Connectathon 11 Snapshot

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4.6 Resource ClinicalImpression - Content

Patient Care Work GroupMaturity Level: 0Compartments: Patient, Practitioner

A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score.

4.6.1 Scope and Usage

Performing a clinical assessment is a fundamental part of a clinician's workflow, performed repeatedly throughout the day. In spite of this - or perhaps, because of it - there is wide variance in how clinical impressions are recorded. Some clinical assessments simply result in an impression recorded as a single text note in the patient 'record' (e.g. "Progress satisfactory, continue with treatment"), while others are associated with careful, detailed record keeping of the evidence gathered, the reasoning leading to a differential diagnosis, and the actions taken during or planned as a result of the clinical assessment, and there is a continuum between these. This resource is intended to be used to cover all these use cases.

The assessment is intimately linked to the process of care. It may occur in the context of a care plan, and it very often results in a new (or revised) care plan. Normally. clinical assessments are part of an ongoing process of care, and the patient will be re-assessed repeatedly. For this reason, the clinical impression can explicit reference both care plans (preceeding and resulting) and reference a previous impression that this impression follows on from.

DSTU Note: Unlike many other resources, there is little prior art with regard to exchanging records of clinical assessments. For this reason, this resource should be regarded as particularly prone to ongoing revision. In terms of scope and usage, the Patient Care workgroup wishes to draw the attention of reviewers and implementers to the following issues:

  • When is an existing clinical impression revised, rather than a new one created (that references the existing one)? How does that affect the status? what's the interplay between the status of the diagnosis and the status of the impression? (e.g. for a 'provisional' impression, which bit is provisional?)
  • This structure doesn't differentiate between a working and a final diagnosis. Given an answer to the previous question, should it?
  • Further clarify around the relationship between care plan and impression is needed. Both answers to the previous questions and ongoing discussions around revisions to the care plan will influence the design of clinical impression
  • Should prognosis be represented, and if so, how much structure should it have?
  • Should an impression reference other impressions that are related? (how related?)
  • Investigations - the specification needs a good value set for the code for the group, and will be considering the name "investigations" further

Feedback is welcome here .

4.6.2 Boundaries and Relationships

There is another related clinical concept often called an "assessment": assessment Tools such as Apgar (also known as "Assessment Scales"). This is not what the ClinicalImpression resource is about; assessment tools such as Apgar are represented as Observations, and Questionnaires may be used to help generate these. Clinical Impressions may refer to these assessment tools as one of the investigations that was performed during the assessment process.

4.6.3 Background and Context

An important background to understanding this resource is the FHIR wiki page for clinical assessment . In particular, the storyboards there drove the design of the resource, and will be the basis for all examples created.

This resource is referenced by condition

4.6.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression DomainResourceA clinical assessment performed when planning treatments and management strategies for a patient
... patient Σ1..1Reference(Patient)The patient being assessed
... assessor Σ0..1Reference(Practitioner)The clinician performing the assessment
... status ?! Σ1..1codein-progress | completed | entered-in-error
ClinicalImpressionStatus (Required)
... date Σ0..1dateTimeWhen the assessment occurred
... description Σ0..1stringWhy/how the assessment was performed
... previous 0..1Reference(ClinicalImpression)Reference to last assessment
... problem Σ0..*Reference(Condition | AllergyIntolerance)General assessment of patient state
... trigger[x] 0..1Request or event that necessitated this assessment
SNOMED CT Clinical Findings (Example)
.... triggerCodeableConceptCodeableConcept
.... triggerReferenceReference(Any)
... investigations 0..*BackboneElementOne or more sets of investigations (signs, symptions, etc.)
.... code 1..1CodeableConceptA name/code for the set
Condition/Diagnosis Certainty (Example)
.... item 0..*Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport)Record of a specific investigation
... protocol 0..1uriClinical Protocol followed
... summary 0..1stringSummary of the assessment
... finding 0..*BackboneElementPossible or likely findings and diagnoses
.... item 1..1CodeableConceptSpecific text or code for finding
Condition/Problem/Diagnosis Codes (Example)
.... cause 0..1stringWhich investigations support finding
... resolved 0..*CodeableConceptDiagnoses/conditions resolved since previous assessment
Condition/Problem/Diagnosis Codes (Example)
... ruledOut 0..*BackboneElementDiagnosis considered not possible
.... item 1..1CodeableConceptSpecific text of code for diagnosis
Condition/Problem/Diagnosis Codes (Example)
.... reason 0..1stringGrounds for elimination
... prognosis 0..1stringEstimate of likely outcome
... plan 0..*Reference(CarePlan | Appointment | CommunicationRequest | DeviceUseRequest | DiagnosticOrder | MedicationOrder | NutritionOrder | Order | ProcedureRequest | ProcessRequest | ReferralRequest | SupplyRequest | VisionPrescription)Plan of action after assessment
... action 0..*Reference(ReferralRequest | ProcedureRequest | Procedure | MedicationOrder | DiagnosticOrder | NutritionOrder | SupplyRequest | Appointment)Actions taken during assessment

