# US Core Care Experience Preference Profile - US Core Implementation Guide v8.0.1

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Care Experience Preference Profile**

## Resource Profile: US Core Care Experience Preference Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-care-experience-preference | *Version*:8.0.1 | |
| *Standards status:*[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 2 | *Computable Name*:USCoreCareExperiencePreferenceProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.14 | | |
| **Copyright/Legal**: Used by permission of HL7 International, all rights reserved Creative Commons License | | |

 
The US Core Care Experience Preference Profile inherits from the FHIR[Observation](https://hl7.org/fhir/R4/observation.html)resource; refer to This profile provides guidance on how to record a care experience preference expressed by the patient regarding their care and treatment. Examples include, but are not limited to, religious preferences, dislikes and fears, preferred place for birth, preferred pharmacy, and thoughts and feelings to be shared. This profile does not represent an actual order, but it can guide caregivers and medical personnel about what is important for the person. This profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient care experience preferences. 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 this profile:

* Query for a patient's care experience preferences.
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) clinical observations or assessments about a patient's care experience preferences.

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

**Each Observation Must Have:**

1. a status
1. a fixed code for care experience preference
1. a patient

**Each Observation Must Support:**

1. a category code of "care-experience-preference"
1. a time indicating when the preference was made
1. care experience preference value

**Additional USCDI Requirements:**

These [Additional USCDI Requirements](must-support.md#additional-uscdi-requirements) elements are not Mandatory or Must Support but are required for ASTP Health IT certification testing and are included in the formal definition of the profile and the Observation examples.

1. a performer*

*see guidance below

**Profile Specific Implementation Guidance:**

* Care experience preferences expressed by a patient may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer.
* The context or precondition of a patient's preference SHOULD be supplied in: 
* the `Observation.valueString` (for example, "If this [health scenario] were to occur, …”) or
* an extension such as the PACIO Advance Directive Interoperability Implementation Guide's [Enclosed Precondition Extension](http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension).
 
* Additional codes that translate or map to the Observation code or category codes are allowed. For example: 
* providing both a local code and a LOINC code
* providing a more specific code, for example, the more specific LOINC, "81364-2 (Religious or cultural beliefs [Reported])" , a [SNOMED CT](http://snomed.info/sct/731000124108) concept, or a system-specific code
* See the existing [Care Experience Preferences at End of Life Grouping](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1115.11/expansion) for more specific concepts representing an individual's care experience preferences
 

* *The profile elements `Observation.performer and Observation.device` communicate the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

**Usages:**

* Examples for this Profile: [Observation/care-experience-preference](Observation-care-experience-preference.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.core|current/StructureDefinition/us-core-care-experience-preference)

**Changes since version 7.0.0:**

* The data elements list has changed

* One or more text definitions, invariants or bindings have changed

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-care-experience-preference.csv), [Excel](StructureDefinition-us-core-care-experience-preference.xlsx), [Schematron](StructureDefinition-us-core-care-experience-preference.sch) 

### 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](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to care experience preference data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/Observation.rs`

Servers providing access to care experience preference data **MAY** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [granular scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#finer-grained-resource-constraints-using-search-parameters): `<patient|user|system>/Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|care-experience-preference`

#### Mandatory Search Parameters:

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

1. **SHALL**support searching using the combination of the**[`patient`](SearchParameter-us-core-observation-patient.md)**and**[`category`](SearchParameter-us-core-observation-category.md)**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=care-experience-preference
**Implementation Notes:**Fetches a bundle of all Observation resources for the specified patient and a category code =`laboratory`([how to search by reference](http://hl7.org/fhir/R4/search.html#reference)and[how to search by token](http://hl7.org/fhir/R4/search.html#token))
1. **SHALL**support searching using the combination of the**[`patient`](SearchParameter-us-core-observation-patient.md)**and**[`code`](SearchParameter-us-core-observation-code.md)**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|95541-9
**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](http://hl7.org/fhir/R4/search.html#reference)and[how to search by token](http://hl7.org/fhir/R4/search.html#token))
1. **SHALL**support searching using the combination of the**[`patient`](SearchParameter-us-core-observation-patient.md)**and**[`category`](SearchParameter-us-core-observation-category.md)**and**[`date`](SearchParameter-us-core-observation-date.md)**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=care-experience-preference&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](http://hl7.org/fhir/R4/search.html#reference)and[how to search by token](http://hl7.org/fhir/R4/search.html#token)and[how to search by date](http://hl7.org/fhir/R4/search.html#date))

