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AuDigitalHealth / ci-fhir-r4

Working drafts of HL7™ FHIR® Release 4 (R4) artefacts authored and maintained by the Informatics Architecture team at the Australian Digital Health Agency.
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ValueSet - DiagnosticReport.category - pathology diagnostic service #61

Closed dtr-agency closed 4 years ago

dtr-agency commented 4 years ago

Prerequisites

The feature

Description

We need to create a value set for the category element of pathology domain DiagnosticReport profiles to send pathology diagnostic service. The ValueSet should support exchange of pathology reports issued by pathology service providers for the electronic exchange of pathology reports between healthcare providers, and between healthcare providers and the My Health Record system infrastructure in Australia.

The values are preferred to be drawn from the Diagnostic Service Section Codes ValueSet which uses the v2 DIAGNOSTIC SERVICE SECTION ID v2.0074 code system.

This ValueSet would be bound to the Pathology domain DiagnosticReport profiles in the forthcoming Diagnostics Report FHIR implementation Guide; it would also be used to indicate diagnostic service categories in profiles in Continuity of Care specifications e.g. Discharge Summary and Event Summary. The ValueSet would also be bound in the corresponding CDA implementation guides.

Concerns

  1. the ValueSet needs to be responsive to the release of new codes for pathology

An extensional defined set would need manual intervention but is there a reasonable means of having a intentional defined set when drawing a subset of codes from HL7 Version 2 Table 0074?

What it actually enables people to do

Clarifies to implementers requirements for set of codes relevant to pathology. Provision of management of the set of values in a governed manner that is reusable.

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.

Workarounds

A. Leave the binding as-is. B. Strengthen the binding strength from preferred to extensible or required.

Additional context

dtr-agency commented 4 years ago

This ValueSet when developed will be bound in DiagnosticReport.category as part of:

dtr-agency commented 4 years ago

Analysis of codes in the required value set

Analysis of possible usage of codes in HL7 v2 table 0074 (DIAGNOSTIC SERVICE SECTION ID) Code Display In / Out for Pathology Domain / Rationale
AU Audiology  Out Other/Specialist
BG Blood Gases  In Pathology
BLB Blood Bank  In Pathology
CG Cytogenetics  In Pathology
CH Chemistry  In Pathology
CP Cytopathology  In Pathology
CT CAT Scan  Out Diagnostic Imaging
CTH Cardiac Catheterization  Out Other/Specialist
CUS Cardiac Ultrasound  Out Other/Specialist
EC Electrocardiac (e.g., EKG, EEC, Holter)  Out Other/Specialist
EN Electroneuro (EEG, EMG,EP,PSG)  Out Other/Specialist
GE Genetics  In Pathology
HM Hematology  In Pathology
ICU Bedside ICU Monitoring  Out Other/Specialist
IMM Immunology  In Pathology
LAB Laboratory  In Pathology
MB Microbiology  In Pathology
MCB Mycobacteriology  In Pathology
MYC Mycology  In Pathology
NMR Nuclear Magnetic Resonance  Out Diagnostic Imaging
NMS Nuclear Medicine Scan  Out Diagnostic Imaging
NRS Nursing Service Measures  Out Other/Specialist
OSL Outside Lab  In Pathology
OT Occupational Therapy  Out Other/Specialist
OTH Other  In Pathology & Diagnostic Imaging & Other/Specialist
OUS OB Ultrasound  Out Diagnostic Imaging
PF Pulmonary Function  Out Other/Specialist
PHR Pharmacy  Out Other/Specialist
PHY Physician (Hx. Dx, admission note, etc.)  TBD Other/Specialist
PT Physical Therapy  Out Other/Specialist
RAD Radiology  Out Diagnostic Imaging
RC Respiratory Care (therapy)  Out Other/Specialist
RT Radiation Therapy  Out Other/Specialist? Diagnostic Imaging?
RUS Radiology Ultrasound  TBD Diagnostic Imaging
RX Radiograph  TBD Diagnostic Imaging
SP Surgical Pathology  In Pathology
SR Serology  In Pathology
TX Toxicology  In Pathology
VR Virology  In Pathology
VUS Vascular Ultrasound  Out Diagnostic Imaging
XRC Cineradiograph Out Diagnostic Imaging

The above shallow analysis suggests there is a clear separation in most cases for the three usage scenario domains we are looking at supporting for diagnostic reporting: pathology, diagnostic imaging, and other / specialist.

NOTE: Above table edited based on reviews.

dtr-agency commented 4 years ago

@davidmckillop, can you please review the above analysis of codes against the three domains? and could you please provide a comment on whether the inclusion of OTH would be appropriate in the pathology-specific set we are designing?

davidmckillop commented 4 years ago

@dtr-agency, yes I would include OTH in the pathology-specific set and I've had agreement with @LB-Agency on this. OTH allows a provider to use this code in circumstances where the service provider feels the codes in the valueset do not best suit their needs e.g. a specialist lab or a laboratory for a specific purpose e.g. a forensic laboratory. OTH also accommodates new values that are not suited to any of the existing values. The code "VR" needs to be included in the pathology valueset.
All other codes (including VR) listed in the table above are relevant inclusions in the pathology group.

