Profile Comparison between http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs vs http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/vitalsigns	http://hl7.org/fhir/StructureDefinition/Observation	Values Differ
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	2020-11-17	2022-11-21T18:34:14+00:00	Values Differ
description	To promote interoperability and adoption through common implementation, this profile is based on the base [FHIR Vital Signs Profile](http://hl7.org/fhir/R4/observation-vitalsigns.html) and defines *additional* constraints on the Observation resource to represent vital signs observations. 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. This US Core profiles that are derived from this profile are listed below.	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.	Values Differ
experimental	false		Removed the item 'false'
fhirVersion	4.0.1
jurisdiction
jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	USCoreVitalSignsProfile	SDOHCCObservationScreeningResponse	Values Differ
publisher	HL7 International - Cross-Group Projects	HL7 International - Patient Care WG	Values Differ
purpose
status	active	draft	Values Differ
title	US Core Vital Signs Profile	SDOHCC Observation Screening Response	Values Differ
type	Observation
url	http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs	http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse	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-vitalsigns	US Core Vital Signs Profile	C	0..*	Observation	SDOH screening questionnaire observations	Elements differ in short: 'US Core Vital Signs Profile' vs 'SDOH screening questionnaire observations' Elements differ in definition: '\-' vs 'For Observations derived from SDOH screening surveys/questionnaires.' 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.'
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)	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)	Elements differ in short: 'registered | preliminary | final | amended +' vs 'final | corrected | entered-in-error | unknown' Elements differ in definition: 'The status of the result value.' vs 'The status of the observation value.' 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.'
Slices for category	S	1..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.code, value:coding.system 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.	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.' Elements differ in definition for mustSupport: 'true' vs 'false' Element minimum cardinalities differ: '1' vs '2'
code	SΣ	1..1	CodeableConcept	Coded Responses from C-CDA Vital Sign Results Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required)	Elements differ in short: 'Coded Responses from C-CDA Vital Sign Results' vs 'Type of observation (code / type)' Elements differ in definition: 'Coded Responses from C-CDA Vital Sign Results.' vs 'Describes what was observed. Sometimes this is called the observation "name".' 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]' Elements differ in requirements: '5. SHALL contain exactly one [1..1] code, where the @code SHOULD be selected from ValueSet HITSP Vital Sign Result Type 2.16.840.1.113883.3.88.12.80.62 DYNAMIC (CONF:7301).' 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.'
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	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.'
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	1..1	dateTime S, Period	Often just a dateTime for Vital Signs	SΣ	1..1	dateTime, Period	Clinically relevant time/time-period for observation	Elements differ in short: 'Often just a dateTime for Vital Signs' vs 'Clinically relevant time/time-period for observation' Elements differ in definition: 'Often just a dateTime for Vital Signs.' 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".' Elements differ in comments: '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.' vs 'At least a date should be present unless this observation is a historical report.'
issued	Σ	0..1	instant	Date/Time this version was made available	Σ	0..1	instant	Date/Time this version was made available
performer	Σ	0..*	Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)	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 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).' Elements differ in definition for mustSupport: 'false' vs 'true' Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/Practitioner], CanonicalType[http://hl7.org/fhir/StructureDefinition/PractitionerRole], CanonicalType[http://hl7.org/fhir/StructureDefinition/Organization], CanonicalType[http://hl7.org/fhir/StructureDefinition/CareTeam], CanonicalType[http://hl7.org/fhir/StructureDefinition/Patient], CanonicalType[http://hl7.org/fhir/StructureDefinition/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, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Vital Signs Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.	SΣC	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this	Elements differ in short: 'Vital Signs Value' vs 'Actual result' Elements differ in definition: 'Vital Signs value are typically recorded using the Quantity data type.' vs 'The information determined as a result of making the observation, if the information has a simple value.' Elements differ in requirements: '9. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).' vs 'An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.'
dataAbsentReason	SC	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.	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.'
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			Element maximum cardinalities differ: '1' vs '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			Element maximum cardinalities differ: '1' vs '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(QuestionnaireResponse | MolecularSequence | Vital Signs Profile)	Used when reporting vital signs panel components	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	Related resource that belongs to the Observation group	Elements differ in short: 'Used when reporting vital signs panel components' vs 'Related resource that belongs to the Observation group' Elements differ in definition: 'Used when reporting vital signs panel components.' 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.' Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/StructureDefinition/MolecularSequence], CanonicalType[http://hl7.org/fhir/StructureDefinition/vitalsigns]]) vs Reference([CanonicalType[http://hl7.org/fhir/StructureDefinition/Observation], CanonicalType[http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse], CanonicalType[http://hl7.org/fhir/StructureDefinition/MolecularSequence]])
derivedFrom	Σ	0..*	Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | MolecularSequence | Vital Signs Profile)	Related measurements the observation is made from	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:resolve()	Elements differ in definition for mustSupport: 'false' vs 'true'
component	SΣC	0..*	BackboneElement	Component observations	Σ	0..*	BackboneElement	Component results	Elements differ in short: 'Component observations' vs 'Component results' Elements differ in definition: 'Used when reporting component observation such as systolic and diastolic blood pressure.' vs 'Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.' Elements differ in definition for mustSupport: 'true' vs 'false'
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	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: US Core Vital Signs ValueSet (extensible): The vital sign codes from the base FHIR and US Core Vital Signs.	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.	Elements differ in definition for mustSupport: 'true' vs 'false' Elements differ in binding.description: 'The vital sign codes from the base FHIR and US Core Vital Signs.' vs 'Codes identifying names of simple observations.'
value[x]	SΣC	0..1	Quantity S, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Vital Sign Component Value Binding: VitalSignsUnits (extensible): Common UCUM units for recording Vital Signs.	Σ	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual component result	Elements differ in short: 'Vital Sign Component Value' vs 'Actual component result' Elements differ in definition: 'Vital Signs value are typically recorded using the Quantity data type. For supporting observations such as cuff size could use other datatypes such as CodeableConcept.' vs 'The information determined as a result of making the observation, if the information has a simple value.' Elements differ in requirements: '9. SHALL contain exactly one [1..1] value with @xsi:type="PQ" (CONF:7305).' vs 'An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.' Elements differ in definition for mustSupport: 'true' vs 'false'
dataAbsentReason	SC	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.	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.
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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