doco Documentation for this format

UML Diagram

ClinicalImpression (DomainResource)The patient being assessedpatient : Reference [1..1] « Patient »The clinician performing the assessmentassessor : Reference [0..1] « Practitioner »Identifies the workflow status of the assessment (this element modifies the meaning of other elements)status : code [1..1] « The workflow state of a clinical impression. (Strength=Required)ClinicalImpressionStatus! »The point in time at which the assessment was concluded (not when it was recorded)date : dateTime [0..1]A summary of the context and/or cause of the assessment - why / where was it peformed, and what patient events/sstatus prompted itdescription : string [0..1]A reference to the last assesment that was conducted bon this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changesprevious : Reference [0..1] « ClinicalImpression »This a list of the general problems/conditions for a patientproblem : Reference [0..*] « Condition|AllergyIntolerance »The request or event that necessitated this assessment. This may be a diagnosis, a Care Plan, a Request Referral, or some other resourcetrigger[x] : Type [0..1] « CodeableConcept|Reference(Any); Clinical Findings that may cause an clinical evaluation. (Strength=Example)SNOMED CT Clinical Findings?? »Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosisprotocol : uri [0..1]A text summary of the investigations and the diagnosissummary : string [0..1]Diagnoses/conditions resolved since the last assessmentresolved : CodeableConcept [0..*] « Identification of the Condition or diagnosis. (Strength=Example)Condition/Problem/Diagnosis ?? »Estimate of likely outcomeprognosis : string [0..1]Plan of action after assessmentplan : Reference [0..*] « CarePlan|Appointment|CommunicationRequest| DeviceUseRequest|DiagnosticOrder|MedicationOrder| NutritionOrder|Order|ProcedureRequest|ProcessRequest| ReferralRequest|SupplyRequest|VisionPrescription »Actions taken during assessmentaction : Reference [0..*] « ReferralRequest|ProcedureRequest| Procedure|MedicationOrder|DiagnosticOrder|NutritionOrder| SupplyRequest|Appointment »InvestigationsA name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure|family|travel|nutitirional) history may be usedcode : CodeableConcept [1..1] « A name/code for a set of investigations. (Strength=Example)Condition/Diagnosis Certainty?? »A record of a specific investigation that was undertakenitem : Reference [0..*] « Observation|QuestionnaireResponse| FamilyMemberHistory|DiagnosticReport »FindingSpecific text of code for finding or diagnosisitem : CodeableConcept [1..1] « Identification of the Condition or diagnosis. (Strength=Example)Condition/Problem/Diagnosis ?? »Which investigations support finding or diagnosiscause : string [0..1]RuledOutSpecific text of code for diagnosisitem : CodeableConcept [1..1] « Identification of the Condition or diagnosis. (Strength=Example)Condition/Problem/Diagnosis ?? »Grounds for eliminationreason : string [0..1]One or more sets of investigations (signs, symptions, etc.). The actual grouping of investigations vary greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomesinvestigations[0..*]Specific findings or diagnoses that was considered likely or relevant to ongoing treatmentfinding[0..*]Diagnosis considered not possibleruledOut[0..*]

