jaymeemurdoch
commented
1 year ago Additional comment from Stephen Chu:
After further assessment of this issue, it is even more confusing as information about absence of information in the medication list appears in 3 separate places: At the list level: List.emptyReason 0..1 codeableConcept - valueset: http://hl7.org/fhir/R4/valueset-list-empty-reason.html, which includes 6 values (nil known, not asked, withheld, unavailable, not started, closed) At the item level: List.entry.item 1..1 Reference(AU Assertion of No Relevant Finding) - which includes 2 separate representations) https://build.fhir.org/ig/hl7au/au-fhir-base/StructureDefinition-au-norelevantfinding.html Observation.dataAbsentReason 0..1 CodeableConcept Binding: https://healthterminologies.gov.au/fhir/ValueSet/assertion-of-absence-1 (extensible)
includes 6 values (which include: No know current medicines | no vaccine admin during encounter) Note: "No vaccine admin during encounter" is not a good fit for medication list Binding: http://hl7.org/fhir/R4/valueset-data-absent-reason.html (extensible) includes 15 values These multiple level duplications are highly undesirable. It is highly unlikely that any amount of descriptive guidance will be able to address this issue adequately
Suggestions:
(A) There may be a need to support assertion of absence of data on individual medication list item, e.g. certain vaccine dose administration unknown, or certain vaccine dose was not administered. The International spec includes Invariant statements that could have prevented the confusion: http://hl7.org/fhir/list-definitions.html#List lst-1 Rule A list can only have an emptyReason if it is empty emptyReason.empty() or entry.empty() But this invariant statement is suppressed in the AU spec To prevent confusion, (a) the suppression of invariant statements that exist in the International spec should be removed. (b) Clarify that if List.entry.item includes "AU Assertion of No Relevant Finding" and List.emptyReason are mutually exclusive
(B) Clean up the conflicting value sets in the AU Assertion of No Relevant Finding: https://hl7.org.au/fhir/4.1.0-ballot/StructureDefinition-au-norelevantfinding.html Observation.dataAbsentReason Binding: https://healthterminologies.gov.au/fhir/ValueSet/assertion-of-absence-1 (extensible) Observation.value[x] Binding: DataAbsentReason (extensible): Codes specifying why the result
brettesler-ext
Issues identified in Ballot comments for 4.1.0:
See below - there are two different structures to express changes, but there is no constraint or invariant statement to ensure that the information carried by the two structures do not conflict. Some descriptive guidance is suggested.
https://hl7.org.au/fhir/4.1.0-ballot/StructureDefinition-au-medlist-definitions.html#key_List.entry.flag List.entry.flag - definition: The flag allows the system constructing the list to indicate the role and significance of the item in the list binding: The codes SHOULD be taken from Medicine Item Change
https://hl7.org.au/fhir/4.1.0-ballot/StructureDefinition-au-medlist-definitions.html#key_List.entry.extension:changeDescription Definition: Description of a change including the reason for change Type: Extension(ChangeDescription) (Extension Type: string)
See below - there are two ways to reference information about medicines at item level, and at list level. The two ValueSets have different codes and values, some are semantically similar but not equivalent, and some are different. This creates potential for conflicting assertions, or confusion of how to represent. Suggest harmonising the two ValueSets to remove conflicts, or provide additional descriptive guidance.
List.entry.item - Reference (AU Assertion No relevant finding (https://hl7.org.au/fhir/4.1.0-ballot/StructureDefinition-au-norelevantfinding.html)) Observation.value - value set: https://www.healthterminologies.gov.au/integration/R4/fhir/ValueSet/assertion-of-absence-1 (no known current medicines, No vaccine administered during encounter)
List.entry.emptyReason - binding: http://hl7.org/fhir/R4/valueset-list-empty-reason.html (nil known, not asked, withheld, unavailable, not started, closed) Reporter:Jaymee Murdoch (on behalf of Agency) Email:jaymee.murdoch@digitalhealth.gov.au