| Left: | US Core Observation Clinical Judgment Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-judgment) |
| Right: | SDOHCC Observation Screening Response (http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse) |
| Error | StructureDefinition.url | Values for url differ: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-judgment' vs 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse' |
| Error | StructureDefinition.version | Values for version differ: '6.0.0-ballot' vs '2.0.0' |
| Information | StructureDefinition.name | Values for name differ: 'USCoreObservationClinicalJudgmentProfile' vs 'SDOHCCObservationScreeningResponse' |
| Information | StructureDefinition.title | Values for title differ: 'US Core Observation Clinical Judgment Profile' vs 'SDOHCC Observation Screening Response' |
| Information | StructureDefinition.status | Values for status differ: 'active' vs 'draft' |
| Information | StructureDefinition.date | Values for date differ: '2022-04-20' vs '2022-11-21T18:34:14+00:00' |
| Information | StructureDefinition.publisher | Values for publisher differ: 'HL7 International - Cross-Group Projects' vs 'HL7 International - Patient Care WG' |
| Warning | Observation | Elements differ in short: 'assessment observation' vs 'SDOH screening questionnaire observations' |
| Warning | Observation | Elements differ in definition: '\-' vs 'For Observations derived from SDOH screening surveys/questionnaires.' |
| Warning | Observation | Elements differ in comments: '\-' vs 'Used for simple observations such as education status, food insecurity observations, etc. This profile allows the representation of SDOH observations based on SDOH screening questionnaire responses (which can also be represented using SDC QuestionnaireResponse). Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.' |
| Warning | Observation.status | Elements differ in short: 'registered | preliminary | final | amended +' vs 'final | corrected | entered-in-error | unknown' |
| Warning | Observation.status | Elements differ in definition: 'The status of the result value.' vs 'The status of the observation value.' |
| Warning | Observation.status | Elements differ in requirements: 'Need to track the status of individual results. Some results are finalized before the whole report is finalized.' vs 'Further constrained to values that are relevant for SDOH.' |
| Warning | Observation.category | Elements differ in requirements: 'Used for filtering what observations are retrieved and displayed.' vs 'To identify that an SDOH screening response observation is derived from an SDOH questionnaire, the “social-history” and “survey” codes are required.' |
| Warning | Observation.category | Elements differ in definition for mustSupport: 'true' vs 'false' |
| Information | Observation.category | Element minimum cardinalities differ: '1' vs '2' |
| Warning | Observation.code | Elements differ in comments: '*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.' vs '*All* code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation. For SDOH questions represented in LOINC that specify “check all that apply”, the LOINC question should be used for Observation.code and for Observation.component.code. For “check all that apply” questions, the answers (regardless of whether one or more are selected) should only be represented using Observation.component.value and Observation.value should be empty. As the Gravity Project continues to refine content for the SDOH categories (e.g., food, housing, transportation, etc.), this value set will be refined to codes that pertain to SDOH categories. For further guidance on external value sets vetted by the Gravity Project see: [Supplemental Guide]' |
| Warning | Observation.code | Elements differ in requirements: 'Knowing what kind of observation is being made is essential to understanding the observation.' vs 'Knowing what kind of observation is being made is essential to understanding the observation. The Gravity implemenation guide restricts questionnaire/survey observations to LOINC to move the industry to the use of LOINC panels/surveys (structures that are not available in other terminology systems) to standardize the coding of SDOH related risk assessment instruments. In addition, USCDI and US Core have standardized on the use of LOINC to represent Observations in general.' |
| Warning | Observation.subject | Elements differ in comments: 'One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.' vs 'Cardinality is 1..1.' |
| Information | Observation.effective[x] | Element minimum cardinalities differ: '0' vs '1' |
| Warning | Observation.performer | Elements differ in requirements: 'May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.' vs 'Some questions on an SDOH screening questionnaire are not answered directly (e.g., asserted) by the individual completing the questionnaire. Rather, the answer to some questions (e.g., the Hunger Vital Sign 88124-3 “Food insecurity risk”) may be derived from answers to one or more other questions. For a Screening Response Observation that is derived, as opposed to answered directly, Observation.performer should not be specified and Observation.derivedFrom should reference the relevant Screening Response Observation(s).' |
| Error | Observation.performer | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient], CanonicalType[http://hl7.org/fhir/StructureDefinition/PractitionerRole], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson]]) vs Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/RelatedPerson], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam]]) |
| Warning | Observation.dataAbsentReason | 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. 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.' 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. 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.' |
| Warning | Observation.dataAbsentReason | Elements differ in definition for mustSupport: 'false' vs 'true' |
| Information | Observation.bodySite | Element maximum cardinalities differ: '1' vs '0' |
| Information | Observation.specimen | Element maximum cardinalities differ: '1' vs '0' |
| Warning | Observation.hasMember | Elements differ in definition: 'This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.' vs 'Used when an observation is a group observation (e.g., the LOINC 88121-9 Hunger Vital Sign [HVS] panel) that includes the target as a member of the group.' |
| Warning | Observation.derivedFrom | Elements differ in short: 'Related Observations or QuestionnaireResponses that the observation is made from' vs 'Related measurements the observation is made from' |
