dtr-agency
commented
4 years ago This ValueSet when developed will be bound as required in DiagnosticReport.status as part of:
Closed dtr-agency closed 4 years ago
dtr-agency
commented
4 years ago This ValueSet when developed will be bound as required in DiagnosticReport.status as part of:
dtr-agency
commented
4 years ago | Analysis of possible usage of codes in DiagnosticReportStatus | Code | Applicable context | In / Out for diagnostic reports | Rationale |
|---|---|---|---|---|
| registered | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| partial | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| preliminary | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| final | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| amended | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| corrected | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| appended | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| cancelled | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| entered-in-error | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| unknown | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results |
The shallow analysis suggests that the set of codes relevant in a diagnostic reporting context are relevant across the three domains. There is also a clear set of codes applicable to the reporting usage scenarios.
| Analysis of possible usage of codes in HL7 Version 2 Table 0123 | Code | Display | Applicable context | In / Out for diagnostic reports | Rationale |
|---|---|---|---|---|---|
| A | Some, but not all, results available | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| C | Corrected, final | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| F | Final results | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| I | No results available; specimen received, procedure incomplete | Pathology / Other | Out | Does not serve the use case of reporting of results | |
| M | Corrected, not final | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| N | Procedure completed, results pending | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| O | Order received; specimen not yet received | Pathology / Other | Out | Does not serve the use case of reporting of results | |
| P | Preliminary | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| R | Results stored; not yet verified | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| S | No results available; procedure scheduled, but not done | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| X | No results available; Order canceled | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| Y | No order on record for this test | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| Z | No record of this patient | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results |
The shallow analysis suggests that the set of codes relevant in a diagnostic reporting context are slightly different across the three domains. There is however a clear set of codes applicable to reporting usage scenarios.
| Analysis of possible usage of codes in the CodeSystem NCTIS Result Status Values | Code | Display | Applicable context | In / Out for diagnostic reports | Rationale |
|---|---|---|---|---|---|
| 1 | Registered | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results | |
| 2 | Interim | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results. It is common and meaningful to send a diagnostic report with initial results with a final to follow. | |
| 3 | Final | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| 4 | Amended | Pathology / Diagnostic Imaging / Other | In | Supports use case of reporting of results | |
| 5 | Cancelled / Aborted | Pathology / Diagnostic Imaging / Other | Out | Does not serve the use case of reporting of results |
The shallow analysis suggests that the set of codes relevant in a diagnostic reporting context are relevant across the three domains. There is also a clear set of codes applicable to the reporting usage scenarios.
dtr-agency
commented
4 years ago @davidmckillop, can you please review the above analysis of codes against the three domains?
davidmckillop
commented
4 years ago @dtr-agency - I agree with your analysis of the codes to be included in/out for the diagnostic report use case for the above 3 domains.
dtr-agency
commented
4 years ago Suggested outcomes:
dtr-agency
commented
4 years ago | ValueSet element | Suggested value |
|---|---|
| title | DiagnosticReportStatus Report Available |
| canonical url | https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1 |
| version | 1.0.0 |
| description | The DiagnosticReportStatus Report Available value set includes values that may be used to represent the status of a diagnostic report that is available for electronic exchange of health information between healthcare providers, and between healthcare providers and the My Health Record system in Australia. |
| compose | "system": "http://hl7.org/fhir/diagnostic-report-status"; concept: [code: "partial"; code: "preliminary"; code: "final"; code: "amended"; code: "corrected"; code: "appended"] |
Associated FHIR Terminology Request: FTR-933
NOTE: Design amended to fix list of codes and system value in compose from internal review comments
dtr-agency
commented
4 years ago @davidmckillop - ready for product owner walkthrough of proposed value set design. Product owner okayed, moving to internal review with @LB-Agency .
LB-Agency
commented
4 years ago Review of DiagnosticReportStatus Report Available value set.
I agree with the analysis of codes for this use case. Only comment is to update the design table so compose includes, "system": "http://hl7.org/fhir/diagnostic-report-status"; "version": "4.0.1"; "code": "partial".
