Profile Comparison between http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment vs http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-comorbidities

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/Observation
copyright	Used by permission of HL7 International, all rights reserved Creative Commons License		Removed the item 'Used by permission of HL7 International, all rights reserved Creative Commons License'
date	2022-04-20	2023-03-28T19:28:28+00:00	Values Differ
description	The US Core Observation Screening Assessment Profile meets the requirements of the US Core Data for Interoperability (USCDI) Assessments. To promote interoperability and adoption through common implementation, it sets the minimum expectations for the Observation Resource to record, search, and fetch observations representing the questions and responses to surveys and screening and assessment tools. For example, a social history status such as education or food insecurity or an assessment of the patient's cognitive, functional, or disability status. It can represent a single response, multiple responses, and multi-select "check all that apply" type questions. It identifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource when using this profile. It provides the floor for standards development for specific use cases.	General structure for capturing comorbid conditions with respect to a primary ('index') condition. The user can use this profile in three ways: (1) free-form, listing any conditions they wish to highlight as significant comorbidities, (2) following a formal paradigm such as the Charlson Comorbidity Index or the NCI Comorbidity Index, or (3) use disease categories defined for registry reporting purposes, such as those defined by Center for International Blood and Marrow Transplant Research (CIBMTR).	Values Differ
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	USCoreObservationScreeningAssessmentProfile	Comorbidities	Values Differ
publisher	HL7 International - Cross-Group Projects	HL7 International Clinical Interoperability Council	Values Differ
purpose
status	active
title	US Core Observation Screening Assessment Profile	Comorbidities Profile	Values Differ
type	Observation
url	http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment	http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-comorbidities	Values Differ
version	6.0.0-ballot	3.0.0-ballot	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	L Type	L Description & Constraints	Comments
Observation	C	0..*	Observation	Survey Observation us-core-2: If there is no component or hasMember element then either a value[x] or a data absent reason must be present us-core-3: SHALL use UCUM for coded quantity units.	C	0..*	Observation	Measurements and simple assertions	Elements differ in short: 'Survey Observation' vs 'Measurements and simple assertions' Elements differ in definition: '\-' vs 'Measurements and simple assertions made about a patient, device or other subject.' Elements differ in comments: '\-' vs 'Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.'
id	Σ	0..1	id	Logical id of this artifact	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations	S	0..*	Extension	Extension Slice: Unordered, Open by value:url	Elements differ in short: 'Additional content defined by implementations' vs 'Extension' Elements differ in definition: 'May be used to represent additional information that is not part of the basic definition of the resource. 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.' vs 'An Extension' Elements differ in definition for mustSupport: 'false' vs 'true'
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ?? (required): Codes providing the status of an observation.	?!SΣ	1..1	code	registered | preliminary | final | amended + Binding: ?? (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ?? (preferred): Codes for high level observation categories.		0..*	CodeableConcept	Classification of type of observation Binding: ?? (preferred): Codes for high level observation categories.	Elements differ in definition for mustSupport: 'true' vs 'false' Element minimum cardinalities differ: '1' vs '0'
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: ?? (preferred)	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: ?? (example): Codes identifying names of simple observations. Required Pattern: {"coding":[{"system":"http://snomed.info/sct","version":"http://snomed.info/sct/900000000000207008","code":"398192003"}]}	Example/preferred bindings differ at Observation.code using binding from USCoreObservationScreeningAssessmentProfile
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about	SΣ	0..1	Reference(Cancer Patient Profile)	Who and/or what the observation is about	Elements differ in definition: 'The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.' vs 'The patient whose comorbidities are recorded.' Element minimum cardinalities differ: '1' vs '0'
focus	ΣTU	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record	SΣ	0..*	Reference(Primary Cancer Condition Profile)	The Index Condition	Elements differ in short: 'What the observation is about, when it is not about the subject of record' vs 'The Index Condition' Elements differ in definition: 'The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.' vs 'Comorbid conditions are typically defined with respect to a specific 'index' condition. For example, the US Centers for Disease Control (CDC) has provided a list of comorbid conditions important to COVID-19. In this case, the focus would be COVID-19 and the comorbid condition categories would be those specified by CDC, namely obesity, renal disease, respiratory disease, etc.' Elements differ in definition for mustSupport: 'false' vs 'true'
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣC	0..1	dateTime S, Period, Timing, instant	Clinically relevant time/time-period for observation us-core-1: Datetime must be at least to day.	SΣ	0..1	dateTime, Period, Timing, instant	Clinically relevant time/time-period for observation	Elements differ in definition: 'The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time".' vs 'The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.' Elements differ in comments: 'At least a date should be present unless this observation is a historical report.' vs 'At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the [Timing] datatype which allow the measurement to be tied to regular life events.'
