an employee has changed the status. Image RemovedImage AddedWhen a measurement, here QuestionnaireResponse QR0, is submitted and subjected to automated processing, it is determined whether it plays any role in action triggers. In this case, the corresponding ServiceRequest SR0 is a triggering ServiceRequest, that is, its related ActivityDefinition has a trigger condition defined in the corresponding PlanDefinition. To optimize determining this, the triggering ServiceRequest SR0 (and similarly SR1) has ServiceRequest.meta.tag set to trigger automatically as part of PlanDefinition$apply . The automated processing follows this pseudo-algorithm: On receiving a measurement: If the measurement references a triggering ServiceRequest (if ServiceRequest.meta.tag is set to trigger ) continue, otherwise the check for action triggers is done. Resolve the CarePlan referencing the triggering ServiceRequest Resolve the PlanDefinition referenced by the CarePlan Resolve the triggering ActivityDefinition (referenced from triggering ServiceRequest) and its id in PlanDefinition.action[y].id Determine which depending ServiceRequest (one or more) is depending on the triggering ServiceRequest as follows: For each PlanDefinition.action[x].ehealth-actionTrigger referring in triggerCondition.actionId the triggering PlanDefinition.action[y].id : Resolve the depending ServiceRequest by comparing its reference to the depending ActivityDefintion which must be referenced in the depending PlanDefinition.action[x].definition .
For each depending ServiceRequest, determine whether conditions have been met: If the ServiceRequest.ehealth-trigger-enablement is other than TRIGGER_ENABLED then continue to next depending ServiceRequest, otherwise perform as follows: If the ServiceRequest.status is on-hold continue, continue to next depending on ServiceRequest If the PlanDefinition.action[x].ehealth-actionTrigger has triggerBehavior set to one-or-more Determine whether the ehealth-triggerCondition has been met (searching for measurements and comparing with triggerCoundition.count )
If the PlanDefinition.action[x].ehealth-actionTrigger has triggerBehavior set to all or other triggering ServiceRequest may be defined for this depending on ServiceRequest Determine whether all ehealth-triggerCondition have been met (searching for measurements and comparing with triggerCoundition.count ) Optimized by continuing to next depend ServiceRequest on the first unmet condition found
For each depending ServiceRequest where conditions have been met, perform the actionTrigger’s reaction in actionTrigger.action This is changing ServiceRequest.status to active . The ServiceRequest.occurrence starting time is evaluated: If the occurrence starting time is in the past, then the starting time is set to now with possible adjustment as specified by actionTrigger.offset If the occurrence starting time is in the future, the starting time is kept with possible adjustment as specified by actionTrigger.offset
Change ServiceRequest.ehealth-trigger-enablement to TRIGGER_DONE
The evaluation of starting time is tabulated below for the different types of ServiceRequest.occurrence : Type of ServiceRequest.occurrence | Criteria |
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dateTime
| The dateTime is set to the starting time with possible actionTrigger.offset adjustment | Period
| The duration of the Period is calculated, if it is not an open-ended period. The Period.start is set to starting time with possible actionTrigger.offset adjustment. Finally the Period.end is set to keep the original duration. | Timing
| If the Timing.repeat.bounds is a Period , then the bounds period is set as for the occurrence of type Period . |
The eHealth Infrastructure continuously monitors, if measurements are being submitted on If a measurement is submitted later than the timing specified by the ServiceRequest, then the automated processing will check, if a “missing measurement” task exists (created by Automated Processing of Missing Measurements). If the task has status, requested, and has not been assigned, then the automated processing will change the status to rejected.
Automated Processing of Missing MeasurementsThe eHealth Infrastructure continuously monitors, if measurements are being submitted on time, based on their associated CarePlan. Here's how it works: All active ServiceRequests with a resolved timing (ie. where ServiceRequest.occurrence[x] can be resolved to a specific time period), and specifying an activity, where the patient is expected to submit measurements, are monitored continuously. It performs missing measurement checks at the end time of resolved timing, if a ServiceRequest is effectively active at the end time. This is determined by the related CarePlan and EpisodeOfCare (see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2524872705/Using+EpisodeOfCare+CarePlan+s+and+ServiceRequest+s#Determining-the-ServiceRequest-Effective-Status): The EpisodeOfCare must have status active at the resolved timing end time. The CarePlan must have status active at the resolved timing end time. The ServiceRequest must have status active at the resolved timing end time.
