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  1. FHIR Specification Feedback
  2. FHIR-35640

Need to clarify the meaning/purpose of this profile/observation category

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    • Change Request
    • Status: Resolved - No Change (View Workflow)
    • Highest
    • Resolution: Not Persuasive
    • US Core (FHIR)
    • 4.0.0
    • Cross-Group Projects
    • US Core Observation Category
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      Comment (extracted from attachment):

      Naming and description for what is and isn’t a “Clinical Test Result” is ambiguous. “Non-imaging and non-laboratory clinical test results” could functionally be more than just “procedure” observations; could potentially mean any of the other categories (social-history, vital-signs, procedure, survey, exam, therapy, activity). So this feels ambiguous. You’d have to notice that the other categories have there own profiles and realize “Clinical Test Result” JUST means observation category= procedure results. If this profile were named “Clinical Procedure Results” instead, it would be a bit better.

      Existing Wording:

      This profile sets minimum expectations for the Observation resource to record, search, and fetch non-imaging and non-laboratory clinical tests results for a patient.

      Proposed Wording:

      This profile sets minimum expectations for the Observation resource to record, search, and fetch non-imaging and non-laboratory clinical tests results (clinical procedure results) for a patient. As per the definition of the Procedure category, Observations generated by other procedures. This category includes observations resulting from interventional and non-interventional procedures excluding laboratory and imaging (e.g., cardiology catheterization, endoscopy, electrodiagnostics, etc.). Procedure results are typically generated by a clinician to provide more granular information about component observations made during a procedure. An example would be when a gastroenterologist reports the size of a polyp observed during a colonoscopy. It should not include content associated with any other ObservationCategoryCodes (e.g. social-history, vital-signs, imaging, laboratory, survey, exam, therapy, activity)

      Background:

      USCDI V2 Clinical Test:

      Clinical Tests

      Includes non-imaging and non-laboratory tests performed on a patient that results in structured or unstructured (narrative) findings specific to the patient, such as electrocardiogram (ECG), visual acuity exam, macular exam, or graded exercise testing (GXT), to facilitate the diagnosis and management of conditions.

       

      Reasoning:

      Agree that Clinical Test is under-defined in the specification and in USCDI V2.  However, the proposal may over-define the concept to exclude clinical tests like sleep studies ( activity ) or exam findings.  Needs discussion and possible clarification from ONC.

      Proposed Changes:

      Until we get further clarification from ONC, we need to keep this profile as-is to allow for all the other categories that aren't included as laboratory observations and imaging observations.

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      Comment (extracted from attachment): Naming and description for what is and isn’t a “Clinical Test Result” is ambiguous. “Non-imaging and non-laboratory clinical test results” could functionally be more than just “procedure” observations; could potentially mean any of the other categories (social-history, vital-signs, procedure, survey, exam, therapy, activity). So this feels ambiguous. You’d have to notice that the other categories have there own profiles and realize “Clinical Test Result” JUST means observation category= procedure results. If this profile were named “Clinical Procedure Results” instead, it would be a bit better. Existing Wording: This profile sets minimum expectations for the Observation resource to record, search, and fetch non-imaging and non-laboratory clinical tests results for a patient. Proposed Wording: This profile sets minimum expectations for the Observation resource to record, search, and fetch non-imaging and non-laboratory clinical tests results (clinical procedure results) for a patient. As per the definition of the Procedure category, Observations generated by other procedures. This category includes observations resulting from interventional and non-interventional procedures excluding laboratory and imaging (e.g., cardiology catheterization, endoscopy, electrodiagnostics, etc.). Procedure results are typically generated by a clinician to provide more granular information about component observations made during a procedure. An example would be when a gastroenterologist reports the size of a polyp observed during a colonoscopy. It should not include content associated with any other ObservationCategoryCodes (e.g. social-history, vital-signs, imaging, laboratory, survey, exam, therapy, activity) Background: USCDI V2 Clinical Test: Clinical Tests Includes non-imaging and non-laboratory tests performed on a patient that results in structured or unstructured (narrative) findings specific to the patient, such as electrocardiogram (ECG), visual acuity exam, macular exam, or graded exercise testing (GXT), to facilitate the diagnosis and management of conditions.   Reasoning: Agree that  Clinical Test is under-defined in the specification and in USCDI V2.  However, the proposal may over-define the concept to exclude clinical tests like sleep studies ( activity ) or exam findings.  Needs discussion and possible clarification from ONC. Proposed Changes: Until we get further clarification from ONC, we need to keep this profile as-is to allow for all the other categories that aren't included as laboratory observations and imaging observations.
    • Eric Haas / Floyd Eisenberg: 7-0-0

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            joelbales Joel Bales
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