Requirements These requirements are the fundamental needs that are met by the model, derived from the supplied use cases Provide a way to indicate which things are of concern. The Health Concern concept allows people to indicate which facts are actually of concern (e.g., a “Problem List” for physicians) and should be evident to care providers and other care team members. Support different persons’ and roles’ perspectives. Different users will have different needs and expectations regarding what is actually of concern. Maintain a traceable record of a concern, for understanding, as the concern evolves. As providers investigate health issues, their understanding of the underlying problem often changes. However, it is sometimes important to be able to understand that today’s diagnosis is the same problem that initially presented as something else--pneumonia as the flu, or gastritis as chest pain. This ability is especially important when reconciling data across organizations. Associate events with concerns in order to provide a consolidated view of a concern. The ability to assign specific data to a concern will allow a user to see the information associated with a concern without having to sort through extraneous data. Some systems may be able to perform these assignments by rule (e.g., observations ordered in the context of caring for a particular concern), but the ability to assert a relationship is fundamental. We also observe some implications of this concept. Health concerns can be created by different persons in different systems without knowing about each other. Therefore, the ability to aggregate and reconcile concerns is desirable, although the concerns of one person may differ in relevance, granularity, or certainty compared to those of another. Ownership of a health concern is often a policy matter within an institution.
APPENDIX III – Comparison of Use of “Health Concern” Concept Concept HL7 Health Concern DAM HL7 C-CDA R2 ISO/DIS 13940 Health Concern Definition A Health Concern is a health related matter that is of interest, importance or worry to someone. This may be the patient, the patient's family or a patient's health care provider. Note – there is a Health Concern Section containing a Health Concern Act – The Health Concern Act is a wrapper for a single health concern which may be derived from a variety of sources within an EHR (such as Problem List, Family History, Social History, Social Worker Note, etc.). ISO “Contsys” defines “Health Issue” (synonym: “health concern”) (Section 6.1.3 ) as: health issue which defines and labels associations between specific health issue included with this obscure definition are additional notes: NOTE 3 In other standards the concept of ―concern‖ is used. A concern is said to have a focus of attention. The concept ― “interest” in this standard is equivalent to the concept ― “concern” in those other standards. Health Concern Health Concern Event The identification of a health concern or a risk. The event may involve observation, risk assessment, risk monitoring, or assessment of a condition, an intervention or a goal. A Health Concern Act is used to track physical or psychological situations drawing the patient to the health care system. These may be from the perspective of the care team or from the perspective of the patient. Contains over 30 entry level templates including problem concern act, problem observation, result observation, and functional status observation.. Risk is documented in a separate template.
Health Concern Tracking Health Concernexpressed as issue(s), condition(s), problem(s), diagnosis/diagnoses, risk(s), barrier(s)) Other related topics such as goal(s), preference(s) and intervention(s) [and their related may also be linked to health concern(s) through the health concern tracking. A C-CDA document is by definition a snapshot in time – the health concern act is not dynamic. Health concerns may have relationships. “Health Issue Thread” (Section 6.2): defined association between health issues and/or health issue treads, as decided and labelled by one or several health care actors
Health Concern Risk A type of health concern event A Risk concern act – It is a wrapper for a single risk concern which may be derived from a variety of sources within an EHR (such as Problem List, Family History, Social History, Social Worker Note, etc.). A Risk Concern Act represents a health concern that is a risk. A risk is a clinical or socioeconomic condition that the patient does not currently have, but the probability of developing that condition rises to the level of concern such that an intervention and/or monitoring is needed. “Risk Condition” (Section 6.1.2.2.4): “possible health condition representing an undesirable future health state” Relationship problem Not all health concerns are problems. Not all conditions or problems are considered health concerns. A health concern may be an item/entry on a problem list. A health risk is not to be included a problem list (e.g. risk of diabetic retinopathy is not included on patient’s problem list). The Problem section lists and describes all relevant clinical problems at the time the document is generated. At a minimum, all pertinent current and historical problems should be listed. Overall health status may be represented in this section. Entry level templates associated with the problem section include problem concern and health status observation.