To decide whether a specific ServiceRequest undergoes the missing measurements check, it depends on the activity type, which is taken from ActivityDefinition.code and copied to ServiceRequest.code during processing. The decision is controlled by an automated lookup process using a ConceptMap https://docs.ehealth.sundhed.dk/latest-released/igfhir/ConceptMap-activitydefinition-code-to-do-missing-measurement.html : If the activity type is found in the ConceptMap, then the map determines if the missing measurement check should be done (Y or N ). If the activity type isn't found in the ConceptMap , the ServiceRequest is subject to the missing measurements check by default.
The criteria for deciding that a measurement is missing depends on how the measurement regime is specified, that is, what ServiceRequest.occurrence[x] variant in use: ServiceRequest.occurrence[x] Variant | occurrenceDateTime
| occurrencePeriod
| occurrenceTiming
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Data Type | DateTime | Period | Timing Timing constraints: | Time Criteria | occurrenceDateTime is passed.
and no Observation, QuestionnaireResponse or Media referring to the ServiceRequest exist with a corresponding resolved timing.
| occurrencePeriod.end is passed.
and no Observation, QuestionnaireResponse or Media referring to the ServiceRequest exist with a corresponding resolved timing.
| The resolved timing end is passed. The number of measurements (Observation, QuestionnaireResponse or Media) that can be found is less than the expected frequency for the resolved timing.
| Effective Status Criteria | | | | Measurement Match Criteria | |
Example of active overlap for ServiceRequest.occurrenceTiming with repeat.period : 6 and repeat.periodUnit : h (and repeat.duration : 3 and repeat.durationUnit : h). As described in a row “Time Criteria” for occurrenceTiming , Timing.repeat.periodUnit h (hours) will result in a lookup period starting from Midnight 1 day ago till the current time represented as nearest past Midnight. The resolved timing will be every 6 hours with a duration of 3 hours starting from Timing.repeat.boundsPeriod.start . As the time component of With boundsPeriod.start is 10 AM that means the next resolved timing is 4 PM and the next 10 PM. The first resolved timing in the lookup period is 22-01 which shall at midnight, then the first resolved timing will be between 00 and 03, and the next will be between 06 and 09 and so on. When time passes 03 the first resolved timing with period 00-03 will be checked for missing measurement as EpisodeOfCare, CarePlan and ServiceRequest at that time all had has status active .The When time passes 09 the second resolved timing in the lookup period is 04-07 which shall be checked for missing measurement as EpisodeOfCare, CarePlan and ServiceRequest had status active in a partial overlap during the resolved timing. The third resolved timing in the lookup period is 10-13 and shall not be checked for missing measurement as ServiceRequest had status on-hold for the whole resolved timing. The fourth resolved timing in the lookup period is 16-19 which shall with period 06-09 will NOT be checked as the ServiceRequest has status on-hold at that time. When time passes 15 the third resolved timing with period 12-15 will NOT be checked as both ServiceRequest and the Careplan has status on-hold at that time. When time passes 21 the fourth resolved timing with period 16-19 will be checked for missing measurement as EpisodeOfCare, CarePlan and ServiceRequest had status active has partial active overlap during the resolved timing. The fifth resolved timing in the lookup period is 22-01 which shall not be checked for missing measurement as the end of the resolved timing is outside the lookup period, that is, the citizen still has one hour past Midnight to submit measurement(s). Image RemovedSee the diagram below. Going forward all the resolved timing (based on supported timing) ending within the window since the last job execution will be considered. This means no longer based on a fixed range eg. the last day if periodUnit: hourSee the diagram below. Gliffy |
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baseUrl | https://ehealth-dk.atlassian.net/wiki |
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macroId | 40a89422-146e-4e88-96d7-43def05f5317 |
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name | Missing measurement - status check - example with occurrenceTiming FUT-I 2023.5 |
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pageid | 2562293761 |
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timestamp | 1691588983731 |
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When a measurement is found to be missing, the following resources are prepared for creation: Resource | Element | Value |
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Task | category
| Coding for MissingMeasurementResolving | | status
| requested
| | intent
| plan
| priority
| routine
| description
| Forventede 1 målinger, men fandt 0
| plan
| | priority
| routine
| | description
| Forventede at en aktivitet var udført, men fandt ingen den %s (which is Danish for ‘Expected that an activity was done, but found none at %s’).
