MyHealtheVet use of PGHD - Local Development build (v0.2.10-beta) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Background

Page standards status: Informative

MyHealtheVet contributions to PGHD

MyHealtheVet provides access to the VA managed Patient Generated Health Data (PGHD) FHIR based repository. MyHealtheVet enables viewing of the data, creating new entries, editing existing entries, and deleting entries. In addition MyHealtheVet enables the output of a FHIR-Document Bluebutton report.

currently implemented

MHV Implementation Capability Statement

Vital Signs

1. Blood Pressure
2. Blood Sugar
3. Body Temperature
4. Body Weight
5. Heart Rate - aka Pulse
6. Pain
7. Oxygen Saturation
8. Respiration Rate

profile drafted but feature is not approved for implementation

• Family Health History – Experimental for potential new feature
• Medications
• Allergy and Intolerance
• Immunization
• FHIR Document Bluebutton report – Experimental and incomplete

other FHIR data that could be implemented

• Goals
• Problems / Conditions
• Implanted Devices
• measurement Devices
• Smoking Status
• CareTeam (external clinicians being seen)
• Upload Documents
  • C-CDA
  • Discharge Summary
  • BlueButton
  • ?

From SMHD (e.g., Apple, Fitbit?)

• Exercise Duration - 55411-3
• Active Calories Burned - 41981-2
• BMR Calories Burned - 41981-2
• Energy Burned (Calories) - 41981-2
• Floors Climbed - 93833-2
• Resting Heart Rate - 40443-4
• Steps Taken - 41950-7
• Distance Travled - 93849-8
• Elevation - 93971-0
• category “daily-active-summary – components:
  • Time Spent Fairly Active - code “fairly-active-duration”
  • Heart Rate Variability - code “heart-rate-variability”
  • Heart Rate Zone High - code “heart-rate-zone-high”
  • Heart Rate Zone Low - code “heart-rate-zone-low”
  • Heart Rate Zone Medium - code “heart-rate-zone-medium”
  • Heart Rate Zone Very Low - code “heart-rate-zone-very-low”
  • Time Spent Lightly Active - code “lightly-active-duration”
  • Max Heart Rate - code “max-heart-rate”
  • Minimum Heart Rate - code “min-heart-rate”
  • Mindful Duration - code “mindful-duration”
  • Time Spent Very Active - code “very-active-duration
• category workout - components:
  • average heart rate
  • active duration
  • energy burned
  • steps
  • average cadence
  • average power
  • average speed
  • distance
  • fairly active duration
  • heart rate variability
  • heart rate zone high
  • heart rate zone low
  • heart rate zone medium
  • heart rate zone very low
  • laps
  • lightly active duration
  • max heart rate
  • max speed
  • min heart tate
  • very active duration
• Maximum expiration gas flow Respiratiotory system airway by Peak flow meter - 19935-6
• Body mass index Estimated - 89270-3
• Percentage of Body Fat - 41982-0
• Body Height - 8301-4 or 8302-2
• FEF 25-75% Predicted - 69971-0
• FEV1 - 20150-9
• FEV1/FVC - 19926-5
• Circumference of Arms - 56072-2
• Chest Circumference at nipple line - 8279-2
• Circumference of Hips - 62409-8
• Circumference of Thys - 8286-7
• Circumference of Waist - 8281-8
• Forced Expiratory Time (FET) - 65819-5
• Insulin Consumed - 2339-0 ???
• Nutritian
  • calcium
  • carbohydrate
  • cholestorol
  • dietary fiber
  • energy consumed
  • fat
  • protein
  • sodium
  • water
  • unsaturated fat
  • sugars
• Sleep
  • awake count
  • awake duration
  • deep sleep
  • in bed duration
  • light sleep
  • rem sleep
  • restless count
  • sleep duration
  • sleep score
  • time to fall asleep
• Intraday
  • average heart rate
  • blood glucoe
  • floors climbed
  • steps
  • distance

Additional Features MyHealtheVet could use FHIR for

• Graph data over time – like MyHealtheVet already supports for SEI vital signs, or like VCM supports for PGHD vital signs.
• Change data in PGHD
  • Allowing Delete without Edit – sometimes data gets in there that is not right, especially through automated means (dog weight automatically recorded as me). Note this can also be a safe way to edit, by having the old data deleted and the correct data created.
  • Allowing Edit without Delete – sometimes data are entered wrong.. a mistake.
  • Allowing both Edit and Delete – both
• Support for Delegate user of MyHealtheVet to access PGHD. MyHealtheVet already supports delegate, but the PHGD support does not include this.
  • Read Only access
  • Read/Write/Create access
• Revoke Clinical access
  • Use of FHIR Consent to indicate Veteran has revoked MHV access to the data without removing the data
• Veteran see when data are reviewed
  • Requires PGHD implement FHIR AuditEvent
  • Provide view of who has accessed the data
• Current MyHealtheVet secure messaging include references to PGHD hosted resources. For example being able to tell the doctor you have a new blood-pressure, and include in the message the FHIR Reference id in a rich-text way that appears to the human nicely, but is actually a FHIR URL
• Blue Button
  • Blue Button report as it is today, include PGHD data
  • Blue Button report in FHIR-Document format
• Online method for a Veteran to request corrections to the EHR data. There is a HL7 FHIR Implementation Guide. Well formed request, also can link to the data (if it is FHIR accessible) that needs correction
• CarePlans - Given a CarePlan is started by a clinician (or veteran) allow for the Veteran to submit requested information and link that information to the CarePlan that is requesting it. Help guide the Veteran on the activities requested of them by the CarePlan