Clinical Statement Pattern Conversion

The purpose of this page is to capture the discussion on how to adjust the Clinical Statement to support the RIM-ish approach.

• ConsumableChoice
  • Replace with Product Model
  • Does it allow for devices? Some work in progress with CPM CMET “R2”, but will that be enough.
    • Patient Care (5-Apr): we do need to be able to include devices. We see more work progressing on not only getting blood pressures as clinical statements, but also data on the device, e.g. was it calibrated? maintained? etc. Thus we envision several use cases in which a device must be described in more detail, including id, type, maintenance and so on. This is not clearly identified yet, but the general notion of this use case is actual.
• AgentChoice
  • Replace with Product Model, but food and dust might not quite work. To be worked out.
    • Patient Care (5-Apr): we just have got a message from Karen Nocera that diet and food is important to be included.
    • Patient Care (5-Apr): we also have the allergy model in which Agent has a role and where of course food and dust can be allergogenes.
  • Need to address manufactured vs. any material in CPM.
  • Does CPM cover orderable and aministrable perspectives?
  • Check with Gunther Schadow, Tom de Jong, Mead Walker, Hugh Glover
    • William Goossen (5-Apr): As far as I understand, these are currently not possible. This has been part of the reason for not using clinical statement for several Dutch projects. I look forward to Tom de Jong and Gerrit Boer's opinions on this.
• LocationChoice
  • We want to ask Pt Admin to create one CMET to cover all three variants.
  • The OrganizationChoice should be inside the “CS Location CMET”
  • Patient Care (5-Apr): This would suit PC very much indeed.
• DeviceProductChoice
  • Given all the potential participations with CPM, should collapse them all?
  • Patient Care (5-Apr): need more background to make any suggestions on this one.
• PatientOrRelatedOrSpecimen
  • Create 1 CMET that combines everything and split the participations to go to their own CMET.
• R_InvestigativeSubject
  • Should we replace with R_Subject, or would that widen too much?
  • We don’t think we need the EXPART participation as EXPTRGT is a sub of EXPART and if subject is unknown, there would not be an instance.
  • Check with Austin.
  • Patient Care (5-Apr): No opinion
• ProviderOrPatientOrRelated
  • Replace R_Patient and InvestigatedPerson with R_Subject.
  • Can RelatedEntity become a part of R_Subject
  • Review with Pt Admin.
  • Patient Care (5-Apr): This is a core part for multiple use cases in Patient Care can a foetus' hart rate still be attributed to the foetus in the mother's record? Can a spouse's care giver strain still be documented in a husband's record for a stroke care provision? can we identify a female donor for an egg in case of infertility treatment?
    • For the latter use case Kai Heitmann suggests the following in current approach:

<targetOf typeCode="PERT">

   <procedure classCode="PROC" moodCode="EVN">
       <id nullFlavor="NA"/>
       
       <subject typeCode="SBJ">
           <patient>
               <id nullFlavor="NA"/>
               <statusCode code="completed"/>
               <Person>
                   <birthTime value="1956"/>
               </Person>
           </patient>
       </subject>
   </procedure>

</targetOf>

• • • This is then a pertinent relationship to a procedure (egg donation) with subject "patient" that is played by a person having a birth date.
    • What would be handy according to Kai but is not possible due to lack of a more generic participation:

<participation typeCode="DON">

   <participationRole classCode="ROL">
       <playingPerson>
           <birthTime value="1981"/>
       </playingPerson>
   </participationRole>

</participation>

• • • If we are working to replace the CMET to a more generic one, why not similar for the participation level?
• directTarget
  • Why is this only on Act? What is the purpose?
  • Maybe Charlie Bishop knows history.
• ActReference
  • Can we remove it from the choice box so we only have one level choice box?
  • Patient Care (5-Apr): please keep this act reference! See the File:REPC DM000000UVActReference.png picture for more detail.
    • We sometimes have to refer to a single act / clincal statement from an earlier care provision. E.g. if we discuss a current pregnancy, but need data from an earlier pregnancy, e.g. risk factors.
    • It would become very cluttered / mixed if we can only have one choicebox option. We need the option of referring to older choicebox arrangements.
    • Please give us more directions if we can make the suggested changes and still do what we need to do.