Or if frequency is greater than 1: Forventede at %d aktiviteter var udført, men fandt %d den %s (which is Danish for ‘Expected 1 measurement found 0’that %d activities were done, but found %d at %s’)
| | ehealth-task-responsible
| List of CareTeam from the CarePlan | | ehealth-restriction-category
| Coding for measurement-monitoring | | focus
| The ServiceRequest | | resolvedTiming
| Same as the resolved timing that was expected | | episodeOfCare
| Same as CarePlan.episodeOfCare | | for
| Same as episodeOfCare.patient | | authoredOn
| current date/time | Communication (of profile ehealth-message) | category
| Coding for notification | | status
| completed
| | reasonCode
| Coding for MissingMeasurementResolving | | payload.content
| Need to resolve why scheduled measurement has not been submitted
| | ehealth-title
| Need resolving of why scheduled measurement has not been submitted
| | ehealth-restriction-category
| Coding for measurement-monitoring | | subject
| Same as CarePlan | | episodeOfCare
| Same as CarePlan | | topic
| About Task above | | sent
| current date/time |
Each Communication resource prepared for creation (with the content above), is subjected to the handling of recipients described in Taking applicable CommunicationRequest into account. Periodic Creation of Reminder on Pending Measurement Activity Info |
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In the following, pending measurement activity is used broadly as a term for measuring and answering questionnaires that are supposed to happen. |
To provide reminders to citizens on pending measurement activities, the eHealth Infrastructure performs periodic lookup. Currently, the periodic lookup is configured to be performed every second hour on the hour. The periodic lookup for pending measurements considers two lookup time windows: Info |
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For example: The periodic lookup runs at 08:00. It has a current (lookup) time window of 08:00 to 10:00. It has a previous (lookup) time window of 06:00 to 08:00. |
For an activity to be considered pending, the ServiceRequest.occurrence[x] must be within the ServiceRequest's effective active periods. The effective active periods for a ServiceRequest are the periods where it has status set to active at the same time as the EpisodeOfCare and CarePlan both have status set to active , see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2524872705/Using+EpisodeOfCare+CarePlan+s+and+ServiceRequest+s#Determining-the-ServiceRequest-Effective-Status. In this particular case, the effective active periods are considered for historic & current status and future status changes, that is, the effective active periods are evaluated based on the statusHistory and statusSchedule elements of EpisodeOfCare, CarePlan and ServiceRequest. This is elaborated in the criteria table below. The criteria for a ServiceRequest to have a pending measurement within the lookup time window depends on the ServiceRequest.occurrence[x] alternative used and are as given in the table below. The table’s Time Criteria and Effect Status Criteria, respectively, are elaborated and exemplified in similarly named subsections below. ServiceRequest.occurrence[x] alternative
| ServiceRequest.occurrenceDateTime
| ServiceRequest.occurrencePeriod
| ServiceRequest.occurrenceTiming
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Data type | DateTime | Period | Timing Timing constraints: Note: If the Timing expresses a recurring timing regime, the individual times an activity should be performed are called a resolved-timing and are expressed as a start and an end time for the individual performance of the activity. If the Timing is not recurring the regime is resolved into a single resolved-timing . | Time Criteria | | The occurrencePeriod.start must be within the previous time window The occurrencePeriod.end must, if defined, be equal to or after the start of the current time window, or
| The occurrenceTiming.repeat.boundsPeriod.start must be equal to or before the start of the current time window. The occurrenceTiming.repeat.boundsPeriod.end must, if defined, be equal to or after the start of the current time window If the occurrenceTiming.repeat.boundsPeriod.start is within the previous time window, resolved-timing started before the current window is also accepted (They must still overlap with the boundsPeriod ). At least one of possibly multiple resolved-timing must start within the current time window and the occurrenceTiming.repeat.boundsPeriod .
| Effective Status Criteria | | | | Activity Type Criteria | | Measurement Submission Criteria | |
Time CriteriaThe following three diagrams show 8 examples of ServiceRequest that use different variants of occurrenceDateTime /occurrencePeriod /occurrenceTiming as the periodic lookup progresses along a timeline. This helps visualize when the above-mentioned criteria are satisfied and thus, when a reminder will be automatically generated for the pending activities. O - Annotates a dayOfWeek /timeOfDay -combination X - Annotates the dateTime in an occurrenceDateTime Red - Annotates that the occurrence will not result in a reminder being generated in the current lookup time window. Green - Annotates that the occurrence will result in a reminder being generated in the current lookup time window. Image RemovedImage AddedCurrent Time Window = t0 In the first diagram, the 1. ServiceRequest example is the only one to result in reminder generation Some things to note about the examples that will not result in reminder generation this lookup: The 2. ServiceRequest example will not result in a reminder during this lookup time window as its start is after the beginning of the current time window. However, in the next lookup, its situation should be the same as for the 1. ServiceRequest example above. While 6. ServiceRequest has a boundsPeriod that starts before the current window, it is an occurrenceTiming and therefore also needs a dayOfWeek /timeOfDay -combination within the current or previous time windows to result in reminder generation. This is not the case for the current lookup time window. However, in a later lookup, it should result in a reminder when a dayOfWeek /timeOfDay -combination coincides with a "current" time window. Additionally, while 7. ServiceRequest example has a dayOfWeek /timeOfDay -combination within the current time window, the boundsPeriod did not start before the current window, as is required.
