Conference call minutes 21 November 2013
Health Concern Topic Patient Care WG November 21, 2013
Attendees:
- Stephen Chu – Chair
- Elaine Ayres – Scribe
- Russ Leftwich
- Becky Angeles
- Lisa Nelson
- Emma Jones
- Michael Tan
Contents
Agenda
- Discuss definitions
- Harmonize PC Health Concern with Structured Docs.
Definition
Two concepts –
- An observation of any matters that are of interest to a person/family/provider. There may or may not be interventions.
- Tracking of these concerns over time.
Use case of asthma – multiple observations managed over time. These are grouped with a tracker.
Questions from LCC – tracker concept needs more explanation. Is a tracker a grouper or more of a temporal organizer? The tracker allows an entry point into a time series. Allows any care provider to access information. Note application to care hand-offs from care setting to care setting. Will need to model (conceptual and logical models) what attributes the health concern and the health concern tracker will need to meet these conditions e.g. tagging observations to associate them with specific health concerns.
Harmonize PC Health concern with Structured Docs
Lisa Nelson – CDA Perspective. Note Problem Concern and Health Concern. In CDA 1.1 – Problem Concern Act – groups problem section e.g. progress note, H & P, consults, D/C. Problem Concern Act – groups problem observations. Hard code for “Concern” related to problem observation(s). This may be a finding, symptom, complaint….that is qualified by a SNOMED code. The problem observation has a longitudinal aspect based on time. The grouper also has time elements. These can be active or inactive.
With S & I work – version 2.0 added the notion of goals and interventions. Templates in V2 C-CDA to address problem concern and health concern acts. Health concern is much more broad and includes problem concern act in addition to many other observations.
Note numerous grape analogies (grape clusters, bunches of grapes, grape vines). The Patient Care approach appears to be harmonized with the C-CDA concepts. The Problem Concern is more limited approach – the inclusion of the care plan and interventions needs to be included. The Problem Concern Act – reflects clinical thinking during one episode of care, versus the more broad approach of the Health Concern. The use of a specific medication would be associated to the Problem Concern.
Health Concerns – more longitudinal, Problem concerns appear to be more episodic.
Next steps – develop additional storyboards to ensure that all aspects of health concern are developed.
Storyboards
Storyboards as provided by Stephen Chu: (we did not discuss) Health Concern Observation and Health Concern Tracking – Storyboards
Storyboard 1 – health concern observations and tracking
Health Concern Observations: A 48 year-old male patient was seen by a primary care provider (PCP) on 20 June 2012. Health concern observation: presenting signs and symptoms: He presented to the PCP with complaints of lethargy, polydipsia, polyuria, difficulty in concentration, and recent weight loss. Spot blood glucose level revealed a reading of 11mmol/litre Patient has no family history of Type 1 or Type 2 Diabetes Mellitus Health concern observation: problem/diagnosis Patient’s spot blood pressure was 156/90 (hypertensive) Body weight was 88 kg, height 170cm, BMI = 30.4 (obese) Based on medical history and physical assessment, the GP made a provisional diagnosis of type 2 diabetes mellitus The GP requested fasting blood glucose and glucose challenge, HbA1C, serum lipid profile tests Patient was seen again by his GP on 25 June to discuss the test results. The GP made a diagnosis of Type 2 diabetes taking into consideration clinical history, physical examination and diagnostic test results. Health concern observation: presenting signs and symptoms: On 30 June, patient presented at the ED of his local hospital with the following presenting signs and symptoms: fever, productive cough, dyspnoea for 3 days, severe thirst, muscle weakness and increasing lethargy since onset of respiratory symptoms, warm dry skin, dry oral mucosa, blurred vision, , and mental confusion. Health concern observation: problem/diagnosis Diagnostic tests showed: chest x-ray lateral view showed lobar pneumonia left lower lobe, spot blood glucose level 30 mmol/L, serum osmolality = 325 mOsm/kg, serum pH = 7.40. Based on the clinical history, presentation and diagnostic tests The treating physician diagnosed the patient to be suffering from hyperosmolar hyperglycemic nonketotic syndrome The patient was treated in the hospital and discharged back to the care of his PCP. An electronic discharge summary was sent to the PCP
Health Concern Tracking: From June 2012, the health concern tracker application of the PCP medical record system continues to track the patient’s diabetes problem and related issues: • Presenting signs, symptoms, clinical evaluation at each encounter/visit • Risks for complications: cardiovascular, neurological, renal, ophthalmic, etc • Prognosis of the condition
Storyboard 2 – tracking of health risks as concern
Health Concern (Risk Factor) observation: • A male patient has the following health profile: • High BMI: 31.2 • High blood pressure: 14 days average >157/93 • Smoking: 15 pack year (1.5 pack/day for 10 years) • Elevated lipid profile (including high LDL and LDL:HDL ratio) • Cardiovascular risk (based on Framingham Risk Equation) and stroke risk are assessed to be high
Health Concern Tracking: The risk of atherosclerotic heart disease and stroke associated with this patient’s risk factors are considered immediate health risks The health risk factors as health concerns are continuously tracked by the PCP medical record system health concern tracking application
Storyboard 3 – no health concern tracking required
Health Concern (family history related risk factor) Observation: • A 35-year old female patient has a family history of breast cancer in three first degree female relatives. • The patient is recently diagnosed with aggressive malignant brain tumour. • Prognosis of brain tumour is assessed by neurologist to be very poor
Health Concern Tracking: The risk of breast cancer as a health concern will not be considered in her case. Health concern tracking of breast cancer risk will not be initiated
Next meeting will be on December 5 at 4 PM ET.
