FHIR R4 Symptoms Implementation Guide
1.0.0-ballot - STU 1 Ballot International flag

FHIR R4 Symptoms Implementation Guide, published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-symptoms-ig/ and changes regularly. See the Directory of published versions

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IG Home

Official URL: http://hl7.org/fhir/uv/symptoms/ImplementationGuide/hl7.fhir.uv.symptoms Version: 1.0.0-ballot
IG Standards status: Trial-use Active as of 2025-12-17 Maturity Level: 1 Computable Name: SymptomsDataStandards

Overview

The purpose and rationale for this guide center around the absence of standardized definitions and formats for symptoms data that hinders effective sharing across providers, leading to data silos and interruptions in critical diagnostic thinking. This initiative aims to decrease missed, delayed, or inaccurate diagnoses by enhancing the documentation and exchange of symptoms, a crucial step in the diagnostic process.

This guide provides FHIR profiles that structure symptom data for seamless exchange across visits and health systems. This will enhance recognition of symptom patterns, reducing clinician burden by streamlining the diagnostic process, and ultimately support informed diagnostic decision-making, improving outcomes for patients.

From Pre-Coordinated to Post-Coordinated: Best Practices for Symptom Data Exchange

Electronic health records (EHRs) and other clinical systems sometimes capture and store symptoms as pre-coordinated concepts and/or text, meaning one code combines multiple details—for example, “abdominal pain” includes both the symptom and the body site.

For data exchange, this Implementation Guide (IG) recommends a post-coordinated approach. This means breaking down the combined code (decomposition) so the symptom goes in observation.value, while related details—such as body site—are recorded in separate fields. This structure improves flexibility and supports consistent interoperability across systems. See this Table which provides examples of Pre-Coordinated code versus the Post-Coordinated combinations.

It is still necessary for the original pre-coordinated concept to be included in exchange and the FHIR CodableConcept structure allows this by including multiple Codings. Our recommendation is that a system send the post-coordinated code as one Coding and also send the original concept as another Coding with the Coding.userSelected element set to 'true'.

Pre-coordinated Map to Post-coordinated
Observation.value Observation.value Observation.bodySite
coding.code coding.display value.coding.code value.coding.display coding.code coding.display
51197009 Stomach cramps (finding) 55300003 Cramp (finding) 69695003 Stomach structure (body structure)
53430007 Pain of breast (finding) 22253000 Pain (finding) 76752008 Breast structure (body structure)
25064002 Headache (finding) 22253000 Pain (finding) 69536005 Head structure (body structure)
279039007 Low back pain (finding) 22253000 Pain (finding) 37822005 Structure of back of abdominopelvic segment of trunk (body structure)
30473006 Pain in pelvis (finding) 22253000 Pain (finding) 12921003 Structure of pelvis (body structure)
23924001 Tight chest (finding) 299954009 Tightness sensation (finding) 51185008 Thoracic structure (body structure)
57676002 Pain of joint (finding) 22253000 Pain (finding) 39352004 Joint structure (body structure)
21522001 Abdominal pain (finding) 22253000 Pain (finding) 818983003 Abdomen (body structure)
29857009 Chest pain (finding) 22253000 Pain (finding) 51185008 Thoracic structure (body structure)

Content and Organization

This implementation guide (and the menu for it) is organized into the following sections:

  • Background - Supporting informative pages that do not set conformence expectations
    • Reading this IG points to key pages in the FHIR spec that must be understood in order to understand this guide
    • Use Cases gives examples of symptoms and how they are recorded using the profiles in the guide
    • Projects and Participants identifies the individuals and organizations involved in developing this implementation guide
  • Specification - Pages that set conformance expectations
  • FHIR Artifacts
    • Artifacts points to the complete list of artifacts defined in this guide
    • Terminology lists all of the value sets that are defined in this guide
  • Support - Links to help with the use of this guide
    • Discussion Forum is a place to ask questions about the guide and discuss potential issues
    • Project Home includes information about project calls, agendas, past minutes, and instructions on how to participate
    • Project Dashboard shows new and historical issues that have been logged against the specification
    • Propose a Change allows formal submission of requests for change to the specification
  • Change Log lists all of the changes between versions of the guide

Dependencies

Implementation GuideVersion(s)Reason
FHIR Extensions Pack5.2.0

Automatically added as a dependency - all IGs depend on the HL7 Extension Pack

FHIR R4 package : Core4.0.1Imported by HL7 Terminology (THO) (and potentially others)
FHIR Tooling Extensions IG0.9.0Imported by OpenEHR Base package (and potentially others)
HL7 Terminology (THO)7.0.1

Automatically added as a dependency - all IGs depend on HL7 Terminology

OpenEHR Base package0.1.0-snapshot

IP Statements

This publication includes IP covered under the following statements.