Download “Consolidation vital signs” has the following requirements

General
1. Several items in Consolidation require elements not required in the EMS dataset, e.g., patient
address, which is not always ascertainable prior to arrival at the ED. 1.8.5 & 1.8.8 suggest these
can be null, (e.g., “NAV).
2. Several items in Consolidation are close to the EMS specification, but require IDs. Should EMS
providers generate identifiers (system identifiers, timestamps, or UUIDs) to support this
requirement, even though they will not be tracked or referenced by source systems, in order to
support wider recognition of the information section by template ID? Or should Null Flavors be
used instead?
3. Several Consolidation sections (e.g., History of present illness) contain little or no structure. Is
there value in specializing them for more constrained EMS sections?
4. If an EMS section template specializes a Consolidation template, the new template must use the
same LOINC code. LOINC feels that EMS specializations require EMS-specific LOINC codes,
prohibiting the specialization of Consolidation section templates. See Medical History, History of
past illness, Procedures performed.
5. EMS models negation of collections (medications, allergies) in individual questions. E.g., the
question “Is the patient on any medications” supports unambiguous understanding of the
answer “no.” Consolidation creates a notional medication that is then negated. Should EMS
adopt this more standard but less clear convention?
Header
Conflicts: what effect will requiring these have on NEMSIS? Will Consolidation accept a null or empty
field?
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Consolidation requires a patient address; NEMSIS does not. Patient address is not always
ascertainable prior to delivery to ED.
Consolidation requires Name to have at least one given and exactly one family; NEMSIS names
are “recommended.” Patient name is not always ascertainable prior to delivery to ED.
Consolidation requires human author; NEMSIS “crew member completing this report” is
optional, though the agency and system are not.
Consolidation requires address and telecom for device as well as human author; NEMSIS
requires address only for the human author.
Consolidation requires custodian telecom; NEMSIS does not.
Questions
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If document effective time is document creation time, is Author time different?
EMS notes:
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Add D-side cross references for custodian bits; e.g., dAgency.02 EMS Agency Number for
eResponse.01; dAgency.03 EMS Agency Name for eResponse.02.
Guide needs to represent constraints from Consolidation even when not further constraining
them in order to cross-reference NEMSIS element codes.
Add general requirement for Text in all sections, with guidelines for generating de-referenced
text from entries.
templateID: add root = 2.16.840.1.113883.10.20.22.1.1 to assert header
Assert “DRIV” in section text, except “Narrative”
Injury Incident
Similar to Consolidation “History of Present Illness,” but more specific, and structured.
Decision: see general question 3.
Cardiac Arrest Event
Similar to Consolidation “History of Present Illness,” but more specific, and structured.
Decision: see general question 3.
Current Medications
Consolidation “Medications” section has the same requirements as “Medications Administered that
would require modification of EMS:
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Medication activity requires an ID, status (fixed), start and stop times
These could be provided: ID as a random UUID (not designed to be reused), status as a fixed value (e.g.,
current), both time interval range values as the value of the EMS time.
Decision: see general question 2.
Allergies & Adverse Reactions
Consolidation has the following requirements that would require modification of EMS:
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Deeper structure, including problem act pattern to capture adverse event observations as well
as attested concerns
IDs required for act and observation
Add problem status code = active 2.16.840.1.113883.3.88.12.80.68
Add times to act and observation
Observation value = 20134006 Propensity to adverse reactions (disorder)
Add associated manufactured material for allergen
Consolidation has the following requirements, incompatible with EMS:
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For non-medicine allergies, the value set is FDA UNII. This set is far too granular for EMS, which
only captures classification (food, plant, chemical, etc.).
EMS has the following requirements, incompatible with Consolidation:
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EMS models “no known allergies” as a separate question rather than as a negated observation.
Decision: don’t specialize Consolidation template.
Past Medical History
Consider extending Consolidation Medical (General) History, which has minimal constraints.
