Name Flags Card. Type Description & Constraints RiskAssessment RiskAssessment Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url riskPlan S 0..* Reference(US Core DocumentReference Profile) Extension URL: http://hl7.org/fhir/us/eltss/StructureDefinition/eltss-RiskPlan resource-pertainsToGoal S 0..* Reference(Goal) The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal subject 1..1 Reference(Patient_eltss) Who/what does assessment apply to? encounter 0..1 Reference(US Core Encounter Profile) Where was assessment performed? condition 0..1 Reference(Condition_eltss) Condition assessed performer 0..1 Reference(Practitioner_eltss | eLTSS PractitionerRole Profile | US Core Implantable Device Profile | Device) Who did assessment? reasonReference 0..* Reference(Condition_eltss | Observation_eltss | US Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile) Why the assessment was necessary? prediction 0..* BackboneElement Identified Risk outcome 0..1 CodeableConcept Possible outcome for the subject Binding: hl7VS-patientOutcome (example): The condition or other outcome; e.g. death, remission, amputation, infection, etc. mitigation S 0..1 string Risk Management Plan Documentation for this format
HL7 International / Human and Social Services
RiskAssessment resource mapping for eLTSS
Potential outcomes for a subject with likelihood
An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Observation[classCode=OBS, moodCode=EVN, code="Risk Assessment"]
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Risk Management Plan eLTSS data set element
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
Indicates that the resource is related to either the measurement, achievement or progress towards the referenced goal. For example, a Procedure to exercise pertainsToGoal of losing weight.
This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business identifier assigned to the risk assessment.
A reference to the request that is fulfilled by this risk assessment.
A reference to a resource that this risk assessment is part of, such as a Procedure.
registered | preliminary | final | amended +
The status of the RiskAssessment, using the same statuses as an Observation.
The status of the risk assessment; e.g. preliminary, final, amended, etc.
The algorithm, process or mechanism used to evaluate the risk.
The method can influence the results of the assessment.
The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
The type of the risk assessment performed.
The patient or group the risk assessment applies to.
The encounter where the assessment was performed.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
The date (and possibly time) the risk assessment was performed.
The assessment results lose validity the more time elapses from when they are first made.
For assessments or prognosis specific to a particular condition, indicates the condition being assessed.
.outboundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN]
The provider or software application that performed the assessment.
The reason the risk assessment was performed.
Resources supporting the reason the risk assessment was performed.
Indicates the source data considered as part of the assessment (for example, FamilyHistory, Observations, Procedures, Conditions, etc.).
An aspect of a person’s life, behavior, environmental exposure, personal characteristic, or barrier that increases the likelihood of disease, condition, injury to self or others, or interaction with the criminal justice system.
Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.
probability is decimal implies (probability as decimal) <= 100
not(f:probabilityDecimal) or f:probabilityDecimal/@value <= 100
.outboundRelationship[typeCode=VALUE].target[classCod=OBS, moodCode=RISK]
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
One of the potential outcomes for the patient (e.g. remission, death, a particular condition).
The condition or other outcome; e.g. death, remission, amputation, infection, etc.
Indicates how likely the outcome is (in the specified timeframe).
If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).
low and high must be percentages, if present
(low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum)))
(not(f:low) or f:low[f:code/@value='%' and f:system/@value='http://unitsofmeasure.org']) and (not(f:high) or f:high[f:code/@value='%' and f:system/@value='http://unitsofmeasure.org'])
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="probability"].value
Likelihood of specified outcome as a qualitative value
Indicates how likely the outcome is (in the specified timeframe), expressed as a qualitative value (e.g. low, medium, or high).
The likelihood of the occurrence of a specified outcome.
Indicates the risk for this particular subject (with their specific characteristics) divided by the risk of the population in general. (Numbers greater than 1 = higher risk than the population, numbers less than 1 = lower risk.).
Absolute risk is less meaningful than relative risk.
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="relative risk"].value
Indicates the period of time or age range of the subject to which the specified probability applies.
If not specified, the risk applies "over the subject's lifespan".
.effectiveTime or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age"].value
Additional information explaining the basis for the prediction.
Description of planned activities to minimize identified risks that endanger the person's health and safety. This can be included as free text or attachment.
One of the main reasons for assessing risks is to identify whether interventional steps are needed to reduce risk.
.outboundRelationship[typeCode=MTGT].target[classCode=ACT, moodCode=EVN].text
Additional comments about the risk assessment.