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Introduce reason-for-visit condition category #90

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Mar 23, 2023
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Introduce reason-for-visit condition category #90

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114fd6a
Introduce reason-for-visit condition category
Mar 23, 2023
4c3015c
Fix issues found in review
Mar 23, 2023
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17 changes: 9 additions & 8 deletions input/fsh/condition.fsh
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Original file line number Diff line number Diff line change
@@ -1,20 +1,14 @@

Profile: FiBaseCondition
Parent: http://hl7.org/fhir/uv/ipa/StructureDefinition/ipa-condition
Id: fi-base-condition
Title: "FI Base Condition"
Description: "This is the Finnish base profile for the Condition resource."
* ^status = #draft

* extension contains IsNotAuthoredByMedicalDoctor named isNotAuthoredByMedicalDoctor 0..1
* extension contains Sport named sport 0..1
* extension contains EndocrinologicalDisorder named endocrinologicalDisorder 0..1

Extension: IsNotAuthoredByMedicalDoctor
Id: condition-is-not-authored-by-medical-doctor
Title: "Is not authored by medical doctor"
Description: "Information on whether the reason for the visit or treatment period is recorded by a healthcare professional other than a doctor."
* value[x] only boolean

Extension: Sport
Id: condition-sport
Title: "Type of sport in injury"
Expand Down Expand Up @@ -55,4 +49,11 @@ Title: "Haittavaikutuksen aiheuttaja"
Description: "koodilla ilmaistu tieto haittavaikutuksen ulkoisesta syystä silloin, kun syynä on toimenpide tai lääke"
* value[x] only Coding

*/
*/

CodeSystem: FiBaseConditionCategory
Id: fi-base-condition-category
Title: "Finnish Condition categories"
Description: "Additional categories for the Finnish Base Condition profile"
* #reason-for-visit "Reason for visit"
"Indicates that this Condition is reason for visit (or treatment period). Reason for visit may be a diagnosis asserted by a clinician (a Diagnosis or Diagnoosi in finnish) or other healthcare professional (Käyntisyy in finnish)."
15 changes: 6 additions & 9 deletions input/fsh/examples/diagnosisSimple.fsh
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Instance: DiagnosisSimple
InstanceOf: FiBaseCondition
Title: "Condition - an example diagnosis"
Description: "An example of a diagnosis using the FiBaseCondition pofile."
Description: "An example of a diagnosis using the FiBaseCondition pofile. This diagnosis is asserted by a clinician."
Usage: #example
* id = "id-for-diagnosis-1"
* category[0].coding.system = #urn:oid:1.2.246.537.6.12.2002
* category[0].coding.code = #166
* category[0].coding.display = "Diagnoosit"
* category[0].coding.system = #https://hl7.fi/fhir/finnish-base-profiles/CodeSystem/fi-base-condition-category
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I'm not entirely sure we want to start hosting code systems here, but also not against it. Perhaps requires some discussion?

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Most certainly needs discussion :)

* category[0].coding.code = #reason-for-visit

* category[1].coding.system = #http://terminology.hl7.org/CodeSystem/condition-category
* category[1].coding.code = #encounter-diagnosis
Expand All @@ -15,9 +14,9 @@ Usage: #example
* category[2].coding.code = #PAA
* category[2].coding.display = "Päädiagnoosi tai päätoimenpide"

* category[2].coding.system = #urn:1.2.246.537.5.40003.2003
* category[2].coding.code = #PYS
* category[2].coding.display = "Pysyväisluonteinen"
* category[3].coding.system = #urn:1.2.246.537.5.40003.2003
* category[3].coding.code = #PYS
* category[3].coding.display = "Pysyväisluonteinen"

* subject = Reference(PatientOfMunicipality)
* code.coding.system = #1.2.246.537.6.1.1999
Expand All @@ -31,5 +30,3 @@ Usage: #example

* onsetDateTime = "2023-01-05T02:06:24+03:00"
* clinicalStatus = #active

* extension[IsNotAuthoredByMedicalDoctor].valueBoolean = false
47 changes: 32 additions & 15 deletions input/pagecontent/StructureDefinition-fi-base-condition-intro.md
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Expand Up @@ -10,20 +10,32 @@ Use cases:
* Diagnosis -based conditions and Finnish Kayntisyy
* Other usages?

