Workload/Capacity of a Practitioner in FHIR - hl7-fhir

Would like to know if there are any existing FHIR resource that can be used to update and maintain the workload/capacity of a particular Practitioner/Device. These values are to be updated periodically based on some business logic.
Regards,
Harsha

It sort of depends on what's meant by "workload". You could query the number of appointment Slot instances associated with the Practitioner that are 'open'. You could also capture Observations that evaluate workload/capacity based on other considerations. Each Observation would be a point-in-time assessment. Beyond that, you'd probably be looking at using extensions.

Related

Is it possible to replicate tables from multiple databases in Google Cloud?

The company that I work at uses a microservices architecture with the 'database per service' pattern. This pattern makes it harder to query based on data from multiple services, since each service has its own database. Imagine a service for managing your products and one for managing stock. You would have to somehow combine the data from both services to query for products based on stock.
I know that event sourcing and API composition are potential solutions to the problem, but I was wondering if it is possible to continuously replicate specific tables from the product and stock databases based on database transaction logs. Wouldn't this be much simpler than say implementing an event based solution like event sourcing? One service that I am working with contains a lot of domain events, which would make implementing and maintaining event-based solution rather complex.
Another reason for why I am considering to look at the problem from a different angle is that there is a lot of data. In-memory joins with say API composition will most likely be slow.
To sum it all up, I would like to know if it is possible to continuously replicate specific tables from different databases into one database.
The technologies that my company uses are primarily Spring Framework and PostgreSQL.
I would step back and ask why you have microservices (including why you have multiple databases). This is because it's quite easy to make choices that are superficially easy but which achieve that ease by negating the reason you had the microservices to begin with, and in such a situation, it may in fact be easier to just not do microservices.
For example, you might be doing microservices because you want to be able to have the team maintaining your product service be able to make changes without coordinating with the stock service or vice versa. By setting up a direct replication of a table from service A's database into service B's database, you essentially require many changes service A might want to make to that table to be coordinated with service B. It's perhaps less operationally coupled than unifying the services into a monolith, but in terms of developer velocity, you're giving up a fair amount.
Alternatively, if the rationale is to allow one service to be down (failures, maintenance, releases: doesn't matter) without taking the others down, a replication which guarantees strong consistency implies that taking service B's database down prevents service A from updating its database (because if you allowed service A to update its database in that situation, you couldn't have strong consistency).
Rather than direct replication, it might make sense to use change data capture (e.g. with Debezium) to publish a stream of changes from the transaction logs (e.g. to Kafka). The critical difference from logical replication is that the consumer can, for instance, choose to ignore updates to columns it doesn't care about: the stock service might include details like where things are stocked in a warehouse, for instance, which is data you don't need for answering a query like "show me the products in this category which are in stock". This can be a nice middle ground between going full event-sourcing and other approaches.

Text search for microservice architectures

I am investigating into implementing text search on a microservice based system. We will have to search for data that span across more than one microservice.
E.g. say we have two services for managing Organisations and managing Contacts. We should be able to search for organisations by contact details in one search operation.
Our preferred search solution is Elasticsearch. We already have a working solution based on embedded objects (and/or parent-child) where when a parent domain is updated the indexing payload is enriched with the dependent object data, which is held in a cache (we avoid making calls to the service managing child directly for this purpose).
I am wondering if there is a better solution. Is there a microservice pattern applicable to such scenarios?
It's not particularly a microservice pattern I would suggest you, but it fits perfectly into microservices and it's called Event sourcing
Event sourcing describes an architectural pattern in which events are generated by different sources. An event will now trigger 0 or more so called Projections which then use the data contained in the event to aggregate information in the form it is needed.
This is directly applicable to your problem: Whenever the organisation service changes it's internal state (Added / removed / updated an organization) it can fire an event. If an organization is added, it will for example aggregate the contacts to this organization and store this aggregate. The search for it is now trivial: Lookup the organizations id in the aggregated information (this can be indexed) and get back the contacts associated with this organization. Of course the same works if contracts are added to the contract service: It just fires a message with the contract creation information and the corresponding projections now alter different aggregates that can again be indexed and searched quickly.
You can have multiple projections responding to a single event - which enables you to aggregate information in many different forms - exactly the way you'd like to query it later. Don't be afraid of duplicated data: event sourcing takes this trade-off intentionally and since this is not the data your business-services rely on and you do not need to alter it manually - this duplication will not hurt you.
If you store the events in the chronological order they happened (which I seriously advise you to do!) You can 'replay' these events over and over again. This helps for example if a projection was buggy and has to be fixed!
If your're interested I suggest you read up on event sourcing and look for some kind of event store:
event sourcing
event store
We use event sourcing to aggregate an array of different searches in our system and we aggregate millons of records every day into mongodb. All projections have their own collection create their own indexes and until now we never had to resort to different systems / patterns like elastic search or the likes!
Let me know if this helped!
Amendment
use the data contained in the event to aggregate information in the form it is needed
An event should contain all the information necessary to aggregate more information. For example if you have an organization creation event, you need to at least provide some information on what the organizations name is, an ID of some kind, creation date, parent organizations ID etc. As a rule of thumb, we send all the information we gather in the service that gets the request (don't take it directly form the request ;-) check it first, then write it to the event and send it off) because we do not know what we're gonna need in the future. Just stay cautious - payloads should not get too large!
We can now have multiple projections responding to this event: One that adds the organizations to it's parents aggregate (to get an easy lookup for all children of a given organization), one that just adds it to the search set of all organizations and maybe a third that aggregates all the parents of a given child organization so the lookup for the parent organizations is easy and fast.
We have the same service process these events that also process client requests. The motivation behind it is, that the schema of the data that your projections create is tightly coupled to the way it is read by the service that the client interacts with. This does not have to be that way and it could be separated into two services - but you create an almost invisible dependency there and releasing these two services independently becomes even more challenging. But if you do not mind that additional level of complexity - you can separate the two.
We're currently also considering writing a generic service for aggregating information from events for things like searches, where projections could be scripted. That only makes the invisible dependencies problem less conspicuous, it does not solve it.

