Diagnosis

Diagnosis are retrieved and stored through the Condition_Diagnosis profile. It supports to read or write any kind diagnosis that could read in medico itself.

ICD 10 The profile contains a dedicated slice within the condition's code section to support ICD10. This support is based on basisprofil.de:

Especially the extensions named for the condition profiles are used.

Unlike basisprofil the so-called post-coordinated codes are not supported: E.g. if there are primary and secondary diagnosis that are concatenated using + und * - than:

  • these are expressed in individual condition resources
  • each resource hold the simple ICD10 code for either the primary or secondary code
  • each resource contains the full extensions
  • using those extensions the post-coordinated codes could be created by the FHIR client
Example bundle containing a primary and secondary ICD10 diagnosis

{
"resourceType": "Bundle",
"entry": [
    {
        "resource": {
            "resourceType": "Condition",
            "id": "Diag-5040930",
            "meta": {
                "extension": [
                    {
                        "extension": [
                            {
                                "url": "responsibility",
                                "valueCodeableConcept": {
                                    "coding": [
                                        {
                                            "system": "https://fhir-cerner-eu.com/medico/cs1",
                                            "code": "EncounterResponsibleDepartment"
                                        }
                                    ]
                                }
                            },
                            {
                                "url": "reference",
                                "valueReference": {
                                    "reference": "Organization/Department-PSY",
                                    "identifier": {
                                        "system": "https://fhir-cerner-eu.com/medico/dps/cs/Department",
                                        "value": "PSY"
                                    }
                                }
                            }
                        ],
                        "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Organizational_Responsibility_1"
                    }
                ],
                "profile": [
                    "https://fhir-cerner-eu.com/medico/r4/sd/Condition_Diagnosis_1"
                ]
            },
            "extension": [
                {
                    "extension": [
                        {
                            "url": "createDate",
                            "valueDateTime": "2019-06-13T14:19:40+02:00"
                        },
                        {
                            "url": "createUser",
                            "valueReference": {
                                "reference": "Practitioner/User-MIN",
                                "identifier": {
                                    "system": "https://fhir-cerner-eu.com/medico/dps/cs/User",
                                    "value": "MIN"
                                }
                            }
                        },
                        {
                            "url": "changeDate",
                            "valueDateTime": "2019-06-13T14:20:19+02:00"
                        },
                        {
                            "url": "changeUser",
                            "valueReference": {
                                "reference": "Practitioner/User-MIN",
                                "identifier": {
                                    "system": "https://fhir-cerner-eu.com/medico/dps/cs/User",
                                    "value": "MIN"
                                }
                            }
                        }
                    ],
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_MetaCreateChangeInfo_1"
                },
                {
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Condition_DiagnosisWorkflow_1",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "https://fhir-cerner-eu.com/medico/cs1",
                                "code": "discharge"
                            }
                        ]
                    }
                },
                {
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Condition_DiagnosingOrganization_1",
                    "valueReference": {
                        "reference": "Organization/Department-PSY",
                        "type": "https://fhir-cerner-eu.com/medico/r4/sd/Organization_Department_1"
                    }
                },
                {
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Condition_DiagnosisAttributes_1",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "https://fhir-cerner-eu.com/medico/cs1",
                                "code": "DiagAdminDRG"
                            },
                            {
                                "system": "https://fhir-cerner-eu.com/medico/cs1",
                                "code": "DiagMedicalMain"
                            }
                        ]
                    }
                }
            ],
            "identifier": [
                {
                    "system": "https://fhir-cerner-eu.com/medico/dps/sid1/Diag",
                    "value": "5040930"
                }
            ],
            "clinicalStatus": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/ValueSet/condition-clinical",
                        "code": "active"
                    }
                ]
            },
            "verificationStatus": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/ValueSet/condition-ver-status",
                        "code": "confirmed"
                    }
                ]
            },
            "category": [
                {
                    "coding": [
                        {
                            "system": "https://fhir-cerner-eu.com/medico/cs1",
                            "code": "Diagnosis"
                        }
                    ]
                }
            ],
            "severity": {
                "text": "1"
            },
            "code": {
                "coding": [
                    {
                        "extension": [
                            {
                                "url": "http://fhir.de/StructureDefinition/icd-10-gm-stern",
                                "valueCoding": {
                                    "id": "Diag-5040932",
                                    "system": "http://fhir.de/CodeSystem/dimdi/icd-10-gm",
                                    "version": "2018",
                                    "code": "F00.1",
                                    "display": "Demenz bei Alzheimer-Krankheit, mit spätem Beginn (Typ 1)"
                                }
                            },
                            {
                                "url": "http://fhir.de/StructureDefinition/icd-10-gm-haupt-kreuz",
                                "valueCoding": {
                                    "id": "Diag-5040930",
                                    "system": "http://fhir.de/CodeSystem/dimdi/icd-10-gm",
                                    "version": "2018",
