FHIR   Element 3 STU DefinitionBinding Strengths 3 (STU)Questions/Proposal   to the groupComments  

clinicalStatus
    The clinical status of the condition.
   

Comments: This element is labeled as a modifier because the  status contains codes that mark the condition as not currently valid or   of concern.

Required
    [0..1]
   
    HL7
    hl7.org/fhir/condition-clinical
Add guidance this information   can be captured in the condition.code as the clinical condition: if the   ClinicalStatus can be represented from the codeableConcept Condition.code, it   should not be entered here.
   
    Ex:  Asthma - currently active   (finding)
    Ex:  Inactive thyroid disease   (finding)
    Ex:  Recurrent anxiety   (finding)
    Ex:  Diabetes resolved   (finding) 
   
 
verificationStatus
    The verification status to support the clinical status  of the  condition.
Required
    [0..1]
   
    hl7.org/fhir/ValueSet/condition-ver-status
Should this  element include 'suspected' 
  Add an example  when a Condition is provisional or differential and then becomes confimed 

Category
    A category assigned to the condition.
   

Comments: The categorization is often highly contextual   and may appear poorly differentiated or not very useful in other contexts.

Example
    [0..*]
   
    hl7.org/fhir/ValueSet/condition-category
This element   seems to allow categorisation of types of information found in the resource,   such as: symptom, sign, diagnosis, event, complaint, etc. Is it used for   other purposes? 
  Should there be   guidance to use the list resource with this element? 

Severity
    A subjective assessment of the severity of the   condition as evaluated by the clinician.

Comments:  Coding of the severity with a terminology is preferred, where possible.

Preferred
    [0..1]
   
    Include these codes as defined in http://snomed.info/sct
   
    Severe, Moderate, Mild
Change binding the proposed   intensional definition for this value set: < 272141005 |Severities| 

 Add guidance on validation of   content that is a normal condition, to avoid inappropriate information, e.g.   pregnancy. 
  Add guidance this information   can be captured in the condition.code as the clinical condition: if the   Severity can be represented from the Condition.code codeableConcept, it   should not be entered here.
   
    Ex:  Fatal infectious mononucleosis   (disorder)
    Ex:  Mild gingivitis (disorder)
    Ex:  Moderate head injury   (disorder)
    Ex:  Severe myopia (disorder)   
 

Code

Identification of the condition, problem or diagnosis.

Example
    [0..1]
   
    Include codes from http://snomed.info/sct    where concept is-a 404684003 (Clinical   finding)
     
    Include these codes as defined in http://snomed.info/sct
     
    160245001
    No current problems or disability
   
Change binding strength to Preferred so SNOMED CT is the   Clinical Terminology of choice for this data element, and change binding the   proposed intensional definition for this value set:
    (< 404684003 |Clinical finding|
     INCLUDE << 420134006   |Propensity to adverse reactions|
     INCLUDE << 473010000   |Hypersensitivity condition|
     INCLUDE << 79899007 |Drug   interaction|
    MINUS << 69449002 |Drug action|
    MINUS << 441742003 |Evaluation finding|
    MINUS << 307824009 |Administrative status|
    MINUS << 385356007 |Tumor stage finding|
    MINUS << 80631005 |Clinical stage finding| )
    OR < 413350009 |Finding with explicit context|
    OR < 272379006 |Event|

Corrected ECL expression

((
< 404684003 |Clinical finding|
   OR << 420134006   |Propensity to adverse reactions|
   OR << 473010000   |Hypersensitivity condition|
   OR << 79899007 |Drug   interaction|
) MINUS (
<< 69449002 |Drug action|
OR << 441742003 |Evaluation finding|
   OR << 307824009 |Administrative status|
   OR << 385356007 |Tumor stage finding|
   OR << 80631005 |Clinical stage finding|
))
OR < 413350009 |Finding with explicit context|
OR < 272379006 |Event|

  There is a proposed change to   the Scope and Usage of this resource to better reflect the in   scope elements for this resource.  
  Add guidance when the   condition.code may include the Severity, the ClinicalStatus even the   verificationStatus (confirmed) as the clinical condition: if the   Condition.code includes the severity and/or the clinical status and/or the   verification status these elements should not be captured to avoid duplicated   information.
     
