Stream: terminology
Topic: canonicals for classifications of nursing interventions
Mareike Przysucha (Oct 30 2019 at 09:03):
Hello there. We are currently working on the German eNursing Summary. For this we want to use classifications for nursing. We have gathered some on the IG-page https://simplifier.net/guide/IGePflegeberichtGermaneNursingSummary/CodesystemefrpflegerischeKlassifikationen. What I could not find are canonical urls. Does anyone know the canonical url of one or more classifications?
(I think though the IG is in German you will be able to read it)
Thanks in advance!
Simone Heckmann (Oct 30 2019 at 10:39):
Maybe Patient Care knows more (@Michelle (Moseman) Miller )?
Mareike Przysucha (Dec 03 2019 at 06:37):
As except for Simone no one replied, I try to be more specific.
Does anyone know whether there is a canonical URL for one of the following nursing classifications:
- ICNP,
- NANDA,
- NIC,
- NOC,
- ICF,
- CCC,
- ENP and/or
- LEP?
In case there is not, do you know whom I can/should ask? Or should I put in the oid?
Thanks in advance to anyone replying!
Mareike Przysucha (Dec 03 2019 at 06:42):
Or in case, I am also happy to know how others solve this issue.
Richard Townley-O'Neill (Dec 03 2019 at 06:56):
Does each classification need its own URL?
Maybe they can be values in a code system.
The code system would need its own URL.
Mareike Przysucha (Dec 03 2019 at 07:09):
Hi Richard,
thanks for the answer.
I think bringing them together is quite difficult:
- ICNP, NANDA, ICF, CCC, and ENP can be used to transport problems / conditions,
- ICNP, NIC, CCC, ENP, and LEP can be used to transport interventions, and
- ICNP, NOC, CCC, and ENP can be used to transport outcomes.
Some of these classifications were already mapped to each other or to SNOMED. I never heard of a codesystem resembling similar or equivalent concepts in different codes. Therefore I think every classification is a single codesystem and therefore requires its own URL.
But I might be wrong, so I am open to correction.
Richard Townley-O'Neill (Dec 03 2019 at 07:11):
I misunderstood. I thought you meant that they were classes of nurse, not classifications used by nurses.
Richard Townley-O'Neill (Dec 03 2019 at 07:12):
It sounds like each needs its own URL.
Richard Townley-O'Neill (Dec 03 2019 at 07:14):
Maybe you can get whoever issued the OIDs to also issue URLs.
Richard Townley-O'Neill (Dec 03 2019 at 07:14):
Or start them on the path, and used the OIDs in the meantime.
Mareike Przysucha (Dec 03 2019 at 07:18):
No problem, probably my explanation was not sufficient.
This is an example how I do it now: https://simplifier.net/germanenursingsummary/icnpcoding. The system here is set to "urn:oid:2.16.840.1.113883.6.97". Better than nothing.
I just hoped that there are already URLs and I was just too stupid to find them.
Richard Townley-O'Neill (Dec 03 2019 at 07:25):
Good luck.
Maybe you could use http://hl7.org/fhir/R4/namingsystem.html
I have only noticed it, not investigated it.
Richard Townley-O'Neill (Dec 03 2019 at 07:26):
Probably not useful.
Mareike Przysucha (Dec 03 2019 at 07:31):
Thanks, there was a link that seems useful. I will keep you informed in this topic.
Rob Hausam (Dec 03 2019 at 12:57):
I'm not aware of any canonical urls for these code systems for use in FHIR (but I haven't looked). It certainly seems reasonable to have them. The 'urn:oid:...' syntax does work, as you've noted, but urls (ideally resolvable, if possible) are preferred. If the organizations themselves aren't interested or able to do that, we could consider creating them in HL7.
Mareike Przysucha (Dec 03 2019 at 13:29):
Is anyone already in contact with one of the organizations?
Mareike Przysucha (Dec 03 2019 at 13:29):
If not I would offer to approach the organizations and ask for canonicals unless someone prefers to do it.
