Stream: implementers
Topic: Patient Occupational History
Lauren Wolejsza (Feb 20 2017 at 21:03):
Hello! Has anyone found a solution or can suggest the best method to capture patient occupational history? For our efforts, we are looking at capturing military patient event history such as enlistment, deployments, promotions, discharge, etc. Thanks in advance for your help!
Lloyd McKenzie (Feb 20 2017 at 23:22):
There's been some discussion of an "Employment" resource, but I'm not aware of any current plans.
Brian Postlethwaite (Feb 21 2017 at 03:55):
Yes, this has come up in PA, and we have some people interested in working on this, expect it to come up this year. Would be happy to have more minds on it. (Also depends on your requirements - is this social history?)
Might want to consult with PC also.
Lauren Wolejsza (Feb 21 2017 at 14:09):
@Brian Postlethwaite Per my original post, our specific use case would capturing military occupational history events by description and dates such as enlistment, deployments, promotions, discharge, etc. Before I volunteer, what is "PA"? I am relatively new to FHIR and still learning all the jargon here. Thanks!
Lloyd McKenzie (Feb 21 2017 at 17:45):
@Lauren Wolejsza There's lots and lots of jargon - never feel guilty about calling us on using abbreviations or unfamiliar terms. One of our jobs as a community is to be as accessible as possible to newcomers. PA stands for the Patient Administration work group. They're the group within HL7 who are responsible for Patient, Practitioner, Encounter, Organization and a bunch of the other "administrative" type resources.
Lauren Wolejsza (Feb 21 2017 at 18:41):
@Lloyd McKenzie - Thanks!
Michelle (Moseman) Miller (Feb 21 2017 at 23:48):
PC (Patient Care work group) also has an interest especially when occupational data is used for clinical purposes -- such as when it gets collected as part of social history, which means FHIR's QuestionnaireResponse and/or Observation resources are candidates for consideration. There was a project approved in January to dive into this topic further, but I haven't heard any other updates.
Lloyd McKenzie (Feb 22 2017 at 00:20):
Questionnaire is a user-facing collection mechanism for collection any sort of information, but isn't a replacement for introducing a resource when one is needed.
Michelle (Moseman) Miller (Feb 22 2017 at 14:13):
Speaking as an implementer, we have Social History currently exposed using FHIR Observations (Observation does say Social History is within its scope). Most examples of employment Social History are fairly high level, such as:
- Employment status (e.g. employed, unemployed, retired)
- Work hazards (e.g. hazardous materials, heavy lifting, loud noises, repetitive motion)
However, I did see some instances of more specific military Q&A embedded within our EHR's Social History, such as:
- Military Service (e.g. yes or no)
- Branch of military (e.g. army, navy, air force)
- Military Status (e.g. reserves, active duty, veteran)
- Military Discharge (e.g. honorable, dishonorable)
That said, the answer is not "one size fits all" because we also have other elements related to employment that are captured as part of the administrative/registration workflows. The administrative employer details (in our EHR) are not captured via Observations or Social History.
In sum, different aspects of employment manifest in different workflows, so I think the recently approved project (http://gforge.hl7.org/gf/download/trackeritem/12715/15082/ODH%20HL7%20Project%20Scope%20Statement%20v2016_template_only%2010-13-2016%201.docx) is worthwhile to better define the guidance/boundaries around occupational health data (captured in a clinical workflow, like Social History) and employment history data (captured in an administrative workflow, like registration).
Mikael Rinnetmäki (Feb 22 2017 at 15:31):
Related to this, I'm currently working on a project for occupational healthcare, where the healthcare provider is interested in mapping patients to their employers. I didn't find any existing profiles or extensions to Patient that would include this information directly. Are there any?
Michelle (Moseman) Miller (Feb 22 2017 at 16:32):
When I first asked about that (GF#3838), the recommendation at the time was to use extensions on Patient (and optionally Person/Practitioner). As more and more implementers need this data, I'd like to see it 'promoted' to more of a first class resource.
Eric Haas (Feb 22 2017 at 19:08):
Genevieve email link is the lead on the ODH ( Occupational Data Health) project for FHIR ( for you HL7 folks the PSS approved in January and primary sponsor is PHER). She is interested in following up with you.
Lauren Wolejsza (Feb 23 2017 at 14:34):
@Michelle (Moseman) Miller Thanks for this additional insight! We were looking to use the Observation resource here but unclear how to capture everything we need. I will go back to the drawing board now that I can think of military history as social history events. Never would have made that connection without your post.
Michelle (Moseman) Miller (Feb 23 2017 at 16:56):
@Lauren Wolejsza If it helps, I will add that our Social History obligations are related, too. Each Social History Q&A is a different Observation. There is also another observation per social history form or category (e.g. tobacco, alcohol, employment, etc.) which uses Observation.related.type = has-member and Observation.related.target to reference each of the observations (Q&A) within that form/category (e.g. employment).
Alexander Henket (Apr 01 2017 at 06:36):
@Michelle (Moseman) Miller This is an example that works for us for now. I'm struggling with the right units for "glasses/week". Comments welcome.
