Da Vinci Risk Adjustment Implementation Guide
2.1.0 - STU 2.1

Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

## Resource Profile: Patient Group

Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-patient-group | Version: 2.1.0
Standards status: Trial-use | Maturity Level: 1 | Computable Name: PatientGroup
Other Identifiers: OID:2.16.840.1.113883.4.642.40.29.42.15
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The Patient Group Profile describes a group consisting of one or more patients. It can be used a) when generating risk adjustment gap reports using Bulk FHIR or b) for the evaluated-approach for generating reports as defined on the dCC page.

### Mandatory Data Elements and Terminology

The following data-elements must always be present (Mandatory) or must be supported (Must Support). The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Group must have:

1. A 'Group.type' element
2. An 'Group.actual' element
3. One or more `Group.member` element(s) and each `member` SHALL reference a US Core Patient resource

Usages:

- Examples for this Profile: Group/ra-group01 and Group/ra-group02

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Group | C | 0..* | Group | Group of multiple entities Constraints: grp-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
type | S Σ | 1..1 | code | person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual | S Σ C | 1..1 | boolean | Descriptive or actual Fixed Value: true
member | S C | 1..* | BackboneElement | Who is in group
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
entity | S | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Reference to the patient that is in group
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Group.type | Base | required | GroupType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Group | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Group | 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 | Group | 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 | Group | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Group | 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()`
grp-1 | error | Group | Can only have members if group is "actual" | `member.empty() or (actual = true)`

This structure is derived from Group

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Group |  | 0..* | Group | Group of multiple entities
type | S | 1..1 | code | person | animal | practitioner | device | medication | substance Fixed Value: person
actual | S | 1..1 | boolean | Descriptive or actual Fixed Value: true
member | S | 1..* | BackboneElement | Who is in group
entity | S | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Reference to the patient that is in group
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Group | C | 0..* | Group | Group of multiple entities Constraints: grp-1
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | Unique id
active | Σ | 0..1 | boolean | Whether this group's record is in active use
type | S Σ | 1..1 | code | person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual | S Σ C | 1..1 | boolean | Descriptive or actual Fixed Value: true
code | Σ | 0..1 | CodeableConcept | Kind of Group members Binding Description: (example): Kind of particular resource; e.g. cow, syringe, lake, etc.
name | Σ | 0..1 | string | Label for Group
quantity | Σ | 0..1 | unsignedInt | Number of members
managingEntity | Σ | 0..1 | Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) | Entity that is the custodian of the Group's definition
characteristic |  | 0..* | BackboneElement | Include / Exclude group members by Trait
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 |  | 1..1 | CodeableConcept | Kind of characteristic Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
value[x] |  | 1..1 |  | Value held by characteristic Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
valueCodeableConcept |  |  | CodeableConcept |
valueBoolean |  |  | boolean |
valueQuantity |  |  | Quantity |
valueRange |  |  | Range |
valueReference |  |  | Reference(Any) |
exclude |  | 1..1 | boolean | Group includes or excludes
period |  | 0..1 | Period | Period over which characteristic is tested
member | S C | 1..* | BackboneElement | Who is in group
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
entity | S | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Reference to the patient that is in group
period |  | 0..1 | Period | Period member belonged to the group
inactive |  | 0..1 | boolean | If member is no longer in group
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Group.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Group.type | Base | required | GroupType | 📍4.0.1 | FHIR Std.
Group.code | Base | example |  | Not State | Unknown
Group.characteristic.​code | Base | example |  | Not State | Unknown
Group.characteristic.​value[x] | Base | example |  | Not State | Unknown

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Group | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Group | 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 | Group | 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 | Group | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Group | 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()`
grp-1 | error | Group | Can only have members if group is "actual" | `member.empty() or (actual = true)`

This structure is derived from Group

Summary

Mandatory: 1 element
Must-Support: 4 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)

Maturity: 1

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Group | C | 0..* | Group | Group of multiple entities Constraints: grp-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
type | S Σ | 1..1 | code | person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual | S Σ C | 1..1 | boolean | Descriptive or actual Fixed Value: true
member | S C | 1..* | BackboneElement | Who is in group
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
entity | S | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Reference to the patient that is in group
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Group.type | Base | required | GroupType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Group | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Group | 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 | Group | 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 | Group | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Group | 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()`
grp-1 | error | Group | Can only have members if group is "actual" | `member.empty() or (actual = true)`

Differential View

This structure is derived from Group

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Group |  | 0..* | Group | Group of multiple entities
type | S | 1..1 | code | person | animal | practitioner | device | medication | substance Fixed Value: person
actual | S | 1..1 | boolean | Descriptive or actual Fixed Value: true
member | S | 1..* | BackboneElement | Who is in group
entity | S | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Reference to the patient that is in group
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Group | C | 0..* | Group | Group of multiple entities Constraints: grp-1
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | Unique id
active | Σ | 0..1 | boolean | Whether this group's record is in active use
type | S Σ | 1..1 | code | person | animal | practitioner | device | medication | substance Binding: GroupType (required): Types of resources that are part of group. Fixed Value: person
actual | S Σ C | 1..1 | boolean | Descriptive or actual Fixed Value: true
code | Σ | 0..1 | CodeableConcept | Kind of Group members Binding Description: (example): Kind of particular resource; e.g. cow, syringe, lake, etc.
name | Σ | 0..1 | string | Label for Group
quantity | Σ | 0..1 | unsignedInt | Number of members
managingEntity | Σ | 0..1 | Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) | Entity that is the custodian of the Group's definition
characteristic |  | 0..* | BackboneElement | Include / Exclude group members by Trait
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 |  | 1..1 | CodeableConcept | Kind of characteristic Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
value[x] |  | 1..1 |  | Value held by characteristic Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
valueCodeableConcept |  |  | CodeableConcept |
valueBoolean |  |  | boolean |
valueQuantity |  |  | Quantity |
valueRange |  |  | Range |
valueReference |  |  | Reference(Any) |
exclude |  | 1..1 | boolean | Group includes or excludes
period |  | 0..1 | Period | Period over which characteristic is tested
member | S C | 1..* | BackboneElement | Who is in group
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
entity | S | 1..1 | Reference(US Core Patient Profile(7.0.0)) | Reference to the patient that is in group
period |  | 0..1 | Period | Period member belonged to the group
inactive |  | 0..1 | boolean | If member is no longer in group
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Group.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Group.type | Base | required | GroupType | 📍4.0.1 | FHIR Std.
Group.code | Base | example |  | Not State | Unknown
Group.characteristic.​code | Base | example |  | Not State | Unknown
Group.characteristic.​value[x] | Base | example |  | Not State | Unknown

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Group | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Group | 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 | Group | 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 | Group | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Group | 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()`
grp-1 | error | Group | Can only have members if group is "actual" | `member.empty() or (actual = true)`

This structure is derived from Group

Summary

Mandatory: 1 element
Must-Support: 4 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)

Maturity: 1

Other representations of profile: CSV, Excel, Schematron