US Core Implementation Guide
7.0.0 - STU7 United States of America flag

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core Smoking Status Observation Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus Version: 7.0.0
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreSmokingStatusProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.55

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core Smoking Status Observation Profile inherits from the FHIR Observation resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) Smoking Status Data Element. This profile sets minimum expectations for the Observation resource to record, search, and fetch smoking status data associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

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 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.

Each Observation Must Have:

  1. a status
  2. a category code of “social-history”
  3. a code for smoking observation*
  4. a patient
  5. when the observation occurred
  6. a result value*

* see guidance below

Profile Specific Implementation Guidance:

  • * The Smoking Status Type Value Set on Observation.code is a “starter” set of concepts to capture smoking status, and the Smoking Status Comprehensive Value Set for Observation.valueCodeableConcept contains terms representing nicotine, smoking, vaping, chew, and snuff use to encourage the use of this profile for other smoking and nicotine questions.

Usage:

Formal Views of Profile Content

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

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
us-core-24: Observation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
us-core-25: For Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
... status S 1..1 code final | entered-in-error
Binding: US Core Status for Smoking Status Observation (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
.... category:SocialHistory S 1..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://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: social-history
... code SC 1..1 CodeableConcept Smoking Status
Binding: VSAC 2.16.840.1.113762.1.4.1267.6 . (extensible): Smoking status type

... subject S 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... effective[x] S 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
... Slices for value[x] SC 1..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual result
Slice: Unordered, Open by type:$this
.... value[x]:valueQuantity S 0..1 Quantity Quantitative Response
Binding: UnitsOfMeasureCaseSensitive (required)
.... value[x]:valueCodeableConcept S 0..1 CodeableConcept Coded Response
Binding: VSAC 2.16.840.1.113762.1.4.1267.3 . (extensible): Smoking status comprehensive


doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.statusrequiredUSCoreObservationSmokingStatusStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
from this IG
Observation.codeextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
Observation.value[x]:valueQuantityrequiredUnitsOfMeasureCaseSensitive (a valid code from UCUM)
http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.value[x]:valueCodeableConceptextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3

Constraints

IdGradePath(s)DetailsRequirements
us-core-24errorObservationObservation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
: code.coding.where(code in '72166-2'|'11367-0').exists() implies value.is(CodeableConcept)
us-core-25warningObservationFor Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
: code.coding.where(code in '401201003'|'782516008').exists() implies value.is(Quantity)
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
us-core-24: Observation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
us-core-25: For Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
... 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 final | entered-in-error
Binding: US Core Status for Smoking Status Observation (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:SocialHistory S 1..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://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: social-history
... code SΣC 1..1 CodeableConcept Smoking Status
Binding: VSAC 2.16.840.1.113762.1.4.1267.6 . (extensible): Smoking status type

... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
... Slices for value[x] SΣC 1..1 Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... valueString string
.... valueBoolean boolean
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
.... value[x]:valueQuantity SΣC 0..1 Quantity Quantitative Response
Binding: UnitsOfMeasureCaseSensitive (required)
.... value[x]:valueCodeableConcept SΣC 0..1 CodeableConcept Coded Response
Binding: VSAC 2.16.840.1.113762.1.4.1267.3 . (extensible): Smoking status comprehensive


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.statusrequiredUSCoreObservationSmokingStatusStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
from this IG
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:SocialHistorypreferredPattern: social-history
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
Observation.value[x]:valueQuantityrequiredUnitsOfMeasureCaseSensitive (a valid code from UCUM)
http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.value[x]:valueCodeableConceptextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3

Constraints

IdGradePath(s)DetailsRequirements
us-core-24errorObservationObservation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
: code.coding.where(code in '72166-2'|'11367-0').exists() implies value.is(CodeableConcept)
us-core-25warningObservationFor Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
: code.coding.where(code in '401201003'|'782516008').exists() implies value.is(Quantity)
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
us-core-24: Observation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
us-core-25: For Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code final | entered-in-error
Binding: US Core Status for Smoking Status Observation (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:SocialHistory S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: social-history
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣC 1..1 CodeableConcept Smoking Status
Binding: VSAC 2.16.840.1.113762.1.4.1267.6 . (extensible): Smoking status type

... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
... Slices for value[x] SΣC 1..1 Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... valueString string
.... valueBoolean boolean
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
.... value[x]:valueQuantity SΣC 0..1 Quantity Quantitative Response
Binding: UnitsOfMeasureCaseSensitive (required)
.... value[x]:valueCodeableConcept SΣC 0..1 CodeableConcept Coded Response
Binding: VSAC 2.16.840.1.113762.1.4.1267.3 . (extensible): Smoking status comprehensive

... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity Low Range, if relevant
.... high C 0..1 SimpleQuantity High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) Related measurements the observation is made from
... component Σ 0..* BackboneElement Component results
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.

.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.statusrequiredUSCoreObservationSmokingStatusStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
from this IG
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:SocialHistorypreferredPattern: social-history
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
Observation.value[x]:valueQuantityrequiredUnitsOfMeasureCaseSensitive (a valid code from UCUM)
http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.value[x]:valueCodeableConceptextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard
Observation.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
http://hl7.org/fhir/ValueSet/referencerange-meaning
from the FHIR Standard
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
http://hl7.org/fhir/ValueSet/referencerange-appliesto
from the FHIR Standard
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
us-core-24errorObservationObservation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
: code.coding.where(code in '72166-2'|'11367-0').exists() implies value.is(CodeableConcept)
us-core-25warningObservationFor Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
: code.coding.where(code in '401201003'|'782516008').exists() implies value.is(Quantity)

This structure is derived from Observation

Summary

Mandatory: 5 elements
Must-Support: 9 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Observation.category
  • The element 1 is sliced based on the value of Observation.value[x]

Maturity: 3

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
us-core-24: Observation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
us-core-25: For Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
... status S 1..1 code final | entered-in-error
Binding: US Core Status for Smoking Status Observation (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
.... category:SocialHistory S 1..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://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: social-history
... code SC 1..1 CodeableConcept Smoking Status
Binding: VSAC 2.16.840.1.113762.1.4.1267.6 . (extensible): Smoking status type

... subject S 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... effective[x] S 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
... Slices for value[x] SC 1..1 Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period Actual result
Slice: Unordered, Open by type:$this
.... value[x]:valueQuantity S 0..1 Quantity Quantitative Response
Binding: UnitsOfMeasureCaseSensitive (required)
.... value[x]:valueCodeableConcept S 0..1 CodeableConcept Coded Response
Binding: VSAC 2.16.840.1.113762.1.4.1267.3 . (extensible): Smoking status comprehensive


doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.statusrequiredUSCoreObservationSmokingStatusStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
from this IG
Observation.codeextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
Observation.value[x]:valueQuantityrequiredUnitsOfMeasureCaseSensitive (a valid code from UCUM)
http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.value[x]:valueCodeableConceptextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3

Constraints

IdGradePath(s)DetailsRequirements
us-core-24errorObservationObservation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
: code.coding.where(code in '72166-2'|'11367-0').exists() implies value.is(CodeableConcept)
us-core-25warningObservationFor Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
: code.coding.where(code in '401201003'|'782516008').exists() implies value.is(Quantity)

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
us-core-24: Observation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
us-core-25: For Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
... 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 final | entered-in-error
Binding: US Core Status for Smoking Status Observation (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:SocialHistory S 1..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://terminology.hl7.org/CodeSystem/observation-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: social-history
... code SΣC 1..1 CodeableConcept Smoking Status
Binding: VSAC 2.16.840.1.113762.1.4.1267.6 . (extensible): Smoking status type

... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
... Slices for value[x] SΣC 1..1 Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... valueString string
.... valueBoolean boolean
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
.... value[x]:valueQuantity SΣC 0..1 Quantity Quantitative Response
Binding: UnitsOfMeasureCaseSensitive (required)
.... value[x]:valueCodeableConcept SΣC 0..1 CodeableConcept Coded Response
Binding: VSAC 2.16.840.1.113762.1.4.1267.3 . (extensible): Smoking status comprehensive