issued	Σ	0..1	instant	Date/Time this version was made available	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile)	Who is responsible for the observation	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	Who is responsible for the observation	Elements differ in definition for mustSupport: 'true' vs 'false'
value[x]	SΣC	0..1	Quantity S, CodeableConcept S, string S, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result	ΣC	0..1	Quantity, integer	Actual result	Elements differ in definition: 'The information determined as a result of making the observation, if the information has a simple value.' vs 'Comorbidity score or risk index' Elements differ in comments: 'An observation may have a value if it represents an individual survey, screening, or assessment question and answer pair. An observation should not have a value if it represents a multi-question or multi-select “check all that apply” responses. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value.' vs 'An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the [Notes section] below.' Elements differ in definition for mustSupport: 'true' vs 'false'
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing.	C	0..1	CodeableConcept	Why the result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing.	Elements differ in comments: '"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For a given LOINC question, if the LOINC answer list includes concepts such as 'unknown' or 'not available', they should be used for Observation.value. Where these concepts are not part of the value set for Observation.value, the Observation.dataAbsentReason can be used if necessary and appropriate.' vs 'Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.' Elements differ in definition for mustSupport: 'true' vs 'false'
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations.		0..*	CodeableConcept	High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation		0..*	Annotation	Comments about the observation
bodySite		0..1	CodeableConcept	Observed body part Binding: ?? (example): Codes describing anatomical locations. May include laterality.		0..1	CodeableConcept	Not used in this profile Binding: ?? (example): Codes describing anatomical locations. May include laterality.	Elements differ in short: 'Observed body part' vs 'Not used in this profile' Elements differ in definition: 'Indicates the site on the subject's body where the observation was made (i.e. the target site).' vs 'Not used in this profile'
method		0..1	CodeableConcept	How it was done Binding: ?? (example): Methods for simple observations.		0..1	CodeableConcept	Comorbidity framework used. Binding: ?? (example): Methods for simple observations.	Elements differ in short: 'How it was done' vs 'Comorbidity framework used.' Elements differ in definition: 'Indicates the mechanism used to perform the observation.' vs 'The formal methodology used, such as Charlson, NCI, Elixhauser, or ACE-27. The method must be specified if a comorbidity index is specified, otherwise the index cannot be correctly interpreted.'
specimen		0..1	Reference(Specimen)	Specimen used for this observation		0..1	Reference(Specimen)	Not used in this profile	Elements differ in short: 'Specimen used for this observation' vs 'Not used in this profile' Elements differ in definition: 'The specimen that was used when this observation was made.' vs 'Not used in this profile'
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device		0..1	Reference(Device | DeviceMetric)	Not used in this profile	Elements differ in short: '(Measurement) Device' vs 'Not used in this profile' Elements differ in definition: 'The device used to generate the observation data.' vs 'Not used in this profile'
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation	C	0..*	BackboneElement	Provides guide for interpretation
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	??	Low Range, if relevant	C	0..1	??	Low Range, if relevant
high	C	0..1	??	High Range, if relevant	C	0..1	??	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ?? (preferred): Code for the meaning of a reference range.		0..1	CodeableConcept	Reference range qualifier Binding: ?? (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ?? (example): Codes identifying the population the reference range applies to.		0..*	CodeableConcept	Reference range population Binding: ?? (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation		0..1	string	Text based reference range in an observation
hasMember	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile S | QuestionnaireResponse | MolecularSequence)	Reference to panel or multi-select responses	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Not used in this profile	Elements differ in short: 'Reference to panel or multi-select responses' vs 'Not used in this profile' Elements differ in definition: 'Aggregate set of Observations that represent question answer pairs for both multi-question surveys, screenings, and assessments and multi-select questions.' vs 'Not used in this profile' Elements differ in comments: 'This grouping element is used to represent surveys, screenings, and assessments that group several questions together or individual questions with “check all that apply” responses. For example in the simplest case a flat multi-question survey where the "panel" observation is the survey instrument itself and instead of an `Observation.value` the `hasMember` element references other Observation that represent the individual questions answer pairs. When there is a heirarchical grouping of questions, the observation "panels" can be nested. Because surveys, screenings, and assessments can be arbitrarily complex structurally, not all structures can be represented using this Observation grouping pattern.' vs 'When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see [Notes] below. Note that a system may calculate results from [QuestionnaireResponse] into a final score and represent the score as an Observation.' Elements differ in definition for mustSupport: 'true' vs 'false'
derivedFrom	SΣ	0..*	Reference(US Core Observation Screening Assessment Profile S | QuestionnaireResponse | US Core DocumentReference Profile | ImagingStudy | Media | MolecularSequence)	Related Observation(s) or other resource the observation is made from	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)	Related measurements the observation is made from	Elements differ in short: 'Related Observation(s) or other resource the observation is made from' vs 'Related measurements the observation is made from' Elements differ in definition: 'Observations or or other resource such as a QuestionnaireResponse from which this observation value is derived.' vs 'The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.' Elements differ in definition for mustSupport: 'true' vs 'false' Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment], CanonicalType[http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference], CanonicalType[http://hl7.org/fhir/StructureDefinition/ImagingStudy], CanonicalType[http://hl7.org/fhir/StructureDefinition/Media], CanonicalType[http://hl7.org/fhir/StructureDefinition/MolecularSequence]]) vs Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/DocumentReference], CanonicalType[http://hl7.org/fhir/StructureDefinition/ImagingStudy], CanonicalType[http://hl7.org/fhir/StructureDefinition/Media], CanonicalType[http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/StructureDefinition/Observation], CanonicalType[http://hl7.org/fhir/StructureDefinition/MolecularSequence]])
component	Σ	0..*	BackboneElement	Component results	Σ	0..*	BackboneElement	Not used in this profile	Elements differ in short: 'Component results' vs 'Not used in this profile' Elements differ in definition: 'Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.' vs 'Not used in this profile'
id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: ?? (example): Codes identifying names of simple observations.	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: ?? (example): Codes identifying names of simple observations.
value[x]	Σ	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual component result	Σ	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual component result
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing.	C	0..1	CodeableConcept	Why the component result is missing Binding: ?? (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations.		0..*	CodeableConcept	High, low, normal, etc. Binding: ?? (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format