This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

9.11 Resource RiskAssessment - Content

Clinical Decision Support icon

Work Group

Maturity Level: 2

Trial Use

Security Category: Patient

Compartments: Device, Patient, Practitioner

An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.

9.11.1 Scope and Usage

This resource is an event resource from a FHIR workflow perspective - see Workflow, specifically Event.

This resource captures predicted outcomes for a patient or population on the basis of source information. Examples include:

A prognosis statement for a particular condition
Risk of health outcome (heart attack, particular type of cancer) on the basis of lifestyle factors and/or family history
List of potential health risks based on a patient's genetic analysis
A prediction of outbreak infection rates within a geography based on immunization rates

This resource can be used to represent the results of formal scoring/decision support tools that evaluate risk. It can also be used to capture a practitioner's subjective assessment of the patient's risk based on existing knowledge and previous experience.

9.11.2 Boundaries and Relationships

Risk assessments are a specialized type of observation. A specialized resource is used to provide a simpler mechanism to capture of a series of risks and to associate those risks with time-ranges, probabilities, etc. All risk assertions are captured at one time based on a single set of source inputs. Capture of a single risk MAY be done using the Observation class, particularly in circumstances where it's treated as a generic observation, but for consistency, all risk assessments and prognosis SHOULD be captured using RiskAssessment.

Risk assessments may be based on a variety of factors, including:

Basic demographic information from the Patient or Group resources
Various Observations including vital signs, lab information, assessments, genetic information, etc.
FamilyMemberHistory
Current, past and proposed therapies Immunization, Procedure, CarePlan, etc.

Because so many resources can potentially be used, no limit is placed on what resources can be sent in RiskAssessment.basis. However, some resources would be nonsensical for this use (e.g. MessageHeader).

AllergyIntolerance and RiskAssessment

AllergyIntolerance describes a specific type of risk - propensity to reaction to a substance while RiskAssessment describes general risks to a subject, not generally based on a reaction.

9.11.3 Background and Context

Risk Assessments can be determined manually by health-care providers based on their professional expertise, by using an algorithmic scoring system or through a combination. Risk assessments can also be computed by decision support systems. OperationDefinitions may be defined by servers to generate risk assessments based on particular combinations of source resources or other inputs.

9.11.4 References to this Resource

Implements: Event
Resource References: ClinicalImpression, Flag and Goal
Extension References: DiagnosticReport Risk

