HL7.FHIR.US.CORE\US Core Observation Pregnancy Intent Profile

US Core Implementation Guide
6.1.0 - STU6 United States of America flag

This page is part of the US Core (v6.1.0: STU6 Update) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: US Core Observation Pregnancy Intent Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancyintent				Version: 6.1.0
Active as of 2022-08-24				Computable Name: USCoreObservationPregnancyIntentProfile
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Pregnancy Intent Observation Profile is based upon the core FHIR Observation Resource and implements the US Core Data for Interoperability (USCDI) v3 Pregnancy status requirements. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch the “patient’s intent to become pregnant” over the next year. It identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this 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 pregnancy intention
Record or update a past or present pregnancy intention

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 pregnancy intention observation
a patient
when the observation occurred
the pregnancy intention

Each Observation Must Support:

a category code of “social-history”

Profile Specific Implementation Guidance:

For representing the patient’s pregnancy status use the US Core Observation Pregnancy Status Profile.
The US Core Pregnancy Intent Codes value set includes SNOMED CT codes and the HL7 V3 code for the concept “unknown”. These codes have historically been used to communicate the pregnancy intent of a patient.

Usage:

Examples for this Resource Profile: Observation/pregnancy-intent

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	Measurements and simple assertions
status	S	1..1	code	(USCDI) registered \| preliminary \| final \| amended +
Slices for category	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this
category:SocialHistory	S	0..1	CodeableConcept	(USCDI) 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	(USCDI) Pregnancy Status 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: 86645-9
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) Who and/or what the observation is about
effectiveDateTime	S	1..1	dateTime	(USCDI) Clinically relevant time/time-period for observation
valueCodeableConcept	S	1..1	CodeableConcept	(USCDI) Coded Responses from Pregnancy Intent Value Set Binding: US Core Pregnancy Intent Codes (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.valueCodeableConcept	extensible	USCorePregnancyIntentCodes

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	Measurements and simple assertions
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	(USCDI) registered \| preliminary \| final \| amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	0..1	CodeableConcept	(USCDI) Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
code	SΣ	1..1	CodeableConcept	(USCDI) Pregnancy Status Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 86645-9
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who and/or what the observation is about
Slices for effective[x]	Σ	1..1	dateTime	Clinically relevant time/time-period for observation Slice: Unordered, Closed by type:$this
effective[x]:effectiveDateTime	SΣ	1..1	dateTime	(USCDI) 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	(USCDI) Coded Responses from Pregnancy Intent Value Set Binding: US Core Pregnancy Intent Codes (extensible)
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 86645-9
Observation.value[x]:valueCodeableConcept	extensible	USCorePregnancyIntentCodes

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()

Description & Constraints

Observation

C

0..*

Observation

Measurements and simple assertions

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path

Conformance

ValueSet / Code

Observation.language

preferred

CommonLanguages

Additional Bindings

Purpose

AllLanguages

Max Binding

Observation.status

required

ObservationStatus

Observation.category

preferred

ObservationCategoryCodes

Observation.category:SocialHistory

preferred

Pattern: social-history

Observation.code

example

Pattern: LOINC code 86645-9

Observation.value[x]:valueCodeableConcept

extensible

USCorePregnancyIntentCodes

Observation.dataAbsentReason

extensible

DataAbsentReason

Observation.interpretation

extensible

ObservationInterpretationCodes

Observation.bodySite

example

SNOMEDCTBodyStructures

Observation.method

example

ObservationMethods

Observation.referenceRange.type

preferred

ObservationReferenceRangeMeaningCodes

Observation.referenceRange.appliesTo

example

ObservationReferenceRangeAppliesToCodes

Observation.component.code

example

LOINCCodes (a valid code from LOINC)

Observation.component.dataAbsentReason

extensible

DataAbsentReason

Observation.component.interpretation

extensible

ObservationInterpretationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
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-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()

This structure is derived from Observation

Summary

Mandatory: 3 elements
Must-Support: 7 elements

Structures

This structure refers to these other structures:

US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Slices

This structure defines the following Slices:

The element Observation.category is sliced based on the value of pattern:$this

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	Measurements and simple assertions
status	S	1..1	code	(USCDI) registered \| preliminary \| final \| amended +
Slices for category	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this
category:SocialHistory	S	0..1	CodeableConcept	(USCDI) 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	(USCDI) Pregnancy Status 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: 86645-9
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) Who and/or what the observation is about
effectiveDateTime	S	1..1	dateTime	(USCDI) Clinically relevant time/time-period for observation
valueCodeableConcept	S	1..1	CodeableConcept	(USCDI) Coded Responses from Pregnancy Intent Value Set Binding: US Core Pregnancy Intent Codes (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.valueCodeableConcept	extensible	USCorePregnancyIntentCodes