### Diagnosis -based conditions and Finnish *käyntisyy*
### Reasons for visit (Diagnosis -based conditions and Finnish *käyntisyy*)

A condition isn't always a diagnosis. `category` is used to identify that a condition is a diagnosis.
To identify that a condition is a diagnosis or Finnish *käyntisyy*, the `category` -field MUST
contain code `166` from Finnish [AR/YDIN - Näkymät](https://koodistopalvelu.kanta.fi/codeserver/pages/classification-view-page.xhtml?classificationKey=226&versionKey=301)
-code system.
Reason for visit may be a diagnosis asserted by a clinician / medical doctor or some other reason
for visit that is asserted by an nurse or some other healthcare professional.

TODO is ok to use `166` for Finnish *käyntisyy* also? Having a category code would clean up this
profile. We would not need an extension.
To identify that a condition resource is a reason for visit, it MUST contain `category` code
`reason-for-visit`.

THL has a data model for Finnish diagnosis in code server:
A reason for visit condition needs to be further categorized to make the distinction between
clinician asserted diagnosis and other *käyntisyy* conditions. When condition is a clinician
asserted diagnosis it MUST contain another `category` code `encounter-diagnosis`. When condition
is not asserted by a clincian it MUST NOT contain `encounter-diagnosis` category code.

THL has a data model for Finnish diagnosis (including *käyntisyy*) in code server:
[THL/Tietosisältö - Diagnoosit](https://koodistopalvelu.kanta.fi/codeserver/pages/classification-view-page.xhtml?classificationKey=543&versionKey=1543)
("THL specification").

Categories match to THL specification in following way:

* when `reason-for-visit` is present --> This is a diagnosis or *käyntisyy* as identifed by THL specification
* (There are many other kind of conditions in FHIR that don't have this category)
* when additionally `encounter-diagnosis` is present --> This is a diagnosis and is not a *käyntisyy*
* In THL specification, codeId 23: Käyntisyy has value False
* when `encounter-diagnosis` is not present --> This is a *käyntisyy*
* In THL specification, codeId 23: Käyntisyy has value True

#### Diagnosis Code Systems

When using [Finnish ICD-10](https://koodistopalvelu.kanta.fi/codeserver/pages/classification-view-page.xhtml?classificationKey=23&versionKey=58)
Expand Down Expand Up @@ -103,7 +115,7 @@ Extension `isNotAuthoredByMedicalDoctor` with value `true` MUST be used when con
It MAY be used with value `false` on medical doctor asserted diagnosis, but absence of this extension
SHALL be interpreted as not being a *käyntisyy*.

In THL specification, this data is codeId 23: Käyntisyy.


#### Type of sport in injury cases

Expand All @@ -121,15 +133,20 @@ TODO add example.

In THL specification, this data is codeId: 27 Endokrinologisen häiriön koodi.

#### 28 Aiheuttajan ATC-koodi
#### 28 Aiheuttajan ATC-koodi

TODO define extension and example

#### 3 Diagnoosin ulkoinen syy
#### 3 Diagnoosin ulkoinen syy

TODO define extension and example

#### 4 Diagnoosin tapaturmatyyppi
#### 4 Diagnoosin tapaturmatyyppi

TODO define extension and example
#### 5 Haittavaikutuksen aiheuttaja

#### 5 Haittavaikutuksen aiheuttaja

TODO define extension and example

#### Other category usages
Expand All @@ -143,7 +160,7 @@ mapping work to be done. Following list contains most relevant parts that need w

* Use of `problem-list-item` for long term diagnosis ("Pitkäaikaisdiagnoosi" or "Pysyvä diagnoosi" in finnish)? The conceptual mapping is not staightforward.
* THL Tietosisältö 10 Tiedon lähde
* extension?
* extension?
* THL Tietosisältö 15 Diagnoosin päättymisen toteajan nimi
* THL Tietosisältö 17 Diagnoosin päättymisen syy
* THL Tietosisältö 18 Diagnoosin päättymisen syyn tarkenne
Expand All @@ -155,4 +172,4 @@ mapping work to be done. Following list contains most relevant parts that need w
#### Links

* [Suomalainen tautien kirjaamisen ohjekirja](https://thl.fi/documents/10531/124365/Opas%202012%2017.pdf)
national guide for the use if ICD-10.
national guide for the use if ICD-10.