[Syphilis] FHIR Mapping for Syphilis AOE data

[DanielSass]

Why should we do this?

• In order to report Syphilis data to STLTs we need to map the disease specific AOE questions to FHIR

User story

As a SimpleReport engineer, I want syphilis AOE data sent in the appropriate FHIR format, so the data can flow through ReportStream and be available to STLTs

Action Requested

• Update FHIR converter logic to include syphilis results and AOE responses in FHIR bundle

Acceptance Criteria

Review

• [ ] Reviewed with design and/or design lead
• [ ] Reviewed with content strategist for final approval
• [ ] Reviewed with product and engineering

Additional Context

Syphilis AOE questions are listed in #7436 and are currently subject to change (4/16/2024). Once they are finalized/confirmed we will need to coordinate with ReportStream to verify the appropriate FHIR format.

-- From Nicole Gallaway, CDC SME for Syphilis:

There is no ‘verified list of symptoms’. I think the signs/symptom list you show looks generally good, except alopecia appears missing.

Suggested order:

If Syphilis result [Radio button] Positive

What is the gender of their sexual partners? (Select all that apply)
[checkbox] Female
[checkbox] Male
[checkbox] Transwoman
[checkbox] Transman
[checkbox] Nonbinary or gender non-conforming
[checkbox] Gender identity not listed here
[checkbox] Prefer not to answer

Has the patient been told they have syphilis before?
[Radio button] Yes: 1087151000119108
[Radio button] No: 14732006
[Radio button] Prefer not to answer: 261665006

Is the patient pregnant?
[Radio button] Yes
[Radio button] No
[Radio button] Prefer not to say

Is the patient currently experiencing or showing signs of symptoms?
[Radio button] Yes
[Radio button] No

Which symptoms are they experiencing?
- Genital sore/lesion (SNOMED: 724386005)
- Anal sore/lesion (SNOMED: 195469007)
- Sore(s) in mouth/lips (SNOMED: 26284000)
- Body Rash (SNOMED: 266128007)
- Palmar (hand)/plantar (foot) rash (SNOMED: 56940005)
- Flat white warts (SNOMED: 91554004)
- Hearing loss (SNOMED: 15188001)
- Blurred vision (SNOMED: 246636008)
- Alopecia (SNOMED: 56317004)

Date of symptom onset
[MM/DD/YYYY]

[Button] Submit results

[jayna-SkylightDigital]

SNOMED codes (below) must be verified before we can proceed.

SNOMED's for the requested symptoms

"Genital sore/lesion": "724386005"

"Anal sore/lesion": "195469007" - Possible other values: Anal skin tag (195469007); Anal tag (195469007); Fibrous polyp of anus (195469007)

"Sore(s) in mouth/lips": "26284000" - Possible other values: Ulcer of mouth (26284000); Oral ulcer (26284000); Mouth ulceration (26284000); Ulceration of oral mucosa (26284000); Mouth ulcer (26284000)

"Body Rash": "266128007"

"Palmar (hand)/plantar (foot) rash": "56940005"

"Flat white warts": "91554004"

"Hearing loss": "15188001"

"Blurred vision": "246636008"

SNOMEDs for our “Has the patient been told they have syphilis before?"

"Yes": "1087151000119108"

"No": "14732006" - This is the SNOMED for "No history of" for a general condition since we couldn't find one specific to syphilis

"Prefer not to answer": "261665006" - This is general “unknown” code, taken from the existing value set we have

[jayna-SkylightDigital]

From Nicole Gallaway, CDC SME for Syphilis:

There is no ‘verified list of symptoms’. I think the signs/symptom list you show looks generally good, except alopecia appears missing.

Suggested order:

Syphilis result
[Radio button] Positive
[Radio button] Negative
[Radio button] Inconclusive

What is the gender of their sexual partners? (Select all that apply)
[checkbox] Female
[checkbox] Male
[checkbox] Transwoman
[checkbox] Transman
[checkbox] Nonbinary or gender non-conforming
[checkbox] Gender identity not listed here
[checkbox] Prefer not to answer

Has the patient been told they have syphilis before?
[Radio button] Yes: 1087151000119108
[Radio button] No: 14732006
[Radio button] Prefer not to answer: 261665006

Is the patient pregnant?
[Radio button] Yes
[Radio button] No
[Radio button] Prefer not to say

Is the patient currently experiencing or showing signs of symptoms?
[Radio button] Yes
[Radio button] No

Which symptoms are they experiencing?
- Genital sore/lesion (SNOMED: 724386005)
- Anal sore/lesion (SNOMED: 195469007)
- Sore(s) in mouth/lips (SNOMED: 26284000)
- Body Rash (SNOMED: 266128007)
- Palmar (hand)/plantar (foot) rash (SNOMED: 56940005)
- Flat white warts (SNOMED: 91554004)
- Hearing loss (SNOMED: 15188001)
- Blurred vision (SNOMED: 246636008)
- Alopecia (SNOMED: 56317004)

Date of symptom onset
[MM/DD/YYYY]

[Button] Submit results

[DanielSass]

Need to coordinate with report stream to figure out how to map new AOE questions

[DanielSass]

New plan: punt the new AOE questions that we don't necessarily know how to map into a different ticket (#TBD) and map the more well understood ones within the scope of this ticket.

[jayna-SkylightDigital]

Please use AOE questions as shown in the above comment with the timestamp Aug 26, 2024 12:56 PM EDT.

*Please note the new question asking if the patient has been told they have syphilis in the past. This question will be present for Syphilis only.

Mapping to FHIR: Has the patient been told they have syphilis before? [Radio button] Yes: 1087151000119108 [Radio button] No: 14732006 [Radio button] Prefer not to answer: 261665006

Copy change only And the revised/update text for symptoms asking if they are experiencing or showing signs of symptoms. This can be updated to display with the same text for all conditions. Is the patient currently experiencing or showing signs of symptoms? [Radio button] Yes [Radio button] No

[DanielSass]

Map the new history of syphilis data in line with other AOE questions, reach out to report stream to verify it looks correct.

[jayna-SkylightDigital]

@DanielSass will reach out to James Gilmore to determine the Syphilis-specific SNOMED code for history of Syphilis.