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Difference between revisions of "IPS NoInfos section"

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== Introduction ==
 
== Introduction ==
  
It has been discussed in the group the best way to express the absence of information about a specific section (e.g. no data about allergies, I don't know anything about medications), since templates evaluated seem to propose different approaches for this.
+
The group has discussed the best way to express the absence of information about the content of a specific section (e.g.; no available data about allergies, I don't know anything about drug treatment for this patient ...), as well as the best way to express that the content is known absent (e.g.; at the best of my knowledge I'm not aware about allergies for this patient)
  
Note: This is different from the case "at the best of my knowledge I'm not aware about allergies for this patient".
+
Existing templates evaluated seem to propose different approaches for this.
  
This problem mainly applies for mandatory sections.
+
This need mainly applies to mandatory sections.
  
The solution should be the same for all the sections.
+
The solution should be the same for all sections.
  
 
=== Cases to be covered ===
 
=== Cases to be covered ===
  
# No info about allergies/intolerances
+
# No info about allergies/intolerances  ;  No allergies/intolerances
# No info about medications
+
# No info about drugs  ;  No current drug treatment
# No info about problems
+
# No info about problems   ;  No current problem
# No info about procedures
+
# No info about procedures   ;  No history of procedure
# No info about medical devices, implants
+
# No info about medical devices, implants ;  No current implant
# No info about immunizations
+
# No info about immunizations   ;  No  history of immunization
  
 
== Solution Selected ==
 
== Solution Selected ==
Line 29: Line 29:
  
 
* Facilitate the work of implementers
 
* Facilitate the work of implementers
* Facilitate the mapping to FHIR resources
+
* Solution independent of the underlying syntax (e.g.; CDA or FHIR), which facilitates the mapping to FHIR resources
 
 
With this approach we aim to provide implementers with a common way to access information about a specific topic (e.g. allergies) indipendently by the fact they are looking for a positive assertions, known absent or no availability of data.
 
  
 +
With this approach we aim to provide implementers with a common way to access information about a specific topic (e.g. allergies) independently of the fact they are looking for a positive assertion, known absent or no availability of data.
  
 
=== Issue to be resolved ===
 
=== Issue to be resolved ===
Line 41: Line 40:
 
! Section || No Infos || Known Absent
 
! Section || No Infos || Known Absent
 
|-
 
|-
| Allergies/intolerances || concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''Allergic disposition not known (situation)'''"<br/>Hierarchy: 413350009 <nowiki>|</nowiki>Finding with explicit context (situation)<nowiki>|</nowiki><br/>Associated finding = 609328004 <nowiki>|</nowiki>Allergic disposition (disorder)<nowiki>|</nowiki><br/>Temporal context = 410589000 <nowiki>|</nowiki>All times past (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Finding context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki><br/>|| 716186003 <nowiki>|</nowiki> No known allergy (situation)
+
| Allergies/intolerances || concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''Allergic disposition not known (situation)'''"<br/>Hierarchy: 413350009 <nowiki>|</nowiki>Finding with explicit context (situation)<nowiki>|</nowiki><br/>Associated finding = 609328004 <nowiki>|</nowiki>Allergic disposition (disorder)<nowiki>|</nowiki><br/>Temporal context = 410589000 <nowiki>|</nowiki>All times past (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Finding context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki>|| 716186003 <nowiki>|</nowiki>'''No known allergy (situation)'''<nowiki>|</nowiki><br/>(this code or any combination of its descendants)
OR ''other more specific concepts (e.g. NKDA)''
 