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.statusrequiredUSCoreObservationSmokingStatusStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
from this IG
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:SocialHistorypreferredPattern: social-history
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
Observation.value[x]:valueQuantityrequiredUnitsOfMeasureCaseSensitive (a valid code from UCUM)
http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.value[x]:valueCodeableConceptextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3

Constraints

IdGradePath(s)DetailsRequirements
us-core-24errorObservationObservation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
: code.coding.where(code in '72166-2'|'11367-0').exists() implies value.is(CodeableConcept)
us-core-25warningObservationFor Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
: code.coding.where(code in '401201003'|'782516008').exists() implies value.is(Quantity)

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 0..* Observation Measurements and simple assertions
obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
us-core-24: Observation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
us-core-25: For Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for observation
... basedOn Σ 0..* Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) Fulfills plan, proposal or order
... partOf Σ 0..* Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) Part of referenced event
... status ?!SΣ 1..1 code final | entered-in-error
Binding: US Core Status for Smoking Status Observation (required)
... Slices for category S 1..* CodeableConcept Classification of type of observation
Slice: Unordered, Open by pattern:$this
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.


.... category:SocialHistory S 1..1 CodeableConcept Classification of type of observation
Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: social-history
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣC 1..1 CodeableConcept Smoking Status
Binding: VSAC 2.16.840.1.113762.1.4.1267.6 . (extensible): Smoking status type

... subject SΣ 1..1 Reference(US Core Patient Profile) Who and/or what the observation is about
... focus Σ 0..* Reference(Resource) What the observation is about, when it is not about the subject of record
... encounter Σ 0..1 Reference(Encounter) Healthcare event during which this observation is made
... effective[x] SΣ 1..1 Clinically relevant time/time-period for observation
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued Σ 0..1 instant Date/Time this version was made available
... performer Σ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson) Who is responsible for the observation
... Slices for value[x] SΣC 1..1 Actual result
Slice: Unordered, Open by type:$this
.... valueQuantity Quantity
.... valueCodeableConcept CodeableConcept
.... valueString string
.... valueBoolean boolean
.... valueInteger integer
.... valueRange Range
.... valueRatio Ratio
.... valueSampledData SampledData
.... valueTime time
.... valueDateTime dateTime
.... valuePeriod Period
.... value[x]:valueQuantity SΣC 0..1 Quantity Quantitative Response
Binding: UnitsOfMeasureCaseSensitive (required)
.... value[x]:valueCodeableConcept SΣC 0..1 CodeableConcept Coded Response
Binding: VSAC 2.16.840.1.113762.1.4.1267.3 . (extensible): Smoking status comprehensive

... dataAbsentReason C 0..1 CodeableConcept Why the result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


... note 0..* Annotation Comments about the observation
... bodySite 0..1 CodeableConcept Observed body part
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.

... method 0..1 CodeableConcept How it was done
Binding: ObservationMethods (example): Methods for simple observations.

... specimen 0..1 Reference(Specimen) Specimen used for this observation
... device 0..1 Reference(Device | DeviceMetric) (Measurement) Device
... referenceRange C 0..* BackboneElement Provides guide for interpretation
obs-3: Must have at least a low or a high or text
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... low C 0..1 SimpleQuantity Low Range, if relevant
.... high C 0..1 SimpleQuantity High Range, if relevant
.... type 0..1 CodeableConcept Reference range qualifier
Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.

.... appliesTo 0..* CodeableConcept Reference range population
Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.


.... age 0..1 Range Applicable age range, if relevant
.... text 0..1 string Text based reference range in an observation
... hasMember Σ 0..* Reference(Observation | QuestionnaireResponse | MolecularSequence) Related resource that belongs to the Observation group
... derivedFrom Σ 0..* Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence) Related measurements the observation is made from
... component Σ 0..* BackboneElement Component results
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 CodeableConcept Type of component observation (code / type)
Binding: LOINCCodes (example): Codes identifying names of simple observations.

