Procedure or Act unknown not done

Background

Out of several projects over here the question came up: Is there a recommended way in HL7 to say that it is unknown whether

• Procedure or Act X occurred (or is planned) or that
• A specific problem is unknown
• A Procedure or Act is not done?

I saw different approaches and would like to hear what can recommended to the HL7 community.

So far

Condensed conversations so far

Lloyd

Unknown: The Act.uncertaintyCode is probably the best way.

Kai

Act.uncertaintyCode is one option I saw… Personally I am not convinced that expressing "unknown" and "unsure" is the always the same.

Gaby, Keith

Per consolidated CDA, I believe what you are saying would be

<entry>
  <substanceAdministration moodCode="EVN" classCode="SBADM" nullFlavor="NI">
  <text>I do not know whether or not patient received an anticoagulant drug</text>
  <consumable>
    <manufacturedProduct>
      <manufacturedLabeledDrug>
      <code code="81839001" displayName="anticoagulant drug" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
      ...

With @nullFlavor you express that the substanceAdministration of a specific drug is unknown.

Kai

What is obvious to convey that a Procedure or Act is not done:

<procedure classCode="PROC" moodCode="ENV" negationInd="true">
  <id...
  <code...
</procedure>

This is a structural way. There is another discussion ongoing where it is discussed whether "not done" should be part of the vocabulary (thus conveyed in code) or it should be structurally conveyed (with negationInd). A recommendation on not done Procedure or Acts is also needed. This is also subject of another thread in the lists.

More

Another solution was: use actionNegationInd with a nullFlavor.

Unfortunately actionNegationInd is immutable and thus a structural attribute (and rendered as an XML attribute). Again you cannot use it to express a null flavor here. It is unavailable in CDA R2, too.

Seeking for recommendations

This should work for CDA R2, "old style V3" (as long as we have DSTUs or standards in this state) and new V3 messaging. This would not necessarily mean one solution if not possible (e.g. introduction of actionNegationInd which isn't present in CDA R2).

I am seeking for a "strong" recommendation from InM.