@davidmckillop I have now edited the table to have VR associated with pathology. Do you have any further comments? @dtr-agency - no further issues found. The pathology list is complete.

dtr-agency commented 4 years ago

This issue is scoped specifically to support exchange of pathology reports so only the pathology context work will be progressed.

Suggested outcomes:

  1. A new ValueSet for pathology diagnostic service the agreed codes marked as applicable to pathology above.
dtr-agency commented 4 years ago

ValueSet Design Notes

1. A new ValueSet for pathology diagnostic service category from HL7 v2 table 0074 (DIAGNOSTIC SERVICE SECTION ID)

ValueSet element Suggested value
title Pathology Diagnostic Service Category
canonical url https://healthterminologies.gov.au/fhir/ValueSet/pathology-diagnostic-service-category-1
version 1.0.0
description The Pathology Diagnostic Service Category value set includes values that may be used to indicate the diagnostic service where a pathology observation was performed.
compose system: "http://terminology.hl7.org/CodeSystem/v2-0074"; the following codes are required to be included "BG", "BLB", "CG", "CH", "CP", "GE", "HM", "IMM", "LAB", "MB", "MCB", "MYC", "OSL", "OTH", "SP", "SR", "TX", "VR"

the codes are listed as a requirement; there is no constraint on the exact means of inclusion when authoring the value set.

Associated FHIR Terminology Request: FTR-953

dtr-agency commented 4 years ago

Query for Terminology Analyst - the ValueSet needs to be responsive to the release of new codes for pathology.

An extensional defined set would need manual intervention but is there a reasonable means of having a intentional defined set when drawing a subset of codes from HL7 Version 2 Table 0074?

What is suggested for meeting this requirement?

dtr-agency commented 4 years ago

Product owner okayed designs; Now for internal review with @robeastwood-agency, and review with Terminology Analyst 01/06.

robeastwood-agency commented 4 years ago

Internal review completed; no issues found.

LB-Agency commented 4 years ago

@dtr-agency, yes I would include OTH in the pathology-specific set and I've had agreement with @LB-Agency on this. OTH allows a provider to use this code in circumstances where the service provider feels the codes in the valueset do not best suit their needs e.g. a specialist lab or a laboratory for a specific purpose e.g. a forensic laboratory. OTH also accommodates new values that are not suited to any of the existing values. The code "VR" needs to be included in the pathology valueset. All other codes (including VR) listed in the table above are relevant inclusions in the pathology group.

@davidmckillop I have now edited the table to have VR associated with pathology. Do you have any further comments? @dtr-agency - no further issues found. The pathology list is complete.

I see little value in using "extensible" binding over "required" with the inclusion of "OTH" in the set. If there is an expectation a code should be provided from the set, including "OTH" means there is always an applicable value available. Further meaning could then be conveyed through an additional coding (cardinality max=*) with a value from a different system. Perhaps SNOMED CT-AU descendants of Pathology service. These are the same services bound in AU Base to HealthcareService.type.

LB-Agency commented 4 years ago

Regarding the responsiveness to new codes being added to HL7 Version 2 Table 0074, the value set definition will be specific to version 2.9. There should be a maintenance review of all value sets binding specific versions of things following the release of a new fhir version.

LB-Agency commented 4 years ago

ValueSet Design Notes

1. A new ValueSet for pathology diagnostic service category from HL7 v2 table 0074 (DIAGNOSTIC SERVICE SECTION ID)

ValueSet element Suggested value title Pathology Diagnostic Service Category name PathologyDiagnosticServiceCategory canonical url https://healthterminologies.gov.au/fhir/ValueSet/pathology-diagnostic-service-category-1 version 1.0.0 description The Pathology Diagnostic Service Category value set includes values that may be used to indicate the diagnostic service where a pathology observation was performed. compose system: "http://hl7.org/fhir/request-status"; the following codes are required to be included "BG", "BLB", "CG", "CH", "CP", "GE", "HM", "IMM", "LAB", "MB", "MCB", "MYC", "OSL", "OTH", "SP", "SR", "TX", "VR" the codes are listed as a requirement; there is no constraint on the exact means of inclusion when authoring the value set.

Associated FHIR Terminology Request: FTR-953

The current proposed naming (Pathology Diagnostic Service Category) implies that there will only be one value set for all pathology categories and restricts the naming of different future ones. Perhaps the naming could reflect the values in the definition and be more along the lines of "Pathology Diagnostic Service Sections"?

dtr-agency commented 4 years ago

@LB-Agency; that term was considered and is not as desired - the word 'section' was intentionally excluded; the peer review and product owner review has ended for content. Unless a defect is identified this content is as designed.

dtr-agency commented 4 years ago

Now accepted. Moving to publication schedule.

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 Pathology Diagnostic Service Category.

ConceptMaps are in the authoring and publication schedule for later this year.