Structure

Name	Flags	Card.	Type	Description & Constraints
RiskAssessment	TU		DomainResource	Potential outcomes for a subject with likelihood Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Unique identifier for the assessment
basedOn		0..1	Reference(Any)	Request fulfilled by this assessment
parent		0..1	Reference(Any)	Part of this occurrence
status	Σ	1..1	code	registered \| preliminary \| final \| amended + Binding: Observation Status (Required)
method	Σ	0..1	CodeableConcept	Evaluation mechanism Binding: RiskAssessmentMethod (Example)
code	Σ	0..1	CodeableConcept	Type of assessment
subject	Σ	1..1	Reference(Patient \| Group)	Who/what does assessment apply to?
encounter	Σ	0..1	Reference(Encounter)	Where was assessment performed?
occurrence[x]	Σ	0..1		When was assessment made?
occurrenceDateTime			dateTime
occurrencePeriod			Period
condition	Σ	0..1	Reference(Condition)	Condition assessed
performer	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device)	Who did assessment?
reason		0..*	CodeableReference(Condition \| Observation \| DiagnosticReport \| DocumentReference)	Why the assessment was necessary?
basis		0..*	Reference(Any)	Information used in assessment
prediction	C	0..*	BackboneElement	Outcome predicted + Rule: Probability as a deciml must be <= 100
outcome		0..1	CodeableConcept	Possible outcome for the subject Binding: RiskAssessmentOutcome (Example)
probability[x]	C	0..1		Likelihood of specified outcome + Rule: low and high must be percentages, if present
probabilityDecimal			decimal
probabilityRange			Range
qualitativeRisk		0..1	CodeableConcept	Likelihood of specified outcome as a qualitative value Binding: Risk Probability (Example)
relativeRisk		0..1	decimal	Relative likelihood
when[x]		0..1		Timeframe or age range
whenPeriod			Period
whenRange			Range
rationale		0..1	string	Explanation of prediction
mitigation		0..1	string	How to reduce risk
note		0..*	Annotation	Comments on the risk assessment
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<RiskAssessment xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier for the assessment --></identifier>
 <basedOn><!-- 0..1 Reference(Any) Request fulfilled by this assessment --></basedOn>
 <parent><!-- 0..1 Reference(Any) Part of this occurrence --></parent>
 <status value="[code]"/><!-- 1..1 registered | preliminary | final | amended + -->
 <method><!-- 0..1 CodeableConcept Evaluation mechanism --></method>
 <code><!-- 0..1 CodeableConcept Type of assessment --></code>
 <subject><!-- 1..1 Reference(Group|Patient) Who/what does assessment apply to? --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Where was assessment performed? --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period When was assessment made? --></occurrence[x]>
 <condition><!-- 0..1 Reference(Condition) Condition assessed --></condition>
 <performer><!-- 0..1 Reference(Device|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who did assessment? --></performer>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) Why the assessment was necessary? --></reason>
 <basis><!-- 0..* Reference(Any) Information used in assessment --></basis>
 <prediction>  <!-- 0..* Outcome predicted -->
  <outcome><!-- 0..1 CodeableConcept Possible outcome for the subject --></outcome>
  <probability[x]><!-- I 0..1 decimal|Range Likelihood of specified outcome --></probability[x]>
  <qualitativeRisk><!-- 0..1 CodeableConcept Likelihood of specified outcome as a qualitative value --></qualitativeRisk>
  <relativeRisk value="[decimal]"/><!-- 0..1 Relative likelihood -->
  <when[x]><!-- 0..1 Period|Range Timeframe or age range --></when[x]>
  <rationale value="[string]"/><!-- 0..1 Explanation of prediction -->
 </prediction>
 <mitigation value="[string]"/><!-- 0..1 How to reduce risk -->
 <note><!-- 0..* Annotation Comments on the risk assessment --></note>
</RiskAssessment>

JSON Template

{
  "resourceType" : "RiskAssessment",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier for the assessment
  "basedOn" : { Reference(Any) }, // Request fulfilled by this assessment
  "parent" : { Reference(Any) }, // Part of this occurrence
  "status" : "<code>", // R!  registered | preliminary | final | amended +
  "method" : { CodeableConcept }, // Evaluation mechanism
  "code" : { CodeableConcept }, // Type of assessment
  "subject" : { Reference(Group|Patient) }, // R!  Who/what does assessment apply to?
  "encounter" : { Reference(Encounter) }, // Where was assessment performed?
  // occurrence[x]: When was assessment made?. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "condition" : { Reference(Condition) }, // Condition assessed
  "performer" : { Reference(Device|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who did assessment?
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], // Why the assessment was necessary?
  "basis" : [{ Reference(Any) }], // Information used in assessment
  "prediction" : [{ // Outcome predicted
    "outcome" : { CodeableConcept }, // Possible outcome for the subject
    // probability[x]: Likelihood of specified outcome. One of these 2:
    "probabilityDecimal" : <decimal>,
    "probabilityRange" : { Range },
    "qualitativeRisk" : { CodeableConcept }, // Likelihood of specified outcome as a qualitative value
    "relativeRisk" : <decimal>, // Relative likelihood
    // when[x]: Timeframe or age range. One of these 2:
    "whenPeriod" : { Period },
    "whenRange" : { Range },
    "rationale" : "<string>" // Explanation of prediction
  }],
  "mitigation" : "<string>", // How to reduce risk
  "note" : [{ Annotation }] // Comments on the risk assessment
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:RiskAssessment;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Unique identifier for the assessment
  fhir:basedOn [ Reference(Any) ] ; # 0..1 Request fulfilled by this assessment
  fhir:parent [ Reference(Any) ] ; # 0..1 Part of this occurrence
  fhir:status [ code ] ; # 1..1 registered | preliminary | final | amended +
  fhir:method [ CodeableConcept ] ; # 0..1 Evaluation mechanism
  fhir:code [ CodeableConcept ] ; # 0..1 Type of assessment
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who/what does assessment apply to?
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Where was assessment performed?
  # occurrence[x] : 0..1 When was assessment made?. One of these 2
    fhir:occurrence [  a fhir:dateTime ; dateTime ]
    fhir:occurrence [  a fhir:Period ; Period ]
  fhir:condition [ Reference(Condition) ] ; # 0..1 Condition assessed
  fhir:performer [ Reference(Device|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who did assessment?
  fhir:reason  ( [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ] ... ) ; # 0..* Why the assessment was necessary?
  fhir:basis  ( [ Reference(Any) ] ... ) ; # 0..* Information used in assessment
  fhir:prediction ( [ # 0..* Outcome predicted
    fhir:outcome [ CodeableConcept ] ; # 0..1 Possible outcome for the subject
    # probability[x] : 0..1 I Likelihood of specified outcome. One of these 2
      fhir:probability [  a fhir:decimal ; decimal ]
      fhir:probability [  a fhir:Range ; Range ]
    fhir:qualitativeRisk [ CodeableConcept ] ; # 0..1 Likelihood of specified outcome as a qualitative value
    fhir:relativeRisk [ decimal ] ; # 0..1 Relative likelihood
    # when[x] : 0..1 Timeframe or age range. One of these 2
      fhir:when [  a fhir:Period ; Period ]
      fhir:when [  a fhir:Range ; Range ]
    fhir:rationale [ string ] ; # 0..1 Explanation of prediction
  ] ... ) ;
  fhir:mitigation [ string ] ; # 0..1 How to reduce risk
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments on the risk assessment
]

