AU Core Implementation Guide
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AU Core Implementation Guide, published by HL7 Australia. This guide is not an authorized publication; it is the continuous build for version 1.1.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/au-fhir-core/ and changes regularly. See the Directory of published versions

Resource Profile: AU Core Condition

Official URL: http://hl7.org.au/fhir/core/StructureDefinition/au-core-condition Version: 1.1.0-ci-build
Standards status: Trial-use Maturity Level: 2 Computable Name: AUCoreCondition

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License. HL7 Australia© 2022+; Licensed Under Creative Commons No Rights Reserved.

This profile sets minimum expectations for a Condition resource to record, search, and fetch problems, diagnoses, and health concerns associated with a patient. It is based on the AU Base Condition profile and identifies the additional mandatory core elements, extensions, vocabularies and value sets that SHALL be present in the Condition resource when conforming to this profile. It provides the floor for standards development for specific uses cases in an Australian context.

See Comparison with other national and international IGs for a comparison between AU Core profiles and profiles in other implementation guides.

Usage scenarios

The following are supported usage scenarios for this profile:

  • Query for a patient’s problems, diagnoses, and health concerns
  • Record or update a patient’s problem, diagnosis, or health concern

Profile specific implementation guidance

  • Condition.category provides an efficient way of supporting system interactions, e.g. restricting searches. Implementers need to understand that data categorisation is somewhat subjective. The categorisation applied by the source may not align with a receiver’s expectations.
  • The use of coding can vary significantly across systems, requesters need to understand that they may encounter codes they do not recognise and be prepared to handle those resources appropriately. Responders SHOULD populate Condition.code.text and/or Condition.code.coding.display so that requesters can display the condition even if the requester does not recognise the code supplied.
  • See the Representing body site, which may include laterality section for guidance on representing a relevant body site and associated laterality.
  • An active condition is represented using “active” in Condition.clinicalStatus
  • To represent that a patient does not have a condition or history of condition, an appropriate negation code is used in Condition.code:
    • For indicating no known conditions or problems of any type Condition.code SHOULD use the code SNOMED CT 160245001 |No current problems or disability (situation)|
  • Refutation is not expected to be handled except as above - an appropriate negation code in Condition.code and Condition.verificationStatus of “confirmed” or “unconfirmed”

Usage:

Changes since version 1.0.0:

  • The resource metadata has changed (description)
  • Formal Views of Profile Content

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

    This structure is derived from AUBaseCondition

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. Condition 0..* AUBaseCondition A condition, problem or diagnosis statement in an Australian healthcare context
    ... clinicalStatus SO 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... verificationStatus SO 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... category SO 1..* CodeableConcept problem-list-item | encounter-diagnosis
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... code SO 1..1 CodeableConcept Identification of the condition, problem or diagnosis
    Binding: Clinical Condition . (extensible)
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... bodySite C 0..* CodeableConcept Anatomical location, if relevant
    Binding: Body Site . (extensible)
    au-core-cond-01: If a coded body site is provided, at least one coding shall be from SNOMED CT
    ... subject SO 1..1 Reference(AU Core Patient) Who has the condition?
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    ... onset[x] SO 0..1 Estimated or actual date, date-time, or age
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... onsetDateTime dateTime
    .... onsetAge Age
    .... onsetPeriod Period
    .... onsetRange Range
    ... abatement[x] SO 0..1 When in resolution/remission
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester
    .... abatementDateTime dateTime
    .... abatementAge Age
    .... abatementPeriod Period
    .... abatementRange Range
    ... note SO 0..* Annotation Additional information about the Condition
    ObligationsActor
    SHALL:populate-if-known AU Core Responder
    SHALL:no-error AU Core Requester

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Condition.severityextensibleCondition/DiagnosisSeverity
    http://hl7.org/fhir/ValueSet/condition-severity
    from the FHIR Standard
    Condition.codeextensibleClinicalCondition .
    https://healthterminologies.gov.au/fhir/ValueSet/clinical-condition-1
    Condition.bodySiteextensibleBodySite .
    https://healthterminologies.gov.au/fhir/ValueSet/body-site-1

    Constraints

    IdGradePath(s)DetailsRequirements
    au-core-cond-01errorCondition.bodySiteIf a coded body site is provided, at least one coding shall be from SNOMED CT
    : coding.exists() implies coding.where(system='http://snomed.info/sct').exists()

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Below is an overview of the mandatory and optional search parameters and combined search parameters. See the AU Core CapabilityStatements for a complete list of supported RESTful interactions for this IG.

