Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

StructureDefinition: RiskAssessment_eltss - Detailed Descriptions

Definitions for the RiskAssessment-eltss Profile.

1. RiskAssessment
Definition

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

Control0..*
Alternate NamesPrognosis
InvariantsDefined on this element
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.div.exists())
2. RiskAssessment.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. RiskAssessment.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Control0..1
TypeMeta
4. RiskAssessment.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

5. RiskAssessment.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHOULD be taken from CommonLanguages
Max Binding: AllLanguages
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

6. RiskAssessment.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

7. RiskAssessment.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

8. RiskAssessment.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on RiskAssessment.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. RiskAssessment.extension:riskPlan
SliceNameriskPlan
Definition

Optional Extension Element - found in all resources.

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(RiskPlan) (Extension Type: Reference(USCoreDocumentReferenceProfile))
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. RiskAssessment.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

11. RiskAssessment.identifier
Definition

Business identifier assigned to the risk assessment.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
12. RiskAssessment.basedOn
Definition

A reference to the request that is fulfilled by this risk assessment.

Control0..1
TypeReference(Resource)
13. RiskAssessment.parent
Definition

A reference to a resource that this risk assessment is part of, such as a Procedure.

Control0..1
TypeReference(Resource)
14. RiskAssessment.status
Definition

The status of the RiskAssessment, using the same statuses as an Observation.

Control1..1
BindingThe status of the risk assessment; e.g. preliminary, final, amended, etc.
The codes SHALL be taken from ObservationStatus
Typecode
15. RiskAssessment.method
Definition

The algorithm, process or mechanism used to evaluate the risk.

Control0..1
BindingThe mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
TypeCodeableConcept
Requirements

The method can influence the results of the assessment.

16. RiskAssessment.code
Definition

The type of the risk assessment performed.

Control0..1
TypeCodeableConcept
17. RiskAssessment.subject
Definition

The patient or group the risk assessment applies to.

Control1..1
TypeReference(Patient_eltss)
18. RiskAssessment.encounter
Definition

The encounter where the assessment was performed.

Control0..1
TypeReference(USCoreEncounterProfile)
19. RiskAssessment.occurrence[x]
Definition

The date (and possibly time) the risk assessment was performed.

Control0..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

The assessment results lose validity the more time elapses from when they are first made.

20. RiskAssessment.condition
Definition

For assessments or prognosis specific to a particular condition, indicates the condition being assessed.

Control0..1
TypeReference(Condition_eltss)
21. RiskAssessment.performer
Definition

The provider or software application that performed the assessment.

Control0..1
TypeReference(Practitioner_eltss | USCorePractitionerRoleProfile | USCoreDeviceProfile)
22. RiskAssessment.reasonCode
Definition

The reason the risk assessment was performed.

Control0..*
TypeCodeableConcept
23. RiskAssessment.reasonReference
Definition

Resources supporting the reason the risk assessment was performed.

Control0..*
TypeReference(Condition_eltss | Observation_eltss | USCoreDiagnosticReportProfileNoteExchange | USCoreDocumentReferenceProfile)
24. RiskAssessment.basis
Definition

Indicates the source data considered as part of the assessment (for example, FamilyHistory, Observations, Procedures, Conditions, etc.).

Control0..*
TypeReference(Resource)
25. RiskAssessment.prediction
Definition

An aspect of a person’s life, behavior, environmental exposure, personal characteristic, or barrier that increases the likelihood of disease, condition, injury to self or others, or interaction with the criminal justice system.

Control0..*
TypeBackboneElement
Comments

Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ras-2: Must be <= 100 (: probability is decimal implies (probability as decimal) <= 100)
26. RiskAssessment.prediction.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
27. RiskAssessment.prediction.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

28. RiskAssessment.prediction.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

29. RiskAssessment.prediction.outcome
Definition

One of the potential outcomes for the patient (e.g. remission, death, a particular condition).

Control0..1
BindingThe condition or other outcome; e.g. death, remission, amputation, infection, etc.
TypeCodeableConcept
30. RiskAssessment.prediction.probability[x]
Definition

Indicates how likely the outcome is (in the specified timeframe).

Control0..1
TypeChoice of: decimal, Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).

InvariantsDefined on this element
ras-1: 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))))
31. RiskAssessment.prediction.qualitativeRisk
Definition

Indicates how likely the outcome is (in the specified timeframe), expressed as a qualitative value (e.g. low, medium, or high).

Control0..1
BindingThe likelihood of the occurrence of a specified outcome.
For example codes, see RiskProbability
TypeCodeableConcept
32. RiskAssessment.prediction.relativeRisk
Definition

Indicates the risk for this particular subject (with their specific characteristics) divided by the risk of the population in general. (Numbers greater than 1 = higher risk than the population, numbers less than 1 = lower risk.).

Control0..1
Typedecimal
Requirements

Absolute risk is less meaningful than relative risk.

33. RiskAssessment.prediction.when[x]
Definition

Indicates the period of time or age range of the subject to which the specified probability applies.

Control0..1
TypeChoice of: Period, Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If not specified, the risk applies "over the subject's lifespan".

34. RiskAssessment.prediction.rationale
Definition

Additional information explaining the basis for the prediction.

Control0..1
Typestring
35. RiskAssessment.mitigation
Definition

Description of planned activities to minimize identified risks that endanger the person's health and safety. This can be included as free text or attachment.

Control0..1
Typestring
Requirements

One of the main reasons for assessing risks is to identify whether interventional steps are needed to reduce risk.

36. RiskAssessment.note
Definition

Additional comments about the risk assessment.

Control0..*
TypeAnnotation