XML Template

<ClinicalImpression xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <patient><!-- 1..1 Reference(Patient) The patient being assessed --></patient>
 <assessor><!-- 0..1 Reference(Practitioner) The clinician performing the assessment --></assessor>
 <status value="[code]"/><!-- 1..1 in-progress | completed | entered-in-error -->
 <date value="[dateTime]"/><!-- 0..1 When the assessment occurred -->
 <description value="[string]"/><!-- 0..1 Why/how the assessment was performed -->
 <previous><!-- 0..1 Reference(ClinicalImpression) Reference to last assessment --></previous>
 <problem><!-- 0..* Reference(Condition|AllergyIntolerance) General assessment of patient state --></problem>
 <trigger[x]><!-- 0..1 CodeableConcept|Reference(Any) Request or event that necessitated this assessment --></trigger[x]>
 <investigations>  <!-- 0..* One or more sets of investigations (signs, symptions, etc.) -->
  <code><!-- 1..1 CodeableConcept A name/code for the set --></code>
  <item><!-- 0..* Reference(Observation|QuestionnaireResponse|FamilyMemberHistory|
    DiagnosticReport) Record of a specific investigation --></item>
 </investigations>
 <protocol value="[uri]"/><!-- 0..1 Clinical Protocol followed -->
 <summary value="[string]"/><!-- 0..1 Summary of the assessment -->
 <finding>  <!-- 0..* Possible or likely findings and diagnoses -->
  <item><!-- 1..1 CodeableConcept Specific text or code for finding --></item>
  <cause value="[string]"/><!-- 0..1 Which investigations support finding -->
 </finding>
 <resolved><!-- 0..* CodeableConcept Diagnoses/conditions resolved since previous assessment --></resolved>
 <ruledOut>  <!-- 0..* Diagnosis considered not possible -->
  <item><!-- 1..1 CodeableConcept Specific text of code for diagnosis --></item>
  <reason value="[string]"/><!-- 0..1 Grounds for elimination -->
 </ruledOut>
 <prognosis value="[string]"/><!-- 0..1 Estimate of likely outcome -->
 <plan><!-- 0..* Reference(CarePlan|Appointment|CommunicationRequest|
   DeviceUseRequest|DiagnosticOrder|MedicationOrder|NutritionOrder|Order|
   ProcedureRequest|ProcessRequest|ReferralRequest|SupplyRequest|
   VisionPrescription) Plan of action after assessment --></plan>
 <action><!-- 0..* Reference(ReferralRequest|ProcedureRequest|Procedure|
   MedicationOrder|DiagnosticOrder|NutritionOrder|SupplyRequest|Appointment) Actions taken during assessment --></action>
</ClinicalImpression>

