Stream: implementers
Topic: Observation and Devices
Dave Hill (Apr 22 2020 at 16:30):
In the PACIO Project (IGs and reference implementations for post-acute care), we are using the Observation resource to hold the data from a post-acute care functional status assessment (e.g. Section GG which measures mobility - ability for patient to walk, toilet, get in/out of bed, etc.). Often, devices are needed to complete the assessment, such as a cane walker, ramp, etc., which is useful to include as part of the assessment. Observation supports a list of devices, but for observation measurement purposes, so it would seem that we would need to add an extension to convey the devices needed by the patient to complete the assessment. I would like to avoid adding an extension if possible.
Thoughts?
Thanks!
Michele Mottini (Apr 22 2020 at 17:10):
Seems more an observation value (or code) than a device - eg 'Can walk' observations have possible values 'Yes', 'No', 'With cane'
Jose Costa Teixeira (Apr 22 2020 at 17:21):
My reading is that @Dave Hill is looking for the device that was used to help in the assessment - not "from now on the patient is able to walk but needs a cane" but "we used this cane to assess the patient's ability to walk)
Jose Costa Teixeira (Apr 22 2020 at 17:21):
right?
Jose Costa Teixeira (Apr 22 2020 at 17:33):
My understanding is that the observation.device has a presumed role - that the device was active in returning the observation value.
Michele Mottini (Apr 22 2020 at 18:07):
we used this cane to assess the patient's ability to walk
...that sounds an observation code to me then: 'Can walk with cane' (LOINC has a bunch of that kind of things: eg https://loinc.org/68260-9/)
Jose Costa Teixeira (Apr 22 2020 at 18:09):
sorry, I should have written "we used THIS cane to assess the ability to walk"
Jose Costa Teixeira (Apr 22 2020 at 18:10):
and I don't think that is the same.
"We used this cane to see if the patient can walk" does not mean "patient can walk with cane".
Jose Costa Teixeira (Apr 22 2020 at 18:11):
(especially when we gave the cane but the patient could still not walk)
Jose Costa Teixeira (Apr 22 2020 at 18:14):
@Dave Hill please chime in on your intent.
My reading of your question is similar to recording the Snellen chart used for checking the vision after surgery
Eric Haas (Apr 22 2020 at 20:19):
Agree with Michelle....This sounds like a terminology thing to me. either the code like he proposed or the value. (e.g. walks with cane, walks with walker, walks with assistance etc. Like mentioned above the device element is for recording the Device used to capture the measurement/finding.
Matt Zajack (Apr 22 2020 at 20:31):
Interesting... If it is not Observation.device (because that is for devised used to capture findings/measurements), then where does something like a cane go?
It looks like "Cane" can be captured as a SNOMED code like in this valueset https://www.hl7.org/fhir/valueset-device-kind.html
From there- Would it then be one of those listed resources, such as Resource: Procedure.usedCode (CodeableConcept / Example)?
Lloyd McKenzie (Apr 23 2020 at 01:28):
If you needed to identify the specific device used, you'd need an extension. If you just need to know the 'kind' of device used, pre-coordinating it into the Observation.code or using Observation.methodCode would be most appropriate
Jose Costa Teixeira (Apr 23 2020 at 04:53):
or an extension on Observation.device to express the role of the device in the observation?
Lloyd McKenzie (Apr 23 2020 at 05:30):
Extensions can't change the meaning of the element. The element is clearly the device that was used in performing the measurement. An extension can't allow it to contain something else.
Eric Haas (Apr 23 2020 at 16:56):
or if you for some reason you choose not to use terminology you could represent it as a form with a bunch of yes/no questions and then create an Observation panel.
Last updated: Apr 12 2022 at 19:14 UTC
