Pulmonary Rehabilitation Guideline Referral in COPD – a FHIR mapping proposal

Résumé fourni par la source

Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent progressive respiratory disease, characterized by airflow limitation, respiratory symptoms, and exercise intolerance, which greatly impacts patient’s daily life. Pulmonary Rehabilitation (PR) is a well-recognized, cost-effective, and safe intervention with known benefits, recommended by COPD management guidelines. Despite this, there is a potential sub-diagnosis of the condition and low access rates to PR in the COPD population. Reasons may include a lack of detailed knowledge about how to refer potential patients to PR and the lack of specific criteria for the referral. Information about the patient’s status and available services also plays a vital role in referrals. Additionally, there is high heterogeneity of outcomes and measures reported in the literature for PR, hindering the benchmark and dissemination of its efficacy and evidence synthesis; it also prevents communication and inter-institutional and international work. Thus, improving information availability and flow can facilitate a more efficient process. This study aims to develop an interoperable digital protocol for PR referral, to support healthcare professionals in the data collection and referral process, making the process simpler and more efficient while also contributing to a transparent and coherent inter-institutional data exchange and continuous workflow. The variables and associated outcomes recommended by the Portuguese General Health Direction (Direção Geral da Saúde, DGS) in the standard 014/2019 regarding PR programs referral in primary care were described and translated to the HL7-FHIR health data standard. The flow of the protocol was also presented. This work aims to contribute to facilitating the process of PR referral by proposing a FHIR-based approach for describing relevant information and the decision-making process for PR referral, aiming to contribute for the support of health professionals in the referral decision-making process in primary care, making it simpler and more efficient while also contributing to inter-institutional workflow articulation and information availability.

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