Profile Comparison between http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessments vs http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationAssessment

Messages

Metadata

Name	Value		Comments
abstract	false	true	Values Differ
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	2022-11-21T18:34:14+00:00	Values Differ
description	To promote interoperability and adoption through common implementation, the US Core Observation Survey Profile sets minimum expectations for the Observation Resource to record, search, and fetch retrieve observations that represent the questions and responses to surveys, and screening and assessment tools. It can be used to 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.	Profile for Social Determinants of Health (SDOH) observations that involve assessment (e.g., by a provider, payer, etc.) as opposed to being derived only from screening surveys (as is the case for the SDOHCC Screening Response Observation). The Cross-Group Projects work group granted a variance to US Core on 06/10/2021 - Jira ticket FHIR-32892.	Values Differ
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	USCoreObservationScreeningAssessmentsProfile	SDOHCCObservationAssessment	Values Differ
publisher	HL7 International - Cross-Group Projects	HL7 International - Patient Care WG	Values Differ
purpose
status	active	draft	Values Differ
title	US Core Observation Screening Assessments Profile	SDOHCC Observation Assessment	Values Differ
type	Observation
url	http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessments	http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationAssessment	Values Differ
version	6.0.0-ballot	2.0.0	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	This is an abstract profile. SDOH assessment observation	Elements differ in short: 'Survey Observation' vs 'SDOH assessment observation' Elements differ in definition: '\-' vs 'For SDOH observations derived from assessment of the individual.' Elements differ in comments: '\-' vs 'For representation of SDOH observations that involve assessment (e.g., by a provider or payer) as opposed to being derived only from screening surveys (as is the case for the SDOHCC Screening Response Observation). 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.'
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. Additional Bindings Purpose AllLanguages Max Binding		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages 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		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	registered | preliminary | final | amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.		1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.	Elements differ in requirements: 'To identify that observation is derived from a questionnaire.' vs 'Used for filtering what observations are retrieved and displayed.' Elements differ in definition for mustSupport: 'true' vs 'false'
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: US Core Survey Codes (preferred)	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: SDOHCC ValueSet LOINC SNOMEDCT (preferred)	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. As the Gravity Project continues to refine content for the SDOH categories (e.g., food, housing, transportation, etc.), this value set binding strength may change and may be refined to codes (including LOINC and SNOMED) that pertain to SDOH categories.' Example/preferred bindings differ at Observation.code using binding from USCoreObservationScreeningAssessmentsProfile
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about	SΣ	1..1	Reference(Group | US Core Patient Profile)	Who and/or what the observation is about	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient]]) vs Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/Group], CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient]])
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]	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.	Σ	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. NOTE: dateTime is Must Support, but currently tooling does not support this.' Elements differ in definition for mustSupport: 'true' vs 'false'
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	Elements differ in comments: 'Some questions on questionnaires are not answered directly (e.g., asserted) by the individual completing the questionnaire, but are derived from answers to one or more other questions. For types of answers, `Observation.performer` should not be specified and `Observation.derivedFrom` should reference the relevant Screening Response Observation(s).' vs 'References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. NOTE: US Core Practitioner is Must Support, but currently tooling does not support this.' 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]])
value[x]	SΣC	0..1	Quantity S, CodeableConcept S, string S, boolean, 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	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.'
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.	C	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (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: 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..1	CodeableConcept	Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
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..1	Reference(Specimen)	Specimen used for this observation
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	SΣ	0..*	Reference(US Core Observation Screening Assessments Profile S | QuestionnaireResponse | MolecularSequence)	Reference to panel or multi-select responses	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group	Elements differ in short: 'Reference to panel or multi-select responses' vs 'Related resource that belongs to the Observation group' 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 '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.' 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 Assessments Profile S | QuestionnaireResponse | US Core DocumentReference Profile | ImagingStudy | Media | MolecularSequence)	Related Observations or QuestionnaireResponses that 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 Observations or QuestionnaireResponses that the observation is made from' vs 'Related measurements the observation is made from' 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.' Elements differ in definition for mustSupport: 'true' vs 'false' Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessments], 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	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
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