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A ClinicalImpresssion:
.finding for each .component in the observation (e.g. systolic and diastolic blood pressure) or a single finding if the observation does not contain components.
Each finding for observation will have one of the following alert levels:
http://snomed.info/sct, 442082004, fund ved måling inden for referenceinterval (green)
http://snomed.info/sct, 442096005, fund ved måling uden for referenceinterval (red, yellow)
If the finding is for a component, then it will contain an observation code identifying the component (e.g. systolic blood pressure).
.finding for the overall assessment which is either green, yellow or red based on the worst severity from components or a single observation, see green, yellow and red in .https://docs.ehealth.sundhed.dk/latest-released/igfhir/ValueSet-ehealth-clinicalimpression-finding-codes.html .
A Task related to the ClinicalImpression with priority based on the highest alert level found:
asap if any values are found in “red alert” reference ranges
urgent if any values are found in “yellow alert” reference ranges (and no “red alert” found)
routine if no red or yellow alerts are found
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Error handling for different situations which result in the rule setting up instructions for creation of one or two Task:
Situation | Generic Task | Possible Specific Task (Stating what was wrong) |
|---|
No absolute reference range found | Task (Stating that measurement needs manual assessment): .category with .code = MeasurementForAssessment, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Need assessment of measurement
.description = Måling til vurdering
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to measurement being processed, for instance Observation, QuestionnaireResponse or Media
| No additional task. |
Unit mismatch between reference range and observation value | Task (Stating that measurement needs manual assessment as auto processing failed): .category with .code = MeasurementForAssessmentFailureInAutoProcessing, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Measurement Assessment failure during automated processing
.description = Vurdering af måling er fejlet under automatisk behandling
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to measurement being processed, for instance Observation, QuestionnaireResponse or Media
| Task: .category with .code = RefRangeFixingNeeded, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Missing in force reference base required for automatic processing
.description = Automatiseret behandling af måledata fejlede. Grænseværdi krævet af automatiseret behandling skal udbedres
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to ServiceRequest referenced by the measurement being processed
|
Missing observation value | Task (Stating that measurement needs manual assessment as auto processing failed): .category with .code = MeasurementForAssessmentFailureInAutoProcessing, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Measurement Assessment failure during automated processing
.description = Vurdering af måling er fejlet under automatisk behandling
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to measurement being processed, for instance Observation, QuestionnaireResponse or Media
| Task: .category with .code = LibraryUseMismatchFixingNeeded, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Input and rule did not match
.description = Automatiseret behandling af måledata fejlede. Aktivitet i plan og tilknyttet regel passer ikke sammen. Det bør overvejes om borger skal have ny plan.
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to ServiceRequest referenced by the measurement being processed
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Assessment of Relative Reference Ranges Library and Rule
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The rule handles different situations which result in the rule setting up instructions for creation of one or two Task:
Situation | Generic Task | Possible Specific Task (Stating what was wrong) |
|---|
Neither reference base nor relative reference range(s) found | Task: .category with .code = MeasurementForAssessmentNotTriaged, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Need assessment of measurement where triage was not performed during automated processing
.description = Måling til vurdering, hvor triagering ikke er udført af automatiseret behandling
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to measurement being processed, for instance Observation, QuestionnaireResponse or Media
| No additional task. |
No reference base found | Task: .category with .code = RefBaseNeeded, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Missing in force reference base required for automatic processing
.description = Mangler gældende referenceværdi påkrævet for automatisk behandling
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to ServiceRequest referenced by the measurement being processed
|
No relative reference range found | Task: .category with .code = RefRangeNeeded, .system = http://ehealth.sundhed.dk/cs/task-category, .display = Missing reference range required for automated processing
.description = Mangler grænseværdi påkrævet for automatisk behandling
.restrictionCategory with .code = measurement-monitoring, system = http://ehealth.sundhed.dk/cs/restriction-category, .display = Monitoring of measurement(s)
.priority = routine
.focus = reference to ServiceRequest referenced by the measurement being processed
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Library for Assessment of Questionnaire Response
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During processing of the rule, each answer significance defined in the Questionnaire (see https://docs.ehealth.sundhed.dk/latest-released/igfhir/StructureDefinition-ehealth-questionnaire.html#answer-significance ) on questions and their linked answers in the QuestionnaireResponse are traversed and checked whether the condition(s) of the answer significance is met by the linked answer. When this is the case, a finding basis is added to internal bookkeeping. Ultimately, the list of finding basis determines the created ClinicalImpression finding and the priority of the created task:
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Output will be a code from the http://hl7.org/fhir/v3/ObservationInterpretation CodeSystem:
Output Coding | Evaluation |
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code=IND, system=http://hl7.org/fhir/v3/ObservationInterpretation, display=Indeterminate | The referenced ServiceRequest does not contain ehealth-reuseCriteria specifying a max age of the height Observation. This max age, although stated for reuse, is used for the height Observation use in an BMI calculation also. |
code=N, system=http://hl7.org/fhir/v3/ObservationInterpretation, display=Normal | The height Observation has not exceeded the max age specified in ehealth-reuseCriteria in the referenced ServiceRequest. |
code=L, system=http://hl7.org/fhir/v3/ObservationInterpretation, display=Low | The height Observation has exceeded the max age specified in ehealth-reuseCriteria in the referenced ServiceRequest. |
Library for Calculating Body Mass Index
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It is not necessary to provide the ServiceRequest as input. The Libary$evaluate operation will retrieve it by resolving the basedOn reference in the weight Observation.
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