Stream: implementers
Topic: Side effects on FHIR
Domenico (Jun 20 2017 at 13:29):
Hi all,
how can I represent one or more side effects on FHIR? Which resourse should I use (Condition or Observation)? For example: Nausea, Vomiting, Difficulty swallowing, Dry mouth etc.
jose duran (Jun 20 2017 at 13:52):
I think Condition is the right resource, you can find "nausea" and "vomiting" in its valueset of codes (https://www.hl7.org/fhir/valueset-condition-code.html). Observation is used to make measurement.
Stefan Lang (Jun 20 2017 at 16:39):
The specification of Condition says:
"This resource is not typically used to record information about subjective and objective information that might lead to the recording of a Condition resource. Such signs and symptoms are typically captured using the Observation resource; although in some cases a persistent symptom, e.g. fever, headache may be captured as a condition before a definitive diagnosis can be discerned by a clinician. "
So, while this is far from being clearly distinctive, it points to Observation (in a 51:49 way, at least from my point of view).
On the other hand, Condition has all the elements you would typically want in the context of side effects, like onset[x], abatement[x] or severity. So this looks like a "natural fit" for representing things like CTCAE.
John Moehrke (Jun 20 2017 at 16:55):
(deleted)
Lloyd McKenzie (Jun 20 2017 at 17:16):
It depends what you're trying to do. Observation lets you capture things like an elevated temperature, the presence of a rash, etc. But if you want to assert an ongoing situation, Condition is what allows you to assert a diagnosis, severity, etc. and manage the evolution of the condition over time. So a single episode of nausea might be an Observation. Noting that the patient experiences ongoing nausea due to one of their other meds would be a Condition.
Peter Bernhardt (Jun 20 2017 at 17:42):
@Lloyd McKenzie so how is death recorded? A permament Condition or an Observation?
Peter Bernhardt (Jun 20 2017 at 17:42):
I'm being somewhat facetious …. edit: based on CDA implementation guide, this would be Condition.
Lloyd McKenzie (Jun 20 2017 at 18:08):
Time of death, cause of death would be Observations. Plus you'd update the patient demographics with deceasedBoolean/deceasedDate. Generally once a patient is dead, you don't capture Conditions anymore . . .
Lloyd McKenzie (Jun 20 2017 at 18:09):
My rule of thumb is if you're dealing with something diagnosis-like, it's most likely a Condition unless there's a particular need to have it as an Observation.
Jenni Syed (Jun 20 2017 at 21:13):
Just to complicate this...
Jenni Syed (Jun 20 2017 at 21:13):
If it's severe enough to be considered an intollerance...
http://hl7.org/fhir/stu3/allergyintolerance.html
Jenni Syed (Jun 20 2017 at 21:13):
It would be on allergyIntolerance as a reaction, I would assume?
Grahame Grieve (Jun 20 2017 at 21:21):
yes, you could also record it in AllergyIntolerance.reaction as supporting evidence for the risk. But that's a different kind of use
Aleksandra Pavlyshina (Jun 21 2017 at 13:04):
So, what is the way to capture side effects for medications in FHIR?
E.g. in our care management applications, we are capturing patient's medications along with the "Does the patient have any unfavorable side-effects to this medication?" Yes/No and follow-up "Describe any side effects" questions. We are seeking for a proper way to store this in FHIR, so we could exchange this information with different companies in the future.
Lloyd McKenzie (Jun 21 2017 at 16:51):
If phrased that way, that would be Observation.
Last updated: Apr 12 2022 at 19:14 UTC