#### Optional Search Parameters:

The following search parameter combinations **SHOULD** be supported:

1. **SHOULD**support searching using the combination of the**[`patient`](SearchParameter-us-core-observation-patient.md)**and**[`category`](SearchParameter-us-core-observation-category.md)**and**[`status`](SearchParameter-us-core-observation-status.md)**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=care-experience-preference&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](http://hl7.org/fhir/R4/search.html#reference)and[how to search by token](http://hl7.org/fhir/R4/search.html#token))
1. **SHOULD**support searching using the combination of the**[`patient`](SearchParameter-us-core-observation-patient.md)**and**[`category`](SearchParameter-us-core-observation-category.md)**and**[`_lastUpdated`](SearchParameter-us-core-observation-lastupdated.md)**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&care-experience-preference&_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](general-guidance.md#searching-using-lastupdated). ([how to search by reference](http://hl7.org/fhir/R4/search.html#reference)and[how to search by token](http://hl7.org/fhir/R4/search.html#token)and[how to search by date](http://hl7.org/fhir/R4/search.html#date))
1. **SHOULD**support searching using the combination of the**[`patient`](SearchParameter-us-core-observation-patient.md)**and**[`code`](SearchParameter-us-core-observation-code.md)**and**[`date`](SearchParameter-us-core-observation-date.md)**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|95541-9&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](http://hl7.org/fhir/R4/search.html#reference)and[how to search by token](http://hl7.org/fhir/R4/search.html#token)and[how to search by date](http://hl7.org/fhir/R4/search.html#date))



