Conditions List for Bahmni

[burke (Burke Mamlin)]

@darius

I don’t understand how the halitosis example is relevant, because FHIR’s clinicalStatus does not have a solution for it either. The clinicalStatus options are active | relapse | remission | resolved. Which one of these indicates “active Halitosis that is not clinically relevant”?

Halitosis would be marked as resolved/inactive, reflecting it is not clinically relevant. The system would not be able to distinguish between Halitosis that was resolved vs Halitosis that remains physiologically active but is no longer clinically relevant, but nobody is going to be collecting or maintaining that granularity of data even if we supported it.

@darius

(3a) redo the concept dictionary for this implementation to have separate concepts for “stroke” and “history of stroke”

Those sites using CIEL likely already have these concepts. If not, there’s no requirement to have them. Setting clinicalStatus for “Stroke” to remission/history would be effectively the same as having “History of stroke” marked as active or remission/history of. For those concepts without a “History of x” concept, you just would have the option of having both “Stroke” (i.e., acute stroke) and “History of stroke” in the condition list simultaneously when a patient comes in with their third stroke. But using “History of x” concepts or not is left to an implementation decision (similar to choosing the name to use in the UI for remission/history of or resolved/inactive).

@darius

You agree that there’s only one status/clinicalStatus column, so I assume you agree it’s appropriate to display by default all conditions whose status is ACTIVE or HISTORY_OF, but not INACTIVE (aka whose clinicalStatus is ACTIVE or REMISSION, but not RESOLVED).

Is that right, or are you proposing something different?

Yes. That’s right. The key point is that clinicalStatus is being used to record clinical relevance, not physiological truth. In other words, the semantics of marking something active, remission/history of, or resolved/inactive reflects the state of the condition’s clinical relevance. Most of the time, this will align with physiology – i.e., when the Pneumonia is resolved, it’s actually resolved. But when clinical relevance and physiological state of a condition do not align, clinical relevance wins – e.g., if the patient still has constipation, but it has been clinically stable for 10 years and the provider wants it off her list, its clinicalStatus becomes resolved/inactive even if the patient is still taking the stool softener he’s taken for the past 10 years for his constipation. If we leave this ambiguous and half the people using the API are using clinicalStatus to have manageable condition lists and the other half are assuming that clinicalStatus must reflect “truth” (physiology), the two will eventually hit an impass like two Zax.