                                    "code": "F05.1",
                                    "display": "Delir bei Demenz"
                                }
                            },
                            {
                                "url": "http://fhir.de/StructureDefinition/icd-10-gm-diagnosesicherheit",
                                "valueCoding": {
                                    "system": "http://fhir.de/CodeSystem/kbv/s-icd-diagnosesicherheit",
                                    "code": "G"
                                }
                            }
                        ],
                        "system": "http://fhir.de/CodeSystem/dimdi/icd-10-gm",
                        "version": "2018",
                        "code": "F05.1",
                        "display": "Delir bei Demenz"
                    }
                ]
            },
            "subject": {
                "reference": "Patient/Patient-10734557"
            },
            "encounter": {
                "reference": "Encounter/Case-9745450"
            },
            "asserter": {
                "reference": "Practitioner/User-MIN"
            }
        }
    },
    {
        "resource": {
            "resourceType": "Condition",
            "id": "Diag-5040932",
            "meta": {
                "extension": [
                    {
                        "extension": [
                            {
                                "url": "responsibility",
                                "valueCodeableConcept": {
                                    "coding": [
                                        {
                                            "system": "https://fhir-cerner-eu.com/medico/cs1",
                                            "code": "EncounterResponsibleDepartment"
                                        }
                                    ]
                                }
                            },
                            {
                                "url": "reference",
                                "valueReference": {
                                    "reference": "Organization/Department-PSY",
                                    "identifier": {
                                        "system": "https://fhir-cerner-eu.com/medico/dps/cs/Department",
                                        "value": "PSY"
                                    }
                                }
                            }
                        ],
                        "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Organizational_Responsibility_1"
                    }
                ],
                "profile": [
                    "https://fhir-cerner-eu.com/medico/r4/sd/Condition_Diagnosis_1"
                ]
            },
            "extension": [
                {
                    "extension": [
                        {
                            "url": "createDate",
                            "valueDateTime": "2019-06-13T14:20:21+02:00"
                        },
                        {
                            "url": "createUser",
                            "valueReference": {
                                "reference": "Practitioner/User-MIN",
                                "identifier": {
                                    "system": "https://fhir-cerner-eu.com/medico/dps/cs/User",
                                    "value": "MIN"
                                }
                            }
                        }
                    ],
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_MetaCreateChangeInfo_1"
                },
                {
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Condition_DiagnosisWorkflow_1",
                    "valueCodeableConcept": {
                        "coding": [
                            {
                                "system": "https://fhir-cerner-eu.com/medico/cs1",
                                "code": "discharge"
                            }
                        ]
                    }
                },
                {
                    "url": "https://fhir-cerner-eu.com/medico/r4/sd/MXT_Condition_DiagnosingOrganization_1",
                    "valueReference": {
                        "reference": "Organization/Department-PSY",
                        "type": "https://fhir-cerner-eu.com/medico/r4/sd/Organization_Department_1"
                    }
                }
            ],
            "identifier": [
                {
                    "system": "https://fhir-cerner-eu.com/medico/dps/sid1/Diag",
                    "value": "5040932"
                }
            ],
            "clinicalStatus": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/ValueSet/condition-clinical",
                        "code": "active"
                    }
                ]
            },
            "verificationStatus": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/ValueSet/condition-ver-status",
                        "code": "confirmed"
                    }
                ]
            },
            "category": [
                {
                    "coding": [
                        {
                            "system": "https://fhir-cerner-eu.com/medico/cs1",
                            "code": "Diagnosis"
                        }
                    ]
                }
            ],
            "severity": {
                "text": "3"
            },
            "code": {
                "coding": [
                    {
                        "extension": [
                            {
                                "url": "http://fhir.de/StructureDefinition/icd-10-gm-stern",
                                "valueCoding": {
                                    "id": "Diag-5040932",
                                    "system": "http://fhir.de/CodeSystem/dimdi/icd-10-gm",
                                    "version": "2018",
                                    "code": "F00.1",
                                    "display": "Demenz bei Alzheimer-Krankheit, mit spätem Beginn (Typ 1)"
                                }
                            },
                            {
                                "url": "http://fhir.de/StructureDefinition/icd-10-gm-haupt-kreuz",
                                "valueCoding": {
                                    "id": "Diag-5040930",
                                    "system": "http://fhir.de/CodeSystem/dimdi/icd-10-gm",
                                    "version": "2018",
                                    "code": "F05.1",
                                    "display": "Delir bei Demenz"
                                }
                            }
                        ],
                        "system": "http://fhir.de/CodeSystem/dimdi/icd-10-gm",
                        "version": "2018",
                        "code": "F00.1",
                        "display": "Demenz bei Alzheimer-Krankheit, mit spätem Beginn (Typ 1)"
                    }
                ]
            },
            "subject": {
                "reference": "Patient/Patient-10734557"
            },
            "encounter": {
                "reference": "Encounter/Case-9745450"
            },
            "asserter": {
                "reference": "Practitioner/User-MIN"
            }
        }
    }
}

}