US Core Care Experience Preference Profile - US Core Implementation Guide v7.0.0-ballot

US Core Implementation Guide
7.0.0-ballot - Ballot United States of America flag

This page is part of the US Core (v7.0.0-ballot: STU7 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 6.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core Care Experience Preference Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-care-experience-preference		Version: 7.0.0-ballot
Standards status: Trial-use	Maturity Level: 3	Computable Name: USCoreCareExperiencePreferenceProfile
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This profile represents a person’s care preferences during their care and treatment. Examples include, but are not limited to religious preferences, dislikes and fears, and thoughts and feelings to be shared. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient’s care experience preferences. This profile identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases.

This page is new content for US Core Version 7.0.0

Example Usage Scenarios:

The following are example usage scenarios for this profile:

Query for a patient’s care experience preferences.
Record or update clinical observations or assessments about a patient’s care experience preferences.

Mandatory and Must Support Data Elements

In addition to the Mandatory and Must Support data elements in the US Core Simple Observation Profile, the following data-elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements. Note that the “Differential Table” displays elements unique to this profile and the “Key Elements Table” displays a combined view of elements for this profile and the US Core Simple Observation Profile.

Each Observation Must Have:

a status
a fixed code for care experience preference
a patient

Each Observation Must Support:

a category code of “care-experience-preference”
a time indicating when the preference was made
treatment intervention preference value*

*see guidance below

Profile Specific Implementation Guidance:

*Care experience preferences are patient-authored information used to share an individual’s goals, preferences, and priorities for overall experiences during their care and treatment. They guide caregivers and medical personnel about what is important to them. The preferences may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer.
Additional codes that translate or map to the Observation code or category codes are allowed. For example:
- providing both a local code and LOINC code
- providing a more specific code, for example, the more specific LOINC, “81364-2 (Religious or cultural beliefs [Reported]) from the ”, a SNOMED CT concept, or a system-specific code.
- See the existing Care Experience Preferences at End of Life Grouping for more specific concepts representing an individual’s care experience preferences
We expect this value set’s “end of life” name and text scope to be removed in a upcoming Value Set Authority Center (VSAC) update before the publication of this version of US Core.

Usage:

Examples for this Resource Profile: Observation/care-experience-preference

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	US Core Care Experience Preference Profile
status	S	1..1	code	registered \| preliminary \| final \| amended +
Slices for category	S	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:us-core	S	0..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: care-experience-preference
code	S	1..1	CodeableConcept	Care experience preferences code Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 95541-9
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	S	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime S
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
value[x]	S	0..1		Actual result
valueString			string S
valueCodeableConcept			CodeableConcept S
valueQuantity			Quantity
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	US Core Care Experience Preference Profile
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered \| preliminary \| final \| amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: care-experience-preference
code	SΣ	1..1	CodeableConcept	Care experience preferences code Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 95541-9
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
value[x]	SΣC	0..1		Actual result
valueString			string
valueCodeableConcept			CodeableConcept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.status	required	ObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:us-core	preferred	Pattern: care-experience-preference
Observation.code	example	Pattern: LOINC code 95541-9

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Description & Constraints

Observation

C

0..*

Observation

US Core Care Experience Preference Profile

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path

Conformance

ValueSet / Code

Observation.language

preferred

CommonLanguages

Additional Bindings

Purpose

AllLanguages

Max Binding

Observation.status

required

ObservationStatus

Observation.category

preferred

ObservationCategoryCodes

Observation.category:us-core

preferred

Pattern: care-experience-preference

Observation.code

example

Pattern: LOINC code 95541-9

Observation.dataAbsentReason

extensible

DataAbsentReason

Observation.interpretation

extensible

ObservationInterpretationCodes

Observation.bodySite

example

SNOMEDCTBodyStructures

Observation.method

example

ObservationMethods

Observation.referenceRange.type

preferred

ObservationReferenceRangeMeaningCodes

Observation.referenceRange.appliesTo

example

ObservationReferenceRangeAppliesToCodes

Observation.component.code

example

LOINCCodes (a valid code from LOINC)

Observation.component.dataAbsentReason

extensible

DataAbsentReason

Observation.component.interpretation

extensible

ObservationInterpretationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from Observation

Summary

Mandatory: 1 element
Must-Support: 7 elements

Structures

This structure refers to these other structures:

US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Slices

This structure defines the following Slices:

