Re: cardinalities of entries in lists of medical summaries

[Andrew McCaffrey]

There is some language here that should get you started in the right
direction:

<http://healthcare.nist.gov/use_testing/faq.html#Meaningful_Use_requires_a_medication_section>

Note that this FAQ concerns HITSP/C32 and not just IHE, so there are
some extra template IDs in those examples that aren't necessary for you.
But the main lesson to learn is that these three SNOMED-CT codes can
be used in this situation:

182904002 -- Drug Treatment Unknown
182849000 -- No Drug Therapy Prescribed
408350003 -- Patient Not On Self-Medications

Hope that helps.


On 07/18/2012 10:28 AM, Tony Schaller wrote:
> Hi PCC team
>
> I�m wondering how we should handle the following situation correctly.
>
> The question refers to IHE EDPN
> (http://www.ihe.net/Technical_Framework/upload/IHE_PCC_Suppl_EDES_Rev2-2_TI_2011-09-09.pdf).
>
> Section 6.3.1.D.4 Data Element Index declares the Medication as �Current
> Medications�.
>
> Section �6.3.1.D.5 Specification� declares the �Medication� section as
> *required*: Medications R 1.3.6.1.4.1.19376.1.5.3.1.3.19
>
> The Medications template (1.3.6.1.4.1.19376.1.5.3.1.3.19) is described
> in PCC-TF2
> (http://www.ihe.net/Technical_Framework/upload/IHE_PCC_TF_Rev7-0_Vol_2_2011-09-09.pdf),
> Section �6.3.3.3.1 Medications Section 1.3.6.1.4.1.19376.1.5.3.1.3.19�
>
> This section declares the Medications as *required*:
> 1.3.6.1.4.1.19376.1.5.3.1.4.7 R Medications
>
> Regarding these specifications it is not possible to have list without
> at least one entry.
>
> But how does a correct document look like when there is no current
> medication?
>
> 1.Should one add a dummy substanceAdministration? or
>
> 2.Should one omit the whole section? or
>
> 3.Is there another solution?
>
> The first alternative is one I � and hopefully most of you - don�t like�
>
> The second alternative is currently not permitted by the Schematron
> rules used by Gazelle for 1.3.6.1.4.1.19376.1.5.3.1.3.19 (/Error: In IHE
> PCC Medications Section (1.3.6.1.4.1.19376.1.5.3.1.3.19), a Medications
> Section must contain Medications./)�
>
> The third alternative is one I do not know about, yet.
>
> The same situation occurs also in almost all other sections containing a
> list of entries (e.g. Allergies and Other Adverse Reactions). One cannot
> assume that there is always at least one real entry! There must exist a
> solution to specify an empty list (e.g. �no current medications�).
>
> Thus I�m kind of lost and I thank you in advance for your clarification.
>
> Kind regards
> Technical project manager IHE Suisse
> Tony Schaller
>
> ________________________________________
>
> Tony Schaller
> Gesch�ftsf�hrer
> Ing. Wirtschaftsinformatik FH/HTL
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>
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--
Andrew McCaffrey
andrew.m...@nist.gov
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[Andrew McCaffrey]

I don't know of a general way to say "empty list", but specifically for
allergies:

IHE PCC Problem Entry also gives more guidance for other codes to use
for no/unknown allergies. See Volume II of the IHE PCC Technical
Framework, Section 6.3.4.14 Problem Entry. Specifically the table in
Section 6.3.4.14.11 which defines the value element.

409137002 -- No Known Drug Allergies -- To indicate that there are
no known Drug allergies for this patient.
160244002 -- No Known Allergies -- To indicate that there are no
known allergies for this patient.
64970000 -- Substance Type Unknown -- To indicate the state where
there is a known allergy or intolerance to an unknown substance.

Unfortunately those are all SNOMED codes...

On 07/18/2012 11:07 AM, Tony Schaller wrote:
> I agree, Keith. This is very helpful. Thanks a lot.
>
> Thanks also to Andrew McCaffrey for his response which is congruent.
>
> Are there also some codes to declare other �empty lists� such as �No
> allergies or other adverse reactions� or �no previous surgeries�.
>
> Please notice, that we currently do not have a SNOMED-CT license in
> Switzerland ;-(
>
> Therefore I assume that we need to define a Helvetic code system for
> these values. Am I right?
>
> Regards, Tony
>
> *Von:*pcc...@googlegroups.com [mailto:pcc...@googlegroups.com] *Im
> Auftrag von *Boone, Keith W (GE Healthcare)
> *Gesendet:* Mittwoch, 18. Juli 2012 16:37
> *An:* Tony Schaller; pcc...@googlegroups.com
> *Betreff:* RE: cardinalities of entries in lists of medical summaries
>
> If the section was omitted or empty, you would have no way to
> distinguish between I don�t know if there are any, and I know there are
> none. Thus, option 1 is the solution we chose.
>
> Section 6.3.4.16.7 of the PCC TF-2 discusses codes you can use a
> medication entry to indicate the following cases:
>
> One of the following values from SNOMED CT shall be used in the <code>
> element to record
>
> that a patient is either not on medications, or that medications are not
> known
>
> Table 6.3.4.16.7-1
>
> Entry Type Code Display Name Description
>
> Medication 182904002 Drug Treatment Unknown To indicate lack of
> knowledge about drug therapy
>
> Medication 182849000 No Drug Therapy Prescribed To indicate the absense
> of any prescribed medications
>
> Medication 408350003 Patient Not On Self-Medications To indicate no
> treatment
>
> Keith
>
> *__________________________________
> _**Keith W. Boone*
> Standards Architect
> GE Healthcare
>
> M +1 617 640 7007
>
> keith...@ge.com <mailto:keith...@ge.com>
> www.gehealthcare.com <http://www.gehealthcare.com/>
>
> 116 Huntington Ave
> Boston, MA 02116
> USA
>
> GE imagination at work
>
> *From:*pcc...@googlegroups.com <mailto:pcc...@googlegroups.com>
> [mailto:pcc...@googlegroups.com]
> <mailto:[mailto:pcc...@googlegroups.com]> *On Behalf Of *Tony Schaller
> *Sent:* Wednesday, July 18, 2012 10:28 AM
> *To:* 'pcc...@googlegroups.com'
> *Subject:* cardinalities of entries in lists of medical summaries

> <mailto:pcc...@googlegroups.com>.

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