Assessing Measurements and Clinical Impressions

Owned by Erik Nielsen
Last updated: 30-07-2024 by malthe lange
2 min read

Technical description of how to add assessments on measurements and clinical impressions.

Adding an Assessment

Assessments can be made on measurements and clinical impressions through ClinicalImpression Create.

As described in ClinicalImpression, Clinical Impression has multiple uses in the eHealth Infrastructure for both automatic and manual assessment.

When preparing the ClinicalImpression resource for a manual assessment performed by a clinician, it is important to add the following to the ClinicalImpression:

  • assessor which shall be set as a reference to the clinician's Practitioner

  • ehealth-clinicalimpression-decision can be set to a decision if applicable

  • investigation.item shall be set to both a versioned and version-less (see info-box below) reference to each measurement

  • ehealth-clinicalimpression-careplan which shall be set as a reference to the CarePlan that references the measurement’s ServiceRequest

 

The implication of setting ehealth-clinicalimpression-careplan is that all measurements referenced in investigation.item must have a ServiceRequest referenced from the same CarePlan.

Versioned and version-less referencing from ClinicalImpression

The versioned reference is required to eliminate ambiguity as to what content the ClinicalImpression has assessment for. An example versioned reference is:

  • https://<base>/fhir/QuestionnaireResponse/11052/_history/2

The version number to use is taken from the resource’s .meta/versionId. Note that <base> is a substitution and that, in reality, it would reflect the eHealth environment in use.

The version-less reference is required to enable searching for the resource reference without having to know which version is referenced. An example version-less reference is:

  • https://<base>/fhir/QuestionnaireResponse/11052

The sections below contain cases for manual assessment that expand on this.

Preparing an assessment of a clinical impression

This is the scenario where a ClinicalImpression already exists. Either created by the infrastructure as a result of automated triaging or created earlier by a clinician. Further information can be added to the existing ClinicalImpression by creating a new ClinicalImpression that references the existing ClinicalImpression as previous

It is recommended to create a new ClinicalImpression rather than updating the existing ClinicalImpression to preserve the history. E.g. assessor and effectiveDateTime.

Add the following to the ClinicalImpression resource being prepared as described above:

  • previous which shall be set as a reference to the ClinicalImpression being assessed

  • investigation.item shall be set to the same values as in the ClinicalImpression.investigation.item in the ClinicalImpression referenced as previous

Approving measurements for sharing

A ClinicalImpression can be used to approve one or more measurements for sharing. Add the following to the ClinicalImpression resource being prepared as described above:

  • ehealth-clinicalimpression-decision shall be set to approved-for-sharing

If measurements reference each other, it is recommended to approve them using a single ClinicalImpression with multiple investigation.item. This makes it possible to share them together when/if support for this is included in document sharing.

Approving Patient’s use of a view

A ClinicalImpression can be used to approve that a Patient may retrieve and project a measurement, typically a QuestionnaireResponse, through a view (see https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-view.html ).

Add the following to the ClinicalImpression resource being prepared as described above:

  • investigation.ehealth-clinicalimpression-viewInvestigationItem shall reference the ehealth-view view