We have been asked about how best to represent Consultation (advice seeking) from provider to provider with a SNOMED code. I don’t think that the concept 11429006 | Consultation (procedure) applies to use case of provider “advice seeking” from another provider.
I wondered if others have applied this concept in any referral/consults use cases and could provide your insight? Looking at for example 1155752006 | Liaising with healthcare provider (procedure) as an option.
I see NZ has created such concepts specific to modalities such as 586071000210106 |Telemedicine consultation between healthcare providers (procedure)| so perhaps we would need to create similar that is not specific to modality to support our use case.
Thank you for bringing this topic forward. The US has run into a similar issue in which the requestor wanted concepts that represented a discussion between pharmacists had taken place.
I clumsily modeled these in the situation with explicit context hierarchy to represent the context shift that the discussion was occurring between two healthcare professionals.
<< 452781000124102 |Discussed with health care professional (situation)|
I will probably take some criticism over doing this, but I thought it was important to override the default soft context of “patient” in the procedure hierarchy using the subject relationship context in the situation hierarchy.
I am not devoted to the way I handled this, so if someone can provide guidance on a better way to handle this, I am open to cleaning up what I did in the US Extension.
Thank you John. I appreciate the information We will assess your approach as well as this might also fit other use cases in the workflow. I believe our project wants the procedure model as activity to be performed as part of the service requested but the context of having it done is worthwhile to explore as well. I grapple with patient context as even though it does not involve the patient directly, the consult pertains to the patient or subject of record.
I am likely entirely wrong, so as you grapple with this please poke holes in my work so I can improve it.
The way I was thinking about it is the concept in the situation with explicit context hierarchy carries the context that the discussion occurred between two clinicians and not between the clinician and the patient. The context that the discussion between the two clinicians was about the patient would be an inferred context based on the concept being documented on a given patient’s medical record.
This is going to be an interesting dance between the context provide by the terminology and the context of the information model (i.e. the EHR) in which the concept is documented.
The one place where this logic is going to break down is in the OBGYN domain when the conversation between the two clinicians could have been with regard to the mother or the fetus during the gestational period. Once birth takes place and the information for the baby is split off into a new medical record. At present, this is the only time I can think of that healthcare data for “two patients” is comingled on a single medical record. Again, I could be wrong but it is an edge case worth considering.
I don’t think the UK does it any better, but we do have the same issue.
We recently added 2386021000000108 |Discussion about subject of record with care professional (situation)|