Changes from both R4 and R4B

RiskAssessment

RiskAssessment.performer

Type Reference: Added Target Types Patient, RelatedPerson

RiskAssessment.reason

Added Element

RiskAssessment.reasonCode

Deleted (-> reason)

RiskAssessment.reasonReference

Deleted (-> reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

Name	Flags	Card.	Type	Description & Constraints
RiskAssessment	TU		DomainResource	Potential outcomes for a subject with likelihood Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Unique identifier for the assessment
basedOn		0..1	Reference(Any)	Request fulfilled by this assessment
parent		0..1	Reference(Any)	Part of this occurrence
status	Σ	1..1	code	registered \| preliminary \| final \| amended + Binding: Observation Status (Required)
method	Σ	0..1	CodeableConcept	Evaluation mechanism Binding: RiskAssessmentMethod (Example)
code	Σ	0..1	CodeableConcept	Type of assessment
subject	Σ	1..1	Reference(Patient \| Group)	Who/what does assessment apply to?
encounter	Σ	0..1	Reference(Encounter)	Where was assessment performed?
occurrence[x]	Σ	0..1		When was assessment made?
occurrenceDateTime			dateTime
occurrencePeriod			Period
condition	Σ	0..1	Reference(Condition)	Condition assessed
performer	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device)	Who did assessment?
reason		0..*	CodeableReference(Condition \| Observation \| DiagnosticReport \| DocumentReference)	Why the assessment was necessary?
basis		0..*	Reference(Any)	Information used in assessment
prediction	C	0..*	BackboneElement	Outcome predicted + Rule: Probability as a deciml must be <= 100
outcome		0..1	CodeableConcept	Possible outcome for the subject Binding: RiskAssessmentOutcome (Example)
probability[x]	C	0..1		Likelihood of specified outcome + Rule: low and high must be percentages, if present
probabilityDecimal			decimal
probabilityRange			Range
qualitativeRisk		0..1	CodeableConcept	Likelihood of specified outcome as a qualitative value Binding: Risk Probability (Example)
relativeRisk		0..1	decimal	Relative likelihood
when[x]		0..1		Timeframe or age range
whenPeriod			Period
whenRange			Range
rationale		0..1	string	Explanation of prediction
mitigation		0..1	string	How to reduce risk
note		0..*	Annotation	Comments on the risk assessment
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<RiskAssessment xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Unique identifier for the assessment --></identifier>
 <basedOn><!-- 0..1 Reference(Any) Request fulfilled by this assessment --></basedOn>
 <parent><!-- 0..1 Reference(Any) Part of this occurrence --></parent>
 <status value="[code]"/><!-- 1..1 registered | preliminary | final | amended + -->
 <method><!-- 0..1 CodeableConcept Evaluation mechanism --></method>
 <code><!-- 0..1 CodeableConcept Type of assessment --></code>
 <subject><!-- 1..1 Reference(Group|Patient) Who/what does assessment apply to? --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Where was assessment performed? --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period When was assessment made? --></occurrence[x]>
 <condition><!-- 0..1 Reference(Condition) Condition assessed --></condition>
 <performer><!-- 0..1 Reference(Device|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who did assessment? --></performer>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) Why the assessment was necessary? --></reason>
 <basis><!-- 0..* Reference(Any) Information used in assessment --></basis>
 <prediction>  <!-- 0..* Outcome predicted -->
  <outcome><!-- 0..1 CodeableConcept Possible outcome for the subject --></outcome>
  <probability[x]><!-- I 0..1 decimal|Range Likelihood of specified outcome --></probability[x]>
  <qualitativeRisk><!-- 0..1 CodeableConcept Likelihood of specified outcome as a qualitative value --></qualitativeRisk>
  <relativeRisk value="[decimal]"/><!-- 0..1 Relative likelihood -->
  <when[x]><!-- 0..1 Period|Range Timeframe or age range --></when[x]>
  <rationale value="[string]"/><!-- 0..1 Explanation of prediction -->