(Note: Consolidation “History of Past Illness” is described as “history related to the patient’s current
complaints, problems, or diagnoses,” which seems counter to the title, and also makes the section too
specific for our needs.)
Consolidation Procedures section may be relevant – if there is a corresponding conditions section.
Decision: see general question 3.
Advanced Directives
“Consolidation Advance Directives Section” and “EMS Advance Directives Section” use the same section
LOINC code.
The Consolidation document captures a directive classified by clinical type (e.g., “Antibiotic therapy”),
and should capture a custodian, verifier, and document.
The EMS document captures a directive classified by source type (e.g., “Living Will”); some values also
indicate the directive itself (e.g., “Family/Guardian request DNR”).
Decision: use the EMS section, not the Consolidation section.
Question: Should the EMS section use the same LOINC code as the Consolidation guide?
Social History
Consolidation Social History contains race and ethnicity, found in our Header.
Consolidation Social History observation types are more deterministic than EMS “indicators”; e.g.,
“Details of drug misuse behavior” rather than “Drug Paraphernalia at Scene.”
Decision: don’t specialize Consolidation template.
Vital signs
“Consolidation vital signs” and “EMS Vital Signs” use common LOINC codes for common observations.
“Consolidation vital signs” has the following requirements, incompatible with “EMS Vital Signs”:
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ID required for each observation (CONF:7300)
“EMS Vital Signs” has the following requirements, incompatible with “Consolidation vital signs”:
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Additional observations, outside the scope of 2.16.840.1.113883.3.88.12.80.62 (HITSP Vital Sign
Result Type)
Grouping to associate vital signs sets with “prior aid”
The EMS template is structurally similar to the Consolidation version, but it allows multiple organizers—
each associated with a “prior care” indicator—and it allows additional observations, some of which also
have structure (e.g., Glasgow Coma Score, cardiac rhythm).
Decision: don’t specialize Consolidation template.
Physical Assessment
Consolidation Assessment “represents the clinician's conclusions and working assumptions that will
guide treatment of the patient,” and is not appropriate.
Consolidation General Status is another candidate, as it contains what might be termed “evidence of
distress;” however, it seems to intend more holistic observations.
Consolidation Physical Exam may contain General Status and Vital Signs. Does Consolidation Physical
Exam section imply diagnosis?
Decision: probably specialize Physical Exam.
Medication Administered
Consolidation Medications Administered has the following requirements that would require
modification of EMS:
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Medication administration requires an ID, status (fixed), times
These could be provided: ID as a random UUID (not designed to be reused), status as a fixed value (e.g.,
current), and time boundaries equal to the single NEMSIS time value. None is optimal.
Decision: see general question 2.
Procedures Performed
Consider extending Consolidation Interventions, which has minimal constraints, subject to LOINC code
constraint.
Decision: see general question 3.
Patient Care Report Narrative
EMS section is narrative only.
Decision: Use history of present illness.
Dispatch
No Consolidation analogue found
Response
No Consolidation analogue found
Disposition
No Consolidation analogue found
Billing
Billing is concerned with classification of services for billing purposes; it does not contain Payer
information and cannot use the Consolidation Payers section.
Exposures or Injuries of EMS Personnel
No Consolidation analogue found
Protocol
No Consolidation analogue found
Scene
Consolidation Service Delivery Location describes recognized healthcare facility types, not field service
locations. In addition, Scene contains event-related information, such as patient count and first
responder.
No Consolidation analogue found
Situation
The Situation section most closely resembles the Consolidation Chief Complaint section in concept.
However, Situation is structured, it may include secondary complaints, and it also includes a condition
assessment not indicated by chief complaint.
The Consolidation Problem section contains a problem concern which contains a problem observation.
The observation requires an ID, value from set problem type (e.g., “complaint”), value from KP/VA
problem list (2009) from SCT. EMS uses a text problem statement, with symptoms taken from ICD-10
CM.
Decision: use an EMS-specific Situation section rather than the Consolidation Chief Complaint section or
Problem section.
Times
No Consolidation analogue found