Image RemovedImage AddedCurrent Time Window = t+1 The periodic lookup has now progressed by one time frame and what was in the last lookup considered the “next” time window is now the current one. Image RemovedImage AddedCurrent Time Window = t+2 The periodic lookup has now progressed by two-time frames since the lookup shown in the first diagram. Effective Status CriteriaThe following three diagrams visualize how ServiceRequest effective periods of status set to active are found and evaluated. The ServiceRequest, CarePlan and EpisodeOfCare all maintain a status history and schedule, which is used to find the active periods where all three related resources had/have status value active at the same time. Info |
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For the reminder check, a status period is considered as exclusive-end. This is because the end time of a period is the same as the start time of a new status, which at that time then takes precedence over the old status. | Image RemovedImage AddedFor the above example, the active periods for the resource are found by: The first one is started by the ongoing active period and ended by the first scheduled on-hold status. The second one is entirely outlined by the statusSchedule as it starts when the status is scheduled to become active and ends at the time of the next scheduled status change, in this case to on-hold .
When the active periods for the individual related resources have been found, one can find the effective active periods of the ServiceRequest, which are the active periods that it has in common with its related CarePlan and EpisodeOfCare. This is visualized in the diagram below. Image RemovedImage AddedIn the diagram below are 6 examples of ServiceRequest that use different variants of occurrenceDateTime /occurrencePeriod /occurrenceTiming . This helps visualize when the earlier-mentioned criteria are satisfied for both the time windows and the active periods, and thus, when a reminder will be automatically generated for the pending activities. Image RemovedImage AddedHaving identified a pending measurement, the infrastructure creates an ehealth-message type Communication with the Patient as the recipient, unless such creation has been suppressed (see Controlling Creation of Messages). Communication Element | Value |
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category
| Coding for advice | status
| completed
| payload.content
| "Du har en opgave. Se den i din telemedicinske løsning."
| ehealth-title
| "Påmindelse om målinger og besvarelse af spørgeskemaer"
| about
| ServiceRequest references
| sent
| current date/time | medium
| Coding for NemSMS (when the Patient.telecom has a NemSMS entry) No medium set when the Patient.telecom has no NemSMS entry. | recipient
| The Patient | sender
| Device reference for eHealth Infrastructure Device |
When possible, the created Communication leads to a NemSMS text notification to the Citizen. A prerequisite to this is that the citizen has subscribed to NemSMS and that the citizen has not suppressed the generation of such messages (see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2415034369/Controlling+Creation+of+Messages#Controlling-Message-Creation-with-Patient-as-Recipient). Validation of SSL orders when activating a CarePlanWhen a CarePlan changes status to active , the infrastructure checks if any related SSL orders are still undelivered. If this is the case, then the Patient may still be missing the necessary equipment. The infrastructure creates a task with the category: OpenSSLOrder for the CareTeam to check if any equipment is missing and if necessary delay the activation of the CarePlan or adjust the measurement regime for specific measurements. Scheduled Automated Application of Planned Changes (EpisodeOfCare, CarePlan and ServiceRequest)Scheduled changes in EpisodeOfCare, CarePlan and ServiceRequest are applied during an automatic job which runs at regular intervals. Upon job execution, the job finds all ServiceRequest, CarePlan and EpisodesOfCare that have unhandled statusSchedule or teamSchedule entries planned for a timestamp between this execution and the previous one. The scheduled changes are then applied to the resources so that they are up to date with their latest scheduled change.
