Stream: argonaut
Topic: Clinical notes: pathology reports in DocumentReference?
Josh Mandel (Feb 14 2019 at 11:54):
In order to enable consistent access to scanned narrative-only clinical reports the Argonaut Clinical Note Server SHALL expose these reports through both DiagnosticReport and DocumentReference by representing the same attachment url
I think this means that pathology reports need to be exposed in DocumentReference as well as DiagnosticReport. Do we have recommendations for which type and class would be used in this case? (I'm just starting to map the Argonaut IG to ONC's proposed expansion of the USCDI and make sure I understand how this plays out.)
Eric Haas (Feb 14 2019 at 19:43):
class = clinical note
type = LP7839-6 Pathology
Is what we are proposing...since that is being used for the DiagnosticReport Category as well.
Josh Mandel (Feb 16 2019 at 00:44):
OK. Do we say that somewhere in the spec? I mean, I know we say to use LP7839-6 for DiagnosticReport.category, but I was having trouble finding where we said to use it for DocumentReference.type.
Josh Mandel (Feb 16 2019 at 00:45):
https://argonautproject.github.io/clinicalnotes/ValueSet-argonaut-clinical-note-type.html doesn't mention it, nor does https://argonautproject.github.io/clinicalnotes/StructureDefinition-argo-diagnosticreport.html
Josh Mandel (Feb 16 2019 at 00:48):
Also the IG refers to "date and time the reference was created (STU3 requirement, removed in R4)" -- but isn't this the date and time when the document was created, rather than the reference?
Josh Mandel (Feb 16 2019 at 00:49):
(Are github issues issues actively monitored at https://github.com/argonautproject/clinicalnotes/issues ? Might be good to include a link to the GH repo in all of our guides.)
Eric Haas (Feb 16 2019 at 02:32):
(Are github issues issues actively monitored at https://github.com/argonautproject/clinicalnotes/issues ? Might be good to include a link to the GH repo in all of our guides.)
I agree - like a footnote link like we do for HL7 IGs. I prefer it - at the top of the page
We have a R4 tracker on the codes and have discussed, I agree should be made explicit.
Also the IG refers to "date and time the reference was created (STU3 requirement, removed in R4)" -- but isn't this the date and time when the document was created, rather than the reference? right
There is Attachment.creation = Date attachment was first created which may be the document creation date? I don't know what an attachment creation date means??
Eric Haas (Feb 16 2019 at 02:32):
pinging @Brett Marquard and @John Moehrke
Lloyd McKenzie (Feb 16 2019 at 04:40):
We'd rather not have issues submitted to Github. We want them all to come to gForge/Jira so that we have a single searchable location for all issue feedback.
Eric Haas (Feb 16 2019 at 09:52):
these are Argo guides
John Moehrke (Feb 16 2019 at 15:02):
(Are github issues issues actively monitored at https://github.com/argonautproject/clinicalnotes/issues ? Might be good to include a link to the GH repo in all of our guides.)
I agree - like a footnote link like we do for HL7 IGs. I prefer it - at the top of the page
We have a R4 tracker on the codes and have discussed, I agree should be made explicit.
Also the IG refers to "date and time the reference was created (STU3 requirement, removed in R4)" -- but isn't this the date and time when the document was created, rather than the reference? right
There is
Attachment.creation= Date attachment was first created which may be the document creation date? I don't know what an attachment creation date means??
There are a few dates in DocumentReferene, they all have different meanings as described in their definitions. The important perspective to understand is that the bits-that-are-the-document are different than the DocumentReference which is the metadata about the document. The document might appear in many places. Attachment.creation is the date the bits-that-are-the-document were created. The DocumentReference.date is the date the DocumentReference was created. This recognizes that the document has a different lifecycle than the DocumentReference. Sometimes they are equal, most of the time they are different.
John Moehrke (Feb 16 2019 at 15:04):
If the definitions can be improved, then a gForge tracker should be created... If argonaut simply didn't understand (even due to poor core definitions) then fixing that can be handled within Argonaut (much similar to fixing MHD is done using IHE governance). Most of the time an opportunity for improvement is an opportunity in many places. Improvement is good.
Eric Haas (Feb 16 2019 at 21:06):
thanks @John Moehrke My confusion is around the term 'attachment' in the phrase 'Date attachment was first created ' what I am hearing is that mean the document(pdf/image/audio/csv) creation date.
Brett Marquard (Feb 18 2019 at 14:49):
OK. Do we say that somewhere in the spec? I mean, I know we say to use
LP7839-6forDiagnosticReport.category, but I was having trouble finding where we said to use it forDocumentReference.type.https://argonautproject.github.io/clinicalnotes/ValueSet-argonaut-clinical-note-type.html doesn't mention it, nor does https://argonautproject.github.io/clinicalnotes/StructureDefinition-argo-diagnosticreport.html
@Josh Mandel In the DocumentReference profile we are trying to say you SHALL support these 5 concepts (https://argonautproject.github.io/clinicalnotes/ValueSet-argonaut-clinical-note-type.html) and may extent to any LOINC document codes. The pathology codes would be from the larger set.
Brett Marquard (Feb 18 2019 at 14:51):
With the ONC NPRM mentioning a few more I am going to ask on a future call about including explicit guidance for those
Brett Marquard (Feb 18 2019 at 14:54):
It has became very clear through development of this guide that categorization of notes is not consistent across sites.
Josh Mandel (Feb 18 2019 at 16:35):
I understand the SHALL constraints we have today. I think they just don't provide guidance for somebody who is trying to follow our recommendation that pathology notes appear in both places. I think our guidance needs to explain exactly what to do, i.e. if you have a diagnostic report that looks like this, here is how you create the equivalent document reference, and here's the slot that you fill in with the same code that you used in the diagnostic report.
Josh Mandel (Feb 18 2019 at 16:36):
And separately: I definitely agree we should update our guidance to make sure we cover all concepts included in the onc proposed rule.
Last updated: Apr 12 2022 at 19:14 UTC
