Stream: cql
Topic: FlowSheet in Clinical Reasoning
Chris Moesel (Feb 12 2018 at 22:13):
I'm not sure if this is the right stream, but... what would be the recommended way of representing CDS that results in a flowsheet (using Clinical Reasoning)? For example, say I want a flowsheet that returns a list of chronic conditions, a list of active medications, and the date/score of the last PHQ-9.
Chris Moesel (Feb 12 2018 at 22:18):
The Clinical Reasoning documentation suggests that Document Templates can represent flowsheets, so perhaps the CQIF Questionnaire -- but the intent of this flowsheet is that it is a read-only summary of carefully curated data (and in this case CQL is used to query and filter the specific data to display) -- not a form to be filled out. I suppose I could have every item in the Questionnaire have a calculatedValue extension -- but is that really the recommended approach?
Bryn Rhodes (Feb 13 2018 at 03:45):
So, I have an idea in my head of what a flowsheet is, based on various usages I've heard from different EHRs, but I'm not sure I have it exactly right, reading this. Can you tell me what you mean by "flowsheet"?
Chris Moesel (Feb 13 2018 at 14:40):
I think the term "flow-sheet" may be used in various ways, but the 2nd definition here most closely aligns with what I'm thinking:
https://medical-dictionary.thefreedictionary.com/flow+sheet
That definition says a "graphic" summary, but I know that's outside the scope of the standard. I'm really looking more for a way to say something like, "this is the important data to display: Chronic conditions and their onset, Active medications, inpatient surgeries in the last two years, most recent BMI." In a pseudo-structured format, it might look something like this:
<summary>
<items name="Chronic Conditions" expression="ChronicConditions" iterator="C">
<property name="name" expression="C.code.text" />
<property name="onset" expression="C.onsetDateTime" />
</items>
<items name="Active Medications" expression="ActiveMedications" iterator="M">
<property name="name" expression="m.medicationCodeableContext.text" />
<property name="ordered" expression="m.authoredOn" />
</items>
<items name="Inpatient Surgeries in Last Two Years" expression="InpProceduresLast2Y" iterator="P">
<property name="name" expression="P.code.text" />
<property name="date" expression="P.performedDateTime" />
</items>
<item name="BMI">
<property name="value" expression="LastBMI.valueQuantity" />
<property name="date" expression="LastBMI.issued" />
</item>
</summary>
Like I said, I just made that up above, but perhaps it could potentially be approximated via CQIF Questionnaire? Or is this just something that the standards don't support?
Chris Moesel (Feb 13 2018 at 14:41):
If there isn't a formal way to specify such a thing, I suppose I could just create a CQL expression that returns that summary as a tuple -- but that's still a non-standard approach (it just happens to use a standard language).
Chris Moesel (Feb 13 2018 at 14:42):
I could also create a CDS Hooks app that returns a card w/ this in Markdown, but that's not quite the same -- and there's still no _formal_ way to tie the card to the CQL expressions (that would all be implementation detail).
Bryn Rhodes (Feb 13 2018 at 15:29):
Yes, that could definitely be approximated with a Questionnaire, but it won't be nearly as concise as what you've got there, mostly because you'll have to identify each element independently. And I think you'd have to do something to "bind" group elements to expressions.
Bryn Rhodes (Feb 13 2018 at 15:30):
PlanDefinition may be a better fit, but it still would need some extensions I think.
Bryn Rhodes (Feb 13 2018 at 15:31):
You're right that it's effectively a list of queries.
Last updated: Apr 12 2022 at 19:14 UTC
