tag:blogger.com,1999:blog-733074358901582680.post4117599150572264169..comments2024-03-23T05:28:35.472-04:00Comments on Healthcare Standards: Smells like I dunno...Keith W. Boonehttp://www.blogger.com/profile/16883038460949909300noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-733074358901582680.post-80264400593949368852015-06-08T15:47:58.174-04:002015-06-08T15:47:58.174-04:00Apparently I missed in Problem Observation
10. SH...Apparently I missed in Problem Observation<br /><br />10. SHALL contain exactly one [1..1] value with @xsi:type="CD", where the @code<br />SHOULD be selected from ValueSet Problem<br />2.16.840.1.113883.3.88.12.3221.7.4 DYNAMIC (CONF:9058).<br />a. This value MAY contain zero or one [0..1] @nullFlavor<br />(CONF:10141).<br />i. If the diagnosis is unknown or the SNOMED code is<br />unknown, @nullFlavor SHOULD be “UNK”. If the code is<br />something other than SNOMED, @nullFlavor SHOULD be<br />“OTH” and the other code SHOULD be placed in the translation<br />element (CONF:10142).<br /><br />So DSTU should actually read<br /><br />Any element with a SHALL conformance statement may use nullFlavor unless it has a attribute with a SHALL conformance statement or the nullFlavor is explicitly disallowed or allowed by another constraint. Elements with SHOULD and MAY<br />conformance statement may use nullFlavor in the same way as above.<br />Chris Topinkahttps://www.blogger.com/profile/00358614697430181895noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-90520922175306852015-06-05T18:04:43.463-04:002015-06-05T18:04:43.463-04:00Furthermore, what is the meaning of the statement ...Furthermore, what is the meaning of the statement in the HL& spec: <br /><br />"Any SHALL conformance statement may use nullFlavor, unless the attribute is<br />required or the nullFlavor is explicitly disallowed. SHOULD and MAY<br />conformance statement may also use nullFlavor."<br /><br />Should this read:<br /><br />"Any element with a SHALL conformance statement may use nullFlavor unless it has a attribute with a SHALL conformance statement or the nullFlavor is explicitly disallowed by another constraint. Elements with SHOULD and MAY<br />conformance statement may use nullFlavor in the same way as above."Chris Topinkahttps://www.blogger.com/profile/00358614697430181895noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-56776353389300801772015-06-05T17:55:21.777-04:002015-06-05T17:55:21.777-04:00Not my question. My question is, why is pattern #2...Not my question. My question is, why is pattern #2 allowed when the spec says otherwise?Chris Topinkahttps://www.blogger.com/profile/00358614697430181895noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-39747399795974790922015-06-05T13:47:53.254-04:002015-06-05T13:47:53.254-04:00Pattern #2 is necessary when you want to say somet...Pattern #2 is necessary when you want to say something about the fact that you tried to ascertain the allergy status, and that the answer you got was "I don't know". This could be relevant when asking whether a patient is allergic to latex for example. The patient (or their representative) might simply not know. In that particular case, you might want to take precautions in caring for the patient until you are able to determine a better answer to the question.Keith W. Boonehttps://www.blogger.com/profile/16883038460949909300noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-48409446566193546362015-06-05T13:42:27.150-04:002015-06-05T13:42:27.150-04:00In pattern #2 above why is allowed?