Rob Hausam (Dec 03 2019 at 13:39):
I think we would be happy to have you contact them (and would be good to report back here). And if there are further questions to resolve we can work with them on that.
Mareike Przysucha (Dec 03 2019 at 13:40):
All right, then I will contact them and give the results back to the stream.
Lloyd McKenzie (Dec 03 2019 at 14:25):
Don't use the OIDs if you can possibly avoid it. Once you've started with OIDs, it's next to impossible to migrate away
Lloyd McKenzie (Dec 03 2019 at 14:27):
You can submit a change request to ask for canonical URLs for any code systems needed from HL7. Obviously seeking them from the original source if the original source is "standards-aware", but if you don't think you can reasonably get a permalink from the source, having HL7 issue the URL is a reasonable (and not super-lengthy) alternative.
Mareike Przysucha (Dec 03 2019 at 14:35):
This is probably an alternative for some, if not all classifications. E.g. the canonical for ICD 10 from WHO is http://hl7.org/fhir/sid/icd-10.
But I have to contact the University of Iowa and NANDA international anyway, as I have wrong OIDs for some classifications, I can ask them.
Thanks for the input.
Mareike Przysucha (Dec 03 2019 at 14:59):
Mareike Przysucha (Jul 06 2020 at 19:20):
Hello there. I found some canonicals, provided by HL7 (thanks a lot to whoever did that): https://terminology.hl7.org/1.0.0/codesystems.html The remaining ones for me are probably too German-specific to be included into this list.
Morten Ernebjerg (Aug 24 2020 at 16:12):
Hi @Mareike Przysucha . I'm involved in a European project that might also need to use ICF codes and was wondering where you landed on this particular system. I saw that ICF is, alas, not on the list you mention in the last message. However, on the page https://www.hl7.org/fhir/terminologies-systems.html, I actually found one (apparent) URI for ICF which, however, superficially looks like it might be Netherland-specific: http://hl7.org/fhir/sid/icf-nl . The OID given in the same line (though greyed out...?) - 2.16.840.1.113883.6.254) -however, seems to be general.
Mareike Przysucha (Aug 24 2020 at 18:39):
Hi @Morten Ernebjerg. Thank you for your message!
I agree with you that the canonicalURL seems specific for the Netherlands. But taking the dutch version for our German Nursing Summary might lead to problems the moment the Netherlands add additional codes.
I was also in contact with the BfArM (a German institution which also is responsible for classifications), and they said I was to ask HL7 International, as the OID is also from HL7. Therefore I wound prefer having an international canonicalURL (the BfArM will not provide one).
But as it is not that neccessary for our nursing summary, I decided not to include it anymore and not make a fuss about it. Though: If someone else also needs a canonical at the moment, I will support her or him.
Morten Ernebjerg (Aug 25 2020 at 07:58):
Thanks for the update! It is not certain that we will need ICF yet, but would be nice to get a URL. Would that also be a plus for you, too, or is ICF out in the nursing summary? - if the former, I might give it a shot :smile:
Mareike Przysucha (Aug 25 2020 at 08:05):
You're welcome. Hope the information are helpful for you.
The nursing summary IG isn't balloted yet, so any canonicalURL for nursing related classifications used in Germany can still be included in our list.
Also my JIRA ticket (J#25263) is still pending. At the end of July I added a comment to it to include ICF.
Rob Hausam (Aug 25 2020 at 10:47):
@Mareike Przysucha Tracker J#25263 has been flagged for the queue for HTA. You may want to reach out and see when it can be taken up on their agenda. @Julie James @Carol Macumber @Reuben Daniels @Sylvia Thun
Mareike Przysucha (Aug 25 2020 at 11:25):
I'll do that!
Carol Macumber (Sep 02 2020 at 19:12):
@Susan Matney thoughts here?
Mareike Przysucha (May 19 2021 at 12:30):
@Grahame Grieve We found out that you were the one adding the canonicalURL for ICF Morten mentioned above. The information was added on Aug 20, 2015. Do you know whether the canonical is Netherlands-specific or global? Thanks in advance for your answer!