Scheduled Import of Organization Data from SOR and FK OrganisationThe eHealth Infrastructure run scheduled jobs that Import of Organization Data from SOR and FK Organisation. The import of Organization data is described in Importing and updating Organization information from SOR and FK-Organisation into eHealth Infrastructure. Scheduled Check for Calibration of EquipmentSome equipment needs to be periodically calibrated to ensure precise measurements. The eHealth Infrastructure runs a periodic job that checks if any devices require calibration. If that is the case then the Infrastructure created a Task with a category set to CalibrationNeeded . The Task is assigned to the CareTeam(s) for the CarePlan that currently uses the Device. Handling of EpisodeOfCare and CarePlan CreatedWhen an EpisodeOfCare is created with $create-episode-of-care , two ehealth-message types of Communication are automatically created. These correspond to the Communication created for the change of EpisodeOfCare status and team, respectively. When a CarePlan is created with $apply performed on a PlanDefinition, two ehealth-message types of Communication are automatically created. These correspond to the Communication created for the change of CarePlan status and team, respectively. Such a pair of Communication is created for each sub-CarePlan. Handling of Change of EpisodeOfCare and CarePlan Status, CareTeam, Scheduled Status and/or Scheduled CareTeamThe EpisodeOfCare and CarePlan have two elements ehealth-episodeofcare-statusschedule and ehealth-teamschedule which capture: When one of the following elements in CarePlan/EpisodeOfCare is changed, then an ehealth-message type Communication is automatically created. Communication created with the Patient as the recipientResource | Element | Value |
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Communication (of profile ehealth-message) | category | Coding for notification | | status | completed
| | payload.content | One of: “Der er oprettet nyt forløb den %s. Se det i din telemedicinske løsning.” “Der er oprettet ny plan den %s. Se den i din telemedicinske løsning.” “Der er sket ændringer i dit forløb den %s. Se i din telemedicinske løsning.“ “Der er sket ændringer i din plan den %s. Se i din telemedicinske løsning.”
| | ehealth-title | One of: "Status er opdateret for det telemedicinske forløb den %s" "Status er opdateret for den telemedicinske pakke den %s" "Listen af ansvarlige for det telemedicinske forløb er opdateret den %s" "Listen af ansvarlige for den telemedicinske pakke er opdateret den %s" "Der er planlagt ændring af status for det telemedicinske forløb" "Der er planlagt ændring af status for den telemedicinske pakke" "Der er planlagt ændring af ansvarlige for det telemedicinske forløb" "Der er planlagt ændring af ansvarlige for den telemedicinske pakke"
| | topicReference to EpisodeOfCare or CarePlan, depending on the situation | Coding for communication-topic | | sent | current date/time | | recipient | The Patient | | sender | Device reference for eHealth Infrastructure Device |
Communication created with CareTeam as the recipientResource | Element | Value |
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Communication (of profile ehealth-message) | category | Coding for notification | | status | completed
| | payload.content | One of: “Der er oprettet nyt forløb den %s. Se det i din telemedicinske løsning.” “Der er oprettet ny plan den %s. Se den i din telemedicinske løsning.” “Der er sket ændringer i dit forløb den %s. Se i din telemedicinske løsning.“ “Der er sket ændringer i din plan den %s. Se i din telemedicinske løsning.”
| | ehealth-title | One of: "Status er opdateret for det telemedicinske forløb den %s" "Status er opdateret for den telemedicinske pakke den %s" "Listen af ansvarlige for det telemedicinske forløb er opdateret den %s" "Listen af ansvarlige for den telemedicinske pakke er opdateret den %s" "Der er planlagt ændring af status for det telemedicinske forløb" "Der er planlagt ændring af status for den telemedicinske pakke" "Der er planlagt ændring af ansvarlige for det telemedicinske forløb" "Der er planlagt ændring af ansvarlige for den telemedicinske pakke"
| | topic | Reference to EpisodeOfCare or CarePlan, depending on the situation | | sent | current date/time | | ehealth-communication-recipientCareTeam | The CareTeam | | sender | Device reference for eHealth Infrastructure Device |
Reminder for Participation in AppointmentCommunication with the Patient as the recipientAlso see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2415034369/Controlling+Creation+of+Messages#Controlling-Message-Creation-with-Patient-as-Recipient. Resource | Element | Value |
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Communication (of profile ehealth-message) | category | Coding for notification | | status | completed
| | payload.content | One of: (Unless otherwise stated by matching CommunicationRequest) | | sent | current date/time | | medium | Coding for NemSMS (unless otherwise stated by matching CommunicationRequest) | | recipient | The Patient | | sender | Device reference for eHealth Infrastructure Device |
Communication with CareTeam as the recipientAlso see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2415034369/Controlling+Creation+of+Messages#Controlling-Message-Creation-with-CareTeam-as-Recipient. Resource | Element | Value |
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Communication (of profile ehealth-message) | category | Coding for notification | | status | completed