 
 
see note2
 
 
|-
 
|-
| Medications ||concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''Drug treatment not known (situation)'''"<br/>Hierarchy: 129125009 <nowiki>|</nowiki>Procedure with explicit context (situation)<nowiki>|</nowiki><br/>Associated procedure = 416608005 <nowiki>|</nowiki>Drug therapy (procedure)<nowiki>|</nowiki><br/>Temporal context = 410589000 <nowiki>|</nowiki>All times past (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>PRocedure context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki><br/>|| 182849000 <nowiki>|</nowiki> No drug therapy prescribed (situation)  
+
| Medications ||concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''Drug treatment not known (situation)'''"<br/>Hierarchy: 129125009 <nowiki>|</nowiki>Procedure with explicit context (situation)<nowiki>|</nowiki><br/>Associated procedure = 416608005 <nowiki>|</nowiki>Drug therapy (procedure)<nowiki>|</nowiki><br/>Temporal context = 410512000 <nowiki>|</nowiki>Current or specified time (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Procedure context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki><br/>|| concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''No drug treatment (situation)'''"<br/>Hierarchy: 129125009 <nowiki>|</nowiki>Procedure with explicit context (situation)<nowiki>|</nowiki><br/>Associated procedure = 416608005 <nowiki>|</nowiki>Drug therapy (procedure)<nowiki>|</nowiki><br/>Temporal context = 410512000 <nowiki>|</nowiki>Current or specified time (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Procedure context = 385660001 <nowiki>|</nowiki>Not done (qualifier value)<nowiki>|</nowiki><br/>
OR
 
408350003 <nowiki>|</nowiki> Patient not on self-medication (finding)
 
 
|-
 
|-
| Problems || 396782006 <nowiki>|</nowiki> Medical history unknown (situation) ||160245001 <nowiki>|</nowiki> No current problems or disability (situation) (tentative FM)  
+
| Problems ||concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''History of problems not known (situation)'''"<br/>Hierarchy: 413350009 <nowiki>|</nowiki>Finding with explicit context (situation)<nowiki>|</nowiki><br/>Associated finding = 404684003 <nowiki>|</nowiki>Clinical finding (finding)<nowiki>|</nowiki><br/>Temporal context = 410589000 <nowiki>|</nowiki>All times past (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Finding context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki> ||160245001 <nowiki>|</nowiki>'''No current problems or disability (situation)'''<nowiki>|</nowiki>  
 
|-
 
|-
| Procedures ||399714002 <nowiki>|</nowiki> Procedure status unknown (situation) (tentative FM) || 416128008 <nowiki>|</nowiki> No history of procedure (situation) (tentative FM)
+
| Procedures ||concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''History of procedures not known (situation)'''"<br/>Hierarchy: 129125009 <nowiki>|</nowiki>Procedure with explicit context (situation)<nowiki>|</nowiki><br/>Associated procedure = 71388002 <nowiki>|</nowiki>Procedure (procedure)<nowiki>|</nowiki><br/>Temporal context = 410589000 <nowiki>|</nowiki>All times past (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Procedure context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki>|| 416128008 <nowiki>|</nowiki>'''No history of procedure (situation)'''<nowiki>|</nowiki>
 
|-
 
|-
| Medical devices, implants ||concept "Presence of implanted device not known (situation)" to be created in HL7 Int extension with these defining attributes:<br/>Associated finding = 397578001 <nowiki>|</nowiki>Device in situ (finding) <br/>Temporal context = current or specified time<br/>Subject relationship = subject of the record<br/>Finding context = unknown<br/>(tentative FM) || concept "No implant in situ (situation)" to be created in HL7 Int extension with these defining attributes:<br/>Associated finding = 397578001 <nowiki>|</nowiki>Device in situ (finding) <br/>Temporal context = current or specified time<br/>Subject relationship = subject of the record<br/>Finding context = known absent<br/>(tentative FM)
+
| Medical devices, implants ||concept to be created in HL7 Int extension with these defining characteristics:<br/>FSN: "'''Presence of implanted device not known (situation)'''"<br/>Associated finding = 397578001 <nowiki>|</nowiki>Device in situ (finding) <br/>Temporal context = 410512000 <nowiki>|</nowiki>Current or specified time (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Finding context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki> || concept to be created in HL7 Int extension with these defining characteristics:<br/>FSN: "'''No implant in situ (situation)'''"<br/>Associated finding = 397578001 <nowiki>|</nowiki>Device in situ (finding)<nowiki>|</nowiki><br/>Temporal context = current or specified time<br/>Subject relationship = subject of the record<br/>Finding context = known absent<br/>  
 
