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

Allergy Problem Observation in C-CDA 1.1 2/25/2019

Allergy Status Observation in C-CDA 1.1 Table 126: Allergy Status Observation 2/25/2019

Problem Observation in C-CDA 1.1 Health Status Observation: This template represents observations regarding the outcome of care from the interventions used to treat the patient. These observations represent status, at points in time, related to established care plan goals and/or interventions (Contains “Outcome Observation” template) Outcome Observation contains: Act Reference (NEW); Author Participation (NEW); Goal Observation (NEW); Intervention Act (NEW); Progress Toward Goal Observation (NEW) The “Problem Status” Observation uses the same HITSPProblemStatus values 2/25/2019

In C-CDA 2.0 Allergy Status Observation and Problem Status templates are deprecated 2/25/2019

In C-CDA 2.0 Allergy Status Observation and Problem Status templates are deprecated 2/25/2019

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 2/25/2019

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 2/25/2019

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 2/25/2019

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 2/25/2019

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 2/25/2019

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:cmiotn@gmail.com] 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 2/25/2019

Is recurrence an exact synonym for relapse? From: Stephen Chu Sent: Tuesday, 7 October 2014 11:47 AM To: cmiotn@gmail.com; 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 2/25/2019