Proposed HealthCareProviderRoleType changes

In Canada, all Nurse Practitioners are registered nurses, but there is no such thing as a Registered Nurse Practitioner. This seems like a simple labelling error that has finally been noticed by someone in the know. As Lloyd notes, changing the code would cause chaos and provide no value, but officially changing the label seems very sensible.

Most existing systems have life cycles measured in years, not months. They also have significant legacy data. Codes should only be retired and replaced if there's not practical alternative. It's not clear that there's any pressing need to change the existing code. Revising the definition and display name should be sufficient and is a much easier change for existing implementations to mange.

Thanks for Lloyd's comment.

The transition time could be extended to several years.

Also, with the extra information in the NP description, the relationship could be clarified and I hope this effort will help maintain the data integrity.


My proposal is to add an additional code value ("NP") with the display ("Nurse Practitioner") and its description. Also, the description specifies that this concept is the replacement of the RNP.

The original RNP code will stay.

And one sentence will be added to the RNP description to indicate that this concept has been deprecated and will be removed after a certain period of time, for example, six months.

In this context, the transition should be smooth and peaceful, with minimal impact on prospective users.

The same strategy can also apply to the medical doctor concept.The main goal is to clarify the relationship among the concepts and give a transition period for the deprecated concept to phase out.

Update:

I wanted to provide you with a couple of updates on the RFC that we submitted for changes to the HealthcareProviderRoleType subset

• For “Registered Nurse Practitioner”, we understand from community feedback that changing the code is not ideal. Therefore, we would like to propose leaving the code as is (RNP) and updating the value label only (from “Registered Nurse Practitioner” to “Nurse Practitioner”). Our health workforce information team has already made this change to their data standard and has heard from their stakeholders that “Nurse Practitioner” is more accurate. As the concept has not changed and we are simply proposing that we re-label the concept to be more accurate, we think that it’s okay to leave the code as is.

• For “Medical Doctor”, CIHI has decided to leave the definition as is for the next release of our CRDM in January 2023. We will continue to investigate the desire to capture medical students separately from medical doctors and will inform you of any changes as we progress with this work. At this time, this part of the RFC is no longer necessary.

Shannon O’Connor (she/her)
Program Consultant, Data Standards
Canadian Institute for Health Information (CIHI)
495 Richmond Road, Suite 600
Ottawa, Ontario K2A 4H6
T: 613-694-6203
F: 613-241-8120
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Codes shouldn't change. Changing the code breaks interoperability and there's no need for the code to change here.

Changing the direction of medical doctor is also problematic. If the concept has been used to include "physicians in training", then the definition change would be a breaking change. It'd be better to define a new specialization concept.

CIHI is proposing changes to the ‘HealthcareProviderRoleType’ subset, which is associated with the Provider Type data element in the Pan-Canadian Primary Health Care EMR Minimum Data Set

The proposed changes are
1) Drop “Registered” from the value label for Nurse practitioner.
- Changes from “Registered Nurse Practitioner” to “Nurse Practitioner” (French display also changes).
- Code changes from "RNP" to "NP".
- Value meaning/description remains unchanged.

2) Drop “or is studying to become” from the value meaning/description for Medical Doctor.
- Current: A health service provider who is or is studying to become academically and legally qualified as a doctor of medicine.
- Proposed: A health service provider who is academically and legally qualified as a doctor of medicine.

Please join us at the December 6th HL7 Meeting at 12 pm to discuss the proposal.