CA Baseline Condition Profile

This profile is seeking community and implementer feedback on whether further constraints on use of verificationStatus are needed.

VerificationStatus has been identified by members of our community as having clinical significance, though standardization around its use is still evolving in the international community (particularly in implementation guidance and value sets). We are currently seeking feedback from implementers on current utilization practices before further strengthening guidance on its use.
Feedback can be provided through the Simplifier issue log for this profile.. Proposed language for inclusion under our Best Practice/Should support section is also welcomed.

This profile constrains the Condition resource to record a list of problems associated with a patient. It identifies which elements, vocabularies and value sets to be present in the resource when using this profile.

This profile defines localization concepts for use in a Canadian context.

Mandatory Data Elements

All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.

Most elements in FHIR specification have a minimum cardinality of 0, which means that they may be missing from a resource when it is exchanged between systems.

Required elements:

• code identifying the patient’s relevant condition
• reference to a subject

Must Support Data Elements

Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide “support” for the element in some meaningful way (see Must Support definition).

Following elements are marked as Must Support in the Canadian Condition profile to aid record matching in databases with many pediatric records.

Must Support elements:

• clinical status of the condition
• code identifying the patient’s relevant condition
• reference to subject
• onset - estimated or actual date of the condition

Usage Note

Condition is intended for capturing and querying patient’s current and historical problems.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Condition

Name	Flags	Card.	Type	Description & Constraints
Condition		0..*	Condition	Condition Profile
clinicalStatus	?!S	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved
verificationStatus	?!	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
code	S	0..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode (preferred): Codes for problems from the SNOMED CT Canadian edition value set
Slices for coding	S	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:binding.valueSet
coding:HealthConcernCode		0..1	Coding	CHI identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode (required): Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.
coding:@default		0..1	Coding	Other identifications of the condition, problem or diagnosis Binding: Condition/Problem/DiagnosisCodes (example)
subject	S	1..1	Reference(Patient Profile)	Who has the condition?
encounter		0..1	Reference(Encounter Profile)	Encounter created as part of
onset[x]	S	0..1	dateTime, Age, Period, Range, string	Estimated or actual date, date-time, or age
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Who recorded the condition
asserter		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Person who asserts this condition
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Condition.code	preferred	https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
Condition.code.coding:HealthConcernCode	required	https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
Condition.code.coding:@default	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	Condition	Condition Profile con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
code	SΣ	0..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode (preferred): Codes for problems from the SNOMED CT Canadian edition value set
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:binding.valueSet
coding:HealthConcernCode	Σ	0..1	Coding	CHI identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode (required): Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.
coding:@default	Σ	0..1	Coding	Other identifications of the condition, problem or diagnosis Binding: Condition/Problem/DiagnosisCodes (example)
subject	SΣ	1..1	Reference(Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter Profile)	Encounter created as part of
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
recorder	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Person who asserts this condition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Condition.clinicalStatus	required	ConditionClinicalStatusCodes http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1 from the FHIR Standard
Condition.verificationStatus	required	ConditionVerificationStatus http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1 from the FHIR Standard
Condition.code	preferred	https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
Condition.code.coding:HealthConcernCode	required	https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
Condition.code.coding:@default	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item : clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission : abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Condition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Condition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Condition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Condition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	Condition	Condition Profile con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
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 Bindings Purpose 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	External Ids for this condition
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
category		0..*	CodeableConcept	problem-list-item | encounter-diagnosis Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	0..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode (preferred): Codes for problems from the SNOMED CT Canadian edition value set
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:binding.valueSet
coding:HealthConcernCode	Σ	0..1	Coding	CHI identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode (required): Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.
coding:@default	Σ	0..1	Coding	Other identifications of the condition, problem or diagnosis Binding: Condition/Problem/DiagnosisCodes (example)
text	Σ	0..1	string	Plain text representation of the concept
bodySite	Σ	0..*	CodeableConcept	Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
subject	SΣ	1..1	Reference(Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter Profile)	Encounter created as part of
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	C	0..1		When in resolution/remission
abatementDateTime			dateTime
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	Σ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Person who asserts this condition
stage	C	0..*	BackboneElement	Stage/grade, usually assessed formally con-1: Stage SHALL have summary or assessment
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
summary	C	0..1	CodeableConcept	Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	C	0..*	Reference(ClinicalImpression | DiagnosticReport | Observation)	Formal record of assessment
type		0..1	CodeableConcept	Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence	C	0..*	BackboneElement	Supporting evidence con-2: evidence SHALL have code or details
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	ΣC	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣC	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Condition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Condition.clinicalStatus	required	ConditionClinicalStatusCodes http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1 from the FHIR Standard
Condition.verificationStatus	required	ConditionVerificationStatus http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1 from the FHIR Standard
Condition.category	extensible	ConditionCategoryCodes http://hl7.org/fhir/ValueSet/condition-category from the FHIR Standard
Condition.severity	preferred	Condition/DiagnosisSeverity http://hl7.org/fhir/ValueSet/condition-severity from the FHIR Standard
Condition.code	preferred	https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
Condition.code.coding:HealthConcernCode	required	https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
Condition.code.coding:@default	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
Condition.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Condition.stage.summary	example	ConditionStage http://hl7.org/fhir/ValueSet/condition-stage from the FHIR Standard
Condition.stage.type	example	ConditionStageType http://hl7.org/fhir/ValueSet/condition-stage-type from the FHIR Standard
Condition.evidence.code	example	ManifestationAndSymptomCodes http://hl7.org/fhir/ValueSet/manifestation-or-symptom from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
con-1	error	Condition.stage	Stage SHALL have summary or assessment : summary.exists() or assessment.exists()
con-2	error	Condition.evidence	evidence SHALL have code or details : code.exists() or detail.exists()
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item : clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission : abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Condition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Condition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Condition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Condition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Condition