|-
 
|-
| Immunizations || ???? || ????
+
| Immunizations ||concept to be created in HL7 Int extension, with these defining characteristics:<br/> FSN: "'''History of immunizations not known (situation)'''"<br/>Hierarchy: 129125009 <nowiki>|</nowiki>Procedure with explicit context (situation)<nowiki>|</nowiki><br/>Associated procedure = 127785005 <nowiki>|</nowiki>Administration of substance to produce immunity, either active or passive (procedure)<nowiki>|</nowiki><br/>Temporal context = 410589000 <nowiki>|</nowiki>All times past (qualifier value)<nowiki>|</nowiki><br/>Subject relationship = 410604004 <nowiki>|</nowiki>Subject of record (person)<nowiki>|</nowiki><br/>Procedure context = 261665006 <nowiki>|</nowiki>Unknown (qualifier value)<nowiki>|</nowiki>||401179006 <nowiki>|</nowiki>'''No previous immunizations (situation)'''<nowiki>|</nowiki>
 
|}
 
|}
 
 
''Note1: is this correct ? does it mean that there is a treatment that is unknown ? or are the "drug treatments" unknown ? (GC) <br/> The concepts in the left column o this matrix should come from the Situation with explicit context hierarchy, not Clinical finding, and should be defined with the value "Unknown (qualifier value)" for the "finding context" or "procedure context" attribute. (FM)''
 
 
''Note2: what about "no known allergies or intolerances" ? ''
 
  
 
=== To Do ===
 
=== To Do ===
  
* Search for possible candidates in existing code systems
+
* Search for possible candidates in existing code systems -> done
* Define the missing codes to be added
+
* Define the missing codes to be added -> done
* Evaluate the request to have an HL7 extension in SNOMED CT
+
* Evaluate the request to have an HL7 extension in SNOMED CT -> done
 
* In case, add the missing codes in this extension
 
* In case, add the missing codes in this extension
 
  
 
== Options evaluated ==
 
== Options evaluated ==

Latest revision as of 13:59, 27 March 2017

Introduction

The group has discussed the best way to express the absence of information about the content of a specific section (e.g.; no available data about allergies, I don't know anything about drug treatment for this patient ...), as well as the best way to express that the content is known absent (e.g.; at the best of my knowledge I'm not aware about allergies for this patient)

Existing templates evaluated seem to propose different approaches for this.

This need mainly applies to mandatory sections.

The solution should be the same for all sections.

Cases to be covered

  1. No info about allergies/intolerances ; No allergies/intolerances
  2. No info about drugs ; No current drug treatment
  3. No info about problems ; No current problem
  4. No info about procedures ; No history of procedure
  5. No info about medical devices, implants ; No current implant
  6. No info about immunizations ; No history of immunization

Solution Selected

The information about the absence of information should be coveyed through the coded element that also conveys the main information (e.g. the type of allergy) (decision of the 2017-02-22 call)

see below for details

Rational for the choice

  • Facilitate the work of implementers
  • Solution independent of the underlying syntax (e.g.; CDA or FHIR), which facilitates the mapping to FHIR resources

With this approach we aim to provide implementers with a common way to access information about a specific topic (e.g. allergies) independently of the fact they are looking for a positive assertion, known absent or no availability of data.

