Transcript Allergy Problem Observation inC

PCWG – Chicago WGM
C-CDA: Problem/Allergy Problem
Status Observation Templates
Stephen Chu, PCWG co-chair
Russ Leftwich, PCWG co-chair
Elaine Ayres, PCWG co-chair
Laura Heermann Langford, PCWG co-chair
Rob Hausam, vocab facilitator
Lisa Nelson, PCWG Liaison from SDWG
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Allergy Problem Observation in
C-CDA 1.1
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Allergy Status Observation in
C-CDA 1.1
Table 126: Allergy
Status Observation
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Problem Observation in
C-CDA 1.1
The “Problem Status” Observation uses the same HITSPProblemStatus
values
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In C-CDA 2.0
Allergy Status Observation and Problem
Status templates are deprecated
© 2014 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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In C-CDA 2.0
Allergy Status Observation and Problem
Status templates are deprecated
© 2014 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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Determining Problem status in absence of
Allergy Status Observation and Problem Status
inadequate for
expressing the
rich semantics
clinical status
of the problem
or concern
statusCode:
- metadata
Not displayed
as human
readable data.
How is that
useful for
expressing
clinical status?
Using “statusCode + effectiveTime to communicate “status”: inadequate
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HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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In C-CDA 2.0
Allergy Status Observation and Problem
Status templates are deprecated

Determining “Problem Concern Status” in the
absence of these templates:

The statusCode of the Problem Concern Observation
is the definitive indication of the status of the concern


Issues
• Status of the concern = status of the Act (status of
workflow)
• ≠ rich semantics of clinical status of the
problem/concern
The effectiveTime of the Problem Observation is the
definitive indication of whether or not the underlying
condition is resolved
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Determining Allergy Status


The Allergy Status Observation template has
been deprecated in Consolidated CDA
Release 2
"Determining a Clinical Statement's Status",
i.e. the status of an allergy is determined
based on attributes of the Allergy Problem Act
and Allergy - Intolerance Observation

statusCode + effectiveTime
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Semantics of clinical status:
much more complex

The status of most clinical problems or
conditions (allergy and intolerance included)
need to be represented by one of the
following values:
Active
 Inactive (semantically different from resolved)
 Resolved
 Refuted

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Semantics of clinical status:
much more complex

Cancer, psychiatric/psychological problems (substances
dependencies included) require additional status values:

Remission states






In remission
Partial remission
Full/complete remission
Early full/partial remission
Sustained full/partial remission
Relapse states



Relapse
relapse after partial remission
relapse after full remission
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Semantics of clinical status:
much more complex

The semantic complexity requires the reinstatement of:
 Problem status template
 Allergy status observation template
Post Chicago WGM communications:
From: Russ Leftwich [mailto:[email protected]]
Sent: Tuesday, 7 October 2014 11:06 AM
To: Stephen Chu; Lisa Nelson; Elaine Ayres
Subject: Re: SDWG Agenda Request
A couple of questions. I don't know that they need to be answered on Thursday, or even asked.
Is recurrence an exact synonym for relapse?
Are asymptomatic and clinically undetectable synonyms for inactive?
Russ
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From: Stephen Chu
Sent: Tuesday, 7 October 2014 11:47 AM
To: [email protected]; Lisa Nelson; Elaine Ayres
Subject: RE: SDWG Agenda Request
Hi Russ,
Is recurrence an exact synonym for relapse?
[Stephen: It depends on the context of use.
Synonyms of “recurrence” = returning, repeating, reoccurring. In that context, yes, “recurrence” may be
considered as a synonym for relapse.
“Recurrent” in the context of concepts such as “recurrent pyrogenic cholangitis” is a diagnosis of its own
right.
One may argue that “pyrogenic cholangitis” with a clinical status = “recurrence” or “relapse” may be treated
as synonymous as “recurrent pyrogenic cholangitis”. But I would not use it in that way.]
Are asymptomatic and clinically undetectable synonyms for inactive?
[Stephen: inactive = quiescent, at rest, state of quietness
Remission = disappearance of signs and symptoms of a disease.
It may be considered that diseases/problems in inactive state are therefore asymptomatic and clinically
undetectable; although the concept of remission (rather than inactive) is used to qualify clinical status of
diseases/disorders such as cancer, multiple sclerosis, behavioural disorders)
As such, the answer is likely to be these concepts may be considered synonymous, but the context of use
will determine which specific concept to be used.
Regards,
Stephen
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