    FHIR search operations are described here and the syntax used to describe AU Core interactions is defined here.

    Any search parameter defined in FHIR may be ‘allowed’ by the system unless explicitly marked as “SHALL NOT”. A few items are marked as MAY in this implementation guide to highlight their potential relevance.

    Parameter(s) Conformance Type(s) Requirements (when used alone or in combination)
    patient SHALL reference The requester SHALL provide at least an id value and MAY provide both the Type and id values. The responder SHALL support both.

    The requester SHOULD support chained search patient.identifier using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile. The responder SHOULD support chained search patient.identifier using IHI, Medicare Number, and DVA Number identifiers as defined in the AU Core Patient profile.
    patient+category SHALL reference+token
    patient+clinical-status SHALL reference+token
    patient+category+clinical-status SHOULD reference+token+token
    patient+code SHOULD reference+token
    patient+onset-date SHOULD reference+date
    category MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.
    clinical-status MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.
    code MAY token The requester SHALL provide at least a code value and MAY provide both the system and code values. The responder SHALL support both.

    The requester SHOULD support multipleOr. The responder SHOULD support multipleOr.
    onset-date MAY date A requester SHALL provide a value precise to the second + time offset. A responder SHALL support a value precise to the second + time offset.

    The requester SHALL support these search comparators gt, lt, ge, le. The responder SHALL support these search comparators gt, lt, ge, le.

    The requester SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le. The responder SHOULD support multipleAnd, and if multipleAnd is supported, SHALL support the search comparators gt, lt, ge, le.

    Mandatory Search Parameters

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

    1. SHALL support searching using the patient search parameter:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Condition?patient={Type/}[id] or optionally GET [base]/Condition?patient.identifier=[system|][code]

      Example:

      1. GET [base]/Condition?patient=5678
      2. GET [base]/Condition?patient.identifier=http://ns.electronichealth.net.au/id/medicare-number|32788511952
      3. GET [base]/Condition?patient.identifier=http://ns.electronichealth.net.au/id/hi/ihi/1.0|8003608833357361

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

    2. SHALL support searching using the combination of the patient and category search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Condition?patient={Type/}[id]&category={system|}[code]

      Example:

      1. GET [base]/Condition?patient=5678&category=http://terminology.hl7.org/CodeSystem/condition-category|encounter-diagnosis

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

    3. SHALL support searching using the combination of the patient and clinical-status search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Condition?patient={Type/}[id]&clinical-status={system|}[code]

      Example:

      1. GET [base]/Condition?patient=5678&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active

      Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and a clinical status (how to search by reference and how to search by token)

    Optional Search Parameters

    The following search parameters and search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and category and clinical-status search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])

      GET [base]/Condition?patient={Type/}[id]&category={system|}[code]&clinical-status={system|}[code]

      Example:

      1. GET [base]/Condition?patient=5678&category=http://terminology.hl7.org/CodeSystem/observation-category|encounter-diagnosis&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active

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

    2. SHOULD support searching using the combination of the patient and code search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHOULD support multipleOr search on code (e.g.code={system|}[code],{system|}[code],...)

      GET [base]/Condition?patient={Type/}[id]&code={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/Condition?patient=5678&code=http://snomed.info/sct|68566005,http://snomed.info/sct|394659003

      Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and condition code(s). SHOULD support search by multiple codes. The Condition code parameter searches Condition.code only. (how to search by reference and how to search by token)

    3. SHOULD support searching using the combination of the patient and onset-date search parameters:
      • SHOULD support chained searching of patient canonical identifier patient.identifier (e.g. patient.identifier=[system|][code])
      • SHALL support these onset-date comparators: gt,lt,ge,le
      • SHOULD support multipleAnd search on onset-date (e.g.onset-date=[date]&date=[date]]&...), and if multipleAnd is supported, SHALL support the search comparators gt,lt,ge,le

      GET [base]/Condition?patient={Type/}[id]&onset-date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/Condition?patient=5678&onset-date=ge2020-01-01T00:00:00Z
      2. GET [base]/Condition?patient.identifier=http://example.org/fhir/mrn|12345&onset-date=ge2020-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and onset-date (how to search by reference and how to search by date)