 </prediction>
 <mitigation value="[string]"/><!-- 0..1 How to reduce risk -->
 <note><!-- 0..* Annotation Comments on the risk assessment --></note>
</RiskAssessment>

JSON Template

{
  "resourceType" : "RiskAssessment",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Unique identifier for the assessment
  "basedOn" : { Reference(Any) }, // Request fulfilled by this assessment
  "parent" : { Reference(Any) }, // Part of this occurrence
  "status" : "<code>", // R!  registered | preliminary | final | amended +
  "method" : { CodeableConcept }, // Evaluation mechanism
  "code" : { CodeableConcept }, // Type of assessment
  "subject" : { Reference(Group|Patient) }, // R!  Who/what does assessment apply to?
  "encounter" : { Reference(Encounter) }, // Where was assessment performed?
  // occurrence[x]: When was assessment made?. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "condition" : { Reference(Condition) }, // Condition assessed
  "performer" : { Reference(Device|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who did assessment?
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], // Why the assessment was necessary?
  "basis" : [{ Reference(Any) }], // Information used in assessment
  "prediction" : [{ // Outcome predicted
    "outcome" : { CodeableConcept }, // Possible outcome for the subject
    // probability[x]: Likelihood of specified outcome. One of these 2:
    "probabilityDecimal" : <decimal>,
    "probabilityRange" : { Range },
    "qualitativeRisk" : { CodeableConcept }, // Likelihood of specified outcome as a qualitative value
    "relativeRisk" : <decimal>, // Relative likelihood
    // when[x]: Timeframe or age range. One of these 2:
    "whenPeriod" : { Period },
    "whenRange" : { Range },
    "rationale" : "<string>" // Explanation of prediction
  }],
  "mitigation" : "<string>", // How to reduce risk
  "note" : [{ Annotation }] // Comments on the risk assessment
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:RiskAssessment;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Unique identifier for the assessment
  fhir:basedOn [ Reference(Any) ] ; # 0..1 Request fulfilled by this assessment
  fhir:parent [ Reference(Any) ] ; # 0..1 Part of this occurrence
  fhir:status [ code ] ; # 1..1 registered | preliminary | final | amended +
  fhir:method [ CodeableConcept ] ; # 0..1 Evaluation mechanism
  fhir:code [ CodeableConcept ] ; # 0..1 Type of assessment
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who/what does assessment apply to?
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Where was assessment performed?
  # occurrence[x] : 0..1 When was assessment made?. One of these 2
    fhir:occurrence [  a fhir:dateTime ; dateTime ]
    fhir:occurrence [  a fhir:Period ; Period ]
  fhir:condition [ Reference(Condition) ] ; # 0..1 Condition assessed
  fhir:performer [ Reference(Device|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who did assessment?
  fhir:reason  ( [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ] ... ) ; # 0..* Why the assessment was necessary?
  fhir:basis  ( [ Reference(Any) ] ... ) ; # 0..* Information used in assessment
  fhir:prediction ( [ # 0..* Outcome predicted
    fhir:outcome [ CodeableConcept ] ; # 0..1 Possible outcome for the subject
    # probability[x] : 0..1 I Likelihood of specified outcome. One of these 2
      fhir:probability [  a fhir:decimal ; decimal ]
      fhir:probability [  a fhir:Range ; Range ]
    fhir:qualitativeRisk [ CodeableConcept ] ; # 0..1 Likelihood of specified outcome as a qualitative value
    fhir:relativeRisk [ decimal ] ; # 0..1 Relative likelihood
    # when[x] : 0..1 Timeframe or age range. One of these 2
      fhir:when [  a fhir:Period ; Period ]
      fhir:when [  a fhir:Range ; Range ]
    fhir:rationale [ string ] ; # 0..1 Explanation of prediction
  ] ... ) ;
  fhir:mitigation [ string ] ; # 0..1 How to reduce risk
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments on the risk assessment
]