JSON Template

{doco
  "resourceType" : "ClinicalImpression",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "patient" : { Reference(Patient) }, // R!  The patient being assessed
  "assessor" : { Reference(Practitioner) }, // The clinician performing the assessment
  "status" : "<code>", // R!  in-progress | completed | entered-in-error
  "date" : "<dateTime>", // When the assessment occurred
  "description" : "<string>", // Why/how the assessment was performed
  "previous" : { Reference(ClinicalImpression) }, // Reference to last assessment
  "problem" : [{ Reference(Condition|AllergyIntolerance) }], // General assessment of patient state
  // trigger[x]: Request or event that necessitated this assessment. One of these 2:
  "triggerCodeableConcept" : { CodeableConcept },
  "triggerReference" : { Reference(Any) },
  "investigations" : [{ // One or more sets of investigations (signs, symptions, etc.)
    "code" : { CodeableConcept }, // R!  A name/code for the set
    "item" : [{ Reference(Observation|QuestionnaireResponse|FamilyMemberHistory|
    DiagnosticReport) }] // Record of a specific investigation
  }],
  "protocol" : "<uri>", // Clinical Protocol followed
  "summary" : "<string>", // Summary of the assessment
  "finding" : [{ // Possible or likely findings and diagnoses
    "item" : { CodeableConcept }, // R!  Specific text or code for finding
    "cause" : "<string>" // Which investigations support finding
  }],
  "resolved" : [{ CodeableConcept }], // Diagnoses/conditions resolved since previous assessment
  "ruledOut" : [{ // Diagnosis considered not possible
    "item" : { CodeableConcept }, // R!  Specific text of code for diagnosis
    "reason" : "<string>" // Grounds for elimination
  }],
  "prognosis" : "<string>", // Estimate of likely outcome
  "plan" : [{ Reference(CarePlan|Appointment|CommunicationRequest|
   DeviceUseRequest|DiagnosticOrder|MedicationOrder|NutritionOrder|Order|
   ProcedureRequest|ProcessRequest|ReferralRequest|SupplyRequest|
   VisionPrescription) }], // Plan of action after assessment
  "action" : [{ Reference(ReferralRequest|ProcedureRequest|Procedure|
   MedicationOrder|DiagnosticOrder|NutritionOrder|SupplyRequest|Appointment) }] // Actions taken during assessment
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalImpression DomainResourceA clinical assessment performed when planning treatments and management strategies for a patient
... patient Σ1..1Reference(Patient)The patient being assessed
... assessor Σ0..1Reference(Practitioner)The clinician performing the assessment
... status ?! Σ1..1codein-progress | completed | entered-in-error
ClinicalImpressionStatus (Required)
... date Σ0..1dateTimeWhen the assessment occurred
... description Σ0..1stringWhy/how the assessment was performed
... previous 0..1Reference(ClinicalImpression)Reference to last assessment
... problem Σ0..*Reference(Condition | AllergyIntolerance)General assessment of patient state
... trigger[x] 0..1Request or event that necessitated this assessment
SNOMED CT Clinical Findings (Example)
.... triggerCodeableConceptCodeableConcept
.... triggerReferenceReference(Any)
... investigations 0..*BackboneElementOne or more sets of investigations (signs, symptions, etc.)
.... code 1..1CodeableConceptA name/code for the set
Condition/Diagnosis Certainty (Example)
.... item 0..*Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport)Record of a specific investigation
... protocol 0..1uriClinical Protocol followed
... summary 0..1stringSummary of the assessment
... finding 0..*BackboneElementPossible or likely findings and diagnoses
.... item 1..1CodeableConceptSpecific text or code for finding
Condition/Problem/Diagnosis Codes (Example)
.... cause 0..1stringWhich investigations support finding
... resolved 0..*CodeableConceptDiagnoses/conditions resolved since previous assessment
Condition/Problem/Diagnosis Codes (Example)
... ruledOut 0..*BackboneElementDiagnosis considered not possible
.... item 1..1CodeableConceptSpecific text of code for diagnosis
Condition/Problem/Diagnosis Codes (Example)
.... reason 0..1stringGrounds for elimination
... prognosis 0..1stringEstimate of likely outcome
... plan 0..*Reference(CarePlan | Appointment | CommunicationRequest | DeviceUseRequest | DiagnosticOrder | MedicationOrder | NutritionOrder | Order | ProcedureRequest | ProcessRequest | ReferralRequest | SupplyRequest | VisionPrescription)Plan of action after assessment
... action 0..*Reference(ReferralRequest | ProcedureRequest | Procedure | MedicationOrder | DiagnosticOrder | NutritionOrder | SupplyRequest | Appointment)Actions taken during assessment

doco Documentation for this format

UML Diagram

ClinicalImpression (DomainResource)The patient being assessedpatient : Reference [1..1] « Patient »The clinician performing the assessmentassessor : Reference [0..1] « Practitioner »Identifies the workflow status of the assessment (this element modifies the meaning of other elements)status : code [1..1] « The workflow state of a clinical impression. (Strength=Required)ClinicalImpressionStatus! »The point in time at which the assessment was concluded (not when it was recorded)date : dateTime [0..1]A summary of the context and/or cause of the assessment - why / where was it peformed, and what patient events/sstatus prompted itdescription : string [0..1]A reference to the last assesment that was conducted bon this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changesprevious : Reference [0..1] « ClinicalImpression »This a list of the general problems/conditions for a patientproblem : Reference [0..*] « Condition|AllergyIntolerance »The request or event that necessitated this assessment. This may be a diagnosis, a Care Plan, a Request Referral, or some other resourcetrigger[x] : Type [0..1] « CodeableConcept|Reference(Any); Clinical Findings that may cause an clinical evaluation. (Strength=Example)SNOMED CT Clinical Findings?? »Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosisprotocol : uri [0..1]A text summary of the investigations and the diagnosissummary : string [0..1]Diagnoses/conditions resolved since the last assessmentresolved : CodeableConcept [0..*] « Identification of the Condition or diagnosis. (Strength=Example)Condition/Problem/Diagnosis ?? »Estimate of likely outcomeprognosis : string [0..1]Plan of action after assessmentplan : Reference [0..*] « CarePlan|Appointment|CommunicationRequest| DeviceUseRequest|DiagnosticOrder|MedicationOrder| NutritionOrder|Order|ProcedureRequest|ProcessRequest| ReferralRequest|SupplyRequest|VisionPrescription »Actions taken during assessmentaction : Reference [0..*] « ReferralRequest|ProcedureRequest| Procedure|MedicationOrder|DiagnosticOrder|NutritionOrder| SupplyRequest|Appointment »InvestigationsA name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure|family|travel|nutitirional) history may be usedcode : CodeableConcept [1..1] « A name/code for a set of investigations. (Strength=Example)Condition/Diagnosis Certainty?? »A record of a specific investigation that was undertakenitem : Reference [0..*] « Observation|QuestionnaireResponse| FamilyMemberHistory|DiagnosticReport »FindingSpecific text of code for finding or diagnosisitem : CodeableConcept [1..1] « Identification of the Condition or diagnosis. (Strength=Example)Condition/Problem/Diagnosis ?? »Which investigations support finding or diagnosiscause : string [0..1]RuledOutSpecific text of code for diagnosisitem : CodeableConcept [1..1] « Identification of the Condition or diagnosis. (Strength=Example)Condition/Problem/Diagnosis ?? »Grounds for eliminationreason : string [0..1]One or more sets of investigations (signs, symptions, etc.). The actual grouping of investigations vary greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomesinvestigations[0..*]Specific findings or diagnoses that was considered likely or relevant to ongoing treatmentfinding[0..*]Diagnosis considered not possibleruledOut[0..*]

