Stream: CCDA / FHIR mapping stream
Topic: verficationStatus calculation
Tushar Nair (Aug 26 2020 at 15:39):
Hello,
I am trying to map certain USCDI elements from C-CDA to FHIR. While mapping clinical status lke Allergy Status or Problem status etc. (from C-CDA to FHIR) what should be the guidance to calculate the corresponding verificationStatus in FHIR. Is there any guideline/business rule thats already been published in confluence? @David Riddle , @Lisa Nelson , @Lloyd McKenzie -please advise . Thank you.
Tushar Nair (Aug 27 2020 at 15:42):
@Lloyd McKenzie - Should this be addressed to anyone else?
Lloyd McKenzie (Aug 27 2020 at 15:44):
@Rick Geimer
David Riddle (Aug 31 2020 at 12:28):
Tushar Nair said:
Hello,
I am trying to map certain USCDI elements from C-CDA to FHIR. While mapping clinical status lke Allergy Status or Problem status etc. (from C-CDA to FHIR) what should be the guidance to calculate the corresponding verificationStatus in FHIR. Is there any guideline/business rule thats already been published in confluence? David Riddle , Lisa Nelson , Lloyd McKenzie -please advise . Thank you.
@Tushar Nair , I am not aware of any explicit guideline/business rule that has been published related to 'mapping clinical status like Allergy Status or Problem status (from C-CDA to FHIR)'; however, can you be more specific about what you mean by 'clinical status'? For example, for Problems, are you referring to whether or not the condition has been resolved? e.g. 'The effectiveTime of the Problem Observation is the definitive indication of whether or not the underlying condition is resolved. If the problem is known to be resolved, then an effectiveTime/high would be present. If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK". ' And/or the optional Problem Status observation (2.16.840.1.113883.10.20.22.4.6)? Or something else?
Also, @Lisa Nelson or @Rick Geimer may be aware of published guidelines/business rules that I am not.
Tushar Nair (Aug 31 2020 at 16:09):
@David Riddle , thank you for responding. Yes, I meant the status of the problem is 'active' or'inactive' or 'resolved' etc. Similarly I meant for allergy where status of the allergy could be 'active' or 'inactive' etc. I do understand the rules like -" If the problem is known to be resolved, then an effectiveTime/high would be present. If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK". " But my question is related to verficationStatus that accompanies the 'status' field in 'Condition' or 'AllergyIntolerance' resource. How do we infer the verificationStatus while mapping the C-CDA elements from 'Problem' or' Allergy ' to FHIR resources Condition and AllergyIntolerance. I hope I am making sense.
David Riddle (Sep 04 2020 at 12:57):
@Tushar Nair ,
Since AllergyIntolerance.verificationStatus 0..1 and Condition.verificationStatus 0..1 are both optional attributes, I would not think that it would be appropriate to infer a verificationStatus for AllergyIntolerance or Conditon resources derived from C-CDA documents.
I do see a note in the SOA Model-Based Transformation Service (MBTS) C-CDA to FHIR mappings for C-CDA Problem Observations (CCDA to CCDA-on-FHIR ProblemObservation to Condition.xlsx) that indicates ' verificationStatus mandatory for US-Core-Condition and no ProblemObservation element to map'; however, looking here https://build.fhir.org/ig/HL7/US-Core-R4/StructureDefinition-us-core-condition-definitions.html#Condition.verificationStatus, I don't understand why that MBTS mapping note indicates ' verificationStatus mandatory for US-Core-Condition'.
I am not aware of any C-CDA Problem Observation (2.16.840.1.113883.10.20.22.4.4) or Allergy - Intolerance Observation (2.16.840.1.113883.10.20.22.4.7) attributes that explicitly convey a verficationStatus (e.g., refuted, entered-in-error...).
Are you thinking that verificationStatus on FHIR resources derived from these C-CDA entries might be impacted by @negationInd scenarios? e.g., HL7 No Known Medication Allergies? I don't believe that any FHIR verificationStatus can be inferred from the C-CDA @negationInd.
cc @Michelle (Moseman) Miller @Lisa Nelson
Last updated: Apr 12 2022 at 19:14 UTC
