Patient-daf - FHIR v1.4.0

STU 3 Candidate

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). 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.17.0 U.S. Data Access Framework (DAF) Patient Profile

D.17.0.1 Scope and Usage

This profile sets expectations for use of the Patient 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.17.0.2 Meaningful Use Data Element Mapping

The DAF-Patient 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
Patient Name	Patient Name	Patient.name
Sex	Gender	Patient.gender
Date of Birth	Date of Birth	Patient.birthDate
Race	Race	Patient.extension(us-core-race)
Ethnicity	Ethnicity	Patient.extension(us-core-ethnicity)
Preferred Language	Preferred Language	Patient.communication.preferred
	Patient Identifiers	Patient.identifier
	Multiple Birth Indicator	Patient.multipleBirthBoolean
	Birth Order	Patient.multipleBirthInteger
	Mother's Maiden Name	Patient.extension(patient-mothers-maiden-name)
	Address	Patient.address
	Telephone	Patient.telecom
	Marital Status	Patient.maritalStatus
	Birth Place	Patient.extension(birthplace)
	Religious Affiliation	Patient.extension(religion)
	Guardian	Patient.contact

Meaningful Use Data Element Name

Mapping to Priority DAF Data Elements

FHIR Resource Mapping

Patient Name

Patient.name

Sex

Gender

Patient.gender

Date of Birth

Patient.birthDate

Race

Patient.extension(us-core-race)

Ethnicity

Patient.extension(us-core-ethnicity)

Preferred Language

Patient.communication.preferred

Patient Identifiers

Patient.identifier

Multiple Birth Indicator

Patient.multipleBirthBoolean

Birth Order

Patient.multipleBirthInteger

Mother's Maiden Name

Patient.extension(patient-mothers-maiden-name)

Address

Patient.address

Telephone

Patient.telecom

Marital Status

Patient.maritalStatus

Birth Place

Patient.extension(birthplace)

Religious Affiliation

Patient.extension(religion)

Guardian

Patient.contact

D.17.0.3 Boundaries and Relationships

This profile relies on the following other profiles:

US Core which defines common properties related to Patient such as race and ethnicity.
Patient Extensions defines other extensions such as birthPlace, patient-mothers-maiden-name which are used by the profile
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.17.0.4 Content

Profiles:
DAF-Patient	Defines constraints and extensions on the patient resource for use in querying and retrieving patient demographic information.

D.17.0.4.1 Search Parameters

The full list of supported patient search parameters are can be accessed at DAF Requestor conformance expectations and DAF Responder conformance expectations.

D.17.0.4.2 Example Usage Scenarios

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

Query for a Patient demographic information using Medical Record Number (MRN), which is a type of identifier. The MRN is identifiable by identifier.system and may be location specific.
Query for a Patient demographic information using first name, last name etc.
Query for Patients based on race, ethnicity, gender etc.
Query for Patients based on geographical area such as city, state, postalCode information
Query for Patients less than 5 years of age
Query for Patients between ages of 25 and 50

D.17.0.4.3 Profile specific implementation guidance

Implementers need to be mindful of the following during their implementation

Patient Identifiers: Patient Identifiers are represented as part of the Patient.identifier data element. Identifiers must be scoped using a URI data type represented within the Patient.identifier.system element. If systems are using OID's to scope their patient identifiers, then OID's can be converted to URI's per RFC-3001. However, systems are encouraged to adopt parallel URIs and map to allow the benefits of human readability and resolvability. Since DAF profiles deal with queries of Patient data, identifiers play a critical role in identifying the right resources to be queried and returned.

Representing Patient Names: Patient Names are represented using the HumanName datatype. Per the FHIR specification, the first name is represented using the first occurrence of the element HumanName.given element. Middle names and other parts of the name can be represented using subsequent occurrences of the HumanName.given element.

Specifying multiple race codes: Many systems may capture race codes at a very granular level which can be rolled up to higher level race codes such as "Asian", "White" etc. In cases where these systems intend to include these granular race codes in addition to the higher level race codes permitted by the value set they can do so by using the coding element which can be repeated as many times as needed within the race element.

Capturing BirthPlace: Many systems may only capture the birth place as a city name, or a state name or a county name instead of using a highly structured Address data type. In these cases these systems should use the address.text field to record the birth place.

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