[leovander]

Spec. Off's [1]

  - Doctor enters your visit (encounter), cross your fingers that his system has the most up-to-date medical codes (e.g. snomed, cpt, icd, etc)  
  - Doctors notes for that encounter are potentially entered as a text area in one system (u/petermcneeley). Can be notes at the encounter level or for a specific diagnosis/lab result/etc.
  - The codes vs free text, is what we refer to as discreet and narrative/free text.
  - The current IHE spec. [2] (last updated in 2015?), allows for codes to be interpreted from narrative text if a valid code is not provided. I think there are a few startups that have popped up here that are trying to make sense of the narrative text.
  - That same spec would be great if everyone followed it but they have to get their system to bend a little bit or throw an integration engine in front of the problem to play nicely with others. (u/nradov)
  - Start sending those back and forth and you either end up losing those notes or butchering them up.


  - There are some orgs (e.g. DoD, VA, Sequoia, etc) that have everyone follow the basic requirements but then add their own flavor on top. [3]
  - FHIR [4] is here, but I think everyone is already scrambling or haven't had the need to make the cut over to it until its government mandated. I have to say this has been the easiest spec. to grok, but it is still way too flexible for these companies to mess up. A cut over to FHIR for everyone should ideally be that you have to use the Hapi FHIR models [5]. Maybe have a way for Hapi to sign the models on their way out?

Sorry, this turned out to be more of a rant, but I stare at this stuff everyday. There are a few other folks on the thread that know the industry as well that have some good info too.

[1] https://media1.tenor.com/images/af0c71048d5a130cefc335423c59...

[2] http://www.hl7.org/implement/standards/product_brief.cfm?pro...

[3] https://xkcd.com/927/

[4] https://www.hl7.org/fhir/

[5] http://hapifhir.io/