Changes from both R4 and R4B

RiskAssessment

RiskAssessment.performer

Type Reference: Added Target Types Patient, RelatedPerson

RiskAssessment.reason

Added Element

RiskAssessment.reasonCode

Deleted (-> reason)

RiskAssessment.reasonReference

Deleted (-> reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

9.11.5.1 Terminology Bindings

Path	ValueSet	Type	Documentation
RiskAssessment.status	ObservationStatus	Required	Codes providing the status of an observation.
RiskAssessment.method	??	Example
RiskAssessment.prediction.outcome	??	Example
RiskAssessment.prediction.qualitativeRisk	RiskProbability	Example	Codes representing the likelihood of a particular outcome in a risk assessment.

Path

ValueSet

Type

Documentation

RiskAssessment.status

ObservationStatus

Required

Codes providing the status of an observation.

RiskAssessment.method

Example

RiskAssessment.prediction.outcome

Example

RiskAssessment.prediction.qualitativeRisk

RiskProbability

Example

Codes representing the likelihood of a particular outcome in a risk assessment.

9.11.5.2 Constraints

UniqueKey

Level

Location

Description

Expression

ras-1

Rule

RiskAssessment.prediction.probability[x]

low and high must be percentages, if present

(low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum)))

ras-2

Rule

RiskAssessment.prediction

Probability as a deciml must be <= 100

probability.empty() or ((probability is decimal) implies ((probability as decimal) <= 100))

9.11.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
condition	reference	Condition assessed	RiskAssessment.condition (Condition)
date	date	When was assessment made?	(RiskAssessment.occurrence.ofType(dateTime))	26 Resources
encounter	reference	Where was assessment performed?	RiskAssessment.encounter (Encounter)	29 Resources
identifier	token	Unique identifier for the assessment	RiskAssessment.identifier	65 Resources
method	token	Evaluation mechanism	RiskAssessment.method
patient	reference	Who/what does assessment apply to?	RiskAssessment.subject.where(resolve() is Patient) (Patient)	66 Resources
performer	reference	Who did assessment?	RiskAssessment.performer (Practitioner, Device, Patient, PractitionerRole, RelatedPerson)
probability	number	Likelihood of specified outcome	RiskAssessment.prediction.probability.ofType(decimal)
risk	token	Likelihood of specified outcome as a qualitative value	RiskAssessment.prediction.qualitativeRisk
subject	reference	Who/what does assessment apply to?	RiskAssessment.subject (Group, Patient)