Where should claim related artefacts go?

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As the tile said, I’ve been wondering where claim related artefacts should be placed in the CKM? Similarily, discussion topics on such artefacts might also need a separate category in the forum.

In addition, this question reminds me of the counterparts/modules in the FHIR Specification, such as Financial Module and Administration Module.

Thanks

Cheers,
Lin Zhang

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Generally claims are not part of the EHR, but part of the financial system that takes information from the EHR (CPT, ICD, etc.) plus some demographics, scheduling, provider and payor information. Most of that is also not part of the EHR. Claims are sort of reports with aggregated information from many systems (I did some claim work for the US).

But, if you want that info to be part of the EHR, that would be an ADMIN_ENTRY.

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Thanks, Pablo

Helpful reply!

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sorry I fixed some typos on my previous reply (cellphone typing…)

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@linforest really late here, but I remembered this paper Modeling healthcare authorization and claim submissions using the openEHR dual-model approach | BMC Medical Informatics and Decision Making | Full Text

They extended the openEHR model to represent authorization and claim information.

I’m currently working on that area (with claims and also with scheduling) and modeling some concepts outside the openEHR information model, extending it, so we can manage other types of information in the same way and with the same methodologies and tools: base RM, modeling with archetypes and templates, storage of those resources in a vendor neutral and versioned environment, and using a similar REST API for those extra concepts as we have for EHRs, FOLDERs and COMPOSITIONs.

Related to my work, I also have an implementation of a demographic model REST API, which we don’t formally have in openEHR. I proposed one in the openEHR SEC, though it got buried under 100s other things the SEC is doing.

So you might see more models, tooling and repository support soon for those other concepts (it will be published as soon as we have a PoC to show).

Best,
Pablo.

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It’s a fair point @linforest - we have categories/tags for Clinical, Modelling editors, modelling-patterns Clinical > Clinically Relevant RM Discussions Clinical > Ask an editor and many others… In some ways we probably have too many Categories here, it’s overwhelming and confusing.

But, Claims/Billing and other EHR-adjacent administrative concepts, although they are clearly a ‘modellable concept’, they are not directly ‘clinical’ and so at the moment have no natural ‘home’ on this forum.

I’m happy to work with the community to resolve this, either by creating a suitable new category, or by renaming an existing one such that it’s more obvious where such administrative modelling activity could be shared. Happy to take views from the community on this.

For now, does anyone have any objection to these concepts being shared in Clinical but perhaps tagged with something to mark them out as different?

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