QI-Core Implementation Guide: STU Ballot (v3.3.0 for FHIR 4.0.0)
Quality Improvement Core Framework (v3.3.0: STU 4 Ballot 1). The current version is 3.2.0 based on FHIR R4. See the Directory of published versions
| Severe Burn Example |
The official URL for this profile is:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
Profile of Condition for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
This profile builds on USCoreCondition.
This profile was published on Wed Aug 22 00:00:00 EDT 2018 as a draft by Health Level Seven, Inc. - CQI WG.
Description of Profiles, Differentials, and Snapshots.
Summary
Mandatory: 2 elements
Must-Support: 13 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Condition | I | 0..* | Detailed information about conditions, problems or diagnoses | |
  id | Σ | 0..1 | id | Logical id of this artifact |
 meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
 contained | 0..* | Resource | Contained, inline Resources | |
 extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| condition-dueTo | I | 0..* | CodeableConcept, Reference(Condition | Procedure | MedicationAdministration | Immunization | MedicationStatement) | What caused the Condition? URL: http://hl7.org/fhir/StructureDefinition/condition-dueTo Binding: ConditionCauseCodes (example) |
| condition-occurredFollowing | I | 0..* | CodeableConcept, Reference(Condition | Procedure | MedicationAdministration | Immunization | MedicationStatement) | Precedent for this Condition URL: http://hl7.org/fhir/StructureDefinition/condition-occurredFollowing Binding: ConditionPredecessorCodes (example) |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..* | Identifier | External Ids for this condition |
| clinicalStatus | ?!SΣI | 0..1 | CodeableConcept | active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required) |
| verificationStatus | ?!SΣI | 0..1 | CodeableConcept | unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required) |
| category | S | 1..* | CodeableConcept | problem-list-item | encounter-diagnosis Binding: US Core Condition Category Codes (extensible) |
| severity | S | 0..1 | CodeableConcept | Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred) |
| code | SΣ | 1..1 | CodeableConcept | Identification of the condition, problem or diagnosis Binding: US Core Problem (extensible) |
| bodySite | SΣ | 0..* | CodeableConcept | Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example) |
 subject | SΣ | 1..1 | Reference(QICorePatient) | Who has the condition? |
| encounter | SΣ | 0..1 | Reference(QICoreEncounter) | Encounter created as part of |
 onset[x] | SΣ | 0..1 | Estimated or actual date, date-time, or age | |
 onsetDateTime | dateTime | |||
| onsetAge | Age | |||
| onsetPeriod | Period | |||
 onsetRange | Range | |||
| abatement[x] | SI | 0..1 | When in resolution/remission | |
| abatementDateTime | dateTime | |||
| abatementAge | Age | |||
| abatementPeriod | Period | |||
| abatementRange | Range | |||
| recordedDate | SΣ | 0..1 | dateTime | Date record was first recorded |
| recorder | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | Who recorded the condition |
| asserter | Σ | 0..1 | Reference(QICorePatient | QICorePractitioner | QICoreRelatedPerson) | Person who asserts this condition |
| stage | SI | 0..* | BackboneElement | Stage/grade, usually assessed formally |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| summary | SI | 0..1 | CodeableConcept | Simple summary (disease specific) Binding: ConditionStage (example) |
| assessment | I | 0..* | Reference(ClinicalImpression | QICoreDiagnosticReportLab | QICoreObservation) | Formal record of assessment |
| type | 0..1 | CodeableConcept | Kind of staging Binding: ConditionStageType (example) | |
| evidence | I | 0..* | BackboneElement | Supporting evidence con-2: evidence SHALL have code or details |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | ΣI | 0..* | CodeableConcept | Manifestation/symptom Binding: ManifestationAndSymptomCodes (example) |
| detail | ΣI | 0..* | Reference(Resource) | Supporting information found elsewhere |
| note | 0..* | Annotation | Additional information about the Condition | |
| Documentation for this format | ||||
Summary
Mandatory: 2 elements
Must-Support: 13 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Condition | I | 0..* | Detailed information about conditions, problems or diagnoses | |
| id | Σ | 0..1 | id | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages | |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| condition-dueTo | I | 0..* | CodeableConcept, Reference(Condition | Procedure | MedicationAdministration | Immunization | MedicationStatement) | What caused the Condition? URL: http://hl7.org/fhir/StructureDefinition/condition-dueTo Binding: ConditionCauseCodes (example) |
| condition-occurredFollowing | I | 0..* | CodeableConcept, Reference(Condition | Procedure | MedicationAdministration | Immunization | MedicationStatement) | Precedent for this Condition URL: http://hl7.org/fhir/StructureDefinition/condition-occurredFollowing Binding: ConditionPredecessorCodes (example) |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | Σ | 0..* | Identifier | External Ids for this condition |
