HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1

This page is part of the US Core (v3.1.1: STU3) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 8.0.0. For a full list of available versions, see the Directory of published versions. Page versions: R8 R7 R6 R5 R4 R3

StructureDefinition-us-core-smokingstatus

This profile sets minimum expectations for the Observation resource to record, search, and fetch smoking status data associated with a patient. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-SmokingStatus profile:

  • Query for the Smoking Status of a patient
  • Record or update the Smoking Status of a patient

Mandatory and Must Support Data Elements

The following data-elements are mandatory (i.e data MUST be present) 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 Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Observation must have:

  1. a status
  2. a code for smoking observation
  3. a patient
  4. a date representing when the smoking status was recorded
  5. a result value code for smoking status

Profile specific implementation guidance:

  • Smoking observation LOINC = 72166-2 Tobacco smoking status NHIS

Examples

Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus

Published on Tue May 21 10:00:00 AEST 2019 as active by the HL7 US Realm Steering Committee.

This profile builds on Observation

Observation

Summary of the Mandatory Requirements

  1. A code in Observation.status with a required binding to US Core Status for Smoking Status Observation
  2. A CodeableConcept in Observation.code with an extensible binding to US Core Smoking Status Observation Codes
  3. A Patient Reference in Observation.subject
  4. An instant in Observation.issued
  5. A CodeableConcept in Observation.valueCodeableConcept with an extensible binding to US Core Smoking Status

Summary of Constraints

  1. If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
  2. dataAbsentReason SHALL only be present if Observation.value[x] is not present
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*ObservationMeasurements and simple assertions
... status S1..1coderegistered | preliminary | final | amended +
Binding: US Core Status for Smoking Status Observation (required)
... code S1..1CodeableConceptSmoking Status
Binding: US Core Smoking Status Observation Codes (extensible)
... subject S1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... issued S1..1instantDate/Time this version was made available
... valueCodeableConcept S1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: US Core Smoking Status Preferred (preferred)
Max Binding: US Core Smoking Status Max-Binding

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*ObservationMeasurements and simple assertions
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for observation
... basedOn ΣI0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf ΣI0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣI1..1coderegistered | preliminary | final | amended +
Binding: US Core Status for Smoking Status Observation (required)
... category I0..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)
... code SΣI1..1CodeableConceptSmoking Status
Binding: US Core Smoking Status Observation Codes (extensible)
... subject SΣI1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... focus ΣI0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter ΣI0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] ΣI0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued SΣI1..1instantDate/Time this version was made available
... performer ΣI0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] ΣI1..1(Slice Definition)Actual result
Slice: Unordered, Closed by type:$this
.... value[x]:valueCodeableConcept SΣI1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: US Core Smoking Status Preferred (preferred)
Max Binding: US Core Smoking Status Max-Binding
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
... note I0..*AnnotationComments about the observation
... bodySite I0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example)
... method I0..1CodeableConceptHow it was done
Binding: ObservationMethods (example)
... specimen I0..1Reference(Specimen)Specimen used for this observation
... device I0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type I0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred)
.... appliesTo I0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example)
.... age I0..1RangeApplicable age range, if relevant
.... text I0..1stringText based reference range in an observation
... hasMember ΣI0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom ΣI0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component ΣI0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code ΣI1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example)
.... value[x] ΣI0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible)
.... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
.... referenceRange I0..*See referenceRangeProvides guide for interpretation of component result

doco Documentation for this format

Observation

Summary of the Mandatory Requirements

  1. A code in Observation.status with a required binding to US Core Status for Smoking Status Observation
  2. A CodeableConcept in Observation.code with an extensible binding to US Core Smoking Status Observation Codes
  3. A Patient Reference in Observation.subject
  4. An instant in Observation.issued
  5. A CodeableConcept in Observation.valueCodeableConcept with an extensible binding to US Core Smoking Status

Summary of Constraints

  1. If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
  2. dataAbsentReason SHALL only be present if Observation.value[x] is not present

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation 0..*ObservationMeasurements and simple assertions
... status S1..1coderegistered | preliminary | final | amended +
Binding: US Core Status for Smoking Status Observation (required)
... code S1..1CodeableConceptSmoking Status
Binding: US Core Smoking Status Observation Codes (extensible)
... subject S1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... issued S1..1instantDate/Time this version was made available
... valueCodeableConcept S1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: US Core Smoking Status Preferred (preferred)
Max Binding: US Core Smoking Status Max-Binding

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation I0..*ObservationMeasurements and simple assertions
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier ΣI0..*IdentifierBusiness Identifier for observation
... basedOn ΣI0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)Fulfills plan, proposal or order
... partOf ΣI0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)Part of referenced event
... status ?!SΣI1..1coderegistered | preliminary | final | amended +
Binding: US Core Status for Smoking Status Observation (required)
... category I0..*CodeableConceptClassification of type of observation
Binding: ObservationCategoryCodes (preferred)
... code SΣI1..1CodeableConceptSmoking Status
Binding: US Core Smoking Status Observation Codes (extensible)
... subject SΣI1..1Reference(US Core Patient Profile)Who and/or what the observation is about
... focus ΣI0..*Reference(Resource)What the observation is about, when it is not about the subject of record
... encounter ΣI0..1Reference(Encounter)Healthcare event during which this observation is made
... effective[x] ΣI0..1Clinically relevant time/time-period for observation
.... effectiveDateTimedateTime
.... effectivePeriodPeriod
.... effectiveTimingTiming
.... effectiveInstantinstant
... issued SΣI1..1instantDate/Time this version was made available
... performer ΣI0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)Who is responsible for the observation
... value[x] ΣI1..1(Slice Definition)Actual result
Slice: Unordered, Closed by type:$this
.... value[x]:valueCodeableConcept SΣI1..1CodeableConceptCoded Responses from Smoking Status Value Set
Binding: US Core Smoking Status Preferred (preferred)
Max Binding: US Core Smoking Status Max-Binding
... dataAbsentReason I0..1CodeableConceptWhy the result is missing
Binding: DataAbsentReason (extensible)
... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
... note I0..*AnnotationComments about the observation
... bodySite I0..1CodeableConceptObserved body part
Binding: SNOMEDCTBodyStructures (example)
... method I0..1CodeableConceptHow it was done
Binding: ObservationMethods (example)
... specimen I0..1Reference(Specimen)Specimen used for this observation
... device I0..1Reference(Device | DeviceMetric)(Measurement) Device
... referenceRange I0..*BackboneElementProvides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... low I0..1SimpleQuantityLow Range, if relevant
.... high I0..1SimpleQuantityHigh Range, if relevant
.... type I0..1CodeableConceptReference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred)
.... appliesTo I0..*CodeableConceptReference range population
Binding: ObservationReferenceRangeAppliesToCodes (example)
.... age I0..1RangeApplicable age range, if relevant
.... text I0..1stringText based reference range in an observation
... hasMember ΣI0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)Related resource that belongs to the Observation group
... derivedFrom ΣI0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)Related measurements the observation is made from
... component ΣI0..*BackboneElementComponent results
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code ΣI1..1CodeableConceptType of component observation (code / type)
Binding: LOINCCodes (example)
.... value[x] ΣI0..1Actual component result
..... valueQuantityQuantity
..... valueCodeableConceptCodeableConcept
..... valueStringstring
..... valueBooleanboolean
..... valueIntegerinteger
..... valueRangeRange
..... valueRatioRatio
..... valueSampledDataSampledData
..... valueTimetime
..... valueDateTimedateTime
..... valuePeriodPeriod
.... dataAbsentReason I0..1CodeableConceptWhy the component result is missing
Binding: DataAbsentReason (extensible)
.... interpretation I0..*CodeableConceptHigh, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible)
.... referenceRange I0..*See referenceRangeProvides guide for interpretation of component result

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON), Schema: XML Schematron


Quick Start

Below is an overview of the required set of Server RESTful FHIR interactions - for example, search and read operations - for this profile. See the Conformance requirements for a complete list of supported RESTful interactions for this IG.

  • The syntax used to describe the interactions is described here.
  • See the General Guidance 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.

Mandatory Search Parameters:

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

  1. SHALL support searching using the combination of the patient and code search parameters:
    • including optional support for composite OR search on code (e.g.code={system|}[code],{system|}[code],...)

    GET [base]/Observation?patient=[reference]&code=http://loinc.org|72166-2

    Example:

    1. GET [base]/Observation?patient=1032702&code=http://loinc.org|72166-2

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and observation code. (how to search by reference and how to search by token)