Existing Wording: 2.4.3 Narrative

FHIR is intended to support sharing data in a computable manner. I.e. The information shared should be useable for computer-mediated processes such as decision support, rules triggering, trend analysis, etc. However, not every system is the same and not all systems are able to recognize all discrete data. Also, there is still considerable value in data exchange in circumstances where not all or even none of that data is captured in a discrete manner. For this reason, FHIR resources support sharing not only discrete data for computation, but also a human-readable view so that the humans on each end of a healthcare information exchange can still get a full picture of what's going on.

Narrative is expected to exist for most resource instances, although it can be omitted in a few limited circumstances. In some cases the narrative will be generated from discrete information. ... In other cases, the narrative might be free-form text commentary entered directly by a practitioner such as referral letters, pathology reports, etc. Certain parts of the narrative would content could also later be exposed as discrete data.

Comment:

Agree that non-discrete data provides considerable value and must be available for sharing. However, structures and processes to drive the capture of more discrete data and less "narrative" data should be prioritized for the purposes mentioned (decision support, trend analysis, reporting).

In addition, in cases where data is being transmitted for secondary data usages, the receiving party may require that the data is limited to only the PII and PHI that is required for them to perform their work. Frequently this would require that the receiving entity, such as The Joint Commission, reject files containing non-discrete data.

Enhance discussion to guide implementers to prioritize discrete data capture whenever possible.

Add discussion concerning secondary data usages and the possible need to suppress transmission of non-discrete data.

Summary:

Prioritize discrete data capture whenever possible and add discussion concerning secondary data usages