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9.11 Resource RiskAssessment - Content

Clinical Decision Support icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Device, Group, Patient, Practitioner

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

9.11.1 Scope and Usage

This resource is an event resource from a FHIR workflow perspective - see Workflow, specifically Event.

This resource captures predicted outcomes for a patient or population on the basis of source information. Examples include:

  • A prognosis statement for a particular condition
  • Risk of health outcome (heart attack, particular type of cancer) on the basis of lifestyle factors and/or family history
  • List of potential health risks based on a patient's genetic analysis
  • A prediction of outbreak infection rates within a geography based on immunization rates

This resource can be used to represent the results of formal scoring/decision support tools that evaluate risk. It can also be used to capture a practitioner's subjective assessment of the patient's risk based on existing knowledge and previous experience.

9.11.2 Boundaries and Relationships

Risk assessments are a specialized type of observation. A specialized resource is used to provide a simpler mechanism to capture of a series of risks and to associate those risks with time-ranges, probabilities, etc. All risk assertions are captured at one time based on a single set of source inputs. Capture of a single risk MAY be done using the Observation class, particularly in circumstances where it's treated as a generic observation, but for consistency, all risk assessments and prognosis SHOULD be captured using RiskAssessment.

Risk assessments may be based on a variety of factors, including:

Because so many resources can potentially be used, no limit is placed on what resources can be sent in RiskAssessment.basis. However, some resources would be nonsensical for this use (e.g. MessageHeader).

AllergyIntolerance and RiskAssessment

AllergyIntolerance describes a specific type of risk - propensity to reaction to a substance while RiskAssessment describes general risks to a subject, not generally based on a reaction.

9.11.3 Background and Context

Risk Assessments can be determined manually by health-care providers based on their professional expertise, by using an algorithmic scoring system or through a combination. Risk assessments can also be computed by decision support systems. OperationDefinitions may be defined by servers to generate risk assessments based on particular combinations of source resources or other inputs.

9.11.4 References to this Resource

9.11.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. RiskAssessment TU DomainResource Potential outcomes for a subject with likelihood

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ 0..* Identifier Unique identifier for the assessment

... basedOn 0..1 Reference(Any) Request fulfilled by this assessment
... parent 0..1 Reference(Any) Part of this occurrence
... method Σ 0..1 CodeableConcept Evaluation mechanism
Binding: Risk Assessment Method (Example)
... code Σ 0..1 CodeableConcept Type of assessment
Binding: Risk Assessment Method (Example)
... subject Σ 1..1 Reference(Patient | Group) Who/what does assessment apply to?
... encounter Σ 0..1 Reference(Encounter) Where was assessment performed?
... occurrence[x] Σ 0..1 When was assessment made?
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
... condition Σ 0..1 Reference(Condition) Condition assessed
... performer Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Device) Who did assessment?
... reason 0..* CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference) Why the assessment was necessary?

... basis 0..* Reference(Any) Information used in assessment

... prediction C 0..* BackboneElement Outcome predicted
+ Rule: Probability as a deciml must be <= 100

.... outcome 0..1 CodeableConcept Possible outcome for the subject
Binding: Risk Assessment Outcome (Example)
.... probability[x] C 0..1 Likelihood of specified outcome
+ Rule: low and high must be percentages, if present
..... probabilityDecimal decimal
..... probabilityRange Range
.... qualitativeRisk 0..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: Risk Probability (Example)
.... relativeRisk 0..1 decimal Relative likelihood
.... when[x] 0..1 Timeframe or age range
..... whenPeriod Period
..... whenRange Range
.... rationale 0..1 string Explanation of prediction
... mitigation 0..1 string How to reduce risk
... note 0..* Annotation Comments on the risk assessment


doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

9.11.5.1 Terminology Bindings

Path ValueSet Type Documentation
RiskAssessment.status ObservationStatus Required

Codes providing the status of an observation.
RiskAssessment.method RiskAssessmentMethod Example

Example value set illustrating possible codes for identifying the mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
RiskAssessment.code RiskAssessmentMethod Example

Example value set illustrating possible codes for identifying the mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
RiskAssessment.prediction.outcome RiskAssessmentOutcome Example

Example value set illustrating possible codes for identifying the condition or other outcome; e.g. death, remission, amputation, infection, etc.
RiskAssessment.prediction.qualitativeRisk RiskProbability Example

Codes representing the likelihood of a particular outcome in a risk assessment.

9.11.5.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img ras-1Rule RiskAssessment.prediction.probability[x]low and high must be percentages, if present(low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum)))
img ras-2Rule RiskAssessment.predictionProbability as a deciml must be <= 100probability.empty() or ((probability is decimal) implies ((probability as decimal) <= 100))

9.11.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
condition reference Condition assessed RiskAssessment.condition
(Condition)
date date When was assessment made? (RiskAssessment.occurrence.ofType(dateTime)) 26 Resources
encounter reference Where was assessment performed? RiskAssessment.encounter
(Encounter)		 29 Resources
identifier token Unique identifier for the assessment RiskAssessment.identifier 65 Resources
method token Evaluation mechanism RiskAssessment.method
patient reference Who/what does assessment apply to? RiskAssessment.subject.where(resolve() is Patient)
(Patient)		 65 Resources
performer reference Who did assessment? RiskAssessment.performer
(Practitioner, Device, Patient, PractitionerRole, RelatedPerson)
probability number Likelihood of specified outcome RiskAssessment.prediction.probability.ofType(decimal)
risk token Likelihood of specified outcome as a qualitative value RiskAssessment.prediction.qualitativeRisk
subject reference Who/what does assessment apply to? RiskAssessment.subject
(Group, Patient)