Overview
This section details the design approach using FHIR Resources to support the PRSB heading model for a condition list. The condition Resource is referenced via the List Resource. Implementation guidance on diagnoses from the discharge summary PRSB standard: The discharge summary should inform the GP of the main diagnosis / diagnoses that were important during the admission (or symptom(s) if no diagnosis), including any new diagnosis that came to light during the admission. When a diagnosis has not yet been made, the most granular clinical concept with the highest level of certainty should be recorded. This may be a problem, symptom, sign, or test result, and may evolve over time, as a conventional diagnosis is reached. For example, ‘dyspepsia’ may be the diagnosis when a patient first presents with indigestion, upgraded to ‘gastric ulcer’ when this is found at endoscopy, and ‘gastric cancer’ when biopsies reveal this. ‘Co-morbidities’ should be recorded as separate diagnoses. For example, dementia may be recorded as a primary diagnosis by a psycho-geriatrician, but as a co-morbidity where a patient is admitted for a hip replacement. Unconfirmed or excluded diagnoses should not be recorded in structured code.
Resources Used for Profile Design
The following FHIR Resources are profiled to create the condition list.
- CareConnect-ITK-Condition-List-1 - A CareConnect derived NHS Digital Profile for recording a snapshot of the list of Conditions for the patient.
- CareConnect-ITK-Condition-1 - A CareConnect derived NHS Digital Profile for conditions. The Condition Resource records detailed information about conditions (diagnoses) recognised by a clinician.
List
This Resource acts as a container for the conditions. The following is an example of the main elements used:
- identifier - uniquely identifies this list of conditions (UUIDs)
- code - the type of list (for example SNOMED CT concept for “Primary Diagnosis”)
- status - should always be “current”
- mode - should always be “snapshot”
- subject - a reference to the patient whose condition list this is
- Encounter - a reference to the context in which the list was created (the inpatient stay for example)
- date - when the list was prepared
- source - who or what defined the list
- entry - a reference to the condition Resource entry
Condition
This Resource is used to record detailed information about a condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern. The following is an example of the elements that can be used:
- identifier - uniquely identifies this condition (UUIDs)
- clinicalStatus - active, recurrence, inactive, remission, resolved etc
- category - for eDischarge this will normally be encounter-diagnosis
- code - identification of the condition, problem or diagnosis
- subject - the patient
- onset - estimated or actual date, date-time, or age
- abatement - if/when in resolution/remission
- stage - stage/grade, usually assessed formally
- evidence - supporting evidence
Diagnosis Code
Handles information entered for each individual diagnosis. Confirmed diagnosis (or symptom); active diagnosis (or symptom) being treated. Should include the stage of the disease where relevant. The SNOMED CT concept should be from the following ref set:
< 404684003 |Clinical finding| |
OR < 413350009 |Finding with explicit context| |
OR < 272379006 |Event| |
For Inpatient Discharge Summary this is used in conjunction with condition.category with encounter-diagnosis as the ValueSet.
Condition.severity
MUST NOT be used for Digital Medicines Documents.
Condition.bodysite
MUST NOT be used for Digital Medicines Documents.
Condition.subject
A reference to the Patient Resource.
Condition.context
A reference to the Encounter Resource.
Condition.onset
The estimated or actual date, date-time, or age of onset which MUST be populated if available using one of the following sub-elements:
- onsetDateTime
- onsetAge
- onsetPeriod
- onsetRange
- onsetString
Condition.abatement
The estimated or actual date, date-time, or age of abatement which MUST be populated if available using one of the following sub-elements:
- abatementDateTime
- abatementAge
- abatementBoolean
- abatementPeriod
- abatementRange
- abatementString
How the Condition List is Constructed
The condition list is constructed as a list, there may be one or more list types. The diagram below shows the Resources used and relationships between the Resources.
Condition List Item Example
Example to show a condition list.
Condition List
Examples are illustrative only.
Condition
Examples are illustrative only.