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  1. FHIR Specification Feedback
  2. FHIR-36267

Problematic interpretation of Coding with system but no code

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: High High
    • FHIR Core (FHIR)
    • R4
    • Modeling & Methodology
    • Datatypes
    • 2.24.0.4 (Coding)
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      Will change "...in which to represent the code." to "...in which to represent the concept." because the existing wording was clearly wrong.

      Will add an additional sentence saying.

      "The implication of this is that implementers SHOULD never provide a system without a code unless this is the intended meaning AND it is appropriate for the code system and version.  (E.g. the code system does not have an 'OTHER' concept.)  This approach cannot be used if an appropriate code might exist within the code system but does not exist within the bound ValueSet."

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      Will change "...in which to represent the code." to "...in which to represent the concept." because the existing wording was clearly wrong. Will add an additional sentence saying. "The implication of this is that implementers SHOULD never provide a system without a code unless this is the intended meaning AND it is appropriate for the code system and version.  (E.g. the code system does not have an 'OTHER' concept.)  This approach cannot be used if an appropriate code might exist within the code system but does not exist within the bound ValueSet."
    • Grahame Grieve/Ron Shapiro: 3-0-0
    • Clarification
    • Non-substantive
    • R5

    Description

      The specification of the Coding data type currently (R4 and R5) contains the following statement:

      If the system is present, and there is no code, then this is understood to mean that there is no suitable code in the system in which to represent the code.

      This seems to be problematic for several reasons, as discussed in this Zulip thread: 

      https://chat.fhir.org/#narrow/stream/179202-terminology/topic/Interpretation.20of.20Coding.20with.20system.20but.20not.20code

      Some of the problems discussed:

      1. Entries with system but no code can quite easily arise by mistake, e.g. if a system is pre-selected in a UI but the user simply forgets to enter the code, or as a result of simple programming mistakes. Assigning a specific, clear intent to such entries (rather than saying they have no clear meaning or deeming them invalid) could thus lead frequent misinterpretations "in the wild".
      2. "It's a universal "OTHER" which, for classifications is invalid since a classification is by definition exhaustive. Furthermore, you'd want to know the code system version (because a later version may have added an appropriate code)."
      3. Such element may be used to satisfy a "required" constraint on a coded field, but it not clear that it is a valid use, given the possibly more appropriate use of an extension signalling the absence.
      4. While such element may be appropriate in specific situations, it does not seem appropriate for Coding quite generally.

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            Unassigned Unassigned
            morten Morten Ernebjerg
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              Updated:
              Resolved: