OBX -5 where OBX-2 is SN allows for a comparator value of = and <>; however FHIR does not

[lmichlsen]

If you have an OBX similar to below which are both v2 valid comparators OBX|1|SN|3339-4||=^23... or OBX|1|SN|3339-4||<>^23...

From v2.9 2.A.70.1 Comparator (ST) Defined as greater than, less than, greater than or equal, less than or equal, equal, and not equal, respectively (= ">" or "<" or ">=" or "<=" or "=" or "<>" If this component is not valued, it defaults to equal ("=").

Converter converts = and <> to "valueQuantity": { "comparator": "<>", "value": 23

valueSet in FHIR only allows for

Code | Display | Definition-- | -- | -- < | Less than | The actual value is less than the given value. <= | Less or Equal to | The actual value is less than or equal to the given value. >= | Greater or Equal to | The actual value is greater than or equal to the given value. > | Greater than | The actual value is greater than the given value. This results in invalid FHIR output

[lmichlsen]

Not sure how <> should be handled question to chat.fhir.org logged https://chat.fhir.org/#narrow/stream/179188-v2-to-FHIR/topic/Not.20equal.20comparator

[evachen96]

Hi @lmichlsen ! Thanks for submitting this issue. Hoping to get some more information about your use case to help us assess possible solutions.

From https://jira.hl7.org/browse/V2-25657, we agree with you that it could be concluded that = is just a value without a comparator. For the not equal case (<>), you mentioned that you've never seen that result in a lab test but there may be other observation types that need it, could you provide any examples?

Additionally, are you already using extensions right now? Extensions are one possible way we could tackle this, but wanted to see if your current setup already uses extensions/thoughts on usability of extensions.

Thanks!

[lmichlsen]

The suggestion I got from Zulip was to make <> value a string

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From: Eva Chen @.> Sent: Thursday, January 4, 2024 6:33:39 PM To: microsoft/FHIR-Converter @.> Cc: Michaelsen, Linda J @.>; Mention @.> Subject: Re: [microsoft/FHIR-Converter] OBX -5 where OBX-2 is SN allows for a comparator value of = and <>; however FHIR does not (Issue #504)

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Hi @lmichlsenhttps://github.com/lmichlsen ! Thanks for submitting this issue. Hoping to get some more information about your use case to help us assess possible solutions.

From https://jira.hl7.org/browse/V2-25657, we agree with you that it could be concluded that = is just a value without a comparator. For the not equal case (<>), you mentioned that you've never seen that result in a lab test but there may be other observation types that need it, could you provide any examples?

Additionally, are you already using extensions right now? Extensions are one possible way we could tackle this, but wanted to see if your current setup already uses extensions/thoughts on usability of extensions.

Thanks!

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[evachen96]

@lmichlsen Do you happen to have any examples or potential examples of use cases when the not equal <> comparator would be needed?