| | payload.content | One of: (Unless otherwise stated by matching CommunicationRequest) | | sent | current date/time | | medium | Coding for NemSMS (unless otherwise stated by matching CommunicationRequest) | | recipient | The CareTeam | | sender | Device reference for eHealth Infrastructure Device |
Handling of Automatic NemSMS Notification on Creation of Communication of Type message Communication with the Patient as the recipientAlso see https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2415034369/Controlling+Creation+of+Messages#Controlling-Message-Creation-with-Patient-as-Recipient. Resource | Element | Value |
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Communication (of profile ehealth-message) | category | Coding for message | | status | completed
| | payload.content | “Du har modtaget en ny besked. Se den i din telemedicinske løsning.” | | about | The Communication resource that caused this notification | | sent | current date/time | | recipient | The Patient | | sender | Device reference for eHealth Infrastructure Patient |
Resources Created by Automated Processing in the InfrastructureThe Infrastructure automatically creates Task resources for profile ehealth-task and Communication resources for profile ehealth-message in different situations. An overview is provided for each resource type in the following. Overview of Task Created by the InfrastructureThe following table provides an overview of Tasks produced by the Infrastructure. For more detailed information follow the link in the reference column. Overview of Communication Created by the InfrastructureThe following table provides an overview of Communication (of profile ehealth-message) produced by the Infrastructure and how creation and suppression of creation can be controlled with CommunicationRequest. The table does not provide all elements of either Communication or CommunicationRequest. Please consult particular sections corresponding to the situations for details. Element <some element name> describes what values are used in Communication in a specific situation. Situation/Trigger | Created by Default | Opt-in Supported | Opt-out Supported | Element category | Element reasonCode | Element restriction-category | Element medium | Element recipient | Element recipientCareteam |
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Measurement submitted at an unexpected time | No | Yes | No | notification
| UnexpectedMeasurementResolving
| measurement-monitoring
| | | One Communication for each CareTeam associated with the CarePlan and have opted in. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Automated processing rule requests Communication(s) to be made. | Yes | No | Yes | notification
| Can vary with the automated processing rule. See execution of rule and output in https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/538935313/Behind+the+Scenes#Execution-of-rule-and-output . | | | One Communication for each CareTeam associated with the CarePlan which has not opted out. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Missing measurement | Yes | No | Yes | notification
| MissingMeasurementResolving
| measurement-monitoring
| | | One Communication for each CareTeam associated with the CarePlan which has not opted out. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Creation of EpisodeOfCare | Yes | No | Yes | notification
| EpisodeOfCareCreated
| No value assigned | | | One Communication for each CareTeam associated with the CarePlan which has not opted out. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Creation of CarePlan ($apply) | Yes | No | Yes | notification
| CarePlanCreated
| No value assigned | | | One Communication for each CareTeam associated with the CarePlan which has not opted out. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Change in CarePlan of CareTeam, scheduled CareTeam, status or scheduled status | Yes | No | Yes | notification
| CarePlanCareTeamChange , CarePlanScheduledCareTeamChange , CarePlanStatusChange orCarePlanScheduledStatusChange
| No value assigned | | | One Communication for each CareTeam associated with the CarePlan which has not opted out. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Change in EpisodeOfCare of CareTeam, scheduled CareTeam, status or scheduled status | Yes | No | Yes | notification
| EpisodeOfCareCareTeamChange , EpisodeOfCareScheduledCareTeamChange , EpisodeOfCareStatusChange or EpisodeOfCareScheduledStatusChange
| No value assigned | | | One Communication for each CareTeam in EpisodeOfCare.team which has not opted out. | No | Yes | No | Default: none Can be overridden with CommunicationRequest | Patient | | Reminder to submit measurement | Yes | No | Yes | advice
| ReminderSubmitMeasurement
| No value assigned | nemsms when Nem SMS is enabled for the Patient at the time of sending the Communication, otherwise no medium is set.
Can be overridden with CommunicationRequest | Patient | | If a contract has a reminder days setup and a matching order/orderline has an agreedDateFrom – reminder days = current day | Yes | No | No | advice
| ExpectedDelivery
| measuring-support
| nemsms when Nem SMS is enabled for the Patient at the time of sending the Communication, otherwise no medium is set.
| Patient | |
Info |
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Currently, there are no automated processing rules - neither ready for production nor slated for production - that specify or request the creation of Communication. |
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