.... value[x] Σ 0..1 Actual component result
..... valueQuantity Quantity
..... valueCodeableConcept CodeableConcept
..... valueString string
..... valueBoolean boolean
..... valueInteger integer
..... valueRange Range
..... valueRatio Ratio
..... valueSampledData SampledData
..... valueTime time
..... valueDateTime dateTime
..... valuePeriod Period
.... dataAbsentReason C 0..1 CodeableConcept Why the component result is missing
Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.

.... interpretation 0..* CodeableConcept High, low, normal, etc.
Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.


.... referenceRange 0..* See referenceRange (Observation) Provides guide for interpretation of component result

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Observation.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Observation.statusrequiredUSCoreObservationSmokingStatusStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-observation-smoking-status-status
from this IG
Observation.categorypreferredObservationCategoryCodes
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.category:SocialHistorypreferredPattern: social-history
http://hl7.org/fhir/ValueSet/observation-category
from the FHIR Standard
Observation.codeextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.6
Observation.value[x]:valueQuantityrequiredUnitsOfMeasureCaseSensitive (a valid code from UCUM)
http://terminology.hl7.org/ValueSet/v3-UnitsOfMeasureCaseSensitive
Observation.value[x]:valueCodeableConceptextensiblehttp://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.3
Observation.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard
Observation.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard
Observation.methodexampleObservationMethods
http://hl7.org/fhir/ValueSet/observation-methods
from the FHIR Standard
Observation.referenceRange.typepreferredObservationReferenceRangeMeaningCodes
http://hl7.org/fhir/ValueSet/referencerange-meaning
from the FHIR Standard
Observation.referenceRange.appliesToexampleObservationReferenceRangeAppliesToCodes
http://hl7.org/fhir/ValueSet/referencerange-appliesto
from the FHIR Standard
Observation.component.codeexampleLOINCCodes (a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
from the FHIR Standard
Observation.component.dataAbsentReasonextensibleDataAbsentReason
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Observation.component.interpretationextensibleObservationInterpretationCodes
http://hl7.org/fhir/ValueSet/observation-interpretation
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
us-core-24errorObservationObservation.code 72166-2|Tobacco smoking status or 11367-0|History of Tobacco use SHALL use valueCodeableConcept
: code.coding.where(code in '72166-2'|'11367-0').exists() implies value.is(CodeableConcept)
us-core-25warningObservationFor Observation.code 401201003|Cigarette pack-years or 782516008|Number of calculated smoking pack years SHOULD use valueQuantity
: code.coding.where(code in '401201003'|'782516008').exists() implies value.is(Quantity)

This structure is derived from Observation

Summary

Mandatory: 5 elements
Must-Support: 9 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Observation.category
  • The element 1 is sliced based on the value of Observation.value[x]

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.

  • See the Scopes Format section for a description of the SMART scopes syntax.
  • See the Search Syntax section for a description of the US Core search syntax.
  • 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 social history data SHALL support these US Core SMART Scopes:

  • resource level scopes: <patient|user|system>/Observation.rs

  • granular scopes: <patient|user|system>.Observation.rs?category=http://terminology.hl7.org/CodeSystem-observation-category|social-history

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 category search parameters:

    GET [base]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory

    Example:

    1. GET [base]/Observation?patient=1134281&amp;category=http://terminology.hl7.org/CodeSystem/observation-category|social-history

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

  2. 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&amp;code=http://loinc.org|72166-2

    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)

  3. 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=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]Observation?patient=555580&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&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 = laboratory (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:

  1. 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=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/Observation?patient=1134281&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&status=final

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category = laboratory and status (how to search by reference and how to search by token)

  2. SHOULD support searching using the combination of the patient and category and _lastUpdated search parameters:
    • including support for these _lastUpdated comparators: gt,lt,ge,le
    • including optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]]&...)

    GET [base]/Observation?patient={Type/}[id]&category={system|}[code]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]Observation?patient=555580&http://terminology.hl7.org/CodeSystem/observation-category|social-history&_lastUpdated=ge2024-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Observation resources for the specified patient and category and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by token and how to search by date)

  3. 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|72166-2&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)