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  1. FHIR Specification Feedback
  2. FHIR-34468

Condition.clinicalStatus clarification (of invariant con-3)

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    • Change Request
    • Status: Published (View Workflow)
    • Medium
    • Resolution: Persuasive with Modification
    • US Core (FHIR)
    • current
    • Cross-Group Projects
    • STU
    • US Core Condition Profile
    • General Guidance
    • 10.87.1.1, 2.1.1.6
    • Hide

      Background:

      See the commenter Description and the Background discussion for FHIR-35318

      The general guidance section referenced by the commenter states ( with  the text in question highlighted ):

      • For the US Core profiles, the following mandatory status elements with required binding have no appropriate “unknown” concept code:
        • AllergyIntolerance.clinicalStatus*
        • Condition.clinicalStatus*
        • DocumentReference.status
        • Immunization.status
        • Goal.lifecycleStatus

      *The clinicalStatus element has the following constraints: SHALL be present if verification status is not entered-in-error and SHALL NOT be present if verification Status is entered-in-error.

      Reasoning:

      We agree with the commenter that the documentation regarding Condition.clinical status is incorrect and needs to be updated to reflect FHIR R4 constraints.
       

      Proposed Changes:

      1. See Resolution Description for FHIR-35318
      2. change  general guidance section as follows:

      from:

      • For the US Core profiles, the following mandatory status elements with required binding have no appropriate “unknown” concept code:
        • AllergyIntolerance.clinicalStatus*
        • Condition.clinicalStatus*
        • DocumentReference.status
        • Immunization.status
        • Goal.lifecycleStatus

      *The clinicalStatus element has the following constraints: SHALL be present if verification status is not entered-in-error and SHALL NOT be present if verification Status is entered-in-error.

      to: ( see colored text)

      • For the US Core profiles, the following mandatory or conditionally mandatory* status elements with required binding have no appropriate “unknown” concept code:
        • AllergyIntolerance.clinicalStatus*
        • Condition.clinicalStatus*
        • DocumentReference.status
        • Immunization.status
        • Goal.lifecycleStatus

      *The clinicalStatus element is conditionally mandatory based on resource specific constraints.

        

      Show
      Background: See the commenter Description and the Background discussion for FHIR-35318 The general guidance section referenced by the commenter states ( with  the text in question highlighted ): For the US Core profiles, the following mandatory status elements with required binding have no appropriate “unknown” concept code: AllergyIntolerance.clinicalStatus * Condition.clinicalStatus * DocumentReference.status Immunization.status Goal.lifecycleStatus * The clinicalStatus element has the following constraints: SHALL be present if verification status is not entered-in-error and SHALL NOT be present if verification Status is entered-in-error. Reasoning: We agree with the commenter that the documentation regarding Condition.clinical status is incorrect and needs to be updated to reflect FHIR R4 constraints.   Proposed Changes: See Resolution Description for FHIR-35318 change  general guidance section as follows: from: For the US Core profiles, the following mandatory status elements with required binding have no appropriate “unknown” concept code: AllergyIntolerance.clinicalStatus * Condition.clinicalStatus * DocumentReference.status Immunization.status Goal.lifecycleStatus *The clinicalStatus element has the following constraints: SHALL be present if verification status is not entered-in-error and SHALL NOT be present if verification Status is entered-in-error. to: ( see colored text) For the US Core profiles, the following mandatory  or conditionally mandatory*  status elements with required binding have no appropriate “unknown” concept code: AllergyIntolerance.clinicalStatus * Condition.clinicalStatus * DocumentReference.status Immunization.status Goal.lifecycleStatus *The clinicalStatus element is conditionally mandatory based on resource specific constraints.    
    • Brett Marquard/Eric Haas: 15-0-0
    • Clarification
    • Non-substantive

    Description

      Section 10.87.1.1 says

      *The status element has the following constraints: SHALL be present if verification status is not entered-in-error and SHALL NOT be present if verification Status is entered-in-error.

      Section 2.1.1.6 says

      where the minimum cardinality is > 0

      • Condition.clinicalStatus

      Both of these imply that Condition.clinicalStatus is required, but the Condition.clinicalStatus has cardinality 0..1 and the invariant con-3 is only applicable to problems (not diagnoses)

      con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (: clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())

      Can the sections above be clarified to include the additional context that clinicalStatus is only required when it's a problem (i.e. clinicalStatus can be empty when category is encounter-diagnoses)?

      This has been a frequent implementer question (how to handle diagnoses on claims without a clinicalStatus) per:

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              Unassigned Unassigned
              michelle.m.miller Michelle Miller
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                Updated:
                Resolved: