2015May core #177 - Explain whether Contraindication is definition or instance

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • FHIR Core (FHIR)
    • DSTU1 [deprecated]
    • Clinical Decision Support
    • DetectedIssue
    • 4.10
    • Hide

      Will add an explicit sentence to the scope and usage section: "This resource represents a specific instance of a potential issue for a particular patient. ?It is not intended to represent general patient-independent?knowledge"

      The resource is intended to be used for systems that already convey this sort of information. ?It is needed now for decision support systems. ?Will also add a Usage Notes section that says the following:

      "Contraindication is a resource that is frequently associated with workflow challenges where frequent alerts that are not clinically relevant result in clinicians tuning out (or turning off) the content and thus missing relevant alerts. ?Give consideration to this issue before making heavy use of this resource."

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      Will add an explicit sentence to the scope and usage section: "This resource represents a specific instance of a potential issue for a particular patient. ?It is not intended to represent general patient-independent?knowledge" The resource is intended to be used for systems that already convey this sort of information. ?It is needed now for decision support systems. ?Will also add a Usage Notes section that says the following: "Contraindication is a resource that is frequently associated with workflow challenges where frequent alerts that are not clinically relevant result in clinicians tuning out (or turning off) the content and thus missing relevant alerts. ?Give consideration to this issue before making heavy use of this resource."
    • Bryn Rhodes/Claude Nanjo: 8-0-0
    • Clarification
    • Non-substantive
    • DSTU1 [deprecated]

      Existing Wording: This resource maintained by the Clinical Decision Support (http://www.hl7.org/Special/committees

      /dss/index.cfm) Work Group

      Indicates an actual or potential clinical issue with or between one or more active or proposed clinical

      actions for a patient. E.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition

      conflict, etc.

      Comment:

      It is still not crystal clear if this resource carries the knowledge base for what would constitute a DDI, Drug DX interaction, or tables of maximum doses etc., or an instance of an upcoming contraindication, specific to the patient. From reading this I suspect it is the latter. The former would make sense as a resource. The latter seems 3rd order for this stage of EMR development. And it will also demand more provider time to feed and care for; it would be honey pot for lawyers trying to find some way to blame a bad outcome.

      This will also tie in with need to indicate why an alert was ignored. When allergy AND DDI alerts are not really applicable 90% of the time this is a horrible waste of time.

      Clinicians could hate it, I think it should be re thought and put off to the future. Or much better justified.

            Assignee:
            Unassigned
            Reporter:
            clemmcdonald
            clemmcdonald
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved: