Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 Ballot 3
World
Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 Ballot 3
World
Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions
| Page standards status: Informative |
{
"resourceType" : "Evidence",
"id" : "104155",
"meta" : {
"versionId" : "14",
"lastUpdated" : "2026-06-07T15:07:59.725Z",
"profile" : [
🔗 "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence"🔗 ,
"http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence"
]
},
"language" : "en",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Evidence 104155</b></p><a name=\"104155\"> </a><a name=\"hc104155\"> </a><div style=\"display: inline-block; background-color: #fbffeb; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 14; Last updated: 2026-06-07 15:07:59+0000</p><p style=\"margin-bottom: 0px\">Profiles: <a href=\"StructureDefinition-comparative-evidence.html\">ComparativeEvidence</a>, <a href=\"StructureDefinition-single-study-evidence.html\">SingleStudyEvidence</a></p></div><p><b>ArtifactPublicationStatus</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-status-type active}\">Active</span></p><p><b>url</b>: <a href=\"Evidence-104155.html\">Evidence ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study</a></p><p><b>identifier</b>: FEvIR Object Identifier/104155, <a href=\"http://terminology.hl7.org/7.5.0/NamingSystem-uri.html\" title=\"As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt \r\n\r\nThis oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: \r\n\r\nNote that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.\r\n\r\nThis OID may also be used in CD.codeSystem.\">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.40.44.22.30</p><p><b>version</b>: 1.0.0-ballot3</p><p><b>name</b>: ComparativeEvidence_Bypass_surgery_effects_on_New_onset_depression_in_JAMA_2018_Norwegian_cohort_study</p><p><b>title</b>: ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study</p><p><b>citeAs</b>: </p><div><p>ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study [Database Entry: FHIR Evidence Resource]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104155. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104155. Computable resource at: https://fevir.net/resources/Evidence/104155#json.</p>\n</div><p><b>status</b>: Active</p><p><b>date</b>: 2022-09-19 21:16:07+0000</p><p><b>author</b>: Brian S. Alper: </p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href=\"http://www.hl7.org/Special/committees/dss\">http://www.hl7.org/Special/committees/dss</a></p><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"CodeSystem-179423.html#179423-evidence-communication\">Evidence Based Medicine on FHIR Implementation Guide Code System: evidence-communication</a> (Evidence Communication)</td><td><span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 ComparativeEvidence}\">ComparativeEvidence</span></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"CodeSystem-179423.html#179423-evidence-communication\">Evidence Based Medicine on FHIR Implementation Guide Code System: evidence-communication</a> (Evidence Communication)</td><td><span title=\"Codes:{https://fevir.net/resources/CodeSystem/179423 SingleStudyEvidence}\">SingleStudyEvidence</span></td></tr></table><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>\n</div><h3>RelatesTos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Target[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/artifact-relationship-type derived-from}\">Derived From</span></td><td><a href=\"https://jamanetwork.com/journals/jama/fullarticle/2669729\">https://jamanetwork.com/journals/jama/fullarticle/2669729</a></td></tr></table><p><b>description</b>: </p><div><p>greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]</p>\n</div><p><b>assertion</b>: </p><div><p>Compared with specialized medical treatment, bariatric surgery may slightly increase the incidence of depression.</p>\n</div><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n\u2009=\u20092109) with severe obesity assessed (221 patients excluded and 1888 patients included).</p>\n</div><p><b>variableRole</b>: Population</p><p><b>observed</b>: <a href=\"Group-178427.html\">StudyGroup: Severely Obese Adults 2018 Norwegian Cohort</a></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>bariatric surgery vs. specialized medical treatment without bariatric surgery</p>\n</div><p><b>variableRole</b>: Exposure</p><p><b>comparatorCategory</b>: no bariatric surgery</p><p><b>observed</b>: <a href=\"EvidenceVariable-172427.html\">GroupAssignment: Bariatric Surgery vs. no bariatric surgery</a></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>New onset depression</p>\n</div><p><b>variableRole</b>: Outcome</p><p><b>observed</b>: <a href=\"EvidenceVariable-104118.html\">OutcomeVariable: New onset depression</a></p></blockquote><p><b>synthesisType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/synthesis-type NotApplicable}\">not applicable</span></p><p><b>studyDesign</b>: <span title=\"Codes:{https://fevir.net/sevco SEVCO:01002}\">observational research</span>, <span title=\"Codes:{https://fevir.net/sevco SEVCO:01011}\">parallel cohort design</span>, <span title=\"Codes:{https://fevir.net/sevco SEVCO:01028}\">longitudinal data collection</span></p><blockquote><p><b>statistic</b></p><p><b>description</b>: </p><div><p>Relative risk 1.5; 95% CI 1.4 to 1.7</p>\n</div><p><b>note</b>: </p><blockquote><div><p>Result observed without bariatric surgery was 6.5%, result observed with bariatric surgery was 8.9%</p>\n</div></blockquote><p><b>statisticType</b>: <span title=\"Codes:{https://fevir.net/sevco STATO:0000245}\">risk ratio</span></p><p><b>quantity</b>: 1.5</p><h3>SampleSizes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>NumberOfStudies</b></td><td><b>NumberOfParticipants</b></td><td><b>KnownDataCount</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>1888</td><td>1888</td></tr></table><h3>AttributeEstimates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Description</b></td><td><b>Type</b></td><td><b>Level</b></td><td><b>Range</b></td></tr><tr><td style=\"display: none\">*</td><td><div><p>95% CI 1.4 to 1.7</p>\n</div></td><td><span title=\"Codes:{https://fevir.net/sevco STATO:0000196}\">confidence interval</span></td><td>0.95</td><td>1.4-1.7</td></tr></table></blockquote><blockquote><p><b>statistic</b></p><p><b>description</b>: </p><div><p>odds ratio 1.55 (1.44 to 1.79) derived from risk ratio and control event rate during the generation of the Summary of Findings</p>\n</div><p><b>statisticType</b>: <span title=\"Codes:{https://fevir.net/sevco STATO:0000182}\">odds ratio</span></p><p><b>quantity</b>: 1.5540166204986148</p><h3>AttributeEstimates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Range</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{https://fevir.net/sevco STATO:0000196}\">confidence interval</span></td><td>1.44004400440044-1.7869589657110734</td></tr></table></blockquote><h3>Certainties</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Description</b></td><td><b>Type</b></td><td><b>Rating</b></td></tr><tr><td style=\"display: none\">*</td><td><div><p>rated down 2 levels due to observational study</p>\n</div></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/certainty-type Overall}\">Overall certainty</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/certainty-rating low}\">Low quality</span></td></tr></table></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/uv/ebm/StructureDefinition/artifact-publication-status",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cited-artifact-status-type",
"code" : "active",
"display" : "Active"
}
]
}
}
],
"url" : "https://fevir.net/resources/Evidence/104155",
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "ACSN",
"display" : "Accession ID"
}
],
"text" : "FEvIR Object Identifier"
},
"system" : "https://fevir.net/FOI",
"value" : "104155",
"assigner" : {
"display" : "Computable Publishing LLC"
}
},
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.4.642.40.44.22.30"
}
],
"version" : "1.0.0-ballot3",
"name" : "ComparativeEvidence_Bypass_surgery_effects_on_New_onset_depression_in_JAMA_2018_Norwegian_cohort_study",
"title" : "ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study",
"citeAs" : "ComparativeEvidence: Bypass surgery effects on New onset depression in JAMA 2018 Norwegian cohort study [Database Entry: FHIR Evidence Resource]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104155. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104155. Computable resource at: https://fevir.net/resources/Evidence/104155#json.",
"status" : "active",
"date" : "2022-09-19T21:16:07.557Z",
"author" : [
{
"name" : "Brian S. Alper"
}
],
"publisher" : "HL7 International / Clinical Decision Support",
"contact" : [
{