Grahame Grieve (Jun 03 2021 at 00:59):
finally getting to this... I have no idea or memory of this
Mareike Przysucha (Jun 04 2021 at 12:32):
@Grahame Grieve Thanks for the reply.
I ask because we do need a canonical URL for the unchanged ICF. Is there any possibility to get one from HL7 International?
We already asked the WHO, but the answer we received was not really helpful: We just got the URL for a ICF and ICD browser...
Mareike Przysucha (Jun 04 2021 at 12:33):
Thanks in advance for any answer...
(By the way: @Sylvia Thun was the one asking the WHO.)
John Moehrke (Jun 04 2021 at 12:58):
If you are writing an Implementation Guide, then you can use the canonical root of the implementation guide. Define what you need to in there.
Mareike Przysucha (Jun 04 2021 at 13:05):
True, but I don't think an e.g. "German canonical" for an international classification enhances interoperability. If each country creates its own canonical, there would be several different canonicals for the same classification and thus for the "same" code system...
If you modify it, then I agree. In Germany we modify ICD 10 and thus have a Germany-specific canonical for ICD 10. But we use the original ICF with just a German translation. But that's not a modification...
Rob Hausam (Jun 04 2021 at 13:50):
@Mareike Przysucha This is a question to bring to the HTA (if that hasn't already happened). @Carol Macumber? @Reuben Daniels?
Rob Hausam (Jun 04 2021 at 13:55):
But since @Sylvia Thun is on the HTA, I would assume that has already happened?
Mareike Przysucha (Jun 04 2021 at 14:01):
It was part of my JIRA Ticket J#25263. It says "ready for review". We were curious, as there was a canonical which seemed to be NL-specific, whether we could use it as the internationally valid canonical for the unmodified ICF...
Mareike Przysucha (Jun 04 2021 at 14:13):
If it helps: I am willing to join the next HTA meeting...
Rob Hausam (Jun 04 2021 at 14:29):
This issue seems to have gotten stalled in the review phase? If it can get added to the next HTA agenda, it seems (to me) that it should be helpful if you could join the meeting.
Mareike Przysucha (Jun 04 2021 at 14:39):
It's next Wednesday, is that correct?
Rob Hausam (Jun 04 2021 at 15:04):
Yes, the HTA has a call next Wednesday (9th) at 3:00 PM EDT.
Mareike Przysucha (Jun 04 2021 at 15:07):
Thank you, I'll do my best to attend.
Carol Macumber (Jun 07 2021 at 15:14):
@Julie James can we get this added to the HTA agenda?
@Susan Matney FYI
Mareike Przysucha (Jul 02 2021 at 15:02):
Sorry to start this stream again, but I have a question again about nursing classifications, this time about CCC (Clinical Care Classification System, see also https://terminology.hl7.org/1.0.0/CodeSystem-CCC.html.
When I had a look into the code builder on https://careclassification.org/, I noticed that it's possible to have the same code for Diagnosis and Intervention. Thus from the code alone it's hard to say whether it is a diagnosis or an intervention. Is there any experience how to cope with this problem e.g. in the builiding of valuesets? Or should I better ask in the implementers stream?
Thanks for your help.
Mareike Przysucha (Jul 02 2021 at 15:03):
By the way: I asked them how they do it, and they answered: We have two different data bases.
Lloyd McKenzie (Jul 02 2021 at 15:37):
Are you saying that the same code can have two meanings? Do you have an example?
Rob Hausam (Jul 02 2021 at 18:43):
@Mareike Przysucha Yes, do you have some examples (one or more) of codes where this the same code is used for a diagnosis or an intervention? As Lloyd is asking, if it turns out that the actual meaning of the code is different when it is used in the two different contexts, then that would be an argument for considering that the CCC diagnosis and intervention code sets should actually be respresented as two different code systems, rather than one. We will need to look further at the examples to figure out if that is actually the case. I think it makes sense to continue to discuss those aspects further in this stream (rather than moving all of the discussion on it to implementers).
