In the UK the following have been considered best practice for some time now. SNOMED CT currently has Heart rate as a subtype of pulse, when the pulse is actually an indication of heart rate detectable at the central or peripheral pulse.
I am not sure what other measures of levels of consciousness are used worldwide, the only one I know of in widespread use in adults is Glasgow Coma Scale. There are some paediatric and ventilatory variants but most seem to be based on this scale.
Definition of pulse
1a: the regular expansion of an artery caused by the ejection of blood into the arterial system by the contractions of the heartb: the palpable beat resulting from such pulse as detected in a superficial artery; also: the number of individual beats in a specified time period (as one minute) <a resting pulse of 70>
The question is whether the various site specific concepts should be included. So long as modelled appropriately then there should be few issues, but there are a large number of the values that if trended would not be comparable unless against the specific concept. This is particularly the case with blood pressures where many of the values would be completely misleading and I am not sure the inheritance is appropriate. A GP recording 120/80 against 75367002 | Blood pressure (observable entity) is hardly comparable with the subtype 118433006 | Pulmonary artery wedge pressure (observable entity) which might be recorded in Intensive Care
Hi, the U.S. Federal Health Information Modeling (FHIM) group would like to contribute to this effort but we are not sure what the exact "ask" is. Are you asking what the basic observations are (e.g. systolic, diastolic, etc.) or are you also interested in the qualifiers (e.g. body position, cuff size, etc.). Thanks...Susan
the specific question asked here is what the more specific vital signs are. The current representation where all body temperatures are vital signs, by inheritance, makes finger temperature a vital sign. If possible, the vital signs (primitive) concept could be further specified to only subsume observables which are always vital signs, e.g. core body temperature observables.
The U.S. Federal Health Information Model group met today and came up with the following:
Documentation on the observables confluence page states that the “vital sign” concept “cannot reasonably be fully define”, therefore, why is “vital signs” a concept at all rather than a refset?
“Grouper” concepts should be indicated as such.
We suggest the vital signs concepts chosen for modeling within the scope of this effort should come from one or more the LOINC vital signs panels. This should be agreed upon with Regenstrief. We suggest using the vital signs identified in the FHIR Vital Signs Resource http://hl7-fhir.github.io/valueset-observation-vitalsignresult.html.
In reviewing the vital sign concepts in LOINC, we question why concepts that are properties of the vital signs (e.g. exercise state, body position, etc.) are in the Qualifiers We would like to model these items as “preconditions” (i.e either findings or descendants of the qualifier concept “Precondition value (qualifier value)” | 703763000) in the CIMI vital signs model.
I would support vital signs being a refset rather than a concept since it may well e context dependent and really part of the care plan of the individual person or person with specific needs. Core temperature taken at different sites may vary and so are not really comparable http://www.altmedrev.com/publications/11/4/278.pdf In intensive care peripheral temperature is frequently included in vital signs whereas on a ward this would rarely be the case, except following vascular surgery.
So are there common features that make the use of vital signs as an organising concept useful for modelling purposes? There is much diversity and the frequency of recording should probably be part of the care plan information model? Is it a clinical observation? Usually it is now a device recording the value, whether this is carried to the EHR direct or human mediated.
Many of the areas of the world do not use LOINC for clinical observation or laboratory values so I would prefer that the real world was used as the gold standard. We need to be careful that SNOMED CT's unique power of being both multidisciplinary and multilingual is not fragmented by being influenced unduly by other terminologies and being forced to adapt its modelling to suit.
We are in the process of publishing our subset of grouper concepts and identification of concepts with no real world utility would be supported, although it can be a challenging task to identify them all.
5 Comments
Zac Whitewood-Moores
In the UK the following have been considered best practice for some time now. SNOMED CT currently has Heart rate as a subtype of pulse, when the pulse is actually an indication of heart rate detectable at the central or peripheral pulse.
I am not sure what other measures of levels of consciousness are used worldwide, the only one I know of in widespread use in adults is Glasgow Coma Scale. There are some paediatric and ventilatory variants but most seem to be based on this scale.
Definition of pulse
1a : the regular expansion of an artery caused by the ejection of blood into the arterial system by the contractions of the heartb : the palpable beat resulting from such pulse as detected in a superficial artery; also : the number of individual beats in a specified time period (as one minute) <a resting pulse of 70>
http://www.merriam-webster.com/dictionary/pulse
The question is whether the various site specific concepts should be included. So long as modelled appropriately then there should be few issues, but there are a large number of the values that if trended would not be comparable unless against the specific concept. This is particularly the case with blood pressures where many of the values would be completely misleading and I am not sure the inheritance is appropriate. A GP recording 120/80 against 75367002 | Blood pressure (observable entity) is hardly comparable with the subtype 118433006 | Pulmonary artery wedge pressure (observable entity) which might be recorded in Intensive Care
Susan Matney
Hi, the U.S. Federal Health Information Modeling (FHIM) group would like to contribute to this effort but we are not sure what the exact "ask" is. Are you asking what the basic observations are (e.g. systolic, diastolic, etc.) or are you also interested in the qualifiers (e.g. body position, cuff size, etc.). Thanks...Susan
Daniel Karlsson
Hi Susan,
the specific question asked here is what the more specific vital signs are. The current representation where all body temperatures are vital signs, by inheritance, makes finger temperature a vital sign. If possible, the vital signs (primitive) concept could be further specified to only subsume observables which are always vital signs, e.g. core body temperature observables.
/Daniel
Susan Matney
The U.S. Federal Health Information Model group met today and came up with the following:
Zac Whitewood-Moores
I would support vital signs being a refset rather than a concept since it may well e context dependent and really part of the care plan of the individual person or person with specific needs. Core temperature taken at different sites may vary and so are not really comparable http://www.altmedrev.com/publications/11/4/278.pdf In intensive care peripheral temperature is frequently included in vital signs whereas on a ward this would rarely be the case, except following vascular surgery.
So are there common features that make the use of vital signs as an organising concept useful for modelling purposes? There is much diversity and the frequency of recording should probably be part of the care plan information model? Is it a clinical observation? Usually it is now a device recording the value, whether this is carried to the EHR direct or human mediated.
Many of the areas of the world do not use LOINC for clinical observation or laboratory values so I would prefer that the real world was used as the gold standard. We need to be careful that SNOMED CT's unique power of being both multidisciplinary and multilingual is not fragmented by being influenced unduly by other terminologies and being forced to adapt its modelling to suit.
We are in the process of publishing our subset of grouper concepts and identification of concepts with no real world utility would be supported, although it can be a challenging task to identify them all.