Conditions

Overview

The Conditions component allows providers to easily manage patient Problem Lists leveraging a summarized history of conditions reported for that patient and detailed chronologies of clinical documentation associated with each condition. Providers can:

Manage a list of active and inactive patient conditions
See a de-duplicated list of conditions reported by other providers and not in your patient problem list
See a chronological history of condition documentation by your team or other providers
Easily reconcile and add conditions from other providers’ lists to your own problem list

Conditions List and Outside Conditions

Conditions are divided into two sections:

Conditions List: Any conditions your provider team chooses to add to the patient problem list
Outside Conditions: Any conditions other provider teams have reported about the patient and are not in your patient problem list

The component summarizes conditions based on SNOMED CT terminology so providers have a simple de-duplicated problem list to review. Additionally, the Conditions List and Outside Conditions are mutually exclusive so Outside Conditions only highlights data that is "new to you."

If you've never seen a patient, Conditions List will be blank while Outside Conditions will contain a summarized list of all conditions found in the patient's ZAP.
On later visits, Conditions List will contain any conditions your provider team has recorded to the patient problem list. Outside Conditions will contain a summarized list of all conditions found in the patient's ZAP and not in your problem list. Additionally, if a conflicting determination is reported (e.g., your record says Anemia is inactive but a newer report says its active), this new information will be reported in Outside Conditions.

Although not all raw clinical data includes SNOMED CT codes, the Zus Data Enrichment service supplements these codes where 1:1 mappings are available enabling 97% coverage of SNOMED CT for conditions in Zus. When SNOMED is not available, Zus also de-duplicates on ICD-10 and name strings. In rare occasions, this can result in duplicates (e.g., an uncoded condition duplicates a coded SNOMED condition).

Condition History

Condition History is available for any condition in Conditions List or Outside Conditions.

Details

In Conditions List, Details show the latest information in your patient record.
In Outside Conditions, limited information is available. The most recent recorded date and status, as well as earliest onset date are shown.

History

History shows all individual records in the ZAP associated with a given condition, including encounter diagnoses and problem list documentation. Expanding a record provides available detail such as the reporting physician (Recorder), status, and the associated encounter. If a source document is available, it'll be notated with an icon and linked.

Managing Conditions (Add / Edit, Remove, Dismiss)

Conditions can be added from Outside Conditions or de novo using the Add Condition button. The form allows you to search for and select any condition, select an appropriate status, record onset and / or abatement date, and includes notes.

The auto-complete allows Zus to include the associated SNOMED CT code for any saved conditions.
In addition to Active, Inactive, and Refuted, Zus offers Pending and Entered in Error statuses.
- Entered in Error is equivalent to a soft delete. This is the status that will be placed on any conditions you choose to remove from your Conditions List
- Pending is not adopted by all organizations. Some use it to denote conditions with labs pending or for pre-charting and other supporting care team workflows that occur prior to the physician visit.

Dismissing Outside Conditions

The component includes a Dismiss feature for Outside Conditions. This is meant to enable situations where you do not want to include an externally reported condition in your record for administrative purposes and want to 'hide' the Outside Condition. For example:

Edema of foot and lower extremity are both reported in Outside Conditions. You choose to add Edema to your provider record and then dismiss the two Outside Conditions.
You choose not to discuss a problem with a patient because it is irrelevant to your care (e.g., fracture from 5 years ago, unrelated to your specialty) and the patient does not report the problem. You dismiss the associated Outside Conditions.

If you believe a condition is inactive or would like to refute it based on your own clinical assessment, this is considered clinical documentation. You should add the condition and then specify the correct status.

Note: The dismiss functionality is reversible. Dismissed conditions can be found by updating the Status filter.

Sorting and Filtering

Sort is supported for condition name, category, status and last updated date.
Filtering is supported for category and status.
Category helps group conditions into clinically meaningful categories and generally align to certain body systems. Category is defined by applying HCUP's Clinical Classifications Software Refined (CCSR) via the Zus Data Enrichment service.

FAQs

Why isn't a patient condition visible in the UI? I see it when I query the Zus platform via API or data mart.

The component excludes Outside Conditions categorized as FAC (factors influencing health status and contact with health services) or assigned no category by HCUP's Clinical Classifications Software Refined. This is because -- although reported as conditions data -- the information is inconsistent with conditions and problems appropriate for a problem list.

Common examples:

Encntr for obs for susp expsr to oth biolg agents ruled out (SNOMED 315215002, FAC016 Exposure, encounters, screening or contact with infectious disease)
Healthcare maintenance (SNOMED 305058001, FAC014 Medical examination/evaluation)
Dietary management surveillance (SNOMED 424928005, FAC012 Other specified encounters and counseling)
No current problems or disability (SNOMED 160245001, no CCSR mapping)