US Core Observation Occupation Profile - US Core Implementation Guide v7.0.0-ballot

This page is part of the US Core (v7.0.0-ballot: STU7 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 6.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core Observation Occupation Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-occupation		Version: 7.0.0-ballot
Standards status: Trial-use	Maturity Level: 3	Computable Name: USCoreObservationOccupationProfile
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Occupation Observation Profile is based upon the core FHIR Observation Resource and implements the US Core Data for Interoperability (USCDI) Occupation and Occupation Industry requirements. This profile promotes interoperability and adoption through common implementation by setting minimum expectations for the Observation resource to record, search, and fetch a patient’s past or present job as occupation and industry, in other words, the type of work and type of business that compensates for work or assigns work to an unpaid worker or volunteer. In the context of this profile, a job is defined as a work situation, or a training or volunteer position held for a specified period. It identifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains the way the elements are used and constrains the way the elements are used when using the profile. It provides the floor for standards development for specific use cases.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

Query for a patient’s work history
Record or update past or present jobs belonging to a patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Observation Must Have:

a status
a code for job history
a patient
the job code or text

Each Observation Must Support:

a category code of “social-history”
when the job occurred
a code for the job history industry
the industry code or text

Profile Specific Implementation Guidance:

Additional codes that translate or map to the Observation code or category codes are allowed. For example:
- providing both a local code and LOINC code
- providing a more specific code, a SNOMED CT concept, or a system-specific code.
For the current job, omit observation.effectivePeriod.end to indicate it is ongoing.
When the industry is known, but the occupation is not, use the value “unknown” from the DataAbsentReason Code System. However, when the occupation is known but the industry is not, omit the industry Observation.component. The guide provides examples for both scenarios.
In the Quick Start section below, you can find instructions on searching for Occupations (Jobs) by patient, date, and other core search parameters. For more advanced queries using Observation, refer to the FHIR search specification.
Implementers may consider referring to Occupational Data for Health (ODH) FHIR IG to convey additional details; data elements, such as Employer; or different topics, such as Usual (Longest-Held) Work.

Usage:

Examples for this Resource Profile: Observation/observation-occupation-industry-unknown, Observation/observation-occupation-unknown and Observation/observation-occupation

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	Past Or Present Occupation
status	S	1..1	code	registered \| preliminary \| final \| amended +
Slices for category	S	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:socialhistory	S	0..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
code	S	1..1	CodeableConcept	Occupation history Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11341-5
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effectivePeriod	S	0..1	Period	Clinically relevant time/time-period for observation
valueCodeableConcept	S	1..1	CodeableConcept	Coded occupation or text Binding: Occupation ONETSOC Detail (ODH) (extensible): Occupational Data for Health
Slices for component	S	0..*	BackboneElement	Component results Slice: Unordered, Open by pattern:code
component:industry	S	0..1	BackboneElement	Occupation industry
code	S	1..1	CodeableConcept	Occupation industry history Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 86188-0
valueCodeableConcept	S	1..1	CodeableConcept	Occupation industry or text Binding: Industry NAICS Detail (ODH) (extensible): Occupational Data for Health
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.valueCodeableConcept	extensible	PHVS_Occupation_ONETSOC_Detail_ODH
Observation.component:industry.valueCodeableConcept	extensible	PHVS_Industry_NAICS_Detail _ODH

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	Past Or Present Occupation
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered \| preliminary \| final \| amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:socialhistory	S	0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
code	SΣ	1..1	CodeableConcept	Occupation history Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11341-5
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
Slices for effective[x]	Σ	0..1		Clinically relevant time/time-period for observation Slice: Unordered, Open by type:$this
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
effective[x]:effectivePeriod	SΣ	0..1	Period	Clinically relevant time/time-period for observation
Slices for value[x]	ΣC	1..1	CodeableConcept	Actual result Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	SΣC	1..1	CodeableConcept	Coded occupation or text Binding: Occupation ONETSOC Detail (ODH) (extensible): Occupational Data for Health
Slices for component	SΣ	0..*	BackboneElement	Component results Slice: Unordered, Open by pattern:code
component:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
component:industry	SΣ	0..1	BackboneElement	Occupation industry
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Occupation industry history Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 86188-0
value[x]	SΣ	1..1	CodeableConcept	Occupation industry or text Binding: Industry NAICS Detail (ODH) (extensible): Occupational Data for Health
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.status	required	ObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:socialhistory	preferred	Pattern: social-history
Observation.code	example	Pattern: LOINC code 11341-5
Observation.value[x]:valueCodeableConcept	extensible	PHVS_Occupation_ONETSOC_Detail_ODH
Observation.component.code	example	LOINCCodes (a valid code from LOINC)
Observation.component:industry.code	example	Pattern: LOINC code 86188-0
Observation.component:industry.value[x]	extensible	PHVS_Industry_NAICS_Detail _ODH

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()