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  1. FHIR Specification Feedback
  2. FHIR-38784

Relax Encounter.diagnosis.use to allow multiple classifications

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • FHIR Core (FHIR)
    • R4
    • Patient Administration
    • Encounter
    • 8.11 Resource Encounter - Content
    • Hide

      Encounter.reason.use will be updated from 0..1 to 0..*

      Encounter.diagnosis.use will be updated from 0..1 to 0..*

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      Encounter.reason.use will be updated from 0..1 to 0..* Encounter.diagnosis.use will be updated from 0..1 to 0..*
    • Brian Postlethwaite / Reinhard Egelkraut : 10-0-0
    • Enhancement
    • Non-compatible
    • R5

    Description

      [On behalf of Vitaly Rodionov]

      A patient may have more than one diagnosis during, for example, a hospitalization.

      We may slice those as a set of interrelated conditions, each of which represents "a patient's diagnosis". E.g., a diagnosis at admission, a diagnosis at the discharge, one or more slices per surgery (pre- and post- slices), etc.

      The problem here is not to list several condition, but to classify each condition using several axis.

      The proposed solution is to relax Encounter.diagnosis.use cardinality from 0..1 to 0..*, that allows to express several axes of diagnosis classification as part of a complex structured diagnosis for an encounter. I.e.:

      The * diagnosis[0].condition = Reference(Condition/RuCoreDiagnosisNosologyInstance2) "I20 Ischaemic heart diseases"
* diagnosis[=].rank = 1
* diagnosis[=].use[0] = http://terminology.hl7.org/CodeSystem/diagnosis-role#AD "Admission diagnosis"
* diagnosis[=].use[+] = http://fhir.ru/core/cs/core-cs-nsi-diagnosis-justification-degree#10 "Preliminary clinical diagnosis"
* diagnosis[=].use[+] = http://fhir.ru/core/cs/core-cs-nsi-diagnosis-nosology-kind#8 "Competing condition"

* diagnosis[+].condition = Reference(Condition/RuCoreDiagnosisNosologyInstance3) "I49.9 Arrhythmia"
* diagnosis[=].rank = 1
* diagnosis[=].use[0] = http://terminology.hl7.org/CodeSystem/diagnosis-role#AD "Admission diagnosis"
* diagnosis[=].use[+] = http://fhir.ru/core/cs/core-cs-nsi-diagnosis-justification-degree#10 "Preliminary clinical diagnosis"
* diagnosis[=].use[+] = http://fhir.ru/core/cs/core-cs-nsi-diagnosis-nosology-kind#8 "Competing condition"

       

       

      The binding strength for the diagnosis.use component may stay the same, i.e. Preferred that allows to utilize a local CodeSystem if needed.

       

      Related discussion - https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Encounter.2Ediagnosis.2Euse

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            brian.postlethwaite Brian Postlethwaite
            shamil Shamil Nizamov
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              Created:
              Updated:
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