This page is part of the Quality Improvement Core Framework (v2.0.0: STU 2) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

D.4.1.4 StructureDefinition: qicore-familymemberhistory - Detailed Descriptions

Definitions for the StructureDefinition-qicore-familymemberhistory Profile.

FamilyMemberHistory
Definition

Significant health events and conditions for a person related to the patient relevant in the context of care for the patient.

Control0..*
InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
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 (: contained.where(('#'+id in %resource.descendants().reference).not()).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())
fhs-1: Can have age[x] or born[x], but not both (: age.empty() or born.empty())
fhs-2: Can only have estimatedAge if age[x] is present (: age.exists() or estimatedAge.empty())
fhs-3: Not Done Reason can only be specified if NotDone is "true" (: notDone or notDoneReason.exists().not())
FamilyMemberHistory.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.

FamilyMemberHistory.meta
Definition

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

Control0..1
TypeMeta
FamilyMemberHistory.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.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

FamilyMemberHistory.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
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).

FamilyMemberHistory.text
Definition

A human-readable narrative that contains a summary of the resource, and may 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 This element is affected by the following invariants: dom-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 in formation is added later.

FamilyMemberHistory.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.

FamilyMemberHistory.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

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.

FamilyMemberHistory.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. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
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.

FamilyMemberHistory.identifier
Definition

This records identifiers associated with this family member history record that are defined by business processes and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Requirements

Need to allow connection to a wider workflow.

FamilyMemberHistory.definition
Definition

A protocol or questionnaire that was adhered to in whole or in part by this event.

Control0..*
TypeChoice of: Reference(PlanDefinition), Reference(Questionnaire)
FamilyMemberHistory.status
Definition

A code specifying the status of the record of the family history of a specific family member.

Control1..1
BindingA code that identifies the status of the family history record.
The codes SHALL be taken from FamilyHistoryStatus
Typecode
Is Modifiertrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

FamilyMemberHistory.notDone
Definition

If true, indicates the taking of an individual family member's history did not occur. The notDone element should not be used to document negated conditions, such as a family member that did not have a condition.

Control0..1
Typeboolean
Is Modifiertrue
Requirements

Creating a FamilyMemberHistory where notDone is true is intended for situations where there's a need for a specific statement in the record about something not being done. If the need is merely to indicate that a request wasn't fulfilled, that should be handled using Task.

Comments

This element is labeled as a modifier because it marks the family member history as a family member history that did not occur. The more attributes are populated, the more constrained the negated statement is. This notDone element is being evaluated and will likely be removed in a subsequent release.

Default Valuefalse
FamilyMemberHistory.notDoneReason
Definition

Describes why the family member's history is absent.

Control0..1 This element is affected by the following invariants: fhs-3
BindingCodes describing the reason why a family member history was not done.
For example codes, see FamilyHistoryNotDoneReason
TypeCodeableConcept
Requirements

This is a separate element to allow it to have a distinct binding from reasonCode.

Comments

This notDoneReason element is being evaluated and will likely be replaced in a subsequent release (e.g. dataAbsentReason).

FamilyMemberHistory.patient
Definition

The person who this history concerns.

Control1..1
TypeReference(QICore-Patient)
Must Supporttrue
Alternate NamesProband
FamilyMemberHistory.date
Definition

The date (and possibly time) when the family member history was taken.

Control0..1
TypedateTime
Must Supporttrue
Requirements

Allows determination of how current the summary is.

Comments

This should be captured even if the same as the date on the List aggregating the full family history.

FamilyMemberHistory.name
Definition

This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair".

Control0..1
Typestring
Requirements

Allows greater ease in ensuring the same person is being talked about.

FamilyMemberHistory.relationship
Definition

The type of relationship this person has to the patient (father, mother, brother etc.).

Control1..1
BindingA relationship between two people characterizing their "familial" relationship
For example codes, see FamilyMember
TypeCodeableConcept
Must Supporttrue
FamilyMemberHistory.gender
Definition

Administrative Gender - the gender that the relative is considered to have for administration and record keeping purposes.

