How can I represent a negative condition?

I try to represent a condition that is denied by the patient with FHIR. How do I do it? For example, if the patient says he has no chest pain, how do I use a Condition resource to represent it? I am thinking to use “verificationStatus” to set it to “refuted”. Like this:

“resourceType”: “Condition”,
“id”: “aaaa”,
“verificationStatus”: “refuted”,
“code”: {
“coding”: [
“system”: “”,
“code”: “426396005”,
“display”: “Cardiac chest pain”
}, …

but I am not sure that verificationStatus should be used for it. Any comments or suggestions?

Patient Care work group discussed this today and reaffirmed the guidance included in the FHIR specification ( ) is still appropriate.

Generally, electronic records do not contain assertions of conditions that a patient does not have. There are however two exceptions:

It is appropriate to capture a “refuted” Condition record if the patient or anyone else had reason to believe that a patient did have a condition for a period of time and subsequent evidence has demonstrated that belief was mistaken. In this case, a concrete statement acknowledging the belief as well as the refutation of it is useful.

It is common as part of checklists prior to admission, surgery, enrollment in trials, etc. to ask questions such as “are you pregnant”, “do you have a history of hypertension”, etc. This information should NOT be captured using the Condition resource but should instead be captured using QuestionnaireResponse or Observation. In this case, the combination of the question and answer would convey that a particular condition was not present.

We did approve adding a note in the specification that says “When the patient denies a condition, that can be annotated in the Condition.note element”

Thanks for the info. Sometimes a confirmation by patient of non-existence of a symptom can be important in the diagnostics and would be good to be recorded. And it would be weird to record it in QuestionnaireResponse etc because positive symptoms are recorded in Conditions.

This article suggests that we can use negation to represent it:

where the code such as SNOMED 45169001 (“without”) can be used, unless of course a direct negative condition code exist in SNOMED. So I guess with negation as an attribute or modifier together with the condition can express clearly a negative condition.

To elaborate a little more…

Symptoms aren’t always Conditions and can be recorded as Observations. Per the FHIR Condition boundaries ( ), it says “This resource is not typically used to record information about subjective and objective information that might lead to the recording of a Condition resource. Such signs and symptoms are typically captured using the Observation resource; although in some cases a persistent symptom, e.g. fever, headache may be captured as a condition before a definitive diagnosis can be discerned by a clinician. Use the Observation resource when a symptom is resolved without long term management, tracking, or when a symptom contributes to the establishment of a condition. Use Condition when a symptom requires long term management, tracking, or is used as a proxy for a diagnosis or problem that is not yet determined.”

Regarding SNOMED codes, I would call attention to the section on the use of Condition.code ( ) that acknowledges that Condition.code can specify additional properties of the condition. For example, a Condition.code could be SNOMED 62106007 Concussion with no loss of consciousness.

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