US Public Health Travel History - HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR)

HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm
2.1.1 - STU 2.1.1 United States of America flag

HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/case-reporting/ and changes regularly. See the Directory of published versions

Resource Profile: US Public Health Travel History

Official URL: http://hl7.org/fhir/us/ecr/StructureDefinition/us-ph-travel-history				Version: 2.1.1
Active as of 2023-12-14				Computable Name: USPublicHealthTravelHistory

This Observation profile represents a patient’s travel history.

The following data for a patient can be recorded:

travel history as a string, an address, or a coded location
the date or period of time spent in the location (Observation.effectiveTime)
- it is important to accurately capture the most accurate dates possible
- the focus should be on date of arrival and date of departure
- the concepts of dates as related to travel are especially useful for determining need for Federal Public Health Notifications (FPHNs) and these dates are used to alert foreign ministries of health about their residents who may have been contacts of cases, or if a flight that was outbound from the USA had an infectious traveler on it
most uses will involve a single location (Observation.component), however, it is possible to specify multiple locations (but there is only a single effectiveTime)
- this allows for cases where a patient cannot remember exact dates of travel (e.g. I traveled to London, Paris, and Berlin in July and August 2016)
free text describing the travel history details and location (Observation.component.valueCodeableConcept.text element)
use Observation.component.codeableConcept to record a coded location
use Observationcomponent.extension to record a specific address
where a more granular address than state is known (e.g. city, street) it is appropriate to use the extension to record an address rather than using the coded location

Usage:

Refer to this Resource Profile: Electronic Initial Case Report Composition
Examples for this Resource Profile: Observation/observation-travel-history-eve-everywoman-1999, Observation/observation-travel-history-eve-everywoman-201610 and Observation/observation-travel-history-eve-everywoman-201801

Formal Views of Profile Content

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

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	US Public Health Travel History
code	S	1..1	CodeableConcept	Type of observation (code / type) 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://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 420008001
subject	S	1..1	Reference(US Public Health Patient)	Who and/or what the observation is about
effective[x]	S	1..1	dateTime, Period, Timing, instant	Date or period of time spent in the location
hasMember	S	0..*	Reference(US Public Health Transportation Details \| US Public Health Exposure Contact Information)	Related resource that belongs to the Observation group
Slices for component	S	1..*	BackboneElement	Component results Slice: Unordered, Open by value:code
component:travelLocation	S	1..*	BackboneElement	Travel location
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
travelHistoryAddress	S	0..1	Address	Travel history address URL: http://hl7.org/fhir/us/ecr/StructureDefinition/us-ph-address-extension
code	S	1..1	CodeableConcept	Type of component observation (code / type) 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/v3-ParticipationType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LOC
display		1..1	string	Representation defined by the system Fixed Value: Location
value[x]	S	0..1	CodeableConcept	Actual component result
coding	S	0..*	Coding	Code defined by a terminology system Binding: Geographical location history (extensible): Geographical Location History
text	S	0..1	string	Plain text representation of the concept
component:travelPurpose	S	0..*	BackboneElement	Purpose of travel
code	S	1..1	CodeableConcept	Type of component observation (code / type) 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://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 280147009
value[x]	S	1..1	CodeableConcept	Actual component result Binding: Travel Purpose (CDC) (preferred): Travel Purpose
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.component:travelLocation.value[x].coding	extensible	PHVS_GeographicLocationHistory_CDC
Observation.component:travelPurpose.value[x]	preferred	PHVS_TravelPurpose_CDC

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	US Public Health Travel History
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	registered \| preliminary \| final \| amended + Binding: ObservationStatus (required): Codes providing the status of an observation.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. 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://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 420008001
subject	SΣ	1..1	Reference(US Public Health Patient)	Who and/or what the observation is about
effective[x]	SΣ	1..1		Date or period of time spent in the location
effectiveDateTime			dateTime
effectivePeriod			Period
effectiveTiming			Timing
effectiveInstant			instant
hasMember	SΣ	0..*	Reference(US Public Health Transportation Details \| US Public Health Exposure Contact Information)	Related resource that belongs to the Observation group
Slices for component	SΣ	1..*	BackboneElement	Component results Slice: Unordered, Open by value:code
component:All Slices				Content/Rules for all slices
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.
component:travelLocation	SΣ	1..*	BackboneElement	Travel location
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
travelHistoryAddress	S	0..1	Address	Travel history address URL: http://hl7.org/fhir/us/ecr/StructureDefinition/us-ph-address-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. 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/v3-ParticipationType
code		1..1	code	Symbol in syntax defined by the system Fixed Value: LOC
display		1..1	string	Representation defined by the system Fixed Value: Location
value[x]	SΣ	0..1	CodeableConcept	Actual component result
coding	SΣ	0..*	Coding	Code defined by a terminology system Binding: Geographical location history (extensible): Geographical Location History
text	SΣ	0..1	string	Plain text representation of the concept
component:travelPurpose	SΣ	0..*	BackboneElement	Purpose of travel
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	SΣ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations. 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://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 280147009
value[x]	SΣ	1..1	CodeableConcept	Actual component result Binding: Travel Purpose (CDC) (preferred): Travel Purpose
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.status	required	ObservationStatus
Observation.code	example	Pattern: SNOMED CT code 420008001
Observation.component.code	example	LOINCCodes (a valid code from LOINC)
Observation.component:travelLocation.code	example	Pattern: LOC("Location")
Observation.component:travelLocation.value[x].coding	extensible	PHVS_GeographicLocationHistory_CDC
Observation.component:travelPurpose.code	example	Pattern: SNOMED CT code 280147009
Observation.component:travelPurpose.value[x]	preferred	PHVS_TravelPurpose_CDC

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	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	Observation	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	Observation	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Observation	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()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()