The element Observation.category is sliced based on the value of pattern:$this

Maturity: 3

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	US Core Care Experience Preference Profile
status	S	1..1	code	registered \| preliminary \| final \| amended +
Slices for category	S	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this
category:us-core	S	0..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: care-experience-preference
code	S	1..1	CodeableConcept	Care experience preferences code Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 95541-9
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	S	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime S
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
value[x]	S	0..1		Actual result
valueString			string S
valueCodeableConcept			CodeableConcept S
valueQuantity			Quantity
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	US Core Care Experience Preference Profile
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	registered \| preliminary \| final \| amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
Slices for category	S	0..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core	S	0..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: care-experience-preference
code	SΣ	1..1	CodeableConcept	Care experience preferences code Binding: LOINCCodes (example): Codes identifying names of simple observations. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 95541-9
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	SΣ	0..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
value[x]	SΣC	0..1		Actual result
valueString			string
valueCodeableConcept			CodeableConcept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.status	required	ObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:us-core	preferred	Pattern: care-experience-preference
Observation.code	example	Pattern: LOINC code 95541-9

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

Snapshot View

Description & Constraints

Observation

C

0..*

Observation

US Core Care Experience Preference Profile

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path

Conformance

ValueSet / Code

Observation.language

preferred

CommonLanguages

Additional Bindings

Purpose

AllLanguages

Max Binding

Observation.status

required

ObservationStatus

Observation.category

preferred

ObservationCategoryCodes

Observation.category:us-core

preferred

Pattern: care-experience-preference

Observation.code

example

Pattern: LOINC code 95541-9

Observation.dataAbsentReason

extensible

DataAbsentReason

Observation.interpretation

extensible

ObservationInterpretationCodes

Observation.bodySite

example

SNOMEDCTBodyStructures

Observation.method

example

ObservationMethods

Observation.referenceRange.type

preferred

ObservationReferenceRangeMeaningCodes

Observation.referenceRange.appliesTo

example

ObservationReferenceRangeAppliesToCodes

Observation.component.code

example

LOINCCodes (a valid code from LOINC)

Observation.component.dataAbsentReason

extensible

DataAbsentReason

Observation.component.interpretation

extensible

ObservationInterpretationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-3	error	Observation.referenceRange	Must have at least a low or a high or text : low.exists() or high.exists() or text.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()

This structure is derived from Observation

Summary

Mandatory: 1 element
Must-Support: 7 elements

Structures

This structure refers to these other structures:

US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Slices

This structure defines the following Slices:

The element Observation.category is sliced based on the value of pattern:$this

Maturity: 3

Other representations of profile: CSV, Excel, Schematron

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

The syntax used to describe the interactions is described here.
See the General Requirements section for additional rules and expectations when a server requires status parameters.
See the General Guidance section for additional guidance on searching for multiple patients.

US Core Scopes

Servers providing access to observation data SHALL support these US Core SMART Scopes:

resource level scopes: patient/Observation.rs
granular scopes: patient.Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|care-experience-preference.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

SHALL support searching using the combination of the patient and category search parameters:

GET [base]/Observation?patient={Type/}[id]&category={system|}care-experience-preference

Example:
1. GET [base]/Observation?patient=1134281&category=care-experience-preference
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and a category code = care-experience-preference (how to search by reference and how to search by token)
SHALL support searching using the combination of the patient and code search parameters:
- including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

Example:
1. GET [base]/Observation?patient=1134281&code=http://loinc.org|95541-9
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code(s). SHOULD support search by multiple report codes. The Observation code parameter searches `Observation.code only. (how to search by reference and how to search by token)
SHALL support searching using the combination of the patient and category and date search parameters:
- including support for these date comparators: gt,lt,ge,le
- including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)
GET [base]/Observation?patient={Type/}[id]&category={system|}care-experience-preference&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

Example:
1. GET [base]Observation?patient=555580&category=care-experience-preference&date=ge2018-03-14T00:00:00Z
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and a category code = care-experience-preference (how to search by reference and how to search by token and how to search by date)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

SHOULD support searching using the combination of the patient and category and status search parameters:
- including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)
GET [base]/Observation?patient={Type/}[id]&category={system|}care-experience-preference&status={system|}[code]{,{system|}[code],...}

Example:
1. GET [base]/Observation?patient=1134281&category=care-experience-preference&status=final
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category = care-experience-preference and status (how to search by reference and how to search by token)
SHOULD support searching using the combination of the patient and code and date search parameters:
- including optional support for OR search on code (e.g.code={system|}[code],{system|}[code],...)
- including support for these date comparators: gt,lt,ge,le
- including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)
GET [base]/Observation?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

Example:
1. GET [base]Observation?patient=555580&code=http://loinc.org|95541-9&date=ge2019-01-01T00:00:00Z
Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and date and report code(s). SHOULD support search by multiple report codes. (how to search by reference and how to search by token and how to search by date)

IG © 2023+ HL7 International / Cross-Group Projects. Package hl7.fhir.us.core#7.0.0-ballot based on FHIR 4.0.1. Generated 2023-12-19
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