Stream: implementers
Topic: USCDI: Difference between Problems and Health Concerns
Daniel Tam (Dec 02 2021 at 19:21):
Regarding USCDI, can anyone explain the difference between Health Concern and Problem to me? Both in a clinical sense, and also if they should be flagged differently in the Condition resource.
These are separate data elements in USCDI, yet both map to the Condition resource in the US Core to USCDI Guidance page.
https://www.hl7.org/fhir/us/core/general-guidance.html
Someone in this chat also noted that Epic has two separate API's for these, but are both based on Condition
https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Condition.20-.20differing.20between.20problem.20and.20diagnosis/near/241851726
https://fhir.epic.com/Specifications?api=985
https://fhir.epic.com/Specifications?api=953
David Pyke (Dec 02 2021 at 19:24):
A Health Concern is any issue that may affect care that isn't necessarily a healthcare specific issue. That may include SDOH concerns.
David Pyke (Dec 02 2021 at 19:28):
Also, something like Pregnancy is a Concern but not necessarily a Problem.
David Pyke (Dec 02 2021 at 19:29):
There's lots of good information on the difference here: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=443
Cooper Thompson (Dec 02 2021 at 19:33):
I must have missed that thread from back in June, as I would have chimed in there, but for Epic, our "health concerns" are really just items on the problem list that are tagged as a "health concern". So that depends on the clinician manually tagging problem list items, which is pretty rare.
Anything tagged as a "health concern" will also show up as a problem list item, so most folks can probably just use the problem list API.
Cooper Thompson (Dec 02 2021 at 19:36):
Note that the CCDS definition of Health Concerns (which carried forward into USCDIv1) didn't refer to the HL7v2 DAM that David pointed to, so I don't think there is necessarily any expectation that USCDI Health Concerns match the HL7v3 DAM definition. The CCDS/USCDI definition is super generic.
Daniel Tam (Dec 02 2021 at 23:39):
It sounds like a Health Concern is broader, and can include general and even items that are not clinically coded. I have heard that examples can include SDOH items, such as "Transportation difficulties" or "Underinsured". Is that accurate?
However, the guidance page (https://www.hl7.org/fhir/us/core/general-guidance.html) is mapping Health Concerns to US Core Condition Profile -- this profile requires a Category Code (1... *) and a Condition Code (1...1).
Am I correct that Health Concerns may not necessarily have a Category Code and/or a Condition Code?
If so, should we consider mapping Health Concerns to the general Condition Resource? I'd be happy to submit a JIRA for this change.
If I am incorrect, can someone point me to the codes that we should be using for Health Concerns?
I realize I may be a bit pedantic here, but I'm encountering this in the course of certification with my company's EHR, and I think others are going to encounter the same questions.
Michele Mottini (Dec 03 2021 at 00:12):
Health concerns have a category health-concern and must have a code that specifies what the concern is, otherwise they won't really make much sense
Michele Mottini (Dec 03 2021 at 00:13):
Codes can be icd-10, icd-9 and a good chunk of SNOMED, so will likely exist for most anything (eg https://phinvads.cdc.gov/vads/http:/phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.113883.6.96&code=266934004)
Michele Mottini (Dec 03 2021 at 00:14):
..and the binding is extensible, so for things that are not really there you can just make up a code
Daniel Venton (Dec 03 2021 at 13:19):
"make up a code" - If you have an item that doesn't match anything in snomed, I'm sure snomed would like to know about it. And until then if you do make up a code, publish a website that corresponds to your system that defines the code, that way, it might actually be more than a placeholder.
Last updated: Apr 12 2022 at 19:14 UTC
