Stream: implementers
Topic: certainty of Condition
Robin Bosman (Oct 08 2019 at 09:06):
Hello, I am trying to make a Condition that describes it is not likely a patient has a specific condition.
In previous FHIR releases I find a reference to http://hl7.org/fhir/vs/condition-certainty that refers to SNOMED-CT's Known (qualifier value) {is-a 36692007} in which there is a 'NOT suspected' code that would solve my use case.
In R4 condition there is Condition.verificationStatus with required valueset http://hl7.org/fhir/ValueSet/condition-ver-status but that one does not include something like 'NOT suspected'.
Should I solve this by creating a custom negation extension on the code that describes the Condition with a 'provisional' verificationStatus? Unless I am missing something it feels like it was a conscious choice to no longer have this 'not suspected' possibility in the Condition?
Lloyd McKenzie (Oct 08 2019 at 13:38):
@Michelle (Moseman) Miller
Michelle (Moseman) Miller (Oct 08 2019 at 15:49):
See guidance in http://build.fhir.org/condition.html#9.2.4.4 and http://build.fhir.org/condition.html#9.2.4.5. Specifically,
Generally, electronic records do not contain assertions of conditions that a patient does not have. There are however two exceptions:
- It is appropriate to capture a "refuted" Condition record if the patient or anyone else had reason to believe that a patient did have a condition for a period of time and subsequent evidence has demonstrated that belief was mistaken. In this case, a concrete statement acknowledging the belief as well as the refutation of it is useful.
- It is common as part of checklists prior to admission, surgery, enrollment in trials, etc. to ask questions such as "are you pregnant", "do you have a history of hypertension", etc. This information should NOT be captured using the Condition resource but should instead be captured using QuestionnaireResponse or Observation. In this case, the combination of the question and answer would convey that a particular condition was not present.
Michelle (Moseman) Miller (Oct 08 2019 at 15:53):
As an FYI, I think certainty was removed between DSTU1 and DSTU2, per GF#3976
Robin Bosman (Oct 09 2019 at 11:46):
Thank you for clarifying! I guess I can assume that it would be valid then to have a Condition that is 'provisional' or 'unconfirmed' for a while but ends up 'refuted' (with some sort of evidence) -> so other clinicians know that was a condition that was considered for a patient.
Last updated: Apr 12 2022 at 19:14 UTC
