International Patient Summary Implementation Guide
2.0.0 - STU 2

International Patient Summary Implementation Guide, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-ips/ and changes regularly. See the Directory of published versions

## Empty Sections and Missing Data

Page standards status: Informative

### Empty Sections & Missing Data

#### Empty & Known Absent Sections

There are currently 16 sections defined in the IPS. All sections have 0..* references in the IPS Composition.section.entry element of the IPS, meaning that a section may be included without a reference to a structured resource. When not including a resource reference for required sections (Allergies and Intolerances, Problems and Medication Summary), Composition.section.emptyReason SHALL be populated (see ips-comp-1). For non-required sections, a Creator may alternatively choose to omit sections when no data is available. For all sections populated in an IPS, Composition.section.text SHALL be populated to provide a human readable presentation of the information in the section. See Narrative and Language Translation for more on this design convention.

Resources may also be used to assert the known absence of data rather than using the IPS Composition.section.emptyReason. It is recommended to use patterns established within FHIR implementations to assert this known absence. For example, with AllergyIntolerance a SNOMED CT code may be used to represent no known allergy. Prior versions of the IPS implementation guide had included a code system for no known data assertions, this code system has been removed from the guide and is no longer recommended for use. The recommended SNOMED CT concepts for representing known absence of data are included in the profile's primary code binding value set (typically the 'code' element).

It is recommended that when a source system does not have information about a particular IPS section, the emptyReason element for that section is populated with the appropriate empty reason code, generally 'unavailable' or 'notasked'. However, if it is preferred to use an explicit clinical statement to assert the absence of information, it is recommended that a resource be included in the relevant section using the SNOMED CT code '1287211007' "No information available".

A system creating an IPS that can never populate data in a section marked with the SHALL:populate obligation (i.e. Allergies, Problems and Medications) can produce valid IPS Bundle instances, although it cannot comply with the Creator (IPS) actor obligations.

#### Optional Data Elements with Must Support/Obligations (cardinality of 0..1 or 0..*)

If a Creator (IPS) does not have data to be included in the IPS, the data element is omitted.

Note: a Creator (IPS) may have no data to be included in the IPS, either because there are no data, data are not allowed to be shared, or because data available are not pertinent within the scope of the IPS.

#### Required Data Elements with Must Support/Obligations (cardinality of 1..1 or 1..*)

If a Creator (IPS) does not have data to be included in the IPS, the reason for the absence SHALL be specified as follows:

1. For non-coded data elements, use the Data Absent Reason Extension in the data type. Example: Patient resource where the birthDate is not known (note that since birthDate is a date primitive datatype, in JSON the _birthDate sibling property is used for the extension). Other required properties of Patient resource are omitted (shown by …) in the simplified example below.

       {
         "resourceType" : "Patient",
         ...
         "_birthDate": {
           "extension" : [
             {
               "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
               "valueCode" : "unknown"
             }
           ]
         },
         ...
       }

   Example: Procedure resource where the performed value is not known. The performed[x] is a choice of type, although any performed[x] choice element can be used to include the data absent reason extension, in this case performedDateTime is must support and hence a good choice (note that performedDateTime is a dateTime primitive datatype, in JSON the _performedDateTime sibling property is used for the extension). Other required properties of Procedure resource are omitted (shown by …) in the simplified example below.

       {
         "resourceType" : "Procedure",
         ...
         "_performedDateTime": {
           "extension" : [
             {
               "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
               "valueCode" : "unknown"
             }
           ]
         },
         ...
       }

2. For coded data elements:

   - example, preferred, or extensible binding strengths (CodeableConcept datatypes):
     - if the source systems has text but no coded data, only the text element is used.
     - if there is neither text or a code representing actual (i.e non-exceptional) concepts:
       - use the appropriate exceptional concept code from the element's binding value set, if available; or
       - use the appropriate concept code from the Data Absent Reason Code System.
   - required binding strength (CodeableConcept or code datatypes):
     - use the appropriate exceptional concept code from the element's binding value set

   Example: Observation Results - Laboratory/Pathology (IPS) resource where the code is not allowed to be shared (e.g. suppressed), the code element contains the data-absent-reason extension. Other required properties of Observation resource are omitted (shown by …) in the simplified example below.

       {
         "resourceType" : "Observation",
         ...
         "code": {
           "coding" : [
             {
               "system" : "http://terminology.hl7.org/CodeSystem/data-absent-reason",
               "code" : "masked"
             }
           ]
         },
         ...
       }