NCTS resources will contain version specific references to external content unless normative and known to not have future backwards incompatible changes introduced.
RESPONSE
REVIEWER (@LB-Agency) RESPONSE Confirmed changes and accepted
dtr-agency
commented
4 years ago HL7 Version 2 Table 0123 vs NCTIS Result Status Values vs DiagnosticReportStatus.
The semantics of what we are looking to capture here is status of the report itself, as distinct from the status of the results inside the report (similar to status of results of a panel or study), or the status of the result of an observation (Observation.status) or status of the activity (workflow). HL7 Version 2 Table 0123 is predominately populated by codes that describe the status of the results inside the result (e.g. F) with some workflow codes (e.g. R). The codes do not resolve to 'final report' or 'interim report'. Though there is a strong implicit relationship between result status and report status they are not the same concept.
This use of HL7 Version 2 Table 0123 at a report-level is an extant issue on the legacy eHealth Pathology Report CDA implementation guides and eHealth Diagnostic Imaging Report CDA implementation guides.
HL7 Version 2 Table 0123 is not suitable to support the concept of DiagnosticReport status in FHIR-based CDA.
The semantics of what we are looking to capture here is status of the report itself, as distinct from the status of the results inside the report (similar to status of results of a panel or study), or the status of the result of an observation (Observation.status) or status of the activity (workflow). DiagnosticReportStatus is populated by codes that describe the status of a report. These codes have been intended for this exact purpose.
DiagnosticReportStatus is suitable to support the concept of DiagnosticReport status in FHIR-based CDA.
The semantics of what we are looking to capture here is status of the report itself, as distinct from the status of the results inside the report (similar to status of results of a panel or study), or the status of the result of an observation (Observation.status) or status of the activity (workflow). NCTIS Result Status Values does not predefine the context and some codes can be used to indicate the status of result (i.e. Observation.status) or the status of a report (i.e. DiagnosticReport.status) with a workflow code (e.g. Cancelled/Aborted). The codes rely on their use in a particular structure to resolve to either 'final report' or 'final observation result'.
There are extant known issues on the use of NCTIS Result Status Values in current CDA implementation guides - it is noted that these codes are created by the Agency and are less precise and rich than other available terminologies, and it is not a domain accepted terminology.
NCTIS Result Status Values is not recommended (though it is somewhat suitable) to support the concept of DiagnosticReport status in FHIR-based CDA.
Allowing multiple terminologies at authoring time only makes it easy for authoring systems. However the burden on consuming systems is too high. If we move to supporting a single terminology for this concept then with ConceptMaps authoring systems can internally maintain their preferred terminology and convert when sending either FHIR/CDA. And Consuming systems only need to be capable of transforming that one terminology in either FHIR/CDA into their preferred terminology.
NOTE: There is little value in preparing a constrained equivalent representation using NCTIS Result Status Values of the proposed DiagnosticReportStatus Report Available ValueSet to have available in the circumstance that these recommendations are not accepted. NCTIS Result Status Values has much less richness, and of the available codes only the workflow code for 'Cancelled/Aborted' would be constrained out.
dtr-agency
commented
4 years ago @LB-Agency, please review the above discussion of applicability of candidate terminology in CDA. @davidmckillop, please look at this from Pathology SME perspective.
davidmckillop
commented
4 years ago @dtr-agency - I agree with the recommendations described above that :
LB-Agency
commented
4 years ago Review comments:
dtr-agency
commented
4 years ago NOTE: These will be progressed via internal terminology tasks as per the BAU publication schedule; this GitHub issue will not be kept up to date. This content has been included here as an indication of the initial direction of this content.
