This Finnish base profile for the Reason for Care Condition resource is still very early in development, and implementer feedback is appreciated in many aspects. There are many TODO parts intentionally left in this draft version. See also the foreseen further development needs below.

Scope and Usage

This profile describes Diagnosis based conditions and Finnish kayntisyy. These are Condition resources that are asserted by a healthcare professional and directly related to encounters. This profile does not describe how to communicate problem-list-item level conditions.

THL has a data model for Finnish diagnosis (including käyntisyy) in code server: THL/Tietosisältö - Diagnoosit ("THL specification").

For high level documentation, see Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely 2021, versio 1.2.

This profile SHOULD NOT be used to describe reason given by patient for requesting/acquiring healthcare service. Finnish tulosyy.

Separating between Diagnosis based conditions and Finnish käyntisyy

Reason for care may be a diagnosis asserted by a clinician / medical doctor or some other reason for visit that is asserted by an nurse or some other healthcare professional.

A reason for care condition needs to be categorized to make the distinction between clinician asserted diagnosis and other käyntisyy conditions. When reason for care is a clinician asserted diagnosis it MUST contain another category code encounter-diagnosis. When condition is not asserted by a clincian it MUST NOT contain encounter-diagnosis category code.

Categories match to THL specification in following way:

• when additionally encounter-diagnosis is present –> This is a diagnosis and is not a käyntisyy
  • In THL specification, codeId 23: Käyntisyy has value False
• when encounter-diagnosis is not present –> This is a käyntisyy
  • In THL specification, codeId 23: Käyntisyy has value True

Diagnosis Code Systems

When using Finnish ICD-10 it's usage has special rules. These are described below. For reference and detailed specifications, see Potilastiedon arkiston Kertomus ja lomakkeet version 5.11 or later.

Diagnosis code (reason)

code SHALL only contain the reason code.

When using Finnish ICD-10, the code MUST NOT contain special characters (+,&,# after the code indicate reason). Pre-built pairs (like E85.9+I68.0) SHALL be broken down to constituent parts and the code part indicating reason (in case of E85.9+I68.0, Koodi1 field) used here.

In THL specification, this data is codeId 1: Diagnoosi.

In THL specification, there is another codeId 6: "ICD-10 -vastaavuuskoodi ICPC-koodille". This MAY be in code (it's the same code, but coded in another code system, so repetition of code is ok). Other codes, like symptom and accident type SHOULD NOT be repetitions of code.

More than one code may be used in code (in code's repetitions of coding). code itself cannot be repeated. Currently ICD-10, ICPC2 are supported by THL, in near future ICD-11, SNOMED and ORPHA will become supported too. Additional codes may be expressed by repeating coding. Other codes like a symptom SHOULD NOT be communicated via code, repetitions should represent the same concept (see CodeableConcept datatype specification).

Here's a valid example of repeating code.coding (code is not repeating, but coding has repetitions expressing the same information in two code systems):

  "code" : {
    "coding" : [
      {
        "system" : "urn:oid:1.2.246.537.6.1",
        "version" : "1999",
        "code" : "H36.03",
        "display" : "Proliferatiivinen diabeettinen retinopatia"
      },
      {
        "system" : "urn:oid:1.2.246.537.6.31",
        "version" : "2007",
        "code" : "F83",
        "display" : "Retinopatia, verkkokalvon rappeuma"
      }
    ],
    "text" : "..."
  }

Symptom code

In THL specification, this data is codeId 26: Diagnoosin tai käyntisyyn oirekoodi.

Symptom code SHOULD be communicated via evidence.

When using the Finnish ICD-10 version, the code MUST NOT contain special characters (+ after the code and * before code indicating the symptom). Pre-built pairs (like E85.9+I68.0) SHALL be broken down to constituent parts and the code part indicating symptom (in case of E85.9+I68.0, Koodi2 field).

For example:

"evidence" : [
    {
      "code" : [
        {
          "coding" : [
            {
              "system" : "urn:oid:1.2.246.537.6.1",
              "version" : "1999",
              "code" : "E11.3",
              "display" : "Aikuistyypin diabetes diabeteksen silmäkomplikaatiot"
            }
          ]
        }
      ]
    }
  ]

Name of diagnosis

In THL specification, this data is codeId 21: Diagnoosin tai käyntisyyn nimi.

A practitioner may make some adjustments to the name of the diagnosis. code.coding.display SHALL still be the original name from the codesystem and code.text MAY contain an adjusted name for the diagnosis.

Primary diagnosis (käyntisyy)

In THL specification, this data is codeId 2: Diagnoosin tai käyntisyyn ensisijaisuus.

Extension primaryCondition is used to express whether this diagnosis is the primary condition for why the encounter takes place.

The extension SHALL have a code from "AR/YDIN - Diagnoosin /toimenpiteen ensisijaisuus" (oid 1.2.246.537.5.40005).

Permanence (pysyvyys)

In THL specification, this data is codeId 8: Diagnoosin pysyvyys.

Extension permanence is used to express whether the condition is permanent or not.

The extension SHALL have a code from "AR/YDIN - Pysyvyys" (oid 1.2.246.537.5.40003).

This information has some relation to clinicalStatus, but "AR/YDIN - Pysyvyys" cannot be mapped to clinicalStatus codes (doing so would redefine clinicalStatus).

Onset

In THL specification, this data is codeId 12: Diagnoosin tai käyntisyyn toteamispäivä.

Standard onset SHOULD be used.

Abatement

In THL specification, this data is codeId 16: Diagnoosin päättymispäivä.

Standard abatement MAY be used.

Asserter

Standard asserter MAY be used.

When asserter references a Practitioner, it can provide information for codeId 11: Toteajan nimi in THL specification. When asserter references a PractitionerRole, it can provide information for both codeId 11: Toteajan nimi and codeId 19: Toteajan palveluyksikkö.

Type of physical exercise during which injury occurred

In THL specification, this data is codeId 24: Tapaturman liikuntalaji.

Extension physicalExcercise is used.

Endocrinological disorder

In THL specification, this data is codeId 27: Endokrinologisen häiriön koodi.

Extension endocrinologicalDisorder is used.

Medication that caused this condition

In THL specification, this data is codeId 28: Aiheuttajan ATC-koodi.

Extension conditionCausedByMedication is used.

External cause for diagnosis

In THL specification, this data is codeId 3: Diagnoosin ulkoinen syy.

Extension conditionExternalCause is used.

Categorization of the type of accident

In THL specification, this data is codeId 4: Diagnoosin tapaturmatyyppi.

Extension conditionCategorizationOfAccident is used.

Cause of an adverse effect

In THL specification, this data is codeId 5: Haittavaikutuksen aiheuttaja.

Extension causeOfAdverseEffect is used.

Further development needs