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How to choose observation_concept_id of Present illness concept?

CDM Builders
#1

We want to add the PI (Present illness) values, extracted from the discharge summary description, into the observation table

In order to find the correct observaiton_concept_id of the PI, we wrote the following SQL query.
“select * from [dbo].[CONCEPT]
where CONCEPT_NAME like ‘%present%’ and CONCEPT_NAME like ‘%illness%’”

Below are searched concept_ids and concept_names.

  • 3013360 (History of present illness)
  • 4307693 (History of present illness section)
  • 3019666 (History of present illness Narrative)
  • 42870367 (CMS - history of present illness panel)

Among these, what would be the most correct observation_concept_id for PI?
Please give me any idea about this issue.

thanks.

#2

@Dahye:

Hang on. Present illness is the attribute of one of the conditions a patients has depicting the one that was just treated and reported in the discharge summary, correct?

If yes: We are thinking of expanding the CONDITION table with an additional attrribute certainty_of_diagnosis or so (name needs some thoughts), see the upcoming WG discussion items. There, you could have things like “Admitting diagnosis”, “Preliminary diagnosis”, “Working diagnosis”, “Established diagnosis”. Your “present illness” could go there.

Of course, it wouldn’t help you now. In the mean time, you could write an observation and use the FACT_RELATIONSHIP table to connect these. We don’t have a “Present illness” now. Try to pick something from the following:

select an.concept_id as an_id, an.concept_name as an_name, 
  de.concept_id as de_id, de.concept_name as de_name, de.vocabulary_id as de_vocab, de.domain_id as de_domain
from concept an
join concept_ancestor a on a.ancestor_concept_id=an.concept_id
join concept de on de.concept_id=a.descendant_concept_id
where an.concept_id=4021918;
#3

I discussed it with several Korean doctors, and they said that the PI in the discharge summary is actually a simple copy and paste of of PI in the admission note.

#4

@rwpark:

Will submit to SNOMED that particular attribute of a diagnosis. Let’s see what they say.

#5

Finding concepts in SNOMED have what is called ‘default context’ (unless overridden via post-coordination)

See here:

snomed documentation
www.snomed.org/tig?t=att_situations_default_context

  			When a SNOMED CT

code appears in a record without any explicitly stated context, that
code is considered to have a default context. The default is “soft” in
that it can be over-ridden by information carried in the structure of
the record or its information model.
The default context for a clinical finding code
implies that the finding has actually occurred (vs. being absent), that
it applies to the subject of the record (the patient), and that it is
occurring currently or occurred at a past time that is given by a date - time record linked to the code.
The default context for a procedure code implies that
the procedure was completed, that it was performed on the subject of the
record (the patient), and that it was done at the present time or in the past at a time that is given by a date - time record linked to the code.

#6

@voijtech:

Not sure what you are trying to say.

#7

@dahye, @rwpark:

Heard from SNOMED. They essentially say something along the lines of “Present Illness” is the same as “Illness”, because everything by default is “Present”. Can you maybe specify in more detail what it exactly is that distinguishes a “Present Illness” from just any condition or diagnosis?

t