Diagnostic codes for items such as ‘Family History of’, do not belong in the Condition table. Meaning the only alternative is the Observation table. However, I do not see a sufficient number of Observation Types to cover all the possible (or even a majority of the the frequently used qualifiers) diagnostic qualifiers. For example in the source data I am working there are the following:
PROBLEM LIST/PAST MEDICAL
HISTORY OF
FAMILY HISTORY OF
OTHER PAST HISTORY
PAST SURGICAL
PREGNANCY/BIRTH
MATERNAL HISTORY OF
PATERNAL HISTORY OF
DIAGNOSTIC STUDIES
FRATERNAL HISTORY OF
SORORAL HISTORY OF
SNOMED has a number of ‘HISTORY OF…’ or ‘FAMILY HISTORY OF…’ concepts, but I do not see generic concepts for ‘HISTORY OF’ or ‘FAMILY HISTORY OF’. Is there any solution other than to request additional qualifying concepts be added to the vocabulary for Observation Type?
You are totally right. In V4 you can’t really solve this problem well. The current mapping will map history of something to medical history. This has been solved in V5. There, you have a ‘Maps to’ link to “Medical History” and a “Maps to value” to the SNOMED concept representing the condition.
If you have to, you could use the vocabulary 5 to do the trick in V4 CDM.
There’s still a lot of ambiguity around this, so I suggest we write up a
definitive consensus best practice around this.
My opinion:
We should be storing ‘history’, ‘family history’ and other qualifying
observations in the OBSERVATION table. We should make the qualifier the
OBSERVATION_CONCEPT_ID, and the value is the concept of interest. So, if a
person has family history of breast cancer, the OBSERVATION_CONCEPT_ID
would be ‘family history’ and the VALUE_AS_CONCEPT_ID would be the
corresponding standard concept for ‘breast cancer’. The
OBSERVATION_TYPE_CONCEPT_ID should not be used for the qualifier, that is
intended to be the provenence of the data, so did it come from EHR intake,
a claims record, etc.