4.11 Resource RiskAssessment - Content

4.11.1 Scope and Usage

This resource captures predicted outcomes for a patient or population on the basis of source information. Examples include:

• A prognosis statement for a particular condition
• Risk of health outcome (heart attack, particular type of cancer) on the basis of lifestyle factors and/or family history
• List of potential health risks based on a patient's genetic analysis
• A prediction of outbreak infection rates within a geography based on immunization rates

This resource can be used to represent the results of formal scoring/decision support tools that evaluate risk. It can also be used to capture a practitioner's subjective assessment of the patient's risk based on existing knowledge and previous experience.

4.11.2 Boundaries and Relationships

Risk assessments are a specialized type of observation. We use a specialized resource to provide a simpler mechanism to capture of a series of risks and to associate those risks with time-ranges, probabilities, etc. All risk assertions are captured at one time based on a single set of source inputs. Capture of a single risk MAY be done using the Observation class, particularly in circumstances where it's treated as a generic observation, but for consistency, all risk assessments and prognosis SHOULD be captured using RiskAssessment.

Risk assessments may be based on a variety of factors, including:

• Basic demographic information from the Patient or Group resources
• Various Observations including vital signs, lab information, assessments, genetic information, etc.
• FamilyMemberHistory
• Current, past and proposed therapies Immunization, Procedure, CarePlan, etc.

Because so many resources can potentially be used, no limit is placed on what resources can be sent in RiskAssessment.basis. However, some resources would be nonsensical for this use (e.g. MessageHeader).

AllergyIntolerance and RiskAssessment

AllergyIntolerance describes a specific type of risk - propensity to reaction to a substance while RiskAssessment describes general risks to a subject, not generally based on a reaction.

4.11.3 Background and Context

Risk Assessments can be determined manually by health-care providers based on their professional expertise, by using an algorithmic scoring system or through a combination. Risk assessments can also be computed by decision support systems. OperationDefinitions may be defined by servers to generate risk assessments based on particular combinations of source resources or other inputs.

• Structure
• UML
• XML
• JSON
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
RiskAssessment			DomainResource	Potential outcomes for a subject with likelihood
subject	Σ	0..1	Reference(Patient | Group)	Who/what does assessment apply to?
date	Σ	0..1	dateTime	When was assessment made?
condition	Σ	0..1	Reference(Condition)	Condition assessed
encounter	Σ	0..1	Reference(Encounter)	Where was assessment performed?
performer	Σ	0..1	Reference(Practitioner | Device)	Who did assessment?
identifier	Σ	0..1	Identifier	Unique identifier for the assessment
method	Σ	0..1	CodeableConcept	Evaluation mechanism
basis		0..*	Reference(Any)	Information used in assessment
prediction		0..*	BackboneElement	Outcome predicted
outcome		1..1	CodeableConcept	Possible outcome for the subject
probability[x]	I	0..1		Likelihood of specified outcome Risk Probability (Example) low and high must be percentages, if present Must be <= 100
probabilityDecimal			decimal
probabilityRange			Range
probabilityCodeableConcept			CodeableConcept
relativeRisk		0..1	decimal	Relative likelihood
when[x]		0..1		Timeframe or age range
whenPeriod			Period
whenRange			Range
rationale		0..1	string	Explanation of prediction
mitigation		0..1	string	How to reduce risk
Documentation for this format

<RiskAssessment xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <subject><!-- 0..1 Reference(Patient|Group) Who/what does assessment apply to? --></subject>
 <date value="[dateTime]"/><!-- 0..1 When was assessment made? -->
 <condition><!-- 0..1 Reference(Condition) Condition assessed --></condition>
 <encounter><!-- 0..1 Reference(Encounter) Where was assessment performed? --></encounter>
 <performer><!-- 0..1 Reference(Practitioner|Device) Who did assessment? --></performer>
 <identifier><!-- 0..1 Identifier Unique identifier for the assessment --></identifier>
 <method><!-- 0..1 CodeableConcept Evaluation mechanism --></method>
 <basis><!-- 0..* Reference(Any) Information used in assessment --></basis>
 <prediction>  <!-- 0..* Outcome predicted -->
  <outcome><!-- 1..1 CodeableConcept Possible outcome for the subject --></outcome>
  <probability[x]><!-- 0..1 decimal|Range|CodeableConcept Likelihood of specified outcome --></probability[x]>
  <relativeRisk value="[decimal]"/><!-- 0..1 Relative likelihood -->
  <when[x]><!-- 0..1 Period|Range Timeframe or age range --></when[x]>
  <rationale value="[string]"/><!-- 0..1 Explanation of prediction -->
 </prediction>
 <mitigation value="[string]"/><!-- 0..1 How to reduce risk -->
</RiskAssessment>

