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At the projectathon 2020, the following problem popped up: The value set for timing event (such as before meal. After meal etc.) is not the same in FHIR and CDA-CH-EMED. But both value sets are required (by FHIR and IHE PCC, respectively)
- inquire on the international level to resolve this issue
-
- from Rafael Jimenez, May 2020: - Found two valueSet from different source.
1) From list a valueSet (https://art-decor.org/art-decor/decor-valuesets--cdachemed-)
ID: 2.16.840.1.113883.1.11.10706 with name : TimingEvent (http://art-decor.org/decor/services/RetrieveValueSet?prefix=cdachemed-&language=en-US&version=&id=2.16.840.1.113883.1.11.10706&effectiveDate=dynamic&format=xml)
2) From "CDA EMED templates" ID :2.16.756.5.30.1.127.77.4.11.2 with
name : CH-EMED-TimingEvent (http://art-decor.org/decor/services/RetrieveValueSet?prefix=cdachemed-&language=en-US&version=&id=2.16.756.5.30.1.127.77.4.11.2&effectiveDate=dynamic&format=xml)
- no description
- no translation
- remove first value set (it can still be found, or is this for historical purposes?)
- comes from Gazelle ticket, the other points have been addressed separately: [EHS-326] Missing translation in TimingEvent valueset - Gazelle (ihe.net)
The timing event value set currently has 26 codes, few of those are currently used in real life. They pose an issue for representing them on a medication card: while the four usual codes (morning, noon, evening and night) have a simple representation made of four consecutive boxes, others have not and will probably have to be represented in narrative text.
The “Universal medication schedule” – with its common representation of the four usual codes (morning, noon, evening, night) – has been promoted worldwide for safe medication use. It has showed to reduce the risk of confusion and covers about 90% of medication prescribed (e.g. this article among others: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5130952/). It should be the priority. Therefore, we argue to focus on the 4 codes which have a proven and great impact on quality of care, while dropping the other codes which raise the difficulties of implementing the exchange format.
Consequences of status quo are high difficulties for integration to interpret and match codes. This seriously impacts its uptake, and, most of all, increase the risks of errors induced by technologies. Such a long and complex value set impacts usability by clinicians (cognitive-burden, time-consuming).
At the same time, we encourage eHealth Suisse and software providers to invest a continuous effort aiming to improve the quality of patient instructions. Some expansions have been more recently proposed for other drug formulation (e.g. drops, inhalator) based on health literacy principles. (See : https://bmjopen.bmj.com/content/4/1/e003699).
Propositions:
1. Value set TimingEvent : only keep the values “Morning (MORN)”, “Noon (NOON)”, “Evening (EVE)” and “Night (NIGHT)”, encouraging their use.
2. Other notions (with food/drink, before/after meal) appear as comments.
3. The common representation for these dosages (in the narrative text) is the usual 4 boxes one.
4. Other timing events and more complex dosages are described in the non-structured dosage instructions entry.
5. These changes may be temporary or definitive. Evolution may be proposed later as part of an appropriate change management program aiming to achieve health literacy standards and guidelines in collaboration with industry and policy-maker.
Drafted by HUG and CARA.