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Condition/Diagnosis/Health Issue/Problems/Findings Modeling Options
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“CONTEXT” OF FINDINGS
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General Assumption About Finding
• The purpose of finding model is to describe something that exists or is true (a diagnosis, a condition, a finding) about a person
• The finding can be highly pre coordinated or post coordinated. It has substructure that depends on the kind of thing that is being represented
• The finding model gets reused in many different contexts: Health Issue (Problem), Family History, Complication, Reason for Admission, Surgery Complication, Final Discharge Diagnosis, Finding, etc.
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Finding as part of Health Issue
HealthIssue Onset date Date noted Resolution date Rank Link to other issue
Finding
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Finding as part of Family History
Family History Item Relationship Person Id Cause of Death Age at onset
Finding
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Finding as a Complication
Surgery Procedure Type of Surgery Primary surgeon Start time End time Complication Finding
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Incomplete List of Contexts
• Health Issue (Problem)• Family History• Surgery Complication• Reason for Admission• Admitting Diagnosis• Final Discharge
Diagnosis• Goal statement• Risk for
• Reason for: order, procedure, action
• Others…
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OPTIONS CONSIDERED
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Options for Negation(No Diabetes Mellitus)
Option 1 – Negation InsideDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Not Present, Unlikely, Possible, Probable, Present, etc.) Example InstancesDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Present
Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Not Present
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Options for Negation(No Diabetes Mellitus)
Option 2 – Assertion and Negation as ClassesExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [Not Present, Excluded, Not Found]Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Maybe, Possible, Probable, Likely, Unlikely, etc.)Example InstancesExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): ExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Possible
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Options for Negation(No Diabetes Mellitus)
Option 3 – Precoordinated NegationDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with and without precoordinated context: diabetes mellitus, no diabetes mellitus, etc.]
Example InstancesDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus
Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: No Type 1 Diabetes Mellitus
Note: This option could lead to “combinatorial explosion”.
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Options for Negation(No Diabetes Mellitus)
Option 4 – Precoordinated Negation with redundant negation attributeDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with and without precoordinated context: diabetes mellitus, no diabetes mellitus, etc.] certainty (mod): [value set binding to: Not Present, Unlikely, Possible, Probable, Present, etc.) Example InstancesDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Present
Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: No Type 1 Diabetes Mellitus certainty (mod): Not Present
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Extending Option 1(No Family History of Breast Cancer)
Option 1 – Negation InsideDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Not Present, Unlikely, Possible, Probable, Present, etc.] subjectOfInformation (mod): [value set binding to: Relative (Family Hx Of), Aunt, Uncle, Donor]
Example InstancesDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Breast Cancer certainty (mod): Present subjectOfInformation (mod): Relative (Family Hx Of)
Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Breast Cancer certainty (mod): Not Present subjectOfInformation (mod): Relative (Family Hx Of)
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Extending Option 2(No Family History of Breast Cancer)
Option 2 – Assertion and Negation as ClassesExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [Not Present, Excluded, Not Found] subjectOfInformation (mod): [value set binding to: Relative (Family Hx Of), Aunt, Uncle, Donor]Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Maybe, Possible, Probable, Likely, Unlikely, etc.] subjectOfInformation (mod): [value set binding to: Relative (Family Hx Of), Aunt, Uncle, Donor]
Example InstancesExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: Breast Cancer certainty (mod): Excluded subjectOfInformation (mod): Relative (Family Hx Of)
Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Breast Cancer certainty (mod): Possible subjectOfInformation (mod): Relative (Family Hx Of)
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Extending Option 3(No Diabetes Mellitus)
Option 3 – Precoordinated Negation and Subject of InformationDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with and without precoordinated context and subject of information: diabetes mellitus, no diabetes mellitus, family hx of diabetes mellitus, no family hx of diabetes mellitus, etc.]
Example InstancesDiagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Family History of Type 1 Diabetes Mellitus
Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: No Family History of Type 1 Diabetes Mellitus
Note: This option could lead to “combinatorial explosion”.
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Options for Body Site(Rashes)
Option 1 – Post Coordinated Body SiteSite Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated body site: rash, pain, ulcer, wound, burn, etc.] body site (qual): [value set binding to: face, arm, leg, back, axilla, etc.] Example InstanceSite Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: Rash body site (mod): Face
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Options for Body Site(Rashes)
Option 2 – Precoordinated Body SiteSite Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with precoordinated body site: face rash, chest pain, pelvic ulcer, hand wound, lower extremity burn, etc.] Example InstanceSite Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: Face Rash
Note: This strategy could lead to “combinatorial explosion.”
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Options for Body Site(Rashes)
Option 1a – Post Coordinated Body Site with LateralitySite Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated body site: rash, pain, ulcer, wound, burn, etc.] body site with laterality (qual): Collection [ body site (qual): [value set binding to: face, arm, leg, back, axilla, etc.] laterality (qual): [value set binding to: left, right, bilateral]]
Example InstanceSite Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: Rash body site with laterality (qual): Collection [ body site (qual): face laterality (qual): bilateral ]
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Options for Body Site(Rashes)
Option 2a – Precoordinated Body Site with LateralitySite Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with precoordinated body site: bilateral face rash, left sided chest pain, right pelvic ulcer, left hand wound, bilateral lower extremity burn, etc.] Example InstanceSite Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: Bilateral face rash
Note: This strategy could lead to “combinatorial explosion.”
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Options for Body Site(Rashes)
Option 3 – Post Coordinated Finding with Multiple QualifiersSite Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated body site: rash, pain, ulcer, wound, burn, etc.] body site with laterality (qual): Collection [ body site (qual): [value set binding to: face, arm, leg, back, axilla, etc.] laterality (qual): [value set binding to: left, right, bilateral]] quality (qual): [value set binding to: macular, papular, macular-papular] pattern (qual): [value set binding to: butterfly, splotchy, diffuse, marginated]Example InstanceSite Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: Rash body site with laterality (qual): Collection [ body site (qual): face laterality (qual): bilateral ] quality (qual): macular-papular pattern (qual: butterfly
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Options for Body Site(Rashes)
Option 4 – Precoordinated Finding with multiple qualifiersSite Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with precoordinated body site: bilateral macular-papular rash of face, diffuse macular rash of right leg, etc.] Example InstanceSite Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: bilateral macular-papular rash of face
Note: This strategy could lead to “combinatorial explosion.”
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Some conclusions and a proposal
• There will be many qualifiers that are used in different subsets of findings
• We have a previously stated preference for “the most reasonable post coordinated approach”
• We should follow the post coordinated approach for our “preferred” models for interoperability
• Precoordinated models will be useful for data entry and other use cases