Stream: implementers
Topic: Principal Diagnosis
Floyd Eisenberg (Jul 18 2017 at 14:54):
How does one represent a principal diagnosis in FHIR? Principal diagnosis is defined by a Medicare rule as the diagnosis that, after study, to be chiefly responsible for occasioning the admission of the patient to the hospital for care. It is likely, but not necessarily true, that the principal diagnosis will be the first one listed after hospital discharge. Encounter.diagnosis.rank might be considered with "1" as the first, and likely principal diagnosis. However, is there a more correct representation of an Encounter-related principal diagnosis in FHIR?
Lloyd McKenzie (Jul 18 2017 at 15:42):
There's an extension for this: http://hl7.org/fhir/extension-encounter-primarydiagnosis.html
Floyd Eisenberg (Jul 18 2017 at 18:40):
I saw that solution and it is not necessarily the right definition. Primary diagnosis is the one being treated. There are scenarios where the patient is admitted because of an auto accident with trauma requiring surgery – then has a massive MI post-op. The primary diagnosis can change during treatment to MI but the principal diagnosis would still be related to the trauma. The principal diagnosis is an administrative decision – and HIM professionals review the record and discuss with the physician which is the principal diagnosis – it may be documented post-discharge.
Bryn Rhodes (Jul 18 2017 at 19:24):
Perhaps define a "principaldiagnosis" extension as part of QI-Core, which would just be a flag, with this language differentiating it from primarydiagnosis?
Richard Townley-O'Neill (Jul 18 2017 at 23:51):
primaryDiagnosis is poorly named, diagnosticImportance would be better. See #13663
Bryn Rhodes (Jul 19 2017 at 15:19):
Added a tracker to create a principalDiagnosis extension in QI-Core: #13667
Last updated: Apr 12 2022 at 19:14 UTC
