How does FHIR express uncertainty and negation?

Last week I received an e-mail asking how FHIR expresses Uncertainty and Negation. It was a general inquiry, but also asked how FHIR might express a specific clinical statement like “Intolerant to opiods, no known other medication ADEs, and no known environmental/food allergens”.

Here’s what I said…
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SMART, FHIR, and a Plan for Achieving
Healthcare IT Interoperability

Since 2010, the SMART team has been privileged to work on an exciting frontier of health data liberation, exposing structured patient-level data through an open API. We’ve striven for simplicity, with a constrained set of well-described data models, fixed vocabularies, a clean REST API, and Web-based UI integration. And we’ve endeavored to use existing standards where they fit the bill: that is, when existing standards were openly available and met our own subjective criterion of developer-friendliness.

When we launched our first preview of the SMART API back in 2010, there was no structured data content standard that fit the bill, so we rolled our own. We started with simple models for Patient, Medication, and Fulfillment, and over time we’ve expanded the collection to encompass over a dozen top-level clinical statements. Building and maintaining these data models was never our core goal, but until recently, there hasn’t been a suitable alternative on the horizon.
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Healthcare IT Interoperability”

Introducing the SMART C-CDA Collaborative


With support from ONC, the SMART Platforms team is working with Lantana Consulting Group to simplify and improve data exchange based on the HL7 Consolidated Clinical Document Architecture (C-CDA) standard for health summary data. We are working to ensure that real-world Health IT software can consistently produce and consume C-CDA documents, which will be a Meaningful Use Stage 2 (MU2) requirement for transitions of care between providers and for patients’ access to their own data. To this end, we’re formulating clear, “fill-in-the-gaps” implementation guidance for MU2 certification and beyond.

We’ve assembled a team of Health IT organizations for lightweight participation in a pioneering interoperability collaboration. We will identify and address “grey areas” in at least seven key domains of the C-CDA specification: demographics, medications, problems, allergies, vital signs, lab results, smoking status.
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