XML Template

<ClinicalImpression xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <patient><!-- 1..1 Reference(Patient) The patient being assessed --></patient>
 <assessor><!-- 0..1 Reference(Practitioner) The clinician performing the assessment --></assessor>
 <status value="[code]"/><!-- 1..1 in-progress | completed | entered-in-error -->
 <date value="[dateTime]"/><!-- 0..1 When the assessment occurred -->
 <description value="[string]"/><!-- 0..1 Why/how the assessment was performed -->
 <previous><!-- 0..1 Reference(ClinicalImpression) Reference to last assessment --></previous>
 <problem><!-- 0..* Reference(Condition|AllergyIntolerance) General assessment of patient state --></problem>
 <trigger[x]><!-- 0..1 CodeableConcept|Reference(Any) Request or event that necessitated this assessment --></trigger[x]>
 <investigations>  <!-- 0..* One or more sets of investigations (signs, symptions, etc.) -->
  <code><!-- 1..1 CodeableConcept A name/code for the set --></code>
  <item><!-- 0..* Reference(Observation|QuestionnaireResponse|FamilyMemberHistory|
    DiagnosticReport) Record of a specific investigation --></item>
 </investigations>
 <protocol value="[uri]"/><!-- 0..1 Clinical Protocol followed -->
 <summary value="[string]"/><!-- 0..1 Summary of the assessment -->
 <finding>  <!-- 0..* Possible or likely findings and diagnoses -->
  <item><!-- 1..1 CodeableConcept Specific text or code for finding --></item>
  <cause value="[string]"/><!-- 0..1 Which investigations support finding -->
 </finding>
 <resolved><!-- 0..* CodeableConcept Diagnoses/conditions resolved since previous assessment --></resolved>
 <ruledOut>  <!-- 0..* Diagnosis considered not possible -->
  <item><!-- 1..1 CodeableConcept Specific text of code for diagnosis --></item>
  <reason value="[string]"/><!-- 0..1 Grounds for elimination -->
 </ruledOut>
 <prognosis value="[string]"/><!-- 0..1 Estimate of likely outcome -->
 <plan><!-- 0..* Reference(CarePlan|Appointment|CommunicationRequest|
   DeviceUseRequest|DiagnosticOrder|MedicationOrder|NutritionOrder|Order|
   ProcedureRequest|ProcessRequest|ReferralRequest|SupplyRequest|
   VisionPrescription) Plan of action after assessment --></plan>
 <action><!-- 0..* Reference(ReferralRequest|ProcedureRequest|Procedure|
   MedicationOrder|DiagnosticOrder|NutritionOrder|SupplyRequest|Appointment) Actions taken during assessment --></action>
</ClinicalImpression>

JSON Template

{doco
  "resourceType" : "ClinicalImpression",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "patient" : { Reference(Patient) }, // R!  The patient being assessed
  "assessor" : { Reference(Practitioner) }, // The clinician performing the assessment
  "status" : "<code>", // R!  in-progress | completed | entered-in-error
  "date" : "<dateTime>", // When the assessment occurred
  "description" : "<string>", // Why/how the assessment was performed
  "previous" : { Reference(ClinicalImpression) }, // Reference to last assessment
  "problem" : [{ Reference(Condition|AllergyIntolerance) }], // General assessment of patient state
  // trigger[x]: Request or event that necessitated this assessment. One of these 2:
  "triggerCodeableConcept" : { CodeableConcept },
  "triggerReference" : { Reference(Any) },
  "investigations" : [{ // One or more sets of investigations (signs, symptions, etc.)
    "code" : { CodeableConcept }, // R!  A name/code for the set
    "item" : [{ Reference(Observation|QuestionnaireResponse|FamilyMemberHistory|
    DiagnosticReport) }] // Record of a specific investigation
  }],
  "protocol" : "<uri>", // Clinical Protocol followed
  "summary" : "<string>", // Summary of the assessment
  "finding" : [{ // Possible or likely findings and diagnoses
    "item" : { CodeableConcept }, // R!  Specific text or code for finding
    "cause" : "<string>" // Which investigations support finding
  }],
  "resolved" : [{ CodeableConcept }], // Diagnoses/conditions resolved since previous assessment
  "ruledOut" : [{ // Diagnosis considered not possible
    "item" : { CodeableConcept }, // R!  Specific text of code for diagnosis
    "reason" : "<string>" // Grounds for elimination
  }],
  "prognosis" : "<string>", // Estimate of likely outcome
  "plan" : [{ Reference(CarePlan|Appointment|CommunicationRequest|
   DeviceUseRequest|DiagnosticOrder|MedicationOrder|NutritionOrder|Order|
   ProcedureRequest|ProcessRequest|ReferralRequest|SupplyRequest|
   VisionPrescription) }], // Plan of action after assessment
  "action" : [{ Reference(ReferralRequest|ProcedureRequest|Procedure|
   MedicationOrder|DiagnosticOrder|NutritionOrder|SupplyRequest|Appointment) }] // Actions taken during assessment
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.6.4.1 Terminology Bindings

PathDefinitionTypeReference
ClinicalImpression.status The workflow state of a clinical impression.RequiredClinicalImpressionStatus
ClinicalImpression.trigger[x] Clinical Findings that may cause an clinical evaluation.ExampleSNOMED CT Clinical Findings
ClinicalImpression.investigations.code A name/code for a set of investigations.ExampleCondition/Diagnosis Certainty
ClinicalImpression.finding.item
ClinicalImpression.resolved
ClinicalImpression.ruledOut.item 		Identification of the Condition or diagnosis.ExampleCondition/Problem/Diagnosis Codes

4.6.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
actionreferenceActions taken during assessmentClinicalImpression.action
(ReferralRequest, Appointment, ProcedureRequest, SupplyRequest, Procedure, MedicationOrder, NutritionOrder, DiagnosticOrder)
assessorreferenceThe clinician performing the assessmentClinicalImpression.assessor
(Practitioner)
datedateWhen the assessment occurredClinicalImpression.date
findingtokenSpecific text or code for findingClinicalImpression.finding.item
investigationreferenceRecord of a specific investigationClinicalImpression.investigations.item
(FamilyMemberHistory, Observation, QuestionnaireResponse, DiagnosticReport)
patientreferenceThe patient being assessedClinicalImpression.patient
(Patient)
planreferencePlan of action after assessmentClinicalImpression.plan
(CarePlan, ReferralRequest, ProcedureRequest, Appointment, CommunicationRequest, Order, SupplyRequest, VisionPrescription, MedicationOrder, ProcessRequest, DeviceUseRequest, NutritionOrder, DiagnosticOrder)
previousreferenceReference to last assessmentClinicalImpression.previous
(ClinicalImpression)
problemreferenceGeneral assessment of patient stateClinicalImpression.problem
(Condition, AllergyIntolerance)
resolvedtokenDiagnoses/conditions resolved since previous assessmentClinicalImpression.resolved
ruledouttokenSpecific text of code for diagnosisClinicalImpression.ruledOut.item
statustokenin-progress | completed | entered-in-errorClinicalImpression.status
triggerreferenceRequest or event that necessitated this assessmentClinicalImpression.triggerReference
(Any)
trigger-codetokenRequest or event that necessitated this assessmentClinicalImpression.triggerCodeableConcept