"name" : "HL7 International / Clinical Decision Support",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/dss"
}
]
}
],
"useContext" : [
{
"code" : {
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "evidence-communication",
"display" : "Evidence Communication"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "ComparativeEvidence",
"display" : "ComparativeEvidence"
}
]
}
},
{
"code" : {
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "evidence-communication",
"display" : "Evidence Communication"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://fevir.net/resources/CodeSystem/179423",
"code" : "SingleStudyEvidence",
"display" : "SingleStudyEvidence"
}
]
}
}
],
"copyright" : "https://creativecommons.org/licenses/by-nc-sa/4.0/",
"relatesTo" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/artifact-relationship-type",
"code" : "derived-from",
"display" : "Derived From"
}
]
},
"targetUri" : "https://jamanetwork.com/journals/jama/fullarticle/2669729"
}
],
"description" : "greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]",
"assertion" : "Compared with specialized medical treatment, bariatric surgery may slightly increase the incidence of depression.",
"variableDefinition" : [
{
"description" : "Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n\u2009=\u20092109) with severe obesity assessed (221 patients excluded and 1888 patients included).",
"variableRole" : "population",
"observed" : {
🔗 "reference" : "Group/178427",
"type" : "Group",
"display" : "StudyGroup: Severely Obese Adults 2018 Norwegian Cohort"
}
},
{
"description" : "bariatric surgery vs. specialized medical treatment without bariatric surgery",
"variableRole" : "exposure",
"comparatorCategory" : "no bariatric surgery",
"observed" : {
🔗 "reference" : "EvidenceVariable/172427",
"type" : "EvidenceVariable",
"display" : "GroupAssignment: Bariatric Surgery vs. no bariatric surgery"
}
},
{
"description" : "New onset depression",
"variableRole" : "outcome",
"observed" : {
🔗 "reference" : "EvidenceVariable/104118",
"type" : "EvidenceVariable",
"display" : "OutcomeVariable: New onset depression"
}
}
],
"synthesisType" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/synthesis-type",
"code" : "NotApplicable",
"display" : "not applicable"
}
]
}
],
"studyDesign" : [
{
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "SEVCO:01002",
"display" : "observational research"
}
]
},
{
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "SEVCO:01011",
"display" : "parallel cohort design"
}
]
},
{
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "SEVCO:01028",
"display" : "longitudinal data collection"
}
]
}
],
"statistic" : [
{
"description" : "Relative risk 1.5; 95% CI 1.4 to 1.7",
"note" : [
{
"text" : "Result observed without bariatric surgery was 6.5%, result observed with bariatric surgery was 8.9%"
}
],
"statisticType" : {
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "STATO:0000245",
"display" : "risk ratio"
}
]
},
"quantity" : {
"value" : 1.5
},
"sampleSize" : {
"numberOfStudies" : 1,
"numberOfParticipants" : 1888,
"knownDataCount" : 1888
},
"attributeEstimate" : [
{
"description" : "95% CI 1.4 to 1.7",
"type" : {
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "STATO:0000196",
"display" : "confidence interval"
}
]
},
"level" : 0.95,
"range" : {
"low" : {
"value" : 1.4
},
"high" : {
"value" : 1.7
}
}
}
]
},
{
"description" : "odds ratio 1.55 (1.44 to 1.79) derived from risk ratio and control event rate during the generation of the Summary of Findings",
"statisticType" : {
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "STATO:0000182",
"display" : "odds ratio"
}
]
},
"quantity" : {
"value" : 1.5540166204986148
},
"attributeEstimate" : [
{
"type" : {
"coding" : [
{
"system" : "https://fevir.net/sevco",
"code" : "STATO:0000196",
"display" : "confidence interval"
}
]
},
"range" : {
"low" : {
"value" : 1.44004400440044
},
"high" : {
"value" : 1.7869589657110734
}
}
}
]
}
],
"certainty" : [
{
"description" : "rated down 2 levels due to observational study",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-type",
"code" : "Overall",
"display" : "Overall certainty"
}
]
},
"rating" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code" : "low",
"display" : "Low quality"
}
]
}
}
]
}
IG © 2024+ HL7 International / Clinical Decision Support.
Package hl7.fhir.uv.ebm#1.0.0-ballot3 based on FHIR 6.0.0-snapshot1.
Generated
2026-11-05
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change