| Warning | Observation.derivedFrom | Elements differ in definition: 'Observations or QuestionnaireResponses 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.' |
| Error | Observation.derivedFrom | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-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/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/StructureDefinition/Observation]]) |
| 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 |
| |
| date | 2022-04-20 | 2022-11-21T18:34:14+00:00 |
|
| description | The U.S. Core Observation Clinical Judgment Profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) v2 SDOH Assessments and v3 Health Assessments. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and retrieve observations that represent an individual's clinical judgment about a patient's health status. 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 may or may not be associated with a formal survey, screening, or assessment tool. 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. | Profile for observations that represent question and answer pairs from Social Determinants of Health (SDOH) screening instruments that are represented in LOINC. The Cross-Group Projects work group granted a variance to US Core on 12/03/2020 - Jira ticket FHIR-29795. |
|
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
 jurisdiction[0] | urn:iso:std:iso:3166#US | ||
| kind | resource | ||
| name | USCoreObservationClinicalJudgmentProfile | SDOHCCObservationScreeningResponse |
|
| publisher | HL7 International - Cross-Group Projects | HL7 International - Patient Care WG |
|
| purpose | |||
| status | active | draft |
|
| title | US Core Observation Clinical Judgment Profile | SDOHCC Observation Screening Response |
|
| type | Observation | ||
| url | http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-judgment | http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse |
|
| version | 6.0.0-ballot | 2.0.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 Observation | C | 0..* | Observation | assessment observation | C | 0..* | Observation | SDOH screening questionnaire observations |
| ||||||||
 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: CommonLanguages (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||||||||
| 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 | 0..* | Extension | Additional content defined by implementations | |||||||||||
 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: ObservationStatus (required): Codes providing the status of an observation. | ?!SΣ | 1..1 | code | final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required) |
| ||||||||
| Slices for category | S | 1..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. | 2..* | CodeableConcept | Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. |
| |||||||||
| code | SΣ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: LOINCCodes (preferred) | SΣ | 1..1 | CodeableConcept | Type of observation (code / type) Binding: LOINCCodes (required) |
| ||||||||
| subject | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the observation is about |
| ||||||||
| focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record | |||||||||
| 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] | SΣ | 0..1 | dateTime S, Period, Timing, instant | Clinically relevant time/time-period for observation | SΣ | 1..1 | dateTime, Period | Clinically relevant time/time-period for observation |
| ||||||||
| 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 | SΣ | 0..* | Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile) | Who is responsible for the observation |
| ||||||||
| value[x] | SΣC | 0..1 | Quantity S, CodeableConcept S, string S, boolean S, integer, Range, Ratio, SampledData, time, dateTime, Period | Actual result | SΣC | 0..1 | Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period | Actual result Slice: Unordered, Open by type:$this | |||||||||
| dataAbsentReason | C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. | SC | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. |
| ||||||||
| interpretation | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations. | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (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: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality. | 0..0 |
| ||||||||||||
| method | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations. | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations. | |||||||||||
| specimen | 0..1 | Reference(Specimen) | Specimen used for this observation | 0..0 |
| ||||||||||||
| device | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device | |||||||||||
 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 | SimpleQuantity | Low Range, if relevant | C | 0..1 | SimpleQuantity | Low Range, if relevant | |||||||||
| high | C | 0..1 | SimpleQuantity | High Range, if relevant | C | 0..1 | SimpleQuantity | High Range, if relevant | |||||||||
| type | 0..1 | CodeableConcept | Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range. | 0..1 | CodeableConcept | Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range. | |||||||||||
| appliesTo | 0..* | CodeableConcept | Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to. | 0..* | CodeableConcept | Reference range population Binding: ObservationReferenceRangeAppliesToCodes (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 | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group |
| ||||||||
| derivedFrom | SΣ | 0..* | Reference(http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-survey S | http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse S | US Core DocumentReference Profile | ImagingStudy | Media | MolecularSequence) | Related Observations or QuestionnaireResponses that the observation is made from | SΣ | 0..* | Reference(DocumentReference | QuestionnaireResponse | Observation) | Related measurements the observation is made from Slice: Unordered, Open by profile:resolve() |
| ||||||||
 component | Σ | 0..* | BackboneElement | Component results | Σ | 0..* | BackboneElement | Component results | |||||||||
 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: LOINCCodes (example): Codes identifying names of simple observations. | Σ | 1..1 | CodeableConcept | Type of component observation (code / type) Binding: LOINCCodes (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: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. | C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing. | |||||||||
| interpretation | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations. | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (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 | |||||||||||||||||