Details
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Change Request
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Resolution: Persuasive
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Medium
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US QI Core (FHIR)
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4.1.1
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Clinical Quality Information
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Table of Contents
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profiles
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Floyd Eisenberg/ Linda Michaelsen: 13-0-0
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Clarification
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Non-substantive
Description
Add note to balloters to provide input as follows:
Note To Balloters:
Two questions:
1. QI-Core has used the Encounter.diagnosis element to define diagnoses addressed as part of the encounter, and used Must Support elements to request specific data:
Encounter.diagnosis.extension:diagnosisPresentOnAdmission to allow reference to whether each specified diagnosis was present on admission
Encounter.diagnosis.use to indicate the diagnosis-role, and indicate “billing diagnosis” to support identification of principal diagnosis
Encounter.diagnosis.rank to indicate “1” to support identification of principal diagnosis (i.e., principal diagnosis definition is use = billing diagnosis and rank = 1)
FHIR supports the concept of Claim.diagnosis.onAdmission, Claim.diagnosis.sequence, and Claim.diagnosis.type to address concepts of principal diagnosis and present on admission. However, feedback has suggested that use of Encounter.diagnosis is preferred as designed in QI-Core. Some have advised use of the FHIR Account resource but that does not specify diagnoses. Please advise if the current QI-Core approach is preferred or, if not, which path should be taken instead for the information desired.
2. Given the US Core approach to determining encounter diagnoses using Encounter.reasonReference with reference to Condtion Encounter Diagnosis Profile, which of the following approaches are most appropriate to capture all conditions managed during an encounter:
Request Encounter.reasonReference with reference to both Condition Encounter Diagnosis and Condition Problems and Health Concerns, or only one of these two references (and which of the two is preferred)
Request Encounter.diagnosis with reference to both Condition Encounter Diagnosis and Condition Problems and Health Concerns, or only of of these two references (and which of the two is preferred)
Request both Encounter.reasonReference and Encounter.diagnosis as specified in the previous two bulleted items