Question on the APHP HISTORY OF PAST ILLNESS section

Legacy openhie-shr
1

Hi everyone,

A question from our work on the APHP document generation.

We’re currently looking at the HISTORY OF PAST ILLNESS (1.3.6.1.4.1.19376.1.5.3.1.3.8) section. Looking at the IHE PCC document (ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_TF_Vol2.pdf) it seems that there is no value set defined for this.

Is there a recommended value set that we should use for this ? or basically, what concepts should we look at to obtain our answers ? any advice would be appreciated !

Thanks and Best regards,

Suranga

2

Hi Suranga.

I think it is useful to “descend thru the links” to see what some of the coding options are for these CDA sections. For example, the HISTORY OF PAST ILLNESS section (1.3.6.1.4.1.19376.1.5.3.1.3.8) has a wiki page on the IHE site, here:

http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.3.8

This wiki page links to a wiki page for the “Problem Concern Entry” template (1.3.6.1.4.1.19376.1.5.3.1.4.5.2), which is here:

http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5.2

And, in turn, this wiki page has a link to the “Problem Entry” template (1.3.6.1.4.1.19376.1.5.3.1.4.5), which is here:

http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5

I think, Suranga, some of what you’re looking for is found in the “Problem Entry” template. Here is where a constrained list of problem codes is found, as well as an example list of problem vocabularies, and some precise directives regarding how to document “no problems” vs. “unknown problems”, etc.

From the Problem Concern Entry wiki page there is a wiki page link for the “Concern Entry” template (1.3.6.1.4.1.19376.1.5.3.1.4.5.1), too, which is here:

http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5.1

As you can note, many of these templates, on the IHE side, are 1:1 references to underlying HL7 standards. Only occasionally are there constraints specified regarding IHE’s use of these HL7 specs. Where there are, tho, they are documented in the IHE wiki pages and/or the IHE technical framework documents. The full set of IHE published docs can be found on their public ftp site, which is here:

ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/

The CDA Content Modules supplement, in my view, adds an important level of detail to the technical framework (TF) docs and is (likely) more up-to-date than the IHE wiki pages. This important content supplement is found, here:

ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_Suppl_CDA_Content_Modules.pdf

The key takeaway for IHE profiles is that they all (always) reference underlying standards and specifications and (sometimes) describe the constraints to those specs so that interoperability can be achieved. IHE only rarely duplicates these referenced specs in the profile. This is intentional; think of it as similar to object-oriented programming… you don’t want to duplicate all the things described in the object, you just want to invoke/reference it. For the IHE profiles, this means you will (sometimes) have to descend down thru the referenced specs or templates to find specific content such as code sets, etc.

Suranga, I hope this is helpful.

Warmest regards,

Derek.

Derek Ritz, P.Eng., CPHIMS-CA

ecGroup Inc.

+1 (905) 515-0045

www.ecgroupinc.com

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From: openhie-shr@googlegroups.com [mailto:openhie-shr@googlegroups.com] On Behalf Of Suranga Kasthurirathne
Sent: Tuesday, July 22, 2014 3:56 PM
To: openhie-shr@googlegroups.com
Subject: Question on the APHP HISTORY OF PAST ILLNESS section

Hi everyone,

A question from our work on the APHP document generation.

We’re currently looking at the HISTORY OF PAST ILLNESS (1.3.6.1.4.1.19376.1.5.3.1.3.8) section. Looking at the IHE PCC document (ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_TF_Vol2.pdf) it seems that there is no value set defined for this.

Is there a recommended value set that we should use for this ? or basically, what concepts should we look at to obtain our answers ? any advice would be appreciated !

Thanks and Best regards,

Suranga

–
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3

Hi Suranga,

The History of Past Illness section contains “Problem Concern Entries” which are “Concern Entries” which contain “Problem Entries”.

The problem IMO is that a Problem Entry doesn’t really contain an observation, but it is intended to represent a concern about a problem (or allergy) the patient was (or is in the case of active problems) having. Basically the observation is observing the problem. Typically you’ll see this as the structure for a problem concern:

Here the entry is saying “The patient has (statusCode = active) a problem of concern that started sometime in 1950, the problem is a condition of Asthma”. Here the status code of the concern is active meaning the condition is ongoing and being actively tracked, while the observation is completed meaning the observation is complete. What I’ve done on the import is to interpret this as a “Problem” in oMRS which you can draw more information from… This might be a good strategy to use for generating this PAST ILLNESS, ACTIVE PROBLEMS, etc. You can also create one observation per active problem (or two) linking the observations to start/end obs linked to the problem. You can also use N/A codes as the problem concept (I think, at least oMRS doesn’t complain if you do).

What would be nice is if oMRS would allow developers to link multiple Obs to a single problem. This would make it easy to create an OBS of “Condition/Diagnosis” with value of the condition the patient was diagnosed with.

I’m starting to look at generating QED from the OpenMRS data model which is very similar to CDA’s clinical statement model. We should connect and share notes about this in the coming weeks as I imagine we’ll come across common issues like this.

Cheers

-Justin

···

On Tuesday, July 22, 2014 3:55:50 PM UTC-4, Suranga Kasthurirathne wrote:

Hi everyone,

A question from our work on the APHP document generation.

We’re currently looking at the HISTORY OF PAST ILLNESS (1.3.6.1.4.1.19376.1.5.3.1.3.8) section. Looking at the IHE PCC document (ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_TF_Vol2.pdf) it seems that there is no value set defined for this.

Is there a recommended value set that we should use for this ? or basically, what concepts should we look at to obtain our answers ? any advice would be appreciated !

Thanks and Best regards,

Suranga
4

Thank you Justin and Derek,

I’ve been out sick, and just catching up on my emails. Thank you for explaining how all this works out.

However, this also raises one more question to me :slight_smile:

Assuming that for this section, there are no problem entries for this patient. The value set for this section, as pointed out by Derek (http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5) has a number of SNOMED CT concepts such as condition, symptom, problem etc.

How would we represent the absence of any of these per that particular patient ?

As far as I can see, the wiki page tells us to use SNOMED Codes 396782006 (Past Medical History Unknown) or 160243008 (No Significant Medical History) if there are no problems found for that patient. Is that correct ?

···

On Fri, Jul 25, 2014 at 3:26 PM, justin.fyfe@ecgroupinc.com wrote:

Hi Suranga,

The History of Past Illness section contains “Problem Concern Entries” which are “Concern Entries” which contain “Problem Entries”.

The problem IMO is that a Problem Entry doesn’t really contain an observation, but it is intended to represent a concern about a problem (or allergy) the patient was (or is in the case of active problems) having. Basically the observation is observing the problem. Typically you’ll see this as the structure for a problem concern:

<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5" assigningAuthorityName="IHE PCC"/>
<!--Problem observation template - NOT episode template-->
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>

<code code="64572001" displayName="Condition" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
<text>
 <reference value="#PROBSUMMARY_1"/>

</text>
<statusCode code="completed"/>
<effectiveTime>
 <low value="1950"/>
</effectiveTime>
<value xsi:type="CD" displayName="Asthma" code="195967001" codeSystemName="SNOMED" codeSystem="2.16.840.1.113883.6.96"/>

Here the entry is saying “The patient has (statusCode = active) a problem of concern that started sometime in 1950, the problem is a condition of Asthma”. Here the status code of the concern is active meaning the condition is ongoing and being actively tracked, while the observation is completed meaning the observation is complete. What I’ve done on the import is to interpret this as a “Problem” in oMRS which you can draw more information from… This might be a good strategy to use for generating this PAST ILLNESS, ACTIVE PROBLEMS, etc. You can also create one observation per active problem (or two) linking the observations to start/end obs linked to the problem. You can also use N/A codes as the problem concept (I think, at least oMRS doesn’t complain if you do).

What would be nice is if oMRS would allow developers to link multiple Obs to a single problem. This would make it easy to create an OBS of “Condition/Diagnosis” with value of the condition the patient was diagnosed with.

I’m starting to look at generating QED from the OpenMRS data model which is very similar to CDA’s clinical statement model. We should connect and share notes about this in the coming weeks as I imagine we’ll come across common issues like this.

Cheers

-Justin

On Tuesday, July 22, 2014 3:55:50 PM UTC-4, Suranga Kasthurirathne wrote:

Hi everyone,

A question from our work on the APHP document generation.

