Stream: implementers
Topic: Condition resource lifecycle
Travis Stenerson (Nov 06 2017 at 17:40):
Question regarding a condition resource and clinicalStatus. And probably best to use an example. If someone could correct my understanding below, I would appreciate it.
1. Patient gets a confirmed diagnosis of lung cancer.
FHIR: Condition(id: 1) with code Lung cancer is created, clinicalStatus is set to active, and added to $current-problems list.
2.Patient is treated for lung cancer and lung cancer goes into remission.
FHIR: Condition(id: 1) has clinicalStatus set to remission. No new condition is instantiated. Condition(id:1) remains on $current-problems list. All treatments done for this condition continue to reference Condition/1.
3. Surveillance ensues for many months.
FHIR. Procedures occurring in surveillance reference Condition/1.
4. Patient is found to have a recurrence of lung cancer.
FHIR: New condition is created, assigned id: '2', clinicalStatus set to 'recurrence' (or should it be 'relapse?'). Condition(id: 1) removed from $current-problems, Condition(id: 2) is placed on $current-problems. Condition(id: 1) will retain status of 'remission'.
5. New procedures are performed and treatment is successful.
FHIR: New procedures reference Condition("id": 2). Condition(id: 2).clinicalStatus set to 'remission'. Remains on $current-problems.
Is this correct? Or does any status change signal a new Condition being created.
Lloyd McKenzie (Nov 06 2017 at 22:45):
I don't think there are FHIR-defined rules here. What constitutes a distinct Condition instance vs. a change to an existing Condition instance is really a question of local business rules. (Similarly, FHIR doesn't place rules one what sort of changes can be handled as updates to a prescription and which must be handled by cancelling the original order vs. creating a new one.) From FHIR's perspective, if you want to update a Condition to change the patient, the author and change the Condition.code from lung cancer to diabetes, that's totally legitimate. However, it's likely that any one of those changes, let alone all of them, will violate the business rules in many environments.
Last updated: Apr 12 2022 at 19:14 UTC
