Open ExchangeAs I said in the previous article, I started to learn about FHIR for the contest, and I'd like to share an update in my application: detection of inconsistencies in FHIR data.
Note: This document it's also availble in GitHub.
A useful usage for FHIR unified schema is search for inconsistencies. As suggested by @Qi Li, one example could be find patients with records for diabetes medication, however, without diabetes condition.
Another example is search conditions with findings (like diabetes, for instance) and a record for resources denoting "no known problems", e.g., SNOMED CT: "160245001 |No current problems or disability (situation)|", as discussed in HL7 FHIR documentation.
So, in order to deal with them, I setup two SQL KPIs for querying FHIR SQL schema and return resources which match to these kinds of inconsistencies. For input, I manually changed some files which are imported when the container is created.
For diabetes medication inconsistence, I choose a patient without diabetes conditions and insert manually a diabetes medication (file Mikel238_Dickinson688_62644b68-f18b-46e0-86f9-56b3cb2f6737.json). I found the medication code by searching for "snomed ct insulin".
"medicationCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "325072002",
"display": "Insulin Aspart (substance)"
}
],
"text": "Lantus 100 unit/ml injectable solution"
For "no known problems" inconsistencies, I changed the file Adina377_Corkery305_cb12851a-2ebd-4c15-88a9-5bee0f308afc.json, and add a "160245001 |No current problems or disability|" record in an pre-existing "190905008" |Cystic Fibrosis|" condition.
"coding": [
{
"system": "http://snomed.info/sct",
"code": "160245001",
"display": "No current problems or disability"
},
{
"system": "http://snomed.info/sct",
"code": "190905008",
"display": "Cystic Fibrosis"
}
],
Then, the two SQL shown below were setup. The first one gets diabetes medication inconsistencies; the second, "no known problems" inconsistencies:
-- patients with diabetes medication but no diabetes condition
SELECT
(
SELECT GetProp(GetJSON(GetAtJSON(GetJSON(GetJSON(ResourceString, 'medicationCodeableConcept'), 'coding'),0), 'display'), 'display') FROM HSFHIR_I0001_R.Rsrc r where r.Key = m.Key
) "Medication (ingredient)",
encounter "Encounter",
authoredon "Encounter date"
FROM HSFHIR_I0001_S.MedicationRequest m
WHERE
-- data inserted for last 7 days
_lastUpdated BETWEEN DATEADD('dd', -7, CURRENT_TIMESTAMP) and CURRENT_DATE
-- diabetes medication
AND $LISTGET(m.code, 1) %inlist $LISTBUILD('96367001','420837001','421367005','420609005','325072002','427292001','414515005','411529005','411530000','412210000','426313003','422346007')
-- no diabetes condition
AND 0 = (
SELECT count(*) FROM HSFHIR_I0001_S.Condition c
WHERE
-- diabetes conditions
$LISTGET(c.code, 1) %inlist $LISTBUILD('73211009','733072002','530558861000132104','609568004','609569007','105401000119101','199223000','703136005','46635009','44054006','111552007','716362006','123763000','722206009','8801005')
AND m.patient = c.patient
)
-- conditions with "no known problems" no properly
SELECT
'',
encounter "Encounter",
onsetDate "Encounter date"
FROM HSFHIR_I0001_S.Condition
WHERE
-- data inserted for last 7 days
_lastUpdated BETWEEN DATEADD('dd', -7, CURRENT_TIMESTAMP) and CURRENT_DATE
-- 160245001 = no known problems
AND $FIND(code, 160245001) > 0
-- more than 1 condition code recorded (each code recorded generates 2 entries into code list - code and its description)
AND $LISTLENGTH(code) > 2
I found codes for diabetes conditions and medications in the CDC site, here and here.
These SQL feed up the KPIs DiabetesMedicationInconsistence and NoKnowProblemsInconsistence, respectively.
Finally, I setup a dashboard where this information is diplayed. Note that two inconsistencies issue were detected - one for each of them.
