IPS NoInfos section

Introduction

There is an in progress discussion in the group about the best way to express the absence of information about a specific section. For exmaple there are no data about allergies, I don't know anything about medications, and so on. This is different by the case "at the best of my knowledge I'm not aware about allerigies for this patient".

This problem mainly applies for mandatory sections.

Available templates seem to propose different approaches for this.

Principle

The way this case is managed should be the same for all the sections.

Cases to be covered

1. No info about allergies/intollerances
2. No info about medications
3. No info about problems
4. No info about procedures
5. No info about medical devices, implants

Options considered so far

Nullflavored section

• This seems to be the C-CDA suggested approach. The section are nullflavore with "NI" and only the text is present

  <section nullFlavor="NI">  <title> </text></section>

Pros:

1. Simple to model and common for all the sections

Contras:

1. Doubts on the actual semantic of this approach
2. implementers should look to different elements / attributes to get the right information about an element

Coded element

• The coded element that conveys the main information (e.g. the type of allergy) is used also for indicating that there are no info about it.

Pros:

1. Implementers access to the same element / attribute to get positive and "no infos" data

Contras:

1. Codes are not always available for all the cases (how to deal with these cases ?)
2. the approved C-CDA example for known absent uses the negationInd

Possible codes

Section	No Infos	Known Absent
Allergies/intollerances	???	716186003 | No known allergy (situation)
Medications	182904002 | Drug treatment unknown (finding) (see note1)	182849000 | No drug therapy prescribed (situation) OR 408350003 | Patient not on self-medication (finding)
Problems	396782006 | Medical history unknown (situation)	???
Procedures	see note2	???
Medical devices, implants	???	???

Note1: is this correct ? does it mean that there is a treatment that is unknown ? or are the "drug treatments" unknown ?

Note2: there is a "procedure unknown" code the doubt is what is actually representing

Nullflavored entry

• The single nullflavored entry is provided.

   <section > <…> <entry> <act nullFlavor="NI">  <..> </section>

Pros:

1. Simple to model and common for all the sections

Contras:

1. implementers should look to different elements / attributes to get the right information about an element

Comments

Kai Heitmann 2017-02-21 opinion: I doubt that a section is feasible to convey NO INFORMATION in a coded way AT ALL. I consider a section as a coded and labelled TEXT, not more. So the only thing I can convey is "No allergies" or "אין אלרגיות" (sorry for the Hebraic :-) in the section about allergies. If I want to code that no allergies are stated that needs to go into an entry.