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	Measurements and simple assertions
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	(USCDI) registered \| preliminary \| final \| amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	0..*	CodeableConcept	(USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	0..1	CodeableConcept	(USCDI) Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
code	SΣ	1..1	CodeableConcept	(USCDI) Pregnancy Status Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 86645-9
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who and/or what the observation is about
Slices for effective[x]	Σ	1..1	dateTime	Clinically relevant time/time-period for observation Slice: Unordered, Closed by type:$this
effective[x]:effectiveDateTime	SΣ	1..1	dateTime	(USCDI) 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	(USCDI) Coded Responses from Pregnancy Intent Value Set Binding: US Core Pregnancy Intent Codes (extensible)
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 86645-9
Observation.value[x]:valueCodeableConcept	extensible	USCorePregnancyIntentCodes

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()

Snapshot View

Description & Constraints

Observation

C

0..*

Observation

Measurements and simple assertions

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path

Conformance

ValueSet / Code

Observation.language

preferred

CommonLanguages

Additional Bindings

Purpose

AllLanguages

Max Binding

Observation.status

required

ObservationStatus

Observation.category

preferred

ObservationCategoryCodes

Observation.category:SocialHistory

preferred

Pattern: social-history

Observation.code

example

Pattern: LOINC code 86645-9

Observation.value[x]:valueCodeableConcept

extensible

USCorePregnancyIntentCodes

Observation.dataAbsentReason

extensible

DataAbsentReason

Observation.interpretation

extensible

ObservationInterpretationCodes

Observation.bodySite

example

SNOMEDCTBodyStructures

Observation.method

example

ObservationMethods

Observation.referenceRange.type

preferred

ObservationReferenceRangeMeaningCodes

Observation.referenceRange.appliesTo

example

ObservationReferenceRangeAppliesToCodes

Observation.component.code

example

LOINCCodes (a valid code from LOINC)

Observation.component.dataAbsentReason

extensible

DataAbsentReason

Observation.component.interpretation

extensible

ObservationInterpretationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
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-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()

This structure is derived from Observation

Summary

Mandatory: 3 elements
Must-Support: 7 elements

Structures

This structure refers to these other structures:

US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Slices

This structure defines the following Slices:

The element Observation.category is sliced based on the value of pattern:$this

Other representations of profile: CSV, Excel, Schematron

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

The syntax used to describe the interactions is described here.
Servers providing access to social history data can use US Core SMART Scopes for:
- resource level scopes (for example, patient/Observation.rs)
- granular scopes (for example, patient.Observation.rs?category=http://terminology.hl7.org/3.1.0/CodeSystem-observation-category.html|social-history).
See the General Requirements section for additional rules and expectations when a server requires status parameters.
See the General Guidance section for additional guidance on searching for multiple patients.

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

The syntax used to describe the interactions is described here.
Servers providing access to social history data can use US Core SMART Scopes for:
- resource level scopes (for example, patient/Observation.rs)
- granular scopes (for example, patient.Observation.rs?category=http://terminology.hl7.org/3.1.0/CodeSystem-observation-category.html|social-history).
See the General Requirements section for additional rules and expectations when a server requires status parameters.
See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

SHALL support searching using the combination of the patient and category search parameters:

GET [base]/Observation?patient={Type/}[id]&category={system|}social-history

Example:
1. GET [base]/Observation?patient=1134281&category=social-history
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = social-history (how to search by reference and how to search by token)
SHALL support searching using the combination of the patient and code search parameters:
- including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

Example:
1. GET [base]/Observation?patient=1134281&code=http://loinc.org|86645-9
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple report codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)
SHALL support searching using the combination of the patient and category and date search parameters:
- including support for these date comparators: gt,lt,ge,le
- including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)
GET [base]/Observation?patient={Type/}[id]&category={system|}social-history&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

Example:
1. GET [base]Observation?patient=555580&category=social-history&date=ge2018-03-14T00:00:00Z
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = social-history (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

SHOULD support searching using the combination of the patient and category and status search parameters:
- including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)
GET [base]/Observation?patient={Type/}[id]&category={system|}social-history&status={system|}[code]{,{system|}[code],...}

Example:
1. GET [base]/Observation?patient=1134281&category=social-history&status=final
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category = social-history and status (how to search by reference and how to search by token)
SHOULD support searching using the combination of the patient and code and date search parameters:
- including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
- including support for these date comparators: gt,lt,ge,le
- including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)
GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

Example:
1. GET [base]Observation?patient=555580&code=http://loinc.org|86645-9&date=ge2019-01-01T00:00:00Z
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token and how to search by date)

IG © 2023+ HL7 International - Cross-Group Projects. Package hl7.fhir.us.core#6.1.0 based on FHIR 4.0.1. Generated 2023-06-30
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