QI-Core Implementation Guide: STU 3.2 (v3.2.0 for FHIR 3.0.1)

This page is part of the Quality Improvement Core Framework (v3.2.0: STU 3) 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: - Detailed Descriptions

Definitions for the StructureDefinition-qicore-condition Profile.


1. Condition
Definition

A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

Control0..*
InvariantsDefined on this element
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error (: verificationStatus='entered-in-error' or clinicalStatus.exists())
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (: abatement.empty() or (abatement as boolean).not() or clinicalStatus='resolved' or clinicalStatus='remission' or clinicalStatus='inactive')
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())
us-core-1: 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())
2. Condition.id
Definition

Logical id of this artifact.

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. Condition.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
4. Condition.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.

5. Condition.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
Max Binding: All Languages
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. Condition.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.

7. Condition.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.

8. Condition.extension
Definition

An Extension

Control0..*
TypeExtension
9. Condition.extension:criticality
Definition

Characterizes potential impact of the condition on life, durable physiological function, or quality of life.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(criticality) (Extension Type: CodeableConcept)
Comments

What is the value set for this?

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())
10. Condition.extension:dueTo
Definition

Further conditions, problems, diagnoses, procedures or events or the substance that caused/triggered this Condition.

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(dueTo) (Extension Type: Choice of: CodeableConcept, Reference(Condition | Procedure | MedicationAdministration | Immunization | MedicationStatement))
Comments

Although a condition may be caused by a substance, this is not intended to be used to record allergies/adverse reactions to substances.

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())
11. Condition.extension:occurredFollowing
Definition

Further conditions, problems, diagnoses, procedures or events or the substance that preceded this Condition.

Control0..* This element is affected by the following invariants: ele-1
TypeExtension(occurredFollowing) (Extension Type: Choice of: CodeableConcept, Reference(Condition | Procedure | MedicationAdministration | Immunization | MedicationStatement))
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())
12. Condition.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.

13. Condition.identifier
Definition

This records identifiers associated with this condition 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 identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Requirements

Need to allow connection to a wider workflow.

14. Condition.clinicalStatus
Definition

The clinical status of the condition.

Control0..1 This element is affected by the following invariants: con-3, con-4
BindingPreferred value set for Condition Clinical Status.
The codes SHALL be taken from Condition Clinical Status Codes
Typecode
Is Modifiertrue
Must Supporttrue
Comments

This element is labeled as a modifier because the status contains codes that mark the condition as not currently valid or of concern.

15. Condition.verificationStatus
Definition

The verification status to support the clinical status of the condition.

Control1..1 This element is affected by the following invariants: con-3
BindingThe verification status to support or decline the clinical status of the condition or diagnosis.
The codes SHALL be taken from ConditionVerificationStatus
Typecode
Is Modifiertrue
Must Supporttrue
Comments

verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status.

This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.

Default Valueunknown
16. Condition.category
Definition

A category assigned to the condition.

Control1..*
BindingThe US core Condition Category Codes support the separate concepts of problems and health concerns in Condition.category in order for API consumers to be able to separate health concerns and problems.
The codes SHOULD be taken from US Core Condition Category Codes
TypeCodeableConcept
Must Supporttrue
Comments

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

17. Condition.severity
Definition

A subjective assessment of the severity of the condition as evaluated by the clinician.

Control0..1
BindingPreferred value set for Condition/Diagnosis severity grading
The codes SHOULD be taken from Condition/Diagnosis Severity
TypeCodeableConcept
Must Supporttrue
Comments

Coding of the severity with a terminology is preferred, where possible.

18. Condition.code
Definition

This describes the problem.

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

0..1 to account for primarily narrative only resources.

Alternate Namestype
19. Condition.bodySite
Definition

The anatomical location where this condition manifests itself.

Control0..*
BindingThis value set includes all codes from http://snomed.info/sct where concept is-a 442083009 (Anatomical or acquired body site (body structure)).
For example codes, see SNOMED CT Body Structures
TypeCodeableConcept
Must Supporttrue
Comments

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

20. Condition.subject
Definition

Indicates the patient or group who the condition record is associated with.

Control1..1
TypeReference(QICore-Patient)
Must Supporttrue
Requirements

Group is typically used for veterinary or public health use cases.

Alternate Namespatient
21. Condition.context
Definition

Encounter during which the condition was first asserted.

Control0..1
TypeReference(QICore-Encounter | EpisodeOfCare)
Must Supporttrue
Alternate Namesencounter
Comments

This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

22. Condition.onset[x]
Definition

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

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

Age is generally used when the patient reports an age at which the Condition began to occur.

23. Condition.abatement[x]
Definition

The date or estimated date that the condition resolved or went into remission.

Control0..1 This element is affected by the following invariants: con-4
TypeChoice of: dateTime, Age, boolean, Period, Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

24. Condition.assertedDate
Definition

The date on which the existance of the Condition was first asserted or acknowledged.

Control0..1
TypedateTime
Must Supporttrue
Comments

The assertedDate represents the date when this particular Condition record was created in the EHR, not the date of the most recent update in terms of when severity, abatement, etc. were specified.  The date of the last record modification can be retrieved from the resource metadata.

25. Condition.asserter
Definition

Individual who is making the condition statement.

Control0..1
TypeReference(QICore-Patient | QICore-Practitioner | QICore-RelatedPerson)
26. Condition.stage
Definition

Clinical stage or grade of a condition. May include formal severity assessments.

Control0..1
TypeBackboneElement
Must Supporttrue
InvariantsDefined on this element
con-1: Stage SHALL have summary or assessment (: summary.exists() or assessment.exists())
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
27. Condition.stage.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
28. Condition.stage.extension
Definition

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

29. Condition.stage.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.

30. Condition.stage.summary
Definition

A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.

Control0..1 This element is affected by the following invariants: con-1
BindingExample value set for stages of cancer and other conditions
For example codes, see Condition Stage
TypeCodeableConcept
Must Supporttrue
31. Condition.stage.assessment
Definition

Reference to a formal record of the evidence on which the staging assessment is based.

Control0..* This element is affected by the following invariants: con-1
TypeReference(ClinicalImpression | QICore-DiagnosticReport | QICore-Observation)
32. Condition.evidence
Definition

Supporting Evidence / manifestations that are the basis on which this condition is suspected or confirmed.

Control0..*
TypeBackboneElement
Comments

The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

InvariantsDefined on this element
con-2: evidence SHALL have code or details (: code.exists() or detail.exists())
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
33. Condition.evidence.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
34. Condition.evidence.extension
Definition

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

35. Condition.evidence.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.

36. Condition.evidence.code
Definition

A manifestation or symptom that led to the recording of this condition.

Control0..* This element is affected by the following invariants: con-2
BindingExample value set for Manifestation and Symptom codes.
For example codes, see Manifestation and Symptom Codes
TypeCodeableConcept
37. Condition.evidence.detail
Definition

Links to other relevant information, including pathology reports.

Control0..* This element is affected by the following invariants: con-2
TypeReference(Resource)
38. Condition.note
Definition

Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

Control0..*
TypeAnnotation