Chronic liver diseases


Parameter Case Report Form and Response Options

Does the patient suffer from a chronic liver disease? Yes No Unknown
Steatosis of liver
Cirrhosis of liver
Chronic infectious hepatitis
Autoimmune liver disease
Other

This is an example of how the case report form could look like when such a data collection tool is used.


To integrate data from clinical care and research such as clinical trials, the guide relies on FHIR resources for data-exchange from the clinical and diagnostic healthcare process rather than constructing a plain questionnaire.

This profile of a FHIR Condition is derived from the Diagnosis-profile of the Medical Informatics Initiative (MII). The valueset bindings on the Condition.code element have been constrained to solely feature the response options for this particular parameter of the case report form. For the explicitly listed diseases in the case report form, the SNOMED and ICD codes are also explicitly specified in the ValueSets below. Note that for the 'Other' option the ValueSets contain filters that allow a number of other codes for this category that are included in the expansion.

A separate instance of a Condition resource is created for each of the requested diseases.

To represent the presence, absence or uncertainty of findings, use Condition.verificationStatus or uncertaintyOfPresence on Condition.modifierExtension. This is used to map the Yes/No/Unknown scheme from case report forms to the Condition resource. Note the additional constraint on Condition that checks if either verificationStatus or the extension is present:

keyseverityhumanexpression
unk-1errorIf verificationStatus is present, uncertaintyOfPresence-Extension SHALL NOT be present.verificationStatus.exists() != Condition.modifierExtension.where(url = 'https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/uncertainty-of-presence').exists()

Profile - Chronic Liver Diseases

Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/chronic-liver-diseases

Snapshot

ReferenzPrimaerdiagnoseS I0..1Extension(Reference(Condition))
uncertaintyOfPresenceS ?! I0..1Extension(CodeableConcept)
identifierΣ0..*Identifier
clinicalStatusS Σ ?! I0..1CodeableConceptBinding
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
systemS Σ1..1uri
versionΣ0..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
severity0..1CodeableConceptBinding
Mehrfachcodierungs-KennzeichenS I0..1Extension(Coding)
SeitenlokalisationS I0..1Extension(Coding)
DiagnosesicherheitS I0..1Extension(Coding)
systemS Σ1..1uriFixed Value
versionS Σ1..1string
codeS Σ I1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemS Σ1..1uriFixed Value
versionΣ1..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemS Σ1..1uri
versionΣ0..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemS Σ1..1uri
versionΣ0..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
systemS Σ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
subjectS Σ I1..1MII-Reference(Patient | Group)
encounterS Σ I0..1MII-Reference(Encounter)
lebensphase-vonS I0..1Extension(CodeableConcept)
lebensphase-bisS I0..1Extension(CodeableConcept)
onsetDateTimeS Σ0..1dateTime
abatementDateTimedateTime
abatementAgeAge
abatementPeriodPeriod
abatementRangeRange
abatementStringstring
recordedDateS Σ1..1dateTime
recorderΣ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
summaryI0..1CodeableConcept
assessmentI0..*Reference(ClinicalImpression | DiagnosticReport | Observation)
type0..1CodeableConcept
codeΣ I0..*CodeableConcept
detailΣ I0..*Reference(Resource)
noteS0..*Annotation


Extension - Uncertainty of Presence

Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/uncertainty-of-presence

Snapshot

extensionI0..0Extension
url1..1System.StringFixed Value
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string


ValueSets

Valuesets are provided with both SNOMED-CT and ICD-10-GM codes.


Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/ValueSet/chronic-liver-diseases

ValueSet 'ChronicLiverDiseases'

Version1.0.6
Published byBerlin Institute of Health at Charité (BIH)
StatusActive
ExperimentalFalse

Chronic liver diseases in the context of Covid-19

Contact Information

Website: https://www.bihealth.org/en/re...

This value set includes codes from the following code systems:

  • The following codes from system: SNOMED_CT

    CodeDisplay
    197321007Steatosis of liver (disorder)
    19943007Cirrhosis of liver (disorder)
    10295004Chronic viral hepatitis (disorder)
    235890007Autoimmune liver disease (disorder)
  • Include codes from SNOMED_CT where concept DescendentOf 235856003


Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/ValueSet/chronic-liver-diseases-icd

ValueSet 'ChronicLiverDiseasesICD'

Version1.0.6
Published byBerlin Institute of Health at Charité (BIH)
StatusActive
ExperimentalFalse

Chronic liver diseases in the context of Covid-19 from ICD-10-GM

Contact Information

Website: https://www.bihealth.org/en/re...

This value set includes codes from the following code systems:

  • The following codes from system: ICD10GM

    CodeDisplay
    K76.0Fettleber [fettige Degeneration], anderenorts nicht klassifiziert
    K70.0Alkoholische Fettleber
    K74.6Sonstige und nicht näher bezeichnete Zirrhose der Leber
    B18.9Chronische Virushepatitis, nicht näher bezeichnet
    K76.9Leberkrankheit, nicht näher bezeichnet
  • Include codes from ICD10GM where concept Regex ^K7.*Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA B18Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept Regex ^K7.*Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA B18Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept Regex ^K7.*Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA B18Include codes from ICD10GM where child Exists false


Examples

Chronic Liver Disease present
Example condition that is confirmed present

{
    "resourceType": "Condition",
    "id": "chronic-liver-disease-present",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/chronic-liver-diseases"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408472002",
                    "system": "http://snomed.info/sct",
                    "display": "Hepatology"
                }
            ]
        }
    ],
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code": "confirmed",
                "display": "Confirmed"
            },
            {
                "system": "http://snomed.info/sct",
                "code": "410605003",
                "display": "Confirmed present (qualifier value)"
            }
        ]
    },
    "clinicalStatus": {
        "coding":  [
            {
                "code": "active",
                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "display": "Active"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "code": "328383001",
                "system": "http://snomed.info/sct",
                "display": "Chronic liver disease"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}


Chronic Liver Disease absent
Example condition that is confirmed absent

{
    "resourceType": "Condition",
    "id": "chronic-liver-disease-absent",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/chronic-liver-diseases"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408472002",
                    "system": "http://snomed.info/sct",
                    "display": "Hepatology"
                }
            ]
        }
    ],
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code": "refuted",
                "display": "Refuted"
            },
            {
                "system": "http://snomed.info/sct",
                "code": "410594000",
                "display": "Definitely NOT present (qualifier value)"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "code": "235890007",
                "system": "http://snomed.info/sct",
                "display": "Autoimmune liver disease"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}


Chronic Liver Disease unknown
Example condition where the presence is unknown

{
    "resourceType": "Condition",
    "id": "chronic-liver-disease-unknown",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/chronic-liver-diseases"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408472002",
                    "system": "http://snomed.info/sct",
                    "display": "Hepatology"
                }
            ]
        }
    ],
    "modifierExtension":  [
        {
            "url": "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/uncertainty-of-presence",
            "valueCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "261665006",
                        "display": "Unknown (qualifier value)"
                    }
                ],
                "text": "Presence of condition is unknown."
            }
        }
    ],
    "code": {
        "coding":  [
            {
                "code": "19943007",
                "system": "http://snomed.info/sct",
                "display": "Cirrhosis of liver"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}