Issue to be resolved

  • Identify for each case suitable codes for asserting no info and known absent. The table below summarize the current status (to be updated)
Section No Infos Known Absent
Allergies/intolerances concept to be created in HL7 Int extension, with these defining characteristics:
FSN: "Allergic disposition not known (situation)"
Hierarchy: 413350009 |Finding with explicit context (situation)|
Associated finding = 609328004 |Allergic disposition (disorder)|
Temporal context = 410589000 |All times past (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Finding context = 261665006 |Unknown (qualifier value)|
716186003 |No known allergy (situation)|
(this code or any combination of its descendants)
Medications concept to be created in HL7 Int extension, with these defining characteristics:
FSN: "Drug treatment not known (situation)"
Hierarchy: 129125009 |Procedure with explicit context (situation)|
Associated procedure = 416608005 |Drug therapy (procedure)|
Temporal context = 410512000 |Current or specified time (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Procedure context = 261665006 |Unknown (qualifier value)|
concept to be created in HL7 Int extension, with these defining characteristics:
FSN: "No drug treatment (situation)"
Hierarchy: 129125009 |Procedure with explicit context (situation)|
Associated procedure = 416608005 |Drug therapy (procedure)|
Temporal context = 410512000 |Current or specified time (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Procedure context = 385660001 |Not done (qualifier value)|
Problems concept to be created in HL7 Int extension, with these defining characteristics:
FSN: "History of problems not known (situation)"
Hierarchy: 413350009 |Finding with explicit context (situation)|
Associated finding = 404684003 |Clinical finding (finding)|
Temporal context = 410589000 |All times past (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Finding context = 261665006 |Unknown (qualifier value)|
160245001 |No current problems or disability (situation)|
Procedures concept to be created in HL7 Int extension, with these defining characteristics:
FSN: "History of procedures not known (situation)"
Hierarchy: 129125009 |Procedure with explicit context (situation)|
Associated procedure = 71388002 |Procedure (procedure)|
Temporal context = 410589000 |All times past (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Procedure context = 261665006 |Unknown (qualifier value)|
416128008 |No history of procedure (situation)|
Medical devices, implants concept to be created in HL7 Int extension with these defining characteristics:
FSN: "Presence of implanted device not known (situation)"
Associated finding = 397578001 |Device in situ (finding)
Temporal context = 410512000 |Current or specified time (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Finding context = 261665006 |Unknown (qualifier value)|
concept to be created in HL7 Int extension with these defining characteristics:
FSN: "No implant in situ (situation)"
Associated finding = 397578001 |Device in situ (finding)|
Temporal context = current or specified time
Subject relationship = subject of the record
Finding context = known absent
Immunizations concept to be created in HL7 Int extension, with these defining characteristics:
FSN: "History of immunizations not known (situation)"
Hierarchy: 129125009 |Procedure with explicit context (situation)|
Associated procedure = 127785005 |Administration of substance to produce immunity, either active or passive (procedure)|
Temporal context = 410589000 |All times past (qualifier value)|
Subject relationship = 410604004 |Subject of record (person)|
Procedure context = 261665006 |Unknown (qualifier value)|
401179006 |No previous immunizations (situation)|

To Do

  • Search for possible candidates in existing code systems -> done
  • Define the missing codes to be added -> done
  • Evaluate the request to have an HL7 extension in SNOMED CT -> done
  • In case, add the missing codes in this extension

Options evaluated

Nullflavored section

  • This seems to be the C-CDA suggested approach. The section are nullflavore with "NI" and only the text is present

  <section nullFlavor="NI">  <title> </text></section>

Pros:

  1. Simple to model and common for all the sections

Cons:

  1. Doubts on the actual semantic of this approach
  2. implementers should look to different elements / attributes to get the right information about an element


Coded element

  • The coded element that conveys the main information (e.g. the type of allergy) is used also for indicating that there are no info about it.


Pros:

  1. Implementers access to the same element / attribute to get positive and "no infos" data

Cons:

  1. Codes are not always available for all the cases (how to deal with these cases ?)
  2. the approved C-CDA example for known absent uses the negationInd


Nullflavored entry

  • The single nullflavored entry is provided.
   <section > <…> <entry> <act nullFlavor="NI">  <..> </section>

note: the act calls is used here only as example. the nullflavored element is the root elelent of the clincial statement (e.g. observation, supply,...)

Pros:

  1. Simple to model and common for all the sections

Cons:

  1. implementers should look to different elements / attributes to get the right information about an element

Comments

Kai Heitmann 2017-02-21 opinion: I doubt that a section is feasible to convey NO INFORMATION in a coded way AT ALL. I consider a section as a coded and labelled TEXT, not more. So the only thing I can convey is "No allergies" or "אין אלרגיות" (sorry for the Hebraic :-) in the section about allergies. If I want to code that no allergies are stated that needs to go into an entry.