2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

U.S. Data Access Framework (DAF) Patient Profile (Conformance Package)

Scope and Usage

This profile sets expectations for use of the Patient resource within the Data Access Framework (DAF) Implementation Guide. This profile identifies which core elements,extensions,vocabularies and value sets must be supported by DAF actors.

For the purposes of this profile, Supported means the following:

    SearchParameters:

  • DAF Query Requestor (client) SHALL be capable of querying the Patient resource using one or more of the search parameters for data elements tagged as MUST SUPPORT in this profile.
  • DAF Query Responder (server) SHALL be capable of receiving the queries submitted by the DAF Query Requestor and provide Query Results or error responses per the FHIR specifications.
  • DAF Query Responder MAY provide valid or error responses when the query parameters submitted contain data elements which are not tagged as MUST SUPPORT by this profile.
  • Query Results:

  • Query Results returned by DAF Query Responder SHOULD contain the data elements identified as MUST SUPPORT in the profile.
  • Query Results returned MAY contain data elements not tagged as MUST SUPPORT by the this profile.
  • Query Requestor SHALL process the Query Results containing additional data elements without indicating that the response is an erroneous response.
  • Missing Information:

  • When Query Results do not contain a particular data element identified as MUST SUPPORT, Query Requestors SHALL interpret the results to mean that the Query Responder did not have information and there is no further qualifying information as to why the information is missing.
  • In cases, where the Query Responder knows precisely the reason why the data is missing (e.g notasked in the data-absent-reason value set), then Query Responders MAY provide this additional information using the extension element as part of the data element. Query Requestors SHALL correctly process the data-absent-reason extension without rejecting the response as an erroneous response.

Relationship to Meaningful Use

The DAF Patient profile provides a mapping for the following Meaningful Use data elements to FHIR data elements.


Meaningful Use Data Element Name FHIR Resource Mapping
Name Patient.name
Patient Identifiers Patient.identifier
Gender Patient.gender
Date of Birth Patient.birthDate
Race Patient.extension(us-core-race)
Ethnicity Patient.extension(us-core-ethnicity)
Preferred Language Patient.communication
Multiple Birth Indicator Patient.multipleBirthBoolean
Birth Order Patient.multipleBirthInteger
Mother's Maiden Name Patient.extension(patient-mothers-maiden-name)
Address Patient.address
Telephone Patient.telecom
Marital Status Patient.maritalStatus
Birth Place Patient.extension(birthplace)
Religious Affiliation Patient.extension(religion)
Guardian Patient.contact

Boundaries and Relationships

This profile relies on the use of other profiles, some required, others available for use "when necessary":

  • US Core which defines common properties related to Patient such as race and ethnicity.
  • Extensions defines other extensions such as birthPlace, patient-mothers-maiden-name which are used by the profile
  • FHIR Extensibility defines how extensions can be applied to FHIR resources and data types. Specifically the data-absent-reason extension is used to code data elements with missing information when appropriate.

Profile Details

Profiles:
DAFPatientDefines constraints and extensions on the patient resource for use in querying and retrieving patient demographic information. : U.S. Data Access Framework (DAF) Patient Profile

Search Parameters

Search parameters defined by this package. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPathsSource
agenumberComputation based search where the query requestor intends to search based on age rather than the actual birth date.nullXML / JSON
birthOrderBooleantokenSearch based on whether a patient was part of multiple births or not.nullXML / JSON
birthOrderIntegernumberSearch based on birth order if the patient was part of multiple births.nullXML / JSON
citystringSearch based on citynullXML / JSON
ethnicitytokenThe ethnicity of the patientnullXML / JSON
mothersMaidenNamestringPatient's mother's maiden namenullXML / JSON
nametokenThe name of a patient that matches a given name or a family name or the name represented by the text element. (Note: This overrides the base Patient resource name search parameter behavior.)nullXML / JSON
racetokenThe race of the patientnullXML / JSON
streetAddressstringSearch based on street addressnullXML / JSON
telecomstringSearch based on telecom valuenullXML / JSON
zipcodestringSearch based on zipcodenullXML / JSON

Example Usage Scenarios

The following are example usage scenarios for the DAF Patient profile:

  • Query for a Patient demographic information using identifiers such as MRN
  • Query for a Patient demographic information using first name, last name etc.
  • Query for Patients based on race, ethnicity, gender etc.
  • Query for Patients based on geographical area such as city, state, zipcode information
  • Query for Patients less than 5 years
  • Query for Patients between ages of 25 and 50

Additional Implementation Guidance

Implementers need to be mindful of the following during their implementation

    Patient Identifiers: Patient Identifiers are represented as part of the Patient.identifier data element. Identifiers have to be scoped using a URI data type represented within the Patient.identifier.system element. If systems are using OID's to scope their patient identifiers, then OID's can be converted to URI's per RFC-3001. Since DAF profiles deal with queries of Patient data, identifiers play a critical role to identify the right resources to be returned. So all DAF Responders MUST return the Patient.identifier element as part of the Patient resource and further Patient.identifier.system and Patient.identifier.value MUST be populated.

    Patient Matching: Patient Matching rules and criteria have to be evaluated by the implementing organization and have to comply with local policies and regulations. Query Requestors will have to deal with result sets that can return zero,one or more Patient Resources in response to a query.

    Representing Patient Names: Patient Names are represented using the HumanName datatype. Per the FHIR specification, the first name is represented using the first occurrence of the element HumanName.given element. Middle names and other parts of the name can be represented using subsequent occurrences of the HumanName.given element.

    Coding Race Extension: Instances SHALL return the codes corresponding to one of "American Indian or Alaska Native", "Asian", "Black or African American", "Native Hawaiian or Other Pacific Islander", "White" in the first race element within the Patient resource. Instances can contain detailed race categories that can be rolled up to the above five categories as part of the subsequent race data elements.

    Coding Ethnicity: Instances SHALL only use the code "2135-2" representing "Hispanic or Latino" or the code "2186-5" representing "Not Hispanic or Latino" from the Ethnicity Codesystem.