1. Condition/Diagnosis/Health Issue/Problems/Findings Modeling Options

2. “CONTEXT” OF FINDINGS

3. General Assumption About Finding The purpose of finding model is to describe something that exists or is true (a diagnosis, a condition, a finding) about a person The finding can be highly pre coordinated or post coordinated. It has substructure that depends on the kind of thing that is being represented The finding model gets reused in many different contexts: Health Issue (Problem), Family History, Complication, Reason for Admission, Surgery Complication, Final Discharge Diagnosis, Finding, etc.

4. Finding as part of Health Issue HealthIssue Onset date Date noted Resolution date Rank Link to other issue Finding

5. Finding as part of Family History Family History Item Relationship Person Id Cause of Death Age at onset Finding

6. Finding as a Complication Surgery Procedure Type of Surgery Primary surgeon Start time End time Complication Finding

7. Incomplete List of Contexts Health Issue (Problem) Family History Surgery Complication Reason for Admission Admitting Diagnosis Final Discharge Diagnosis Goal statement Risk for Reason for: order, procedure, action Others…

8. OPTIONS CONSIDERED

9. Options for Negation (No Diabetes Mellitus) Option 1 – Negation Inside Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Not Present, Unlikely, Possible, Probable, Present, etc.) Example Instances Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Present Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Not Present

10. Options for Negation (No Diabetes Mellitus) Option 2 – Assertion and Negation as Classes ExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [Not Present, Excluded, Not Found] Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Maybe, Possible, Probable, Likely, Unlikely, etc.) Example Instances ExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Excluded Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod ): Possible

11. Options for Negation (No Diabetes Mellitus) Option 3 – Precoordinated Negation Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with and without precoordinated context: diabetes mellitus, no diabetes mellitus, etc.] Example Instances Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: No Type 1 Diabetes Mellitus Note: This option could lead to “combinatorial explosion”.

12. Options for Negation (No Diabetes Mellitus) Option 4 – Precoordinated Negation with redundant negation attribute Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with and without precoordinated context: diabetes mellitus, no diabetes mellitus, etc.] certainty (mod): [value set binding to: Not Present, Unlikely, Possible, Probable, Present, etc.) Example Instances Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Type 1 Diabetes Mellitus certainty (mod): Present Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: No Type 1 Diabetes Mellitus certainty (mod): Not Present

13. Extending Option 1 (No Family History of Breast Cancer) Option 1 – Negation Inside Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Not Present, Unlikely, Possible, Probable, Present, etc.] subjectOfInformation (mod): [value set binding to: Relative (Family Hx Of), Aunt, Uncle, Donor] Example Instances Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Breast Cancer certainty (mod): Present subjectOfInformation (mod): Relative (Family Hx Of) Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Breast Cancer certainty (mod): Not Present subjectOfInformation (mod): Relative (Family Hx Of)

14. Extending Option 2 (No Family History of Breast Cancer) Option 2 – Assertion and Negation as Classes ExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [Not Present, Excluded, Not Found] subjectOfInformation (mod): [value set binding to: Relative (Family Hx Of), Aunt, Uncle, Donor] Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated context: diabetes mellitus, chronic renal failure, pneumonia, renal disease, etc.] certainty (mod): [value set binding to: Maybe, Possible, Probable, Likely, Unlikely, etc.] subjectOfInformation (mod): [value set binding to: Relative (Family Hx Of), Aunt, Uncle, Donor] Example Instances ExcludedDiagnosis/Condition/Finding name (focus): 1234-5 CID (Negative Assertion) data.value.code: Breast Cancer certainty (mod): Excluded subjectOfInformation (mod): Relative (Family Hx Of) Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Breast Cancer certainty (mod): Possible subjectOfInformation (mod): Relative (Family Hx Of)

15. Extending Option 3 (No Diabetes Mellitus) Option 3 – Precoordinated Negation and Subject of Information Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with and without precoordinated context and subject of information: diabetes mellitus, no diabetes mellitus, family hx of diabetes mellitus, no family hx of diabetes mellitus, etc.] Example Instances Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: Family History of Type 1 Diabetes Mellitus Diagnosis/Condition/Finding name (focus): 1234-5 CID (Assertion) data.value.code: No Family History of Type 1 Diabetes Mellitus Note: This option could lead to “combinatorial explosion”.

16. Options for Body Site (Rashes) Option 1 – Post Coordinated Body Site Site Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated body site: rash, pain, ulcer, wound, burn, etc.] body site (qual): [value set binding to: face, arm, leg, back, axilla, etc.] Example Instance Site Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: Rash body site (mod): Face

17. Options for Body Site (Rashes) Option 2 – Precoordinated Body Site Site Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with precoordinated body site: face rash, chest pain, pelvic ulcer, hand wound, lower extremity burn, etc.] Example Instance Site Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: Face Rash Note: This strategy could lead to “combinatorial explosion.”

18. Options for Body Site (Rashes) Option 1a – Post Coordinated Body Site with Laterality Site Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated body site: rash, pain, ulcer, wound, burn, etc.] body site with laterality (qual): Collection [ body site (qual): [value set binding to: face, arm, leg, back, axilla, etc.] laterality (qual): [value set binding to: left, right, bilateral]] Example Instance Site Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: Rash body site with laterality (qual): Collection [ body site (qual): face laterality (qual): bilateral ]

19. Options for Body Site (Rashes) Option 2a – Precoordinated Body Site with Laterality Site Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with precoordinated body site: bilateral face rash, left sided chest pain, right pelvic ulcer, left hand wound, bilateral lower extremity burn, etc.] Example Instance Site Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: Bilateral face rash Note: This strategy could lead to “combinatorial explosion.”

20. Options for Body Site (Rashes) Option 3 – Post Coordinated Finding with Multiple Qualifiers Site Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items without precoordinated body site: rash, pain, ulcer, wound, burn, etc.] body site with laterality (qual): Collection [ body site (qual): [value set binding to: face, arm, leg, back, axilla, etc.] laterality (qual): [value set binding to: left, right, bilateral]] quality (qual): [value set binding to: macular, papular, macular-papular] pattern (qual): [value set binding to: butterfly, splotchy, diffuse, marginated] Example Instance Site Specific Diagnosis/Condition/Finding Post Coordinated name (focus): 1234-5 CID (Assertion) data.value.code: Rash body site with laterality (qual): Collection [ body site (qual): face laterality (qual): bilateral ] quality (qual): macular-papular pattern (qual: butterfly

21. Options for Body Site (Rashes) Option 4 – Precoordinated Finding with multiple qualifiers Site Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: [value set binding to items with precoordinated body site: bilateral macular- papular rash of face, diffuse macular rash of right leg, etc.] Example Instance Site Specific Diagnosis/Condition/Finding Precoordinated name (focus): 1234-5 CID (Assertion) data.value.code: bilateral macular-papular rash of face Note: This strategy could lead to “combinatorial explosion.”

22. Some conclusions and a proposal There will be many qualifiers that are used in different subsets of findings We have a previously stated preference for “the most reasonable post coordinated approach” We should follow the post coordinated approach for our “preferred” models for interoperability Precoordinated models will be useful for data entry and other use cases