Control0..1
BindingThe gender of a person used for administrative purposes.
The codes SHALL be taken from AdministrativeGender
Typecode
Requirements

Not all relationship codes imply gender and the relative's gender can be relevant for risk assessments.

FamilyMemberHistory.born[x]
Definition

The actual or approximate date of birth of the relative.

Control0..1 This element is affected by the following invariants: fhs-1
TypeChoice of: Period, date, string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

Allows calculation of the relative's age.

FamilyMemberHistory.age[x]
Definition

The age of the relative at the time the family member history is recorded.

Control0..1 This element is affected by the following invariants: fhs-1
TypeChoice of: Age, Range, string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Requirements

While age can be calculated from date of birth, sometimes recording age directly is more natureal for clinicians.

Comments

use estimatedAge to indicate whether the age is actual or not.

FamilyMemberHistory.estimatedAge
Definition

If true, indicates that the age value specified is an estimated value.

Control0..1 This element is affected by the following invariants: fhs-2
Typeboolean
Is Modifiertrue
Requirements

Clinicians often prefer to specify an estimaged age rather than an age range.

Comments

This element is labeled as a modifier because the fact tha age is estimated can/should change the results of any algorithm that calculates based on the specified age.

Meaning if MissingIt is unknown whether the age is an estimate or not
FamilyMemberHistory.deceased[x]
Definition

Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record.

Control0..1
TypeChoice of: boolean, Age, Range, date, string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
FamilyMemberHistory.reasonCode
Definition

Describes why the family member history occurred in coded or textual form.

Control0..*
BindingCodes indicating why the family member history was done.
For example codes, see SNOMED CT Clinical Findings
TypeCodeableConcept
Comments

Textual reasons can be caprued using reasonCode.text.

FamilyMemberHistory.reasonReference
Definition

Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event.

Control0..*
TypeChoice of: Reference(Condition), Reference(Observation), Reference(AllergyIntolerance), Reference(QuestionnaireResponse)
FamilyMemberHistory.note
Definition

This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.

Control0..*
TypeAnnotation
FamilyMemberHistory.condition
Definition

The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.

Control0..*
TypeBackboneElement
Comments

If none of the conditions listed have an outcome of "death" specified, that indicates that none of the specified conditions are known to have been the primary cause of death.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
FamilyMemberHistory.condition.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
FamilyMemberHistory.condition.extension
Definition

An Extension

Control0..*
TypeExtension
FamilyMemberHistory.condition.extension (http://hl7.org/fhir/StructureDefinition/familymemberhistory-abatement)
Definition

The approximate date, age, or flag indicating that the condition of the family member resolved. The abatement should only be specified if the condition is stated in the positive sense, i.e., the didNotHave flag is false.

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: Choice of: date, Age, boolean)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
FamilyMemberHistory.condition.extension (http://hl7.org/fhir/StructureDefinition/familymemberhistory-severity)
Definition

A qualification of the seriousness or impact on health of the family member condition.

Control0..1 This element is affected by the following invariants: ele-1
Type (Extension Type: CodeableConcept)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
FamilyMemberHistory.condition.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
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.

FamilyMemberHistory.condition.code
Definition

The actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.

Control1..1
BindingThe code for the condition
The codes SHOULD be taken from Problem Value Set
TypeCodeableConcept
Must Supporttrue
FamilyMemberHistory.condition.outcome
Definition

Indicates what happened as a result of this condition. If the condition resulted in death, deceased date is captured on the relation.

Control0..1
BindingThe result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.
For example codes, see Condition Outcome Codes
TypeCodeableConcept
FamilyMemberHistory.condition.onset[x]
Definition

Either the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence.

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

Age of onset of a condition in relatives is predictive of risk for the patient.

FamilyMemberHistory.condition.note
Definition

An area where general notes can be placed about this specific condition.

Control0..*
TypeAnnotation