Connectathon 11 Snapshot

This page is part of the FHIR Specification (v1.2.0: STU 3 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

D.22.0 U.S. Data Access Framework (DAF) List Profile

D.22.0.1 Scope and Usage

This profile sets expectations for use of the List resource within the DAF FHIR IG. This profile identifies which core data elements, extensions, vocabularies and value sets must be Supported by DAF actors. For the definition of Supported please refer to DAF FHIR IG. The data elements identified by the profile are based on ONC 2014 Edition S&CC and DAF use cases. The mappings between the ONC 2014 Edition S&CC data elements and DAF data elements are captured in the table below, where the first column identifies the ONC 2014 Edition S&CC data element name, the second column maps the ONC 2014 Edition S&CC data elements to DAF data elements which are derived from ONC 2014 Edition S&CC standards and DAF use cases and lastly the third column identifies the mapping to FHIR resources and attributes.

D.22.0.2 Meaningful Use Data Element Mapping

The DAF List profile mapping to Meaningful Use data elements and FHIR Resources are as shown below.For an overview of how the DAF profiles and data elements were derived from ONC 2014 Edition S&CC please refer to DAF FHIR IG data mapping section.


Meaningful Use Data Element Name Mapping to Priority DAF Data Elements FHIR Resource Mapping
Problem List Active Problem List List using DAF-ProblemList profile
Problems No known Problems List (Empty DAF-ProblemList with coded List.emptyReason)
Medication allergies List of documented allergies List using DAF-AllergyList profile
Medication Allergies No known Allergies DAF-AllergyIntolerance profile with appropriate negation code in AllergyIntolerence.substance.
Medications List* List of active Medications* List using DAF-MedicationList profile
Medications No known Medications List (Empty DAF-MedicationList with coded List.emptyReason)
Immunization List List of Immunizations List using DAF-ImmunizationList profile
Immunizations No Immunization given DAF-Immunization profile with appropriate code in immunization.explanation.reasonNotGiven.
Laboratory Result Values List of lab results List using DAF-ResultsList profile
Encounter Diagnoses List of encounters for a patient List using DAF-EncounterList profile
Procedures List of procedures for a patient List using DAF-ProcedureList profile

*: The DAF-MedicationList summarizes information from other DAF medication profiles. This profile supports three types of medication lists:

  • Admission Medications - Contains the medications taken by the patient prior to and at the time of admission to the facility (LOINC: 42346-7). This list will contain instances of DAF-MedicationStatement and DAF-MedicationOrder.
  • Medications - The DAF-MedicationsList contains a patient's current medications and pertinent medication history (LOINC: 10160-0). At a minimum, the currently active medications are listed. An entire medication history is an option. Typically a DAF Responder system is expected to maintain only one current medication list per patient outside of an individual episode or encounter. This list will contain instances of DAF-MedicationStatement, DAF-MedicationOrder, and may include instances of DAF-MedicationDispense and DAF-MedicationAdministration.
  • Discharge Medications - Contains the medications the patient is intended to take after discharge (LOINC: 75311-1). Current, active medications must be listed. This list will contain instances of DAF-MedicationOrder.

D.22.0.3 Boundaries and Relationships

This profile relies on the following other profiles:

  • FHIR Extensibility defines how extensions can be applied to FHIR resources and data types. Specifically the data-absent-reason extension can be used to code data elements with missing information when appropriate. See DAF FHIR IG for additional guidance.

D.22.0.4 Content

Profiles:
DAF-AllergyListUS Realm Allergy list
DAF-EncounterListUS Realm Encounter list
DAF-ImmunizationListUS Realm Immunization list
DAF-MedicationListUS Realm Medication list
DAF-ProblemListUS Realm Problem list
DAF-ProcedureListUS Realm Procedure list
DAF-ResultListUS Realm Result list

D.22.0.4.1 Search Parameters

The supported search parameters on the DAF List profiles are can be accessed at DAF Requestor conformance expectations and DAF Responder conformance expectations.

D.22.0.4.2 Example Usage Scenarios

The following are example usage scenarios for the DAF List profile:

  • Query for current problem list, medication list or allergy list for a patient

D.22.0.4.3 Profile specific implementation guidance

Implementers need to be mindful of the following during their implementation

    Querying Lists vs Clinical Resources: DAF profiles of the List resource should be used by DAF Requestors to query for data that is curated as a list by the DAF Responder. The following are the curated lists that will be used in the context of DAF:

    • Active Allergies List
    • List of Encounters
    • List of Immunizations
    • Active Medications List
    • Active Problems List
    • List of Procedures
    • List of relevant Laboratory Result values

    DAF Requestors are expected to query the actual Clinical Resources such as Condition, Medication, AllergyIntolerance when they would like to get back a set of resources meeting a specific search criteria.(For example, query for all problems documented for a patient). In contrast, queries on List resources are supposed to be used only when the DAF Requestor expects a curated list to be returned by the DAF Responder. In all cases the List returned is packaged as part of a Bundle similar to other search results.

    See DAF FHIR IG for implementation guidance common to all profiles.