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-care-experience-preference",
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 2
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "cgp"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-care-experience-preference",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.14"
    }
  ],
  "version" : "8.0.1",
  "name" : "USCoreCareExperiencePreferenceProfile",
  "title" : "US Core Care Experience Preference Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-11-02",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [
    {
      "name" : "HL7 International / Cross-Group Projects",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/cgp"
        },
        {
          "system" : "email",
          "value" : "cgp@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "The US Core Care Experience Preference Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to This profile provides guidance on how to record a care experience preference expressed by the patient regarding their care and treatment. Examples include, but are not limited to, religious preferences, dislikes and fears, preferred place for birth, preferred pharmacy, and thoughts and feelings to be shared. This profile does not represent an actual order, but it can guide caregivers and medical personnel about what is important for the person. This profile sets minimum expectations for the Observation resource to record, search, and fetch for a patient care experience preferences. 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.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "copyright" : "Used by permission of HL7 International, all rights reserved Creative Commons License",
  "fhirVersion" : "4.0.1",
  "mapping" : [
    {
      "identity" : "workflow",
      "uri" : "http://hl7.org/fhir/workflow",
      "name" : "Workflow Pattern"
    },
    {
      "identity" : "sct-concept",
      "uri" : "http://snomed.info/conceptdomain",
      "name" : "SNOMED CT Concept Domain Binding"
    },
    {
      "identity" : "v2",
      "uri" : "http://hl7.org/v2",
      "name" : "HL7 v2 Mapping"
    },
    {
      "identity" : "rim",
      "uri" : "http://hl7.org/v3",
      "name" : "RIM Mapping"
    },
    {
      "identity" : "w5",
      "uri" : "http://hl7.org/fhir/fivews",
      "name" : "FiveWs Pattern Mapping"
    },
    {
      "identity" : "sct-attr",
      "uri" : "http://snomed.org/attributebinding",
      "name" : "SNOMED CT Attribute Binding"
    }
  ],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Observation",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation" : "constraint",
  "differential" : {
    "element" : [
      {
        "id" : "Observation",
        "path" : "Observation",
        "short" : "US Core Care Experience Preference Profile"
      },
      {
        "id" : "Observation.status",
        "path" : "Observation.status",
        "mustSupport" : true
      },
      {
        "id" : "Observation.category",
        "path" : "Observation.category",
        "slicing" : {
          "discriminator" : [
            {
              "type" : "value",
              "path" : "$this"
            }
          ],
          "rules" : "open"
        },
        "mustSupport" : true,
        "binding" : {
          "strength" : "preferred",
          "description" : "FHIR and US Core codes for high level observation categories.",
          "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category"
        }
      },
      {
        "id" : "Observation.category:us-core",
        "path" : "Observation.category",
        "sliceName" : "us-core",
        "min" : 0,
        "max" : "1",
        "patternCodeableConcept" : {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
              "code" : "care-experience-preference"
            }
          ]
        },
        "mustSupport" : true,
        "binding" : {
          "strength" : "preferred",
          "description" : "FHIR and US Core codes for high level observation categories.",
          "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category"
        }
      },
      {
        "id" : "Observation.code",
        "path" : "Observation.code",
        "short" : "Care experience preferences code",
        "type" : [
          {
            "code" : "CodeableConcept"
          }
        ],
        "patternCodeableConcept" : {
          "coding" : [
            {
              "system" : "http://loinc.org",
              "code" : "95541-9"
            }
          ]
        },
        "mustSupport" : true
      },
      {
        "id" : "Observation.subject",
        "path" : "Observation.subject",
        "min" : 1,
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
            ]
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.effective[x]",
        "path" : "Observation.effective[x]",
        "definition" : "The time or time-period the observed value is asserted as being true. For biological subjects - e.g., human patients - this is usually called the \"physiologically relevant time\".",
        "comment" : "At least a date should be present unless this observation is a historical report.",
        "type" : [
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                "valueBoolean" : true
              }
            ],
            "code" : "dateTime"
          },
          {
            "code" : "Period"
          },
          {
            "code" : "Timing"
          },
          {
            "code" : "instant"
          }
        ],
        "mustSupport" : true
      },
      {
        "id" : "Observation.performer",
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
            "valueBoolean" : true
          }
        ],
        "path" : "Observation.performer",
        "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation",
        "type" : [
          {
            "code" : "Reference",
            "targetProfile" : [
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam",
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson"
            ],
            "_targetProfile" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                    "valueBoolean" : false
                  }
                ]
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                    "valueBoolean" : false
                  }
                ]
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                    "valueBoolean" : false
                  }
                ]
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                    "valueBoolean" : false
                  }
                ]
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                    "valueBoolean" : false
                  }
                ]
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                    "valueBoolean" : false
                  }
                ]
              }
            ]
          }
        ]
      },
      {
        "id" : "Observation.value[x]",
        "path" : "Observation.value[x]",
        "type" : [
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                "valueBoolean" : true
              }
            ],
            "code" : "string"
          },
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                "valueBoolean" : true
              }
            ],
            "code" : "CodeableConcept"
          },
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                "valueBoolean" : false
              }
            ],
            "code" : "Quantity"
          },
          {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
                "valueBoolean" : false
              }
            ],
            "code" : "boolean"
          },
          {
            "code" : "integer"
          },
          {
            "code" : "Range"
          },
          {
            "code" : "Ratio"
          },
          {
            "code" : "SampledData"
          },
          {
            "code" : "time"
          },
          {
            "code" : "dateTime"
          },
          {
            "code" : "Period"
          }
        ],
        "mustSupport" : true
      }
    ]
  }
}

```