<Observation xmlns="http://hl7.org/fhir">
<id value="example"/>
<meta>
<profile value="http://nictiz.nl/fhir/StructureDefinition/zib-AlcoholUse"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table>
<caption>Patient with id example</caption>
<thead>
<tr>
<th>AlcholIntakeStatus</th>
<th>Explanation</th>
<th>StartDate</th>
<th>StopDate</th>
<th>AlcoholIntakeQuantity</th>
</tr>
</thead>
<tbody>
<tr>
<td>Ex-drinker (finding)</td>
<td>Patient was a binge drinker</td>
<td>2002-04-08</td>
<td>2004-02-01</td>
<td>32 units per week</td>
</tr>
</tbody>
</table>
</div>
</text>
<status value="final"/>
<category>
<coding>
<system value="http://hl7.org/fhir/observation-category"/>
<code value="social-history"/>
<display value="Social History"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="228273003"/>
<display value="Finding related to alcohol drinking behavior"/>
</coding>
</code>
<subject>
<reference value="Patient/example"/>
</subject>
<effectivePeriod>
<start value="2002-04-08"/>
<end value="2004-02-01"/>
</effectivePeriod>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="82581004"/>
<display value="Ex-drinker (finding)"/>
</coding>
</valueCodeableConcept>
<comment value="Patient was a binge drinker"/>
<component>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="160573003"/>
<display value="Alcohol intake"/>
</coding>
</code>
<valueRatio>
<numerator>
<value value="32"/>
<unit value="glasses"/>
</numerator>
<denominator>
<value value="1"/>
<unit value="week"/>
<system value="http://unitsofmeasure.org"/>
<code value="wk"/>
</denominator>
</valueRatio>
</component>
</Observation>
Michelle (Moseman) Miller (Apr 01 2017 at 16:10):
I think we typically have Social History frequency questions (such as alcohol frequency or exercise frequency) with codified answers/values, such as SNOMED has codes for
1391000175107 Three to five times a week (qualifier value)
1371000175106 One to two times per week (qualifier value)
69620002 Daily (qualifier value)
1411000175107 More than once a day (qualifier value)
1381000175109 One to two times per year (qualifier value)
1361000175103 One to two times per month (qualifier value)
396113003 Three to four times a week (qualifier value)
Eric Haas (Apr 01 2017 at 18:07):
@Alexander Henket The rate unit is what you want - not a ratio. Use valueQuantity instead like this:
<valueQuantity>
<value value="1"/>
<unit value="glasses/week"/>
<system value="http://unitsofmeasure.org"/>
<code value="{glasses}/wk"/>
</valueQuantity>
Ratios are used for comparing different things like t-shirts and jeans and specifically in laboratory measures things like titres. ( I think it the ratio data-type needs some editing to make this clearer. GF#13151 )
Andy Stechishin (Apr 01 2017 at 18:27):
@Eric Haas was that a finger slip? Why was that directed to me?
Alexander Henket (Apr 02 2017 at 11:16):
Judging by the length of some of those, I guess they are in the US extension (of SNOMED)?
Alexander Henket (Apr 02 2017 at 19:37):
@Eric Haas Thanks for the addition. Is {glasses}/wk a true thing in UCUM? I have been looking but I did not find that one.
Lloyd McKenzie (Apr 02 2017 at 21:29):
You can put anything in squiggly brackets you like in UCUM. The essential UCUM unit is "1/wk". The "{glasses}" bit is ignored for unit conversion purposes.
Eric Haas (Apr 03 2017 at 01:20):
you can use anything inside of braces '{}' in UCUM. they are psuedo- units that represent a count of something. So is equally valid to use {bottle}/wk or just /wk.
Eric Haas (Apr 03 2017 at 01:20):
From http://unitsofmeasure.org/ucum.html
§6 curly braces ■1 The full range of characters 33–126 can be used within a pair of curly braces (‘{’ and ‘}’). The material enclosed in curly braces is called annotation. ■2 Annotations do not contribute to the semantics of the unit but are meaningless by definition. Therefore, any fully conformant parser must discard all annotations. Parsers of limited conformace should not value annotations in comparison of units. ■3 Annotations do, however, signify the end of a unit symbol. ■4 An annotation without a leading symbol implies the default unit 1 (the unity). ■5 Curly braces must not be nested.
Curly braces are here because people want annotations and deeply believe that they need annotations. Especially in chemistry and biomedical sciences, there are traditional habits to write annotations at units or instead of units, such as “%vol.”, “RBC”, “CFU”, “kg(wet tis.)”, or “mL(total)”. These habits are hard to overcome. Any attempt of a coding scheme to restrict this percieved expressiveness will ultimately result in the coding scheme not being adopted, or just “half-way” adopted (which is as bad as not adopted).
Two alternative responses to this reality exist: either give in to the bad habits and blow up of the code with dimension- and meaningless unit atoms, or canalize this habit so that it does no harm. The Unified Code for Units of Measure canalizes this habit using curly braces. Nevertheless we do continuing efforts to upgrade doubtful units to genuine units of The Unified Code for Units of Measure by defining and linking them to the other units as good as possible. Thus, “g%” is a valid metric unit atom (so that “mg%” is a valid unit too.) A drops, although quite imprecise, is a valid unit of volume “[drp]”. Even HPF and LPF (the so called “high-” and “low power field” in the microscope) have been defined so that at least they relate to each other.
Alexander Henket (Apr 03 2017 at 05:26):
Thanks for the lesson, Eric :-)
Alex Beckner (Dec 17 2021 at 13:50):
Does FHIR have any recommendations for representing the administrative patient/relatedPerson employment details captured during patient registration that are not part of the social history?
Last updated: Apr 12 2022 at 19:14 UTC