Name	Flags	Card.	Type	Description & Constraints
Condition		0..*	Condition	Condition Profile
clinicalStatus	?!S	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved
verificationStatus	?!	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
code	S	0..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode (preferred): Codes for problems from the SNOMED CT Canadian edition value set
Slices for coding	S	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:binding.valueSet
coding:HealthConcernCode		0..1	Coding	CHI identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode (required): Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.
coding:@default		0..1	Coding	Other identifications of the condition, problem or diagnosis Binding: Condition/Problem/DiagnosisCodes (example)
subject	S	1..1	Reference(Patient Profile)	Who has the condition?
encounter		0..1	Reference(Encounter Profile)	Encounter created as part of
onset[x]	S	0..1	dateTime, Age, Period, Range, string	Estimated or actual date, date-time, or age
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Who recorded the condition
asserter		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Person who asserts this condition
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Condition.code	preferred	https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
Condition.code.coding:HealthConcernCode	required	https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
Condition.code.coding:@default	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	Condition	Condition Profile con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
code	SΣ	0..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode (preferred): Codes for problems from the SNOMED CT Canadian edition value set
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:binding.valueSet
coding:HealthConcernCode	Σ	0..1	Coding	CHI identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode (required): Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.
coding:@default	Σ	0..1	Coding	Other identifications of the condition, problem or diagnosis Binding: Condition/Problem/DiagnosisCodes (example)
subject	SΣ	1..1	Reference(Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter Profile)	Encounter created as part of
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
recorder	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Person who asserts this condition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Condition.clinicalStatus	required	ConditionClinicalStatusCodes http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1 from the FHIR Standard
Condition.verificationStatus	required	ConditionVerificationStatus http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1 from the FHIR Standard
Condition.code	preferred	https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
Condition.code.coding:HealthConcernCode	required	https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
Condition.code.coding:@default	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item : clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission : abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Condition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Condition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Condition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Condition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	Condition	Condition Profile con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
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 Bindings Purpose 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	External Ids for this condition
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
category		0..*	CodeableConcept	problem-list-item | encounter-diagnosis Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	0..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode (preferred): Codes for problems from the SNOMED CT Canadian edition value set
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	SΣ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:binding.valueSet
coding:HealthConcernCode	Σ	0..1	Coding	CHI identification of the condition, problem or diagnosis Binding: https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode (required): Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.
coding:@default	Σ	0..1	Coding	Other identifications of the condition, problem or diagnosis Binding: Condition/Problem/DiagnosisCodes (example)
text	Σ	0..1	string	Plain text representation of the concept
bodySite	Σ	0..*	CodeableConcept	Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
subject	SΣ	1..1	Reference(Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter Profile)	Encounter created as part of
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	C	0..1		When in resolution/remission
abatementDateTime			dateTime
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	Σ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile | RelatedPerson)	Person who asserts this condition
stage	C	0..*	BackboneElement	Stage/grade, usually assessed formally con-1: Stage SHALL have summary or assessment
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
summary	C	0..1	CodeableConcept	Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	C	0..*	Reference(ClinicalImpression | DiagnosticReport | Observation)	Formal record of assessment
type		0..1	CodeableConcept	Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence	C	0..*	BackboneElement	Supporting evidence con-2: evidence SHALL have code or details
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	ΣC	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣC	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Condition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Condition.clinicalStatus	required	ConditionClinicalStatusCodes http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1 from the FHIR Standard
Condition.verificationStatus	required	ConditionVerificationStatus http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1 from the FHIR Standard
Condition.category	extensible	ConditionCategoryCodes http://hl7.org/fhir/ValueSet/condition-category from the FHIR Standard
Condition.severity	preferred	Condition/DiagnosisSeverity http://hl7.org/fhir/ValueSet/condition-severity from the FHIR Standard
Condition.code	preferred	https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
Condition.code.coding:HealthConcernCode	required	https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
Condition.code.coding:@default	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
Condition.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Condition.stage.summary	example	ConditionStage http://hl7.org/fhir/ValueSet/condition-stage from the FHIR Standard
Condition.stage.type	example	ConditionStageType http://hl7.org/fhir/ValueSet/condition-stage-type from the FHIR Standard
Condition.evidence.code	example	ManifestationAndSymptomCodes http://hl7.org/fhir/ValueSet/manifestation-or-symptom from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
con-1	error	Condition.stage	Stage SHALL have summary or assessment : summary.exists() or assessment.exists()
con-2	error	Condition.evidence	evidence SHALL have code or details : code.exists() or detail.exists()
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item : clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission : abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Condition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Condition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Condition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Condition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Condition

Cannot invoke "Object.hashCode()" because "key" is null

Clinical Status

Rules derived from the FHIR Condition resource description:

• Condition.clinicalStatus SHALL be present if Condition.verificationStatus is not entered-in-error and category is problem-list-item.
• Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error.

Rational: Most systems will expect a clinicalStatus to be valued for problem-list-items that are managed over time, but might not need a clinicalStatus for point in time encounter-diagnosis.

Verification Status

The verification status supports the clinical status of the condition.

The verification status element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.

The Condition.verificationStatus is optional considering the use case of using the Condition to populate a problem list where clinically documented problems range from general descriptions (e.g. “short of breath”) to specific diagnoses with no verification step.

Code

The identification of the the client’s relevant condition, problem or diagnosis or recording of “problem absent” or of “problems unknown”, as interpreted by the provider.

The Condition.code element is CodeableConcept data type meaning that more than one Coding sub-elements can be present. One of these Coding sub-elements SHALL use Health Concern Code value set from Canada Health Infoway. Other Coding component are transaltion of the HealthConcernCode to other code systems.