{
  "resourceType" : "RiskAssessment",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "subject" : { Reference(Patient|Group) }, // Who/what does assessment apply to?
  "date" : "<dateTime>", // When was assessment made?
  "condition" : { Reference(Condition) }, // Condition assessed
  "encounter" : { Reference(Encounter) }, // Where was assessment performed?
  "performer" : { Reference(Practitioner|Device) }, // Who did assessment?
  "identifier" : { Identifier }, // Unique identifier for the assessment
  "method" : { CodeableConcept }, // Evaluation mechanism
  "basis" : [{ Reference(Any) }], // Information used in assessment
  "prediction" : [{ // Outcome predicted
    "outcome" : { CodeableConcept }, // R!  Possible outcome for the subject
    // probability[x]: Likelihood of specified outcome. One of these 3:
    "probabilityDecimal" : <decimal>,
    "probabilityRange" : { Range },
    "probabilityCodeableConcept" : { CodeableConcept },
    "relativeRisk" : <decimal>, // Relative likelihood
    // when[x]: Timeframe or age range. One of these 2:
    "whenPeriod" : { Period },
    "whenRange" : { Range },
    "rationale" : "<string>" // Explanation of prediction
  }],
  "mitigation" : "<string>" // How to reduce risk
}

Structure

Name	Flags	Card.	Type	Description & Constraints
RiskAssessment			DomainResource	Potential outcomes for a subject with likelihood
subject	Σ	0..1	Reference(Patient | Group)	Who/what does assessment apply to?
date	Σ	0..1	dateTime	When was assessment made?
condition	Σ	0..1	Reference(Condition)	Condition assessed
encounter	Σ	0..1	Reference(Encounter)	Where was assessment performed?
performer	Σ	0..1	Reference(Practitioner | Device)	Who did assessment?
identifier	Σ	0..1	Identifier	Unique identifier for the assessment
method	Σ	0..1	CodeableConcept	Evaluation mechanism
basis		0..*	Reference(Any)	Information used in assessment
prediction		0..*	BackboneElement	Outcome predicted
outcome		1..1	CodeableConcept	Possible outcome for the subject
probability[x]	I	0..1		Likelihood of specified outcome Risk Probability (Example) low and high must be percentages, if present Must be <= 100
probabilityDecimal			decimal
probabilityRange			Range
probabilityCodeableConcept			CodeableConcept
relativeRisk		0..1	decimal	Relative likelihood
when[x]		0..1		Timeframe or age range
whenPeriod			Period
whenRange			Range
rationale		0..1	string	Explanation of prediction
mitigation		0..1	string	How to reduce risk
Documentation for this format

UML Diagram

XML Template

<RiskAssessment xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <subject><!-- 0..1 Reference(Patient|Group) Who/what does assessment apply to? --></subject>
 <date value="[dateTime]"/><!-- 0..1 When was assessment made? -->
 <condition><!-- 0..1 Reference(Condition) Condition assessed --></condition>
 <encounter><!-- 0..1 Reference(Encounter) Where was assessment performed? --></encounter>
 <performer><!-- 0..1 Reference(Practitioner|Device) Who did assessment? --></performer>
 <identifier><!-- 0..1 Identifier Unique identifier for the assessment --></identifier>
 <method><!-- 0..1 CodeableConcept Evaluation mechanism --></method>
 <basis><!-- 0..* Reference(Any) Information used in assessment --></basis>
 <prediction>  <!-- 0..* Outcome predicted -->
  <outcome><!-- 1..1 CodeableConcept Possible outcome for the subject --></outcome>
  <probability[x]><!-- 0..1 decimal|Range|CodeableConcept Likelihood of specified outcome --></probability[x]>
  <relativeRisk value="[decimal]"/><!-- 0..1 Relative likelihood -->
  <when[x]><!-- 0..1 Period|Range Timeframe or age range --></when[x]>
  <rationale value="[string]"/><!-- 0..1 Explanation of prediction -->
 </prediction>
 <mitigation value="[string]"/><!-- 0..1 How to reduce risk -->
</RiskAssessment>

JSON Template

{
  "resourceType" : "RiskAssessment",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "subject" : { Reference(Patient|Group) }, // Who/what does assessment apply to?
  "date" : "<dateTime>", // When was assessment made?
  "condition" : { Reference(Condition) }, // Condition assessed
  "encounter" : { Reference(Encounter) }, // Where was assessment performed?
  "performer" : { Reference(Practitioner|Device) }, // Who did assessment?
  "identifier" : { Identifier }, // Unique identifier for the assessment
  "method" : { CodeableConcept }, // Evaluation mechanism
  "basis" : [{ Reference(Any) }], // Information used in assessment
  "prediction" : [{ // Outcome predicted
    "outcome" : { CodeableConcept }, // R!  Possible outcome for the subject
    // probability[x]: Likelihood of specified outcome. One of these 3:
    "probabilityDecimal" : <decimal>,
    "probabilityRange" : { Range },
    "probabilityCodeableConcept" : { CodeableConcept },
    "relativeRisk" : <decimal>, // Relative likelihood
    // when[x]: Timeframe or age range. One of these 2:
    "whenPeriod" : { Period },
    "whenRange" : { Range },
    "rationale" : "<string>" // Explanation of prediction
  }],
  "mitigation" : "<string>" // How to reduce risk
}