Stream: implementers
Topic: ClinicalImpression
Grahame Grieve (Jan 04 2017 at 02:27):
what happened to ClinicalImpression.plan?
Lloyd McKenzie (Jan 04 2017 at 02:53):
I think it got removed on the grounds that Plan can point to ClinicalImpression and in general the impression would exist before the plan and we try to avoid bidirectional references
Grahame Grieve (Jan 04 2017 at 02:55):
but one of the main things you do as a consquence of your diagnostic process is choose a plan....
Lloyd McKenzie (Jan 04 2017 at 03:53):
Sure. But based on FHIR design principles, it makes sense for the plan to point to the impression rather than the other way around.
Grahame Grieve (Jan 04 2017 at 03:54):
does it? that's not clear to me. especially since careplan etc don't have a slot for that, but even if they do. Which closes first? the plan, or the impression? not obvious...
Lloyd McKenzie (Jan 04 2017 at 05:33):
It doesn't matter which closes first - what matters is which is created first. The link from CarePlan to ClinicalImpression would be through CarePlan.support.
Michelle (Moseman) Miller (Jan 04 2017 at 14:34):
The removal of plan was a result of a ballot comment (GF#11167) from @Stephen Chu, but this is a loaded topic....
There have been ongoing discussions/debates about the scope of the ClinicalImpression - specifically whether it represents the A (assessment) only or the full SOAP. Patient Care WG believes it was intended to be the "A" (assessment) only.
I can appreciate that some systems may represent the assessment and plan together (i.e. the full SOAP note), which led some implementers (e.g. Cerner, Epic) to question which resource to use for unstructured notes that span resources (or resource is unknown). Furthermore, I believe there is an open question on the table whether it was appropriate for Argonaut to have used CarePlan for the US-based MU CCDS Assessment & Plan of Treatment. The pending question seems to be "if not CarePlan, can we reach consensus on which other resource to use?".
The FHIR-I recommendation seems to be Composition narrative (per GF#8780), but I recently heard from @Brett Marquard that
In C-CDA we recently had a long discussion about notes vs documents which ultimately resulted in a new way to include unstructured notes in a structured document
Grahame Grieve (Jan 04 2017 at 20:12):
Composition is about the editorial process, not the content. The answer might very well be that you need to use both composition and care plan.
Grahame Grieve (Jan 04 2017 at 20:14):
I'm fine with the general question of ClinicalImpression being the "A", but I believe that the question of what actions are planned as a consequence of the assessment matters, and needs to be captured somewhere. As things stand now, it's quite unclear how to make the link, and if the answer is Careplan.support, that's a little indirect, and needs better documentation, including as part of ClinicalImpression. At least, I think so.
Brett Marquard (Jan 05 2017 at 01:19):
In SD, we approved a new generic note template for C-CDA. I am sure some folks with love/hate it....here is the text:
Brett Marquard (Jan 05 2017 at 01:19):
The Note Activity represents a clinical note. Notes require authorship, authentication, timing information, and references to other discrete data such as encounters. Similar to the Comment Activity, the Note Activity permits a more specific code to characterize the type of information available in the note. The Note Activity template SHOULD NOT be used in place of a more specific C-CDA entry. Note information included needs to be relevant and pertinent to the information being communicated in the document.
Brett Marquard (Jan 13 2017 at 16:05):
Tried to restart conversation with @Russell Leftwich during the C-CDA implementation-a-thon. I agree the location for the planned piece is quite fuzzy -- especially when all documented together. So...What does PC recommend for communicating a SOAP note with combined impression and plan?
Russell Leftwich (Jan 14 2017 at 19:17):
@Brett Marquard Marquard I will take the action item to take this to PCWG for discussion and comment.
Shamil Nizamov (Apr 10 2022 at 19:37):
Brett Marquard said:
The Note Activity represents a clinical note. Notes require authorship, authentication, timing information, and references to other discrete data such as encounters. Similar to the Comment Activity, the Note Activity permits a more specific code to characterize the type of information available in the note. The Note Activity template SHOULD NOT be used in place of a more specific C-CDA entry. Note information included needs to be relevant and pertinent to the information being communicated in the document.
In scope of this discussion, does it mean that the intention of the Note Activity template was to map it to the ClinicalImpression or what? At the first glance, the Note Activity maps better to the Observation with the code/valueString pair.
Last updated: Apr 12 2022 at 19:14 UTC