| clinicalStatus | ?!SΣI | 0..1 | CodeableConcept | active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required) |
| verificationStatus | ?!SΣI | 0..1 | CodeableConcept | unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required) |
| category | S | 1..* | CodeableConcept | problem-list-item | encounter-diagnosis Binding: US Core Condition Category Codes (extensible) |
| severity | S | 0..1 | CodeableConcept | Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred) |
| code | SΣ | 1..1 | CodeableConcept | Identification of the condition, problem or diagnosis Binding: US Core Problem (extensible) |
| bodySite | SΣ | 0..* | CodeableConcept | Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example) |
| subject | SΣ | 1..1 | Reference(QICorePatient) | Who has the condition? |
| encounter | SΣ | 0..1 | Reference(QICoreEncounter) | Encounter created as part of |
| onset[x] | SΣ | 0..1 | Estimated or actual date, date-time, or age | |
| onsetDateTime | dateTime | |||
| onsetAge | Age | |||
| onsetPeriod | Period | |||
| onsetRange | Range | |||
| abatement[x] | SI | 0..1 | When in resolution/remission | |
| abatementDateTime | dateTime | |||
| abatementAge | Age | |||
| abatementPeriod | Period | |||
| abatementRange | Range | |||
| recordedDate | SΣ | 0..1 | dateTime | Date record was first recorded |
| recorder | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | Who recorded the condition |
| asserter | Σ | 0..1 | Reference(QICorePatient | QICorePractitioner | QICoreRelatedPerson) | Person who asserts this condition |
| stage | SI | 0..* | BackboneElement | Stage/grade, usually assessed formally |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| summary | SI | 0..1 | CodeableConcept | Simple summary (disease specific) Binding: ConditionStage (example) |
| assessment | I | 0..* | Reference(ClinicalImpression | QICoreDiagnosticReportLab | QICoreObservation) | Formal record of assessment |
| type | 0..1 | CodeableConcept | Kind of staging Binding: ConditionStageType (example) | |
| evidence | I | 0..* | BackboneElement | Supporting evidence con-2: evidence SHALL have code or details |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | ΣI | 0..* | CodeableConcept | Manifestation/symptom Binding: ManifestationAndSymptomCodes (example) |
| detail | ΣI | 0..* | Reference(Resource) | Supporting information found elsewhere |
| note | 0..* | Annotation | Additional information about the Condition | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| Condition.language | preferred | CommonLanguages Max Binding: AllLanguages |
| Condition.clinicalStatus | required | ConditionClinicalStatusCodes |
| Condition.verificationStatus | required | ConditionVerificationStatus |
| Condition.category | extensible | USCoreConditionCategoryCodes |
| Condition.severity | preferred | Condition/DiagnosisSeverity |
| Condition.code | extensible | USCoreProblem |
| Condition.bodySite | example | SNOMEDCTBodyStructures |
| Condition.stage.summary | example | ConditionStage |
| Condition.stage.type | example | ConditionStageType |
| Condition.evidence.code | example | ManifestationAndSymptomCodes |
| Id | Path | Details | Requirements |
| dom-2 | Condition | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-4 | Condition | 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-3 | Condition | 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-6 | Condition | A resource should have narrative for robust management : text.div.exists() | |
| dom-5 | Condition | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| con-5 | Condition | Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty() | |
| con-4 | Condition | If condition is abated, then clinicalStatus must be either inactive, resolved, or remission : abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists() | |
| con-3 | Condition | Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item : clinicalStatus.exists() or verificationStatus='entered-in-error' or category.select($this='problem-list-item').empty() | |
| us-core-1 | Condition | A code in Condition.category SHOULD be from US Core Condition Category Codes value set. : where(category in 'http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category').exists() | |
| ele-1 | Condition.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Condition.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Condition.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Condition.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Condition.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | Condition.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
| ele-1 | Condition.stage | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| con-1 | Condition.stage | Stage SHALL have summary or assessment : summary.exists() or assessment.exists() | |
| ele-1 | Condition.evidence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| con-2 | Condition.evidence | evidence SHALL have code or details : code.exists() or detail.exists() |
© HL7.org 2011+. (Clinical Quality Improvement WG). hl7.fhir.us.qicore#3.3.0 based on FHIR v4.0.0 generated 06/08/2019.
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