Stream: implementers
Topic: Addiction
Jose Costa Teixeira (Mar 24 2020 at 18:09):
Addiction is a Condition, more than than Observation, right?
Robin Bosman (Mar 26 2020 at 17:38):
"Social history like tobacco use" is explicitly mentioned in scope of Observation. Could one say e.g addiction to alcohol is an observation but liver chirrhosis is a Condition? Or even: addiction to a certain product is an observation but dependence is a condition?
Jose Costa Teixeira (Mar 26 2020 at 17:46):
@Eric Haas @Michelle (Moseman) Miller ?
Jose Costa Teixeira (Mar 26 2020 at 17:47):
perhaps "known history of abuse" is observation, "addiction" is a condition?
Jose Costa Teixeira (Mar 26 2020 at 17:48):
I prefer to err on the side of not overloading Condition.
Lloyd McKenzie (Mar 26 2020 at 17:52):
Observation is a point-in-time statement, Condition is a record with ongoing evolution
Robin Bosman (Mar 26 2020 at 17:58):
Not sure if this clarifies but as an example, in SNOMED-CT: nicotine abuse is a 'disorder' but smoker/heavy smoker/ cigarette smoker etc. are all 'finding'
Eric Haas (Mar 26 2020 at 23:15):
An addiction is a condition. Information about an addicts usage are Observations.
Jose Costa Teixeira (Apr 24 2020 at 13:02):
How would we quantify the addiction?
Suppose we need to say "2 packs of cigarettes per day" or " 5-7 beers"..
René Spronk (Apr 24 2020 at 13:45):
As pointed out by Eric: observations (on the condition).
Jose Costa Teixeira (May 05 2020 at 14:59):
how do we say "We know this patient's addiction is being treated"?
An extension?
Nathan Hall (May 05 2020 at 15:01):
CarePlan.addresses([Condition]) maybe?
Jose Costa Teixeira (May 05 2020 at 15:09):
I need 2 things - boolean and the treatment itself
Jose Costa Teixeira (May 05 2020 at 15:10):
and I think I need to start from the condition, not the careplan - in other words, i'd need a "Condition.addressedBy" construct... Or perhaps I will have to bundle things together...
Lloyd McKenzie (May 05 2020 at 15:27):
Based on FHIR principles, the addressing resource should point to the thing addressed and we try hard to avoid bi-directional links. Is there a reason you couldn't query using _has or _revinclude?
Jose Costa Teixeira (May 05 2020 at 16:27):
I can. I am in the design phase, so this means that My logical model will be mapped to 2 resources. I just wanted to be really sure.
Jose Costa Teixeira (May 05 2020 at 16:27):
and I still need the extension for the boolean
Jose Costa Teixeira (Jul 31 2020 at 14:14):
1 How do I profile a contained Condition resource? Examples?
- How do I profile the "underTreatment" thing? I think a complex extension, with a boolean and a reference to CarePlan - but the CarePlan may or not exist
Lloyd McKenzie (Jul 31 2020 at 14:24):
- You profile it with a separate profile and indicate that's your target profile of whatever's referencing it and declare the reference to be 'contained'. If you have a contained reference that points to the container, I don't think there's a way
- Wouldn't the fact you have a CarePlan that 'addressses' the Condition be sufficient?
Jose Costa Teixeira (Jul 31 2020 at 14:32):
- any way I'd see see it in the condition profile?
Jose Costa Teixeira (Jul 31 2020 at 14:34):
I could rely on _has for getting the CarePlan when the plan predates the Addiction report, but when the CarePlan does not exist when reporting the addiction, I need to have something.
Jose Costa Teixeira (Jul 31 2020 at 14:35):
do i make a "AddictionCarePlan" profile?
Lloyd McKenzie (Jul 31 2020 at 14:52):
Generally, references point from the thing created second - and management gets created after thing being managed.
Jose Costa Teixeira (Jul 31 2020 at 14:52):
sometimes this is an undocumented management plan
Jose Costa Teixeira (Jul 31 2020 at 14:53):
patient is addicted and say "but i'm in recovery" - and perhaps we do not have a careplan (not documented, not accessible)
Lloyd McKenzie (Jul 31 2020 at 14:55):
You could use Condition.category for "managed" vs "unmanaged". @Michelle (Moseman) Miller - other thoughts?
Jose Costa Teixeira (Jul 31 2020 at 16:29):
using condition.category - that would definitely work instead of the boolean.
Jose Costa Teixeira (Jul 31 2020 at 16:32):
so the remaining thing is :
can I show in my Addiction profile it will be linked to by a CarePlan? (the care plan may exist or not, and may be remote or contained)
Lloyd McKenzie (Jul 31 2020 at 16:39):
Your Condition shouldn't point to your CarePlan. The CarePlan will point to the Condition. You could define an extension with the reverse reference, but it makes REST updating miserable.
Michelle (Moseman) Miller (Sep 17 2020 at 14:50):
@Jose Costa Teixeira For what it's worth, Patient Care had a brief discussion last week:
- Is the condition is managed? While Condition.category is possible, it might be better to log a change request to consider a new element.
- How the condition is managed? Use CarePlan
Jose Costa Teixeira (Sep 17 2020 at 14:56):
Thank you. So "how it is managed" can be a reference (logical or literal). That could work. I'll give it a try and provide an example
Brian Postlethwaite (Dec 16 2021 at 04:54):
Was an explicit code for the cigarettes per day identified?
Jose Costa Teixeira (Dec 16 2021 at 07:13):
we're considering an addicion quantifier extension (ratio)
Jose Costa Teixeira (Dec 16 2021 at 07:13):
this allows cigarettes per day or bottles per week
Last updated: Apr 12 2022 at 19:14 UTC