    Ex.: Tuberculoma of spinal cord confirmed (disorder)
    Ex.: Suspected fetal abnormality affecting management of mother (disorder)
 
  There is a proposed change to   the Scope and Usage of this resource to better reflect the in   scope elements for this resource.
   
    Suggest that the ‘Allergic to X’ be recorded in the condition.code when   this is not a reason for an encounter. Use both the Condition and the   AllergyIntolerance resources when there is an acute state.
 
  Add an example for when the   Condition.code is not required. 

bodySite
    The anatomical location where this condition manifests   itself.

Comments: Only used if not implicit in code   found in Condition.code. If the use case requires attributes from the   BodySite resource (e.g. to identify and track separately) then use the   standard extension body-site-instance. May be a summary code, or a reference   to a very precise definition of the location, or both.

Example
    [0..*]
   
    Include codes from http://snomed.info/sct     where concept is-a 442083009 (Anatomical or   acquired body structure)
   
The binding strength should be   changed for Preferred [0..*] 
  In the examples f202 and f203,   we can see a major discrepancy between the Condition.code and the BodySite.   Should there be guidance when this element is used and how should data be   consolidated for analysis and retrieval? 
stage.summary
    A simple summary of the stage such as "Stage   3". The determination of the stage is disease-specific.
Example
    [0..1]
    Include codes from http://snomed.info/sct where concept is-a   385356007
    (Tumour stage finding)
   
The binding strength should be   changed for Preferred [0..*] 
  The Content Logical Definition   does not seem aligned on the Expansion shown on the page. Add the following   to the Content Logical Definition:
    http://snomed.info/sct where concept is-a     80631005 Clinical stage finding (finding)
 
  Add a «Comment» similar to the   Severity element.
    Comments: Coding of the Stage with a terminology is preferred, where   possible.
 
  Add guidance this information   can be captured in the condition.code as the clinical condition: if the   Condition.Stage.Summary can be represented from the codeableConcept   Condition.code, it should not be entered here.
   
    Ex:  Pressure ulcer stage 3   (disorder)
    Ex:  Systolic heart failure stage D   (disorder)
    Ex:  Mammography assessment (Category   1) - Negative (finding)
    Ex:  Stage 2 pulmonary sarcoidosis   (disorder)
 
  Is there a dependency between   this element and the verificationStatus? 
  Please review the Example f204   whcih does not seem to comply to the definition of this element.  
stage.assessment
    Reference to a formal record of the evidence on which   the staging assessment is based.
There is no Terminology binding currently
    [0..*]
Is there a dependency between   this element and the verificationStatus? 
evidence.code
    A manifestation or symptom that led to the recording of   this condition.
Example
    [0..*]
   
    Include codes from http://snomed.info/sct     where concept is-a 404684003 (Clinical   finding)
   
Change binding strength to Preferred so SNOMED CT is the   Clinical Terminology of choice for this data element and change binding to   the same as for the Condition.code unless there is a rationale for the   bindings to be different, knowinf that the SNOMED CT clinical finding   hierarchy does not have specific sub-hierarchies that are signs or symptoms. Will include the values from the Observation Resource plus items from the Condition Resource.
  Provide guidance for when to use   the evidence.code vs the Observation Resource
  Please review the Example f201,   f002 and f003 which do not seem to comply to the definition of this   element.  
evidence.detail
    Links to other relevant information, including   pathology reports.
There is no Terminology binding currently
    [0..*]
Is there a dependency between   this element and the verificationStatus? The detail field here allows a reference to be made to 0..* Observation Resources.
  How are the other data element   adjusting when a value is populated in this field? Are there validation on   all associated fields? Refer to example f202-malignancy.
    Refer to example f203-sepsis. In this use case, if the report is only   sepsis, how and will the code be validated against that information?