Usage scenarios

The following are supported usage scenarios for this profile:

• Query for a patient’s problems, diagnoses, and health concerns
• Record or update a patient’s problem, diagnosis, or health concern

Comparison with other national and international IGs

A resource conforming to this profile is conformant to:

• IPA-Condition
• and MAY be conformant to
  • IPA-problem-list-item if one Condition.category problem-list-item is supplied
  • Condition (IPS) if patient is supported as Condition.subject.reference
  • US Core Condition Problems and Health Concerns if one Condition.category is supplied with a value from the US Core Problem or Health Concern value set
  • US Core Condition Encounter Diagnosis if one Condition.category encounter-diagnosis is supplied

Conformance in reverse is not guaranteed, i.e. a resource conforming to International Patient Access, International Patient Summary, or US Core MAY NOT conform to AU Core.

Profile specific implementation guidance

• Condition.category provides an efficient way of supporting system interactions, e.g. restricting searches. Implementers need to understand that data categorisation is somewhat subjective. The categorisation applied by the source may not align with a receiver’s expectations.
• The use of coding can vary significantly across systems, requesters need to understand that they may encounter codes they do not recognise and be prepared to handle those resources appropriately. Responders SHOULD populate Condition.code.text and/or Condition.code.coding.display so that requesters can display the condition even if the requester does not recognise the code supplied.
• Condition.code contains the identification of the condition, problem or diagnosis which may include body site information. Where a system has information not supported by the coding in Condition.code.coding (e.g. body site, laterality and other qualification of condition coding terms) that information SHOULD be supplied in Condition.code.text
• An active condition is represented using “active” in Condition.clinicalStatus
• To represent that a patient does not have a condition or history of condition, an appropriate negation code is used in Condition.code:
  • For indicating no known conditions or problems of any type Condition.code SHOULD use the code SNOMED CT 160245001 |No current problems or disability (situation)|
• Refutation is not expected to be handled except as above - an appropriate negation code in Condition.code and Condition.verificationStatus of “confirmed” or “unconfirmed”

Input is requested on how to exchange 'free text' medical history i.e. are these always Condition and/or Procedure resources? Please comment on HL7 Jira FHIR-43846.

Input is requested on how a diagnosis type (e.g. Comorbidity, Complication) would be represented in AU Core Condition. Please comment on HL7 Jira FHIR-43847.

Below is an overview of the mandatory and optional search parameters and combined search parameters. See the AU Core CapabilityStatements for a complete list of supported RESTful interactions for this IG.

FHIR search operations are described here and the syntax used to describe AU Core interactions is defined here.

Any search parameter defined in FHIR may be ‘allowed’ by the system unless explicitly marked as “SHALL NOT”. A few items are marked as MAY in this implementation guide to highlight their potential relevance.

Mandatory Search Parameters

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching using the patient search parameter:
   • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

   GET [base]/Condition?patient={Type/}[id] or optionally GET [base]/Condition?patient.identifier=[system|][code]

   Example:

   1. GET [base]/Condition?patient=5678
   2. GET [base]/Condition?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
   3. GET [base]/Condition?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient (how to search by reference and how to search by token)

2. SHALL support searching using the combination of the patient and category search parameters:
   • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

   GET [base]/Condition?patient={Type/}[id]&category={system|}[code]

   Example:

   1. GET [base]/Condition?patient=5678&category=http://terminology.hl7.org/CodeSystem/condition-category|encounter-diagnosis

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and category code = encounter-diagnosis (how to search by reference and how to search by token)

3. SHALL support searching using the combination of the patient and clinical-status search parameters:
   • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

   GET [base]/Condition?patient={Type/}[id]&clinical-status={system|}[code]

   Example:

   1. GET [base]/Condition?patient=5678&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and a clinical status (how to search by reference and how to search by token)

Optional Search Parameters

The following search parameters and search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and category and clinical-status search parameters:
   • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

   GET [base]/Condition?patient={Type/}[id]&category={system|}[code]&clinical-status={system|}[code]

   Example:

   1. GET [base]/Condition?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|encounter-diagnosis&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical

      active

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and category and clinical-status (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the patient and code search parameters:
   • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
   • SHOULD support multipleOr search on code (e.g.code={system|}[code],{system|}[code],...)

   GET [base]/Condition?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/Condition?patient=5678&code=http://snomed.info/sct|68566005,http://snomed.info/sct|394659003

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and condition code(s). SHOULD support search by multiple codes. The Condition code parameter searches Condition.code only. (how to search by reference and how to search by token)

   1. SHOULD support searching using the combination of the patient and onset-date search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code]
      • SHALL support these onset-date comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on onset-date (e.g.onset-date=[date]&date=[date]]&...)

   GET [base]/Condition?patient={Type/}[id]&onset-date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/Condition?patient=5678&onset-date=ge2020-01-01T00:00:00Z
   2. GET [base]/Condition?patient.identifier=http://example.org/fhir/mrn|12345&onset-date=ge2020-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and onset-date (how to search by reference and how to search by date)