| Interoperability Standards Platform (ISP)

Data Element

Submitted By: Steven Lane / Sutter Health
Data Element Information
Rationale for Separate Consideration	This is related to the Date of Onset and the Date of Diagnosis associated with problems/diagnoses on the active Problem List and in the Past Medical History list. Rather than simply capturing the date that a diagnosis was deleted from or resolved off of the problem list and added to the Past medical history list, this would allow the specific documentation of the date that a previously active problem was resolved, whether or not the problem is to be maintained as a part of the displayed Past Medical History.
Use Case Description(s)
Use Case Description	This would allow the specific documentation of the date that a previously active problem was resolved, whether or not the problem is to be maintained as a part of the displayed Past Medical History. Capturing this data would allow clinicians, data analysts, researchers and decision support apps to calculate the duration of an illness. This data element could also be populated by individuals/patients as part of patient generated health data in situations where patients may track their illnesses and report their resolution.
Estimate the breadth of applicability of the use case(s) for this data element	Potentially tens of thousands of clinicians would populate this data element in the course of clinical care documentation. This data element would be maintained with diagnoses once they have resolved, whether they are maintained as a data element associated with resolved diagnoses as part of an historical problem list or as part of a Past Medical History listing of past diagnoses.
Healthcare Aims	Improving patient experience of care (quality and/or satisfaction) Improving the health of populations Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s)	Date
Additional Specifications	N/A
Current Use	Not currently captured or accessed with an organization
Extent of exchange	N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)	N/A
Restrictions on Use (e.g. licensing, user fees)	N/A
Privacy and Security Concerns	N/A
Estimate of Overall Burden	EHR vendors would need to add an additional date field to associate with diagnoses in the Problem List and Past Medical History. Users would need to be trained in the use of the new data field.
Other Implementation Challenges	The field would ideally support fuzzy dates as the precise date of resolution of a given condition may not be known or knowable.

Comment

Submitted by stevepostal on 2021-09-30

Date of Resolution Data Element

APTA re-iterates its comments that it is unclear when a past medical problem is “resolved.” APTA recommends that ONC define “resolved” and outline criteria for what constitutes a “resolved condition.” For instance, if a patient does not return for additional visits, does that mean the condition should be classified as “resolved,” when in fact, the condition may not have been resolved but the clinician does not know because the patient never returned. Additionally, we recommend that ONC include a data element for “condition status.” Providers could use this to signal “we don’t know what happened after this point,” and then the resolution date would be null. We note that FHIR has two “status” data elements on condition –— one for clinical status and the other for verification status.

Submitted by hmiller@medall… on 2021-04-08

Date of Diagnosis, Date of Onset and Date of Resolution

Please see uploaded file

Submitted by maria.michaels… on 2021-04-06

Suggest aligning with US Core Abatement Date

MedMorph suggests renaming and redefining Date of Resolution to align with the US Core element of Abatement Date. Please note that US Core uses the term "Abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

Element Name: Condition Abatement Date
Element Definition: The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

Submitted by Kara Rose on 2021-03-12

It is unclear when a past…

It is unclear when a past medical problem is “resolved.” We recommend that ONC define “resolved” and outline criteria for what constitutes a “resolved condition.” For instance, if a patient does not return for additional visits, does that mean the condition should be classified as “resolved,” when in fact, the condition may not have been resolved but the clinician does not know because the patient never returned.

Additionally, we recommend that ONC include a data element for “condition status.” Providers could use this to signal “we don’t know what happened after this point,” and then the resolution date would be null. We note that FHIR has two “status” data elements on condition – one for clinical status and the other for verification status.