Mareike Przysucha (Jul 02 2021 at 20:38):
If I understood correctly, the code A.01.2.1 can be used for both:
grafik.png
Mareike Przysucha (Jul 02 2021 at 20:43):
I just had a first glance, but this caught my eye.
When getting in contact with the people behind the homepage linked above, I got the following answer:
I can venture an answer to your question about how one tells the difference between an intervention and a diagnosis code though - they are simply stored in different places in your database.
Lloyd McKenzie (Jul 02 2021 at 20:53):
Based on that, it definitely sounds like there should be two distinct code systems for CCC - one for interventions and one for Diagnosis. Presumably the best thing to do is to deprecate http://terminology.hl7.org/CodeSystem/CCC and add something like http://terminology.hl7.org/CodeSystem/CCC-D and http://terminology.hl7.org/CodeSystem/CCC-I. @Rob Hausam - presume this is something HTA needs to take on?
Rob Hausam (Jul 02 2021 at 21:01):
Yes, based on that I agree that deprecating the current code system and adding two new ones along the lines of what Lloyd has described is probably what is needed. And I also agree that HTA needs to review this and verify the approach (or work out an alternative with the code system owner). @Reuben Daniels @Carol Macumber @Julie James
Julie James (Jul 05 2021 at 14:46):
Looking briefly at the website, the two code systems have different numbers of concepts...which possibly helps to indicate they are different code systems. @Susan Matney this is one for you to weigh in on I think
Robert McClure (Jul 05 2021 at 15:27):
Also agree that this appears to be two different code systems that align. Seems we best confirm this with HCA and get them on board with the approach.
Grahame Grieve (Sep 29 2021 at 20:54):
getting back to this.
@Reuben Daniels @Carol Macumber @Robert McClure It doesn't appear that HTA has done anything about ICF? We just approved an HL7 project building on ICF, so this is pressing.
Does anyone have a source of data for ICF? All I can find is the PDF. @Rob Hausam have we looked at this in the past?
Rob Hausam (Sep 29 2021 at 21:36):
I know about ICF. But I haven't looked for a source or done anything with it for tx.fhir.org (yet).
Grahame Grieve (Sep 29 2021 at 22:28):
looks to me like it'll be too big to be a FHIR code system
Rob Hausam (Sep 29 2021 at 22:28):
How big is too big in this case?
Grahame Grieve (Sep 29 2021 at 23:28):
not sure. it's all the properties that are a factor
Carol Macumber (Sep 30 2021 at 01:56):
Copying in @Susan Matney who is the Nursing terminology lead for HTA.
Davera Gabriel (Sep 30 2021 at 15:17):
Carol Macumber said:
Copying in Susan Matney who is the Nursing terminology lead for HTA.
Susan will likely know this. But understand the ICF is a WHO terminology and its not clear to me that the prior identifier schism we faced dealing with the WHO has been resolved. Are we clear about WHO terminologies? In the future, a resolution for this kind of situation would be to have the appropriate Vocab / HTA folks involved before approving HL7 projects...? Maybe this did happen and Im out of the loop - so please forgive me if this is old news and Im just cathcing-up.
Grahame Grieve (Sep 30 2021 at 19:20):
oh we have to approve the HL7 projects if adopters have the right to use it. we can hardly say, 'oh you can't have a project'
Robert McClure (Oct 01 2021 at 01:41):
@Grahame Grieve What properties? Do you mean all the guidance? That does not have to be in our representation. It's not in the ICD or CPT is it? Users will have to extensive understanding of how to use this but all the guidance does not need to be in the FHIR resource.
Grahame Grieve (Oct 01 2021 at 02:46):
sure the guidance, we wouldn't. But the classifications have properties that control their usage, and that you'd want to filter on.