We’re currently looking at the HISTORY OF PAST ILLNESS (1.3.6.1.4.1.19376.1.5.3.1.3.8) section. Looking at the IHE PCC document (ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_TF_Vol2.pdf) it seems that there is no value set defined for this.

Is there a recommended value set that we should use for this ? or basically, what concepts should we look at to obtain our answers ? any advice would be appreciated !

Thanks and Best regards,

Suranga

–
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5

Hi Suranga,

You are correct, if there is no data use one of the codes supplied in the table that is appropriate to the section.

Cheers

-Justin

···

Thank you Justin and Derek,

I’ve been out sick, and just catching up on my emails. Thank you for explaining how all this works out.

However, this also raises one more question to me :slight_smile:

Assuming that for this section, there are no problem entries for this patient. The value set for this section, as pointed out by Derek (http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5) has a number of SNOMED CT concepts such as condition, symptom, problem etc.

How would we represent the absence of any of these per that particular patient ?

As far as I can see, the wiki page tells us to use SNOMED Codes 396782006 (Past Medical History Unknown) or 160243008 (No Significant Medical History) if there are no problems found for that patient. Is that correct ?

On Fri, Jul 25, 2014 at 3:26 PM, justin.fyfe@ecgroupinc.com wrote:

Hi Suranga,

The History of Past Illness section contains “Problem Concern Entries” which are “Concern Entries” which contain “Problem Entries”.

The problem IMO is that a Problem Entry doesn’t really contain an observation, but it is intended to represent a concern about a problem (or allergy) the patient was (or is in the case of active problems) having. Basically the observation is observing the problem. Typically you’ll see this as the structure for a problem concern:

Here the entry is saying “The patient has (statusCode = active) a problem of concern that started sometime in 1950, the problem is a condition of Asthma”. Here the status code of the concern is active meaning the condition is ongoing and being actively tracked, while the observation is completed meaning the observation is complete. What I’ve done on the import is to interpret this as a “Problem” in oMRS which you can draw more information from… This might be a good strategy to use for generating this PAST ILLNESS, ACTIVE PROBLEMS, etc. You can also create one observation per active problem (or two) linking the observations to start/end obs linked to the problem. You can also use N/A codes as the problem concept (I think, at least oMRS doesn’t complain if you do).

What would be nice is if oMRS would allow developers to link multiple Obs to a single problem. This would make it easy to create an OBS of “Condition/Diagnosis” with value of the condition the patient was diagnosed with.

I’m starting to look at generating QED from the OpenMRS data model which is very similar to CDA’s clinical statement model. We should connect and share notes about this in the coming weeks as I imagine we’ll come across common issues like this.

Cheers

-Justin

On Tuesday, July 22, 2014 3:55:50 PM UTC-4, Suranga Kasthurirathne wrote:

Hi everyone,

A question from our work on the APHP document generation.

We’re currently looking at the HISTORY OF PAST ILLNESS (1.3.6.1.4.1.19376.1.5.3.1.3.8) section. Looking at the IHE PCC document (ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_TF_Vol2.pdf) it seems that there is no value set defined for this.

Is there a recommended value set that we should use for this ? or basically, what concepts should we look at to obtain our answers ? any advice would be appreciated !

Thanks and Best regards,

Suranga

–

You received this message because you are subscribed to the Google Groups “Shared Health Record (OpenHIE)” group.
To unsubscribe from this group and stop receiving emails from it, send an email to openhie-shr+unsubscribe@googlegroups.com.
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6

Awesome. thank you. So we pick the appropriate code based on the section we’re interested in.

