US Core Implementation Guide (Release 1)

This page is part of the US Core (v1.0.0: STU1) based on FHIR R3. The current version which supercedes this version is 5.0.1. For a full list of available versions, see the Directory of published versions

1.0 - StructureDefinition-us-core-smokingstatus

This profile sets minimum expectations for the Observation resource to record, search and fetch smoking status data associated with a patient. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-SmokingStatus profile:

  • Query for the Smoking Status of a patient
  • Record or update the Smoking Status of a patient
Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Observation must have:

  1. a status
  2. a fixed code for smoking observation
  3. a patient
  4. a date representing when the smoking status was recorded
  5. a result value code for smoking status

Profile specific implementation guidance:

Examples

1.2 - Formal Views of Profile Content

The official URL for this profile is: 

http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus

This profile builds on Observation.

This profile was published on Mon Aug 01 00:00:00 AEST 2016 as a draft by HL7 US Realm Steering Committee.

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

Complete Summary of the Mandatory Requirements

  1. One status in Observation.statuswhich has a required binding to:
  2. One code in Observation.code
    • a fixed Observation.code.coding.system= http://loinc.org
    • a fixed Observation.code.coding.code=72166-2
  3. One reference to a Patient in Observation.subject
  4. One DateTime (instant) in Observation.issued
  5. One Observation.valueCodeableConceptwhich has a extensible + max valueset binding to:
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*US Core Smoking Status Observation Profile
... status S1..1codeBinding: ObservationStatus (required)
... code S1..1CodeableConceptSmoking Status: LOINC 72166-2 = Tobacco smoking status NHIS
Required Pattern: {"coding":[{"system":"http://loinc.org","code":"72166-2"}]}
... subject S1..1Reference(US Core Patient Profile)
... issued S1..1instant
... valueCodeableConcept S1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: Smoking Status (extensible)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*US Core Smoking Status Observation Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ProcedureRequest), Reference(ReferralRequest)Fulfills plan, proposal or order
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category 0..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
... code SΣ1..1CodeableConceptSmoking Status: LOINC 72166-2 = Tobacco smoking status NHIS
Binding: LOINC Codes (example)
Required Pattern: {"coding":[{"system":"http://loinc.org","code":"72166-2"}]}
... subject SΣ1..1Reference(US Core Patient Profile)Who and/or what this is about
... context 0..1Reference(Encounter), Reference(EpisodeOfCare)Healthcare event during which this observation is made
... effective[x] Σ0..1dateTime, PeriodClinically relevant time/time-period for observation
... issued SΣ1..1instantDate/Time this was made available
... performer Σ0..*Reference(Practitioner), Reference(Organization), Reference(Patient), Reference(RelatedPerson)Who is responsible for the observation
... valueCodeableConcept SΣI1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: Smoking Status (extensible)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method 0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device), Reference(DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... related ΣI0..*BackboneElementResource related to this observation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 0..1codehas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Binding: ObservationRelationshipType (required)
.... target 1..1Reference(Observation), Reference(QuestionnaireResponse), Reference(Sequence)Resource that is related to this one
... component ΣI0..*BackboneElementComponent results
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINC Codes (example)
.... value[x] Σ0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual component result
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation:uscoresmookingstatus.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

Complete Summary of the Mandatory Requirements

  1. One status in Observation.statuswhich has a required binding to:
  2. One code in Observation.code
    • a fixed Observation.code.coding.system= http://loinc.org
    • a fixed Observation.code.coding.code=72166-2
  3. One reference to a Patient in Observation.subject
  4. One DateTime (instant) in Observation.issued
  5. One Observation.valueCodeableConceptwhich has a extensible + max valueset binding to:

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*US Core Smoking Status Observation Profile
... status S1..1codeBinding: ObservationStatus (required)
... code S1..1CodeableConceptSmoking Status: LOINC 72166-2 = Tobacco smoking status NHIS
Required Pattern: {"coding":[{"system":"http://loinc.org","code":"72166-2"}]}
... subject S1..1Reference(US Core Patient Profile)
... issued S1..1instant
... valueCodeableConcept S1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: Smoking Status (extensible)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*US Core Smoking Status Observation Profile
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional Content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierBusiness Identifier for observation
... basedOn Σ0..*Reference(CarePlan), Reference(DeviceRequest), Reference(ImmunizationRecommendation), Reference(MedicationRequest), Reference(NutritionOrder), Reference(ProcedureRequest), Reference(ReferralRequest)Fulfills plan, proposal or order
... status ?!SΣ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required)
... category 0..*CodeableConceptClassification of type of observation
Binding: Observation Category Codes (preferred)
... code SΣ1..1CodeableConceptSmoking Status: LOINC 72166-2 = Tobacco smoking status NHIS
Binding: LOINC Codes (example)
Required Pattern: {"coding":[{"system":"http://loinc.org","code":"72166-2"}]}
... subject SΣ1..1Reference(US Core Patient Profile)Who and/or what this is about
... context 0..1Reference(Encounter), Reference(EpisodeOfCare)Healthcare event during which this observation is made
... effective[x] Σ0..1dateTime, PeriodClinically relevant time/time-period for observation
... issued SΣ1..1instantDate/Time this was made available
... performer Σ0..*Reference(Practitioner), Reference(Organization), Reference(Patient), Reference(RelatedPerson)Who is responsible for the observation
... valueCodeableConcept SΣI1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: Smoking Status (extensible)
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: Observation Value Absent Reason (extensible)
... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
... comment 0..1stringComments about result
... bodySite 0..1CodeableConceptObserved body part
Binding: SNOMED CT Body Structures (example)
... method 0..1CodeableConceptHow it was done
Binding: Observation Methods (example)
... specimen 0..1Reference(Specimen)Specimen used for this observation
... device 0..1Reference(Device), Reference(DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type 0..1CodeableConceptReference range qualifier
Binding: Observation Reference Range Meaning Codes (extensible)
.... appliesTo 0..*CodeableConceptReference range population
Binding: Observation Reference Range Applies To Codes (example)
.... age 0..1RangeApplicable age range, if relevant
.... text 0..1stringText based reference range in an observation
... related ΣI0..*BackboneElementResource related to this observation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type 0..1codehas-member | derived-from | sequel-to | replaces | qualified-by | interfered-by
Binding: ObservationRelationshipType (required)
.... target 1..1Reference(Observation), Reference(QuestionnaireResponse), Reference(Sequence)Resource that is related to this one
... component ΣI0..*BackboneElementComponent results
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... code Σ1..1CodeableConceptType of component observation (code / type)
Binding: LOINC Codes (example)
.... value[x] Σ0..1Quantity, CodeableConcept, string, Range, Ratio, SampledData, Attachment, time, dateTime, PeriodActual component result
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: Observation Value Absent Reason (extensible)
.... interpretation 0..1CodeableConceptHigh, low, normal, etc.
Binding: Observation Interpretation Codes (extensible)
.... referenceRange 0..*Unknown reference to #Observation:uscoresmookingstatus.referenceRange
Provides guide for interpretation of component result

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON, CSV), Schema: XML Schematron

 

1.3 - Quick Start

Below is an overview of the required search and read operations for this profile. See the Conformance requirements for the US Core Server for a complete list of supported RESTful operations and search parameters for this IG.

GET [base]/Observation?patient=[id]&code=72166-2

Support: Mandatory to support search by patient and code = ‘72166-2’.

Example: GET [base]/Observation?patient=1032702&code=72166-2

Implementation Notes: Search based on smoking status LOINC code. Fetches a bundle of all Observation resources with Observation.code of Tobacco Smoking Status for the specified patient (how to search by reference) and (how to search by token).