Stream: implementers
Topic: Proactive / Expected Problems
Michael van der Zel (Mar 04 2020 at 09:20):
I am trying to figure out how to model expected / possible / known complications. We are working on pro-active plans and want to put on a careplan possible problems (conditions) and what to do if that happens. The current Problem clinicalStatus doesnot have the value for "possible". Am I looking at the right place? Thanks.
Michael van der Zel (Mar 04 2020 at 09:59):
@Dave Carlson Is this question addressed in the Care Plan work you do?
Lloyd McKenzie (Mar 04 2020 at 15:06):
@Michelle (Moseman) Miller
Michelle (Moseman) Miller (Mar 05 2020 at 15:56):
I can bring it back to the Patient Care work group for consideration... My initial thought is that the Condition.clinicalStatus should be describing the status of the condition or health concern where the condition, itself, is a risk. Thus, the risk is an active concern. Again, we'll discuss on the PC call today at 5pm Eastern to see if we need to clarify or update any of the definitions (clinicalStatus definition and/or clinical status code definitions).
Michael van der Zel (Mar 05 2020 at 16:21):
The current definition of active is "The subject is currently experiencing the symptoms of the condition or there is evidence of the condition." which makes sense. There is no value for "possible risk". Would be great if that is added. Thanks for bringing this question to the group. Looking forward to the answer.
Michelle (Moseman) Miller (Mar 05 2020 at 18:39):
The condition is the risk, so it's partially perspective of substituting "risk" where you read "condition". Look at this example, http://build.fhir.org/condition-example-family-history.json.html, where the condition.code = family member history of colon cancer. The status in our example is active. That doesn't mean that the patient has colon cancer, rather it means the family history / risk is still an active concern. Status is always a complex discussion within Patient Care, but I will certainly bring it up to see how we can clarify this.
Michelle (Moseman) Miller (Mar 05 2020 at 18:41):
Stated another way, it feels like you are wanting to use status to augment what the condition.code is representing, whereas in our example the code conveys that independently of status.
Michelle (Moseman) Miller (Mar 05 2020 at 23:50):
@Michael van der Zel Patient Care confirmed my earlier guidance that we would expect the Condition.code to convey Risk of X (such as Risk of Infection). Patient Care agreed that the clinical status code definitions should be clarified. We started to edit the definitions, such that:
active = The condition is being actively managed or tracked. For example, the subject is currently experiencing the symptoms of the condition, there is evidence of the condition, or recognition of a risk.
That said, we did not have enough time to finish the discussion or take a vote. Feel free to add yourself as a watcher to J#26464. We'll probably resume this discussion on Thurs, March 19.
Michael van der Zel (Mar 06 2020 at 10:27):
This helps, thanks! But the other problem I have now is that our used SNOMED CT subset doesnot have the "risk of ..." codes, that is why I wanted to express the "risk of" as a status code.
Michelle (Moseman) Miller (Mar 06 2020 at 13:39):
When Patient Care discussed that, we concluded that there are a subset of risks that rise to the level of concern to warrant management and tracking (e.g. risk of infection, risk of falls, etc). SNOMED does have some of the common Risk of codes available (e.g. Finding of at risk (finding) SCTID: 281694009 and its children). Where codes are not available, the resource allows having Condition.code.text without any codings.
Halina Labikova (Mar 10 2020 at 21:27):
Wouldn't Observation and RiskAssessment resources be more appropriate for capturing the "Risk of..." statements?
Michael van der Zel (Mar 11 2020 at 15:48):
I think RiskAssessment is beter for the probable condition, but there is no way to document for a RiskAssessment what the agreed "action to take" will be. In CarePlan you can do this, but not for a RiskAssessment. It look that we cannot put a RiskAssassment with the associated "action to take" on a CarePlan. And that is what we need for Proactive (Palliative) Care Planning.
Michelle (Moseman) Miller (Mar 12 2020 at 20:21):
Wouldn't Observation and RiskAssessment resources be more appropriate for capturing the "Risk of..." statements?
Refer to http://build.fhir.org/condition.html#scope, which says:
each of the following conditions could rise to the level of importance such that it belongs on a problem or concern list due to its direct or indirect impact on the patient’s health. These examples may also be represented using other resources, such as FamilyMemberHistory, Observation, RiskAssessment, or Procedure.
The key part (for Condition) is rising to a level of concern that warrants ongoing management and tracking.
Last updated: Apr 12 2022 at 19:14 UTC