So I guess looking at this table from (http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5), 407559004 can be used to show that there are no records in the family medical history section, etc. etc. correct ? :slight_smile:

Entry Type
Code
Display Name
Description
Problem
396782006
Past Medical History Unknown
To indicate unknown medical history
Problem
407559004
Family History Unknown
To indicate that the patient’s family history is not known.
Problem
160243008
No Significant Medical History
To indicate no relevant medical history
Problem
160245001
No current problems or disability
To indicate that the patient has no current problems (as distinct from no history).
Allergy
409137002
No Known Drug Allergies
To indicate that there are no known Drug allergies for this patient.
Allergy
160244002
No Known Allergies
To indicate that there are no known allergies for this patient.
Allergy
64970000
Substance Type Unknown
To indicate the state where there is a known allergy or intollerance to an unknown substance

···

On Sat, Jul 26, 2014 at 12:03 PM, Justin Fyfe justin.fyfe@ecgroupinc.com wrote:

Hi Suranga,

You are correct, if there is no data use one of the codes supplied in the table that is appropriate to the section.

Cheers

-Justin

From: Suranga Kasthurirathne [mailto:surangak@openmrs.org]
Sent: Saturday, July 26, 2014 12:13 PM
To: Justin Fyfe
Cc: openhie-shr@googlegroups.com
Subject: Re: Question on the APHP HISTORY OF PAST ILLNESS section

Thank you Justin and Derek,

I’ve been out sick, and just catching up on my emails. Thank you for explaining how all this works out.

However, this also raises one more question to me :slight_smile:

Assuming that for this section, there are no problem entries for this patient. The value set for this section, as pointed out by Derek (http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.4.5) has a number of SNOMED CT concepts such as condition, symptom, problem etc.

How would we represent the absence of any of these per that particular patient ?

As far as I can see, the wiki page tells us to use SNOMED Codes 396782006 (Past Medical History Unknown) or 160243008 (No Significant Medical History) if there are no problems found for that patient. Is that correct ?

On Fri, Jul 25, 2014 at 3:26 PM, justin.fyfe@ecgroupinc.com wrote:

Hi Suranga,

The History of Past Illness section contains “Problem Concern Entries” which are “Concern Entries” which contain “Problem Entries”.

The problem IMO is that a Problem Entry doesn’t really contain an observation, but it is intended to represent a concern about a problem (or allergy) the patient was (or is in the case of active problems) having. Basically the observation is observing the problem. Typically you’ll see this as the structure for a problem concern:

<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5" assigningAuthorityName="IHE PCC"/>
<!--Problem observation template - NOT episode template-->
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>

<code code="64572001" displayName="Condition" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
<text>
 <reference value="#PROBSUMMARY_1"/>

</text>
<statusCode code="completed"/>
<effectiveTime>
 <low value="1950"/>
</effectiveTime>
<value xsi:type="CD" displayName="Asthma" code="195967001" codeSystemName="SNOMED" codeSystem="2.16.840.1.113883.6.96"/>

Here the entry is saying “The patient has (statusCode = active) a problem of concern that started sometime in 1950, the problem is a condition of Asthma”. Here the status code of the concern is active meaning the condition is ongoing and being actively tracked, while the observation is completed meaning the observation is complete. What I’ve done on the import is to interpret this as a “Problem” in oMRS which you can draw more information from… This might be a good strategy to use for generating this PAST ILLNESS, ACTIVE PROBLEMS, etc. You can also create one observation per active problem (or two) linking the observations to start/end obs linked to the problem. You can also use N/A codes as the problem concept (I think, at least oMRS doesn’t complain if you do).

What would be nice is if oMRS would allow developers to link multiple Obs to a single problem. This would make it easy to create an OBS of “Condition/Diagnosis” with value of the condition the patient was diagnosed with.

I’m starting to look at generating QED from the OpenMRS data model which is very similar to CDA’s clinical statement model. We should connect and share notes about this in the coming weeks as I imagine we’ll come across common issues like this.

Cheers

-Justin

On Tuesday, July 22, 2014 3:55:50 PM UTC-4, Suranga Kasthurirathne wrote:

Hi everyone,

A question from our work on the APHP document generation.

We’re currently looking at the HISTORY OF PAST ILLNESS (1.3.6.1.4.1.19376.1.5.3.1.3.8) section. Looking at the IHE PCC document (ftp://ftp.ihe.net/DocumentPublication/CurrentPublished/PatientCareCoordination/IHE_PCC_TF_Vol2.pdf) it seems that there is no value set defined for this.

Is there a recommended value set that we should use for this ? or basically, what concepts should we look at to obtain our answers ? any advice would be appreciated !

Thanks and Best regards,

Suranga

–

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