Create subsets for certain Resources to better fit existing data model?

We are trying to implement a FHIR Rest Server for our application. In our current data model (and thus live data) several FHIR resources are represented by multiple tables, e.g. what would all be Observations are stored in tables for vital values, laboratory values and diagnosis. Each table has an independent, auto-incrementing primary ID, so there are entries with the same ID in different tables. But for GET or DELETE calls to the FHIR server a unique ID is needed. What would be the most sensible way to handle this?
Searching didn't reveal an inherent way of doing this, so I'm considering these two options:
Add a prefix to all (or just the problematic) table IDs, e.g lab-123 and vit-123
Add a UUID to every table and use that as the logical identifier
Both have drawbacks: an ID parser is necessary for the first one and the second requires multiple database calls to identify the correct record.
Is there a FHIR way that allows to split a resource into several sub-resources, even in the Rest URL? Ideally I'd get something like GET server:port/Observation/laboratory/123
Server systems will have all sorts of different divisions of data in terms of how data is stored internally. What FHIR does is provide an interface that tries to hide those variations. So Observation/laboratory/123 would be going against what we're trying to do - because every system would have different divisions and it would be very difficult to get interoperability happening.
Either of the options you've proposed could work. I have a slight leaning towards the first option because it doesn't involve changing your persistence layer and it's a relatively straight-forward transformation to convert between external/fhir and internal.
Is there a FHIR way that allows to split a resource into several
sub-resources, even in the Rest URL? Ideally I'd get something like
GET server:port/Observation/laboratory/123
What would this mean for search? So, what would /Obervation?code=xxx search through? Would that search labs, vitals etc combined, or would you just allow access on /Observation/laboratory?
If these are truly "silos", maybe you could use http://servername/lab/Observation (so swap the last two path parts), which suggests your server has multiple "endpoints" for the different observations. I think more clients will be able to handle that url than the url you suggested.
Best, still, I think is having one of your two other options, for which the first is indeed the easiest to implement.

FHIR search multiple values for the same parameter

For our patient registration system as a standalone web service, we want to use FHIR.
Applications that want to request data from the web service in some cases want to retrieve information about multiple patients. For example a list of last seen patients.
It would be really inefficient to search every patient based on id individually, because it will cause much overhead in networking and searching.
Is it possible to search for multiple patients with a set of IDs?
Http should be able to handle this. I wonder if the FHIR standard supports this.
there's two choices. the first is
GET [base]/Patient?_id=1,2,3,4,5
Using commas like this is documented here: http://hl7.org/fhir/search.html#combining
An alternative is to use a batch. This is a much more flexible arrangement - see http://hl7.org/fhir/http.html#transaction

couchdb validation based on content from existing documents

QUESTION
Is it possible to query other couchdb documents as part of a standard couchdb validation function ?
If not, what is the standard approach for including properties of other documents as part of a validation rule inside a couchdb validation function?
RATIONALE
Consider a run-of-the-mill address book application where the validation function is intended to prevent two or more entries having the same value for the 'e-mail' in one of the address book entry fields.
Consider also an address book application where it is possible to specify validation rules in separate documents, based on whether the postal code is a US-based postal code or something else.
No, it is not possible to query other couchdb documents in a validate_doc_update function. Each runs in isolation passing references only to: the new document, the old document, and user (where applicable).
My personal experience has been there are at least three options for dealing with duplicate checking:
Use Cloudant as your CouchDB provider. They offer a free tier for now if you'd like to experiment, but they guarantee consistency across nodes for a CouchDB database. (See #2)
I've used a secondary "reserve table" for names using the type-key as the ID. Then, you need to check for conflicts if not using a system like Cloudant. Basically, there's a simple document that maintains a key to prevent duplicates. It's not fun code to write given that you need to watch for conflicts. (Even with cloudant, you need to deal with failed requests to write, but it's easier than dealing with timing issues surrounding data replication across multiple nodes).
Use a traditional DB like MySQL for example that can maintain a unique and consistent index for specific data values like you're describing. Store the documents away in CouchDB though. While slightly annoying that you need different data providers, it's reliable.
(Optional: decide that CouchDB isn't a great fit for the type of system you're building)

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