Davera Gabriel (Oct 01 2021 at 18:09):
Ok: I understand re: prior terminology involvement before approving projects - I suggest a course of action that's a little too far upstream then: my bad. Help me understand... are you seeking resolution to the identifier or looking for a server that hosts the reference content or both?
Grahame Grieve (Oct 01 2021 at 19:26):
we need both: resolve the questions about how to represent ICF, and to find a copy of the source so that I can get it on tx.fhir.org
Robert McClure (Oct 02 2021 at 12:15):
@Grahame Grieve I understand that per the usual process, we'd just grab this stuff and dump it into tx.fhir.org. But this is a process that needs a bit more oversight and is something we need to bring through TSMG in addition to HTA. Understanding that with HTA separate from TSMG this is confusing, I'd be interested in your suggestions on how we can improve. You can put that when you have a chance in the TSMG Stream.
Grahame Grieve (Oct 02 2021 at 12:43):
why does it need more oversight?
Robert McClure (Oct 02 2021 at 23:02):
Because tx.fhir.org is the default publication FHIR terminology service and is to be under the management of TSMG. To date it has been updated, added to, and managed in an ad hoc manner to date. We need to improve upon that for a core function of FHIR/HL7.
Grahame Grieve (Oct 02 2021 at 23:04):
in fact, no. it's been an executive function of HL7, managed by the executive arm of HL7. I'm not aware of any discussions about changing that.
Grahame Grieve (Oct 02 2021 at 23:06):
if TSMG wants to have some stake on that, or take over it properly, then that needs to be discussed properly, and there needs to be some service delivery expectations around that.
Robert McClure (Oct 02 2021 at 23:06):
Perhaps to date. But that needs to change. Who other than you decides what goes in, why it goes in, how it's updated, and what others are allowed to obtain from it? That should not be some "executive" team.
Robert McClure (Oct 02 2021 at 23:07):
Inclusion of tx.fhir.org was included proposal for TSMG to TSC.
Grahame Grieve (Oct 02 2021 at 23:07):
what goes in is whatever HL7 publications want and we can figure out how to deliver. If you think that shouldn't be an executive function of HL7, that's a board level discussion. TSC doesn't have authority over that either
Robert McClure (Oct 02 2021 at 23:08):
We'll need to clarify that. tx.fhir.org is not a board function.
Grahame Grieve (Oct 02 2021 at 23:09):
sure we need to. I didn't say tx.fhir.org was a board function. I said it was an executive function that serves the organisation. An argument over what is under the authority of TSC vs Executive is a board level question
Grahame Grieve (Oct 02 2021 at 23:10):
or possibly the CTO, I guess
Robert McClure (Oct 02 2021 at 23:10):
Delivery of standards is under TSC - no need to get any clarity on that. tx.fhir.org falls within that.
Grahame Grieve (Oct 02 2021 at 23:11):
well, you're wrong. It's not a standard. It's a piece of infrastructure that supports standards publication
Robert McClure (Oct 02 2021 at 23:12):
Did not say it's a standard, but it content that exists solely to end up in HL7 standards. That is under TSC. The tools you build to make that are not under TSC, but the content is.
Grahame Grieve (Oct 02 2021 at 23:13):
Since I disagree as FHIR product director, you'll have to kick that upstairs
Robert McClure (Oct 02 2021 at 23:14):
Indeed. But I assure you tx.fhri.org is on TSMG plans
Grahame Grieve (Oct 02 2021 at 23:14):
ok sure. But I'll be very much interested in the question of what value you plan to bring to the process other than adding another choke point
Lloyd McKenzie (Oct 02 2021 at 23:23):
tx.fhir.org is not content that exists solely to end up in HL7 standards. tx.fhir.org is a service that's used by the FHIR community for a wide range of functions. One of those is supporting the use of the IGPublisher tool and validator tool - whether used inside HL7 or out. I.e. It's as much on the "implementation" side of the equation as it is the "standards development" side of the equation.
Rob Hausam (Oct 05 2021 at 05:32):
Yes, agree with Lloyd's comment.
Last updated: Apr 12 2022 at 19:14 UTC
