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

Profile Clinical Quality Framework (CQF) Risk Assessment Profile - Definitions

Todo

Definitions for the cqf-riskassessment-cqf-riskassessment Profile.

RiskAssessment(cqf-riskassessment)
Definition

An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.

Control1..1
Requirements
Alternate NamesPrognosis
Comments
RiskAssessment.id
Definition

The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.

Control0..1
Typeid
Requirements
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

RiskAssessment.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Requirements
Comments
RiskAssessment.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Requirements
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

RiskAssessment.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Typecode
Requirements
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource

Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

RiskAssessment.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Requirements
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

RiskAssessment.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Requirements
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

RiskAssessment.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

RiskAssessment.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

RiskAssessment.subject
Definition

The patient or group the risk assessment applies to.

Control0..1
TypeChoice of: Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Patient)), Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Group))
Must Supporttrue
Requirements
Comments
RiskAssessment.date
Definition

The date (and possibly time) the risk assessment was performed.

Control0..1
TypedateTime
Must Supporttrue
Requirements

The assessment results lose validity the more time elapses from when they are first made.

Comments
RiskAssessment.condition
Definition

For assessments or prognosis specific to a particular condition, indicates the condition being assessed.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Condition))
Must Supporttrue
Requirements
Comments
RiskAssessment.performer
Definition

The provider or software application that performed the assessment.

Control0..1
TypeChoice of: Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner)), Reference(Profile = (Profile = http://hl7.org/fhir/Profile/Device))
Must Supporttrue
Requirements
Comments
RiskAssessment.identifier
Definition

Business identifier assigned to the risk assessment.

Control0..1
TypeIdentifier
Requirements
Comments
RiskAssessment.method
Definition

The algorithm, processs or mechanism used to evaluate the risk.

Control0..1
BindingThe mechanism or algorithm used to make the assessment. E.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
TypeCodeableConcept
Must Supporttrue
Requirements

The method can influence the results of the assessment.

Comments
RiskAssessment.basis
Definition

Indicates the source data considered as part of the assessment (FamilyHistory, Observations, Procedures, Conditions, etc.).

Control0..*
TypeReference(Profile = http://hl7.org/fhir/Profile/Any)
Requirements
Comments
RiskAssessment.prediction
Definition

Describes the expected outcome for the subject.

Control0..*
Must Supporttrue
Requirements
Comments

Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.

RiskAssessment.prediction.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
RiskAssessment.prediction.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

RiskAssessment.prediction.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

RiskAssessment.prediction.outcome
Definition

One of the potential outcomes for the patient (e.g. remission, death, a particular condition).

Control1..1
BindingThe condition or other outcome. E.g. death, remission, amputation, infection, etc.
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
RiskAssessment.prediction.probability[x]
Definition

How likely is the outcome (in the specified timeframe).

Control0..1
BindingThe likelihood of the occurrence of a specified outcome
For example codes, see Risk Probability
TypeChoice of: decimal, Range, CodeableConcept
Requirements
Comments

If range is used, it represents the lower and upper bounds of certainty. E.g. 40-60%

Decimal values are expressed as percentages as well (max = 100).

InvariantsDefined on this element
ras-1: low and high must be percentages, if present (xpath: (not(f:low) or f:low[f:code/@value='%' and f:system/@value='http://unitsofmeasure.org']) and (not(f:high) or f:high[f:code/@value='%' and f:system/@value='http://unitsofmeasure.org']))
ras-2: Must be <= 100 (xpath: @value <= 100)
RiskAssessment.prediction.relativeRisk
Definition

Indicates the risk for this particular subject (with their specific characteristics) divided by the risk of the population in general. (Numbers greater than 1 = higher risk than the population, numbers less than 1 = lower risk.).

Control0..1
Typedecimal
Requirements

Absolute risk is less meaningful than relative risk.

Comments
RiskAssessment.prediction.when[x]
Definition

Indicates the period of time or age range of the subject to which the specified probability applies.

Control0..1
TypeChoice of: Period, Range
Must Supporttrue
Requirements
Comments

If not specified, the risk applies "over the subject's lifespan".

RiskAssessment.prediction.rationale
Definition

Additional information explaining the basis for the prediction.

Control0..1
Typestring
Requirements
Comments
RiskAssessment.mitigation
Definition

A description of the steps that might be taken to reduce the identified risk(s).

Control0..1
Typestring
Requirements

One of the main reasons for assessing risks is to identify whether interventional steps are needed to reduce risk.

Comments