Observation vs Condition

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Background

From the perspective of HL7, the great majority of clinical information falls under the category of "observation". The distinction between general observations (such as signs, symptoms, blood pressure, body temperature, body weight, height, etc), imaging/laboratory test results, problems, diagnosis is achieved through the use of vocabularies.

Extensive debates between clinicians and FHIR team occurred over a period of at least 3 workgroup meetings on whether "problem" and "diagnosis" are structurally different from modelling perspective from the concept - "observation".

Eventually, the FHIR team agreed to create a "condition" FHIR resource to represent "problem" and "diagnosis", and the "observation" FHIR resource to represent general observation findings.

However the question of whether there is any difference between "observation" and "condition" never goes away and has been raised many times since.

The clinical and FHIR communities agree that there is a high need to clearly define these concepts and determine their differentiating characteristics from the clinical and engineering perspectives.

Definitions and Examples

Observation and Clinical Observation

• Observation:

- Dictionary definition: "the act of watching somebody/something carefully for a period of time, especially to learn something"

- Source: http://www.oxfordlearnersdictionaries.com/definition/english/observation

• Clinical:

- Dictionary definitions:

- Relating to the bedside treatment of a patient or to the course of the disease

- Relating to the observed symptoms and course of a disease

- Source: http://medical-dictionary.thefreedictionary.com/clinical

• Clinical observation:

- Definition: "the act of watching and obtaining information about a patient's clinical status including signs, symptoms, and course of a disease"

• Examples of clinical observations:

- "Clinical observations include estimation of haemoglobin-oxygen saturation (SpO2, pulse oximetry), oxygen therapy, respiratory rate, heart/pulse rate, blood pressure (systolic, diastolic and mean), temperature (including measurement method), sedation and pain. In certain clinical circumstances further observations (for example neurological) may be required"

- Source: http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Observation_and_Continuous_Monitoring/

Condition/Health Condition

• Condition:

- Dictionary Definitions:

- Condition is defined as:

(1) a particular mode of being of a person or thing; existing state; situation with respect to circumstances

(2) state of health

(3) a person's or animal's state of health or physical fitness

- Source: http://dictionary.reference.com/browse/condition

- Source: http://www.oxforddictionaries.com/definition/english/condition

• Synonymous Concepts:

- A number of concepts are used synonymously with "condition"/"health condition"

- Examples:

- long-lasting health condition (also called a chronic illness)

- Source: http://kidshealth.org/teen/your_mind/problems/deal_chronic_illness.html

- Under the FMLA (The Family and Medical Leave Act, USA) a serious health condition is an illness, injury, impairment or physical or mental condition

- http://www.shrm.org/templatestools/hrqa/pages/howemployeemedicalabsencequalifiesforfmlaleave.aspx

• Examples of health/medical conditions:

- Tuberculosis, poliomyelitis, Non-Hodgkin's lymphoma, Diabetes mellitus type 1, malnutrition, obesity

- Source: http://www.health.gov.au/internet/publications/publishing.nsf/Content/ageing-acfi-userguide-feb2013-toc~ageing-acfi-userguide-feb2013-app1

Information/data elements collected for Observation and Condition

There are common data elements/components that are collected for both "observation" and "condition". These are the context related information such as:

- Patient details

- Observer/documenter (this can be the same or different person)

- Event/encounter details (including Event/encounter type, location, date and time of encounter/event)

There are also "observation" and "condition" specific data elements/components.

• Observation specific data elements/components:

- Datetime start and DateTime end

- These values apply to sign and symptom observation observation types

o For example: cough, fever, pain, swelling, rash, dyspoenia, cyanosis, 24 hours urine output, panic attack, etc

- For other observations it is uncommon/not very useful to record the start and end values

o For example: temperature, heart/pulse rate, respiratory rate, body weight, height, head circumference, pulse oximetry, etc

- Observation Name/Description

- Identifies the name of the observation/measurement

o Examples: cough, fever, systolic blood pressure, spO2, sputum colour

- Observation value

- Identifies the result of the observation/measurement in numeric or descriptive value

o Examples: 37C (temperature), 180cm (body height), blood stained (sputum/urine colour)

Body site/anatomical location

- Describes, where applicable, the body site/anatomical location where the observation/measurement was made or applied

o Example: right upper abdominal quadrant (pain, tenderness); trunk and legs (petechial skin rash)

- Patient State

- Identifies/describes the physical condition of the patient that may influence the interpretation of the observation/measurement

o Examples: standing, sitting, clothing/shoes on, on room air, on 2L/min O2

- Confounding Factors

- Identifies/describes extraneous/incidental factors that impact on interpretation of the observation or measurements

o Examples: patient in pain, confused, restless

• Condition specific data elements/components: