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) Smoking Status Profile (Conformance Package)

Scope and Usage

This profile sets expectations for use of the Observation resource to record Smoking Status of a patient 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 Observation 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.
  • DAF Query Responders SHALL use Observation.dataAbsentReason with the appropriate code to represent the absence of Smoking Status information. NOTE: Only one of either Observation.valueCodeableConcept or Observation.dataAbsentReason can be present in an DAFSmokingStatus instance.

Relationship to Meaningful Use

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


Meaningful Use Data Element Name FHIR Resource Mapping
Patient for whom smoking status is being captured Observation.subject
Smoking Status Value Observation.valueCodeableConcept
Smoking Status Value Applicability (Time Period when the Smoking Status value is/was applicable) Observation.appliesPeriod

Boundaries and Relationships

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

  • DAFPatient which defines DAF Patient profile used by Encounter.subject.
  • US Core which defines common properties related to Patient such as race and ethnicity.
  • 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:
DAFSmokingStatusSmoking Status Observation

Example Usage Scenarios

The following are example usage scenarios for the DAF Smoking Status profile:

  • Query for Smoking Status of a particular patient
  • Query for all patients who have had a history of smoking
  • Query for all patients who have never had tobacco
  • Query for all patients who have smoked during a time period of interest
  • Query for all patients who have a smoking history and are in an age group

Additional Implementation Guidance

Implementers need to be mindful of the following during their implementation

    Specifying Patients as part of the Smoking Status Queries: DAF Smoking Status profile supports the querying the Smoking Status for a particular patient. In order to achieve this in implementation, it is recommended to use Patient.identifier field to precisely identify the observations relevant to the patient. While other parameters such as Patient.name, Patient.given could be used this could lead to incorrect Patient matching and/or inefficient queries when systems are not tuned.

    Smoking Status Applicability: The Smoking Status values describe point-in-time smoking status, and implementers have to be mindful of the semantic meaning while using these codes to describe smoking behavior. For example, if I want to say that a patient used to smoke heavily between 2000 and 2010, it does not make sense to use the code for Former smoker', along with an appliesPeriod representing 2000-2010. This is because 'Former smoker' did not apply during that time range. Instead implementers should use a 'current smoker' along with a time range representing 2000-2010.

    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 Observation Resources in response to a query.