| ConceptMap element | Suggested value |
|---|---|
| title | DiagnosticReportStatus Report Available to v2 RESULT STATUS - OBR |
| canonical url | https://healthterminologies.gov.au/fhir/ConceptMap/diagnosticreportstatus-report-avail-to-v2-result-status-obr-1 |
| version | 1.0.0 |
| description | The DiagnosticReportStatus Report Available to v2 RESULT STATUS - OBR concept map defines relationships from the concepts in the DiagnosticReportStatus Report Available value set to the concepts in the v2 RESULT STATUS - OBR value set. |
| sourceCanonical | https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1 |
| targetCanonical | http://terminology.hl7.org/ValueSet/v2-0123 |
| group | [code: "partial"; target code: "A"; equivalence: "narrower"; comment: "partial subsumes but is not limited to the concept of some but not all results available"] [code: "partial"; target code: "R"; equivalence: "narrower"; comment: "partial subsumes but is not limited to the concept of results stored but not yet verified"] [code: "preliminary"; target code: "P"; equivalence: "equivalent"] [code: "final"; target code: "F"; equivalence: "equivalent"] [code: "amended"; target code: "C"; equivalence: "narrower"; comment: "amended subsumes but is not limited to the concept of correction"] [code: "corrected"; target code: "C"; equivalence: "equivalent"] [code: "appended"; equivalence: "unmatched"] |
The content in group is a suggested starting point; review and analysis by a terminology analyst when authoring is necessary.
Associated FHIR Terminology Request: FTR-1058
| And | ConceptMap element | Suggested value |
|---|---|---|
| title | v2 RESULT STATUS - OBR to DiagnosticReportStatus Report Available | |
| canonical url | https://healthterminologies.gov.au/fhir/ConceptMap/v2-result-status-obr-to-diagnosticreportstatus-report-avail-1 | |
| version | 1.0.0 | |
| description | The v2 RESULT STATUS - OBR to DiagnosticReportStatus Report Available concept map defines relationships from the concepts in the v2 RESULT STATUS - OBR value set to the concepts in the DiagnosticReportStatus Report Available value set. This mapping is applicable where the v2 RESULT STATUS - OBR value set has been bound to a report level status element. This concept map may be used to support transitioning legacy materials from a conformant Agency CDA template to a FHIR-driven CDA template. | |
| sourceCanonical | http://terminology.hl7.org/ValueSet/v2-0123 | |
| targetCanonical | https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1 | |
| group | [code: "A"; target code: "partial"; equivalence: "wider"] [code: "C"; target code: " corrected"; equivalence: "equivalent"] [code: "F"; target code: "final"; equivalence: "equivalent"] [code: "I"; equivalence: "unmatched"] [code: "M"; target code: "preliminary"; equivalence: "wider"] [code: "N"; equivalence: "unmatched"] [code: "O”; equivalence: "unmatched"] [code: "P"; target code: "preliminary"; equivalence: "equivalent"] [code: "R"; target code: "preliminary"; equivalence: "equivalent"] [code: "S"; equivalence: "unmatched"] [code: "X"; equivalence: "unmatched"] [code: "Y"; equivalence: "unmatched"] [code: "Z”; equivalence: "unmatched"] |
The content in group is a suggested starting point; review and analysis by a terminology analyst when authoring is necessary.
Associated FHIR Terminology Request: FTR-1063
| ConceptMap element | Suggested value |
|---|---|
| title | DiagnosticReportStatus Report Available to NCTIS Result Status Values |
| canonical url | https://healthterminologies.gov.au/fhir/ConceptMap/diagnosticreportstatus-report-avail-to-v2-result-status-obr -1 |
| version | 1.0.0 |
| description | The DiagnosticReportStatus Report Available to NCTIS Result Status Values concept map defines relationships from the concepts in the DiagnosticReportStatus Report Available value set to the concepts in the NCTIS Result Status Values value set. This mapping is applicable where the NCTIS Results Status Values value set has been bound to a report level status element. |
| sourceCanonical | https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1 |
| targetCanonical | https://healthterminologies.gov.au/fhir/ValueSet/nctis-result-status-values-1 |
| group | [code: "partial"; target code: "2"; equivalence: "equivalent"] [code: "preliminary"; target code: "2"; equivalence: "wider"] [code: "final"; target code: "3"; equivalence: "equivalent"] [code: "amended"; target code: "4"; equivalence: " equivalent"] [code: "corrected"; target code: "4"; equivalence: "wider"] [code: "appended"; target code: "4"; equivalence: "wider"] |
The content in group is a suggested starting point; review and analysis by a terminology analyst when authoring is necessary.
Associated FHIR Terminology Request: FTR-1048
| And | ConceptMap element | Suggested value |
|---|---|---|
| title | NCTIS Result Status Values to DiagnosticReportStatus Report Available | |
| canonical url | https://healthterminologies.gov.au/fhir/ConceptMap/v2-result-status-obr-to-diagnosticreportstatus-report-avail-1 | |
| version | 1.0.0 | |
| description | The NCTIS Result Status Values to DiagnosticReportStatus Report Available concept map defines relationships from the concepts in the NCTIS Result Status Values value set to the concepts in the DiagnosticReportStatus Report Available value set. This mapping is applicable where the NCTIS Results Status Values value set has been bound to a report level status element. This concept map may be used to support transitioning legacy materials from a conformant Agency CDA template to a FHIR-driven CDA template. | |
| sourceCanonical | https://healthterminologies.gov.au/fhir/ValueSet/nctis-result-status-values-1 | |
| targetCanonical | https://healthterminologies.gov.au/fhir/ValueSet/diagnosticreportstatus-report-available-1 | |
| group | [code: "1"; equivalence: "unmatched"] [code: "2"; target code: "partial"; equivalence: "equivalent"] [code: "3"; target code: "final"; equivalence: " equivalent "] [code: "4"; target code: "amended"; equivalence: "equivalent"] [code: "5"; equivalence: "unmatched"] |
The content in group is a suggested starting point; review and analysis by a terminology analyst when authoring is necessary.
Associated FHIR Terminology Request: FTR-1053
dtr-agency
commented
4 years ago This issue has been shifted to 'complete'; publication of the content in NCTS is pending release of NTS 2.0.
dtr-agency
commented
4 years ago To remain open until publication is confirmed.
dtr-agency
commented
4 years ago NCTS 2.0 is now live with DiagnosticReportStatus Report Available.
ConceptMaps are in the authoring and publication schedule for later this year.
Prerequisites
The feature
Description
We need to create a more constrained value set for the status element of DiagnosticReport profiles to support exchange of diagnostic reports issued by diagnostic service providers for the electronic exchange of diagnostic reports (e.g. pathology, imaging, specialist and other) between healthcare providers, and between healthcare providers and the My Health Record system infrastructure in Australia.
The usage scenarios expects a meaningful patient-centric snapshot, i.e. one or more investigations have been performed and there is some reported information that is meaningful to share between healthcare providers, and between healthcare providers and the My Health Record system to support provision of healthcare.
The values must be drawn from the required DiagnosticReportStatus ValueSet. Possibly the new ValueSet may contain the codes of "partial", "preliminary", "final", "amended", "corrected", "appended" and exclude "registered", cancelled", "entered-in-error" & "unknown".
This ValueSet would be bound to DiagnosticReport profiles in the forthcoming Diagnostics Report FHIR implementation Guide, and may be used in other implementation guides that contain DiagnosticReport profiles.
What it actually enables people to do
Clarifies to implementers requirements for the state of a diagnostic report in the electronic exchange of diagnostic imaging reports between healthcare providers, and between healthcare providers and the My Health Record system infrastructure in Australia. Provision of management of the set of values in a governed manner that is reusable across multiple profiles.
How awesome would it be?
Pretty awesome - clarity of requirements is always desired, and management by terminology binding is the preferred means in CI Agency profiles of specifying more than one allowed values for an element. This contributes to minimising the risk of inappropriate, invalid or obsolete clinical content.
Workarounds
There are other means of specifying controls on the membership of values including invariants, or alternatively only implementation guidance could be provided instead of a machine processable format.
Additional context