The HL7 Impl...In pattern #2 above why is allowed?<br /><br />The HL7 Implementation Guide for CDA® Release 2:<br />IHE Health Story Consolidation, DSTU Release 1.1<br />(US Realm)<br />Draft Standard for Trial Use<br />July 2012<br /><br />states (pdf bottom page 40): Any SHALL conformance statement may use nullFlavor, unless the attribute is<br />required or the nullFlavor is explicitly disallowed. SHOULD and MAY<br />conformance statement may also use nullFlavor.<br /><br />Both classCode and moodCode are required attributes. <br /><br />ThanksChris Topinkahttps://www.blogger.com/profile/00358614697430181895noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-47528163758942438802012-10-10T11:44:37.720-04:002012-10-10T11:44:37.720-04:00Hi Keith,
Great article ... very informative and ...Hi Keith,<br /><br />Great article ... very informative and succinct.. <br /><br />Rashid A. KhanRashid A. Khanhttp://linkedin.com/in/khanrashidnoreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-1972784338885652792012-07-30T16:49:01.648-04:002012-07-30T16:49:01.648-04:00Keith, even though this is a year after the post, ...Keith, even though this is a year after the post, I just came back to this today (July 30, 2012) because I noticed that Consolidated CDA doesn't include an example of Pattern #3, "Nothing is known about allergies" for example. So rediscovering your post with its examples was very helpful. Thanks!<br />DavidDavidhttps://www.blogger.com/profile/13251393010554964308noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-38815440896536730752011-07-13T09:04:13.029-04:002011-07-13T09:04:13.029-04:00Hugh, see How to say no... which is a followup to ...Hugh, see <a href="http://motorcycleguy.blogspot.com/2011/07/how-to-say-no.html" rel="nofollow">How to say no...</a> which is a followup to this one.Keith W. Boonehttps://www.blogger.com/profile/16883038460949909300noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-38202661518504621372011-07-13T02:37:54.667-04:002011-07-13T02:37:54.667-04:00Hi Keith, as a clinician, while I might want to sa...Hi Keith, as a clinician, while I might want to say some of those things it would be quite rare. It's much more likely that I want to record the following things unambiguously.<br /><br /> I have asked this patient if they are on any medications and they said that they aren't i.e. This patient is on no medications.<br /> I have asked this patient if they have any allergies and they said no. i.e. This patient has no allergies.<br /> I asked this patient if they had any previous diseases/problems/procedures and they said no i.e. This person has no significant past history.<br /><br />I also want to make positive statements about NOT having particular conditions. i.e. this patient has no history of ischaemic heart disease, or no history of diabetes, or no Family history of diabetes etc.<br /><br />These are the important clinical statements the we need to make and the thing about them is that they are actually POSITIVE clinical statements - using flavours of null and negation indicators is only useful if we can unambiguously always know what the clinician was trying to say.<br /><br />Terminology may help here, but as always terminology is useless without proper information modelsHugh Lesliehttp://www.oceaninformatics.comnoreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-31325420178749782622011-07-12T10:29:24.220-04:002011-07-12T10:29:24.220-04:00Anonymous: "No known X" is covered in t...Anonymous: "No known X" is covered in <a href="http://motorcycleguy.blogspot.com/2011/07/how-to-say-no.html" rel="nofollow">today's post</a> on how to say no.<br /><br />Also, see <a href="https://plus.google.com/110278290452728885635/posts/1dyXBxeunSp" rel="nofollow">this stream</a> for more comments on THIS post.Keith W. Boonehttps://www.blogger.com/profile/16883038460949909300noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-8433601327229902722011-07-12T04:39:19.488-04:002011-07-12T04:39:19.488-04:00Agree that Cases 1-3 above do not include the Use ...Agree that Cases 1-3 above do not include the Use Case where a patient has actually asserted that they are unaware that they have any allergies...this is probably covered by SNOMED-CT 160244002 No known allergiesAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-89589256451646141972011-07-11T22:38:12.214-04:002011-07-11T22:38:12.214-04:00Several comments:
- attributes that are booleans ...Several comments:<br /><br />- attributes that are booleans can't have a nullFlavor, but they can still be null - simply by being missing. That isn't what you say<br /><br />- classes that have nullFlavors - I'll take that up on my blog and explain. <br /><br />- you don't describe the case "the patient has no known allergies". This is different to your cases #2 and #3, though it can be hard to know how differentGrahame Grievehttps://www.blogger.com/profile/08635283945076545993noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-60342387619085183742011-07-11T22:15:14.609-04:002011-07-11T22:15:14.609-04:00Bravo!Bravo!DaveOpenCDShttps://www.blogger.com/profile/18338512529768868412noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-32595799239269991092011-07-11T17:10:17.115-04:002011-07-11T17:10:17.115-04:00negationInd didn't allow null flavors because ...negationInd didn't allow null flavors because it was erroneously believed to be structural. I.e. You couldn't possibly have an object instance where it wasn't known. We corrected this issue at the same time we split negationInd into valueNegationInd and actionNegationInd. Unfortunately, this doesn't much help CDA which uses a version of the RIM that doesn't have access to the new attributes.<br /><br />A few other comments:<br />- Not sure about having a CSM participation on an allergy observation. That would mean the subject consumed the substance as part of the observation, which is true for allergy testing, but not for other allergy assessments. Usually we just use Observation.value whether dealing with Allergy tests or other allergy assertions.<br /><br />No issues otherwise, though I think using null flavor on actionNegationInd is better than having it on the base act is cleaner for models where it's available. They type of action is completely known. It's merely whether it occurred or didn't occur that's unknown.Lloydhttps://www.blogger.com/profile/15885320292969372423noreply@blogger.com