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

Resource Profile: ComparativeEvidence - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the comparative-evidence resource profile

Guidance on how to interpret the contents of this table can be foundhere

0. Evidence
Definition

The Evidence Resource provides a machine-interpretable expression of an evidence concept including the evidence variables (e.g., population, exposures/interventions, comparators, outcomes, measured variables, confounding variables), the statistics, and the certainty of this evidence.

ShortSingle evidence bit
Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantscnl-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.exists() implies name.matches('^[A-Z]([A-Za-z0-9_]){1,254}$'))
2. Evidence.implicitRules
Definition

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. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the additionalImplicitRules extension.

ShortA set of rules under which this content was created
Comments

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 its narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Evidence.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

ShortContained, inline Resources
Comments

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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

Control0..*
This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
6. Evidence.extension:publicationStatus
Slice NamepublicationStatus
Definition

The status of the processing for making the artifact publicly available, not necessarily the same as artifact status (Resource.status).

ShortPublication status
Control0..1
TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Evidence.modifierExtension
Definition

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 managable, 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).

ShortExtensions that cannot be ignored
Comments

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.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supportfalse
Summarytrue
Requirements

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.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Evidence.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 10. Evidence.status
    Definition

    The status of this summary. Enables tracking the life-cycle of the content.

    Shortdraft | active | retired | unknown
    Comments

    Allows filtering of summaries that are appropriate for use versus not.

    See guidance around (not) making local changes to elements here.

    Control0..1
    BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot5
    (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot5)

    The lifecycle status of an artifact.

    Typecode
    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired Evidence without due consideration
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Meaning if MissingValue is unknown.
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Evidence.variableDefinition
    Definition

    Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

    ShortDescription, classification, and definition of a single variable
    Comments

    To report comparative evidence for a research question defined by Population, Intervention, Comparator, and Outcome (PICO), one would use three variableDefinition instances: the Population has variableRole of population, the Intervention and Comparator will be expressed as category values for a GroupAssignment EvidenceVariable with the variableRole of exposure, and the Outcome has variableRole of outcome. In some types of Comparative Evidence, where the groups being compared are not from the same Population (and thus not a PICO-style research question), the GroupAssignment EvidenceVariable may have the variableRole of exposure and express the populations being compared as categories, and a combination of these categories can be described in the variableDefinition with variableRole of population. This approach may be used for example to compare cats and dogs.


    Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

    Control30..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Evidence.variableDefinition. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ variableRole
    • 14. Evidence.variableDefinition.modifierExtension
      Definition

      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 managable, 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).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      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.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Evidence.variableDefinition.variableRole
        Definition

        Classification of the role of the variable.

        Shortpopulation | exposure | outcome | covariate
        Control1..1
        BindingThe codes SHALL be taken from EvidenceVariableRolehttp://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5
        (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

        The role that the variable plays.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Evidence.variableDefinition:population
        Slice Namepopulation
        Definition

        Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

        ShortDescription, classification, and definition of a single variable
        Comments

        Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

        Control10..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        20. Evidence.variableDefinition:population.modifierExtension
        Definition

        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 managable, 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).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 22. Evidence.variableDefinition:population.variableRole
          Definition

          Classification of the role of the variable.

          Shortpopulation | exposure | outcome | covariate
          Control1..1
          BindingThe codes SHALL be taken from EvidenceVariableRolehttp://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5
          (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

          The role that the variable plays.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Pattern Valuepopulation
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          24. Evidence.variableDefinition:population.observed
          Definition

          Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

          ShortDefinition of the actual variable related to the statistic(s)
          Control0..1
          TypeReference(StudyGroup, ExposureGroup, ComparatorGroup, MetaanalysisStudyGroup, Group, EvidenceVariable)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. Evidence.variableDefinition:population.intended
          Definition

          Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

          ShortDefinition of the intended variable related to the Evidence
          Control0..1
          TypeReference(Group, Group, EvidenceVariable)
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          28. Evidence.variableDefinition:exposure
          Slice Nameexposure
          Definition

          Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

          ShortDescription, classification, and definition of a single variable
          Comments

          Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

          Control10..1*
          TypeBackboneElement
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
          30. Evidence.variableDefinition:exposure.modifierExtension
          Definition

          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 managable, 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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 32. Evidence.variableDefinition:exposure.variableRole
            Definition

            Classification of the role of the variable.

            Shortpopulation | exposure | outcome | covariate
            Control1..1
            BindingThe codes SHALL be taken from EvidenceVariableRolehttp://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5
            (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

            The role that the variable plays.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summarytrue
            Pattern Valueexposure
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. Evidence.variableDefinition:exposure.comparatorCategory
            Definition

            The reference value used for comparison.

            ShortThe reference value used for comparison
            Comments

            Value should match EvidenceVariable.category.name in the EvidenceVariable referenced in the observed or intended element.

            Control10..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. Evidence.variableDefinition:exposure.observed
            Definition

            Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

            ShortDefinition of the actual variable related to the statistic(s)
            Control0..1
            TypeReference(GroupAssignment, Group, EvidenceVariable)
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. Evidence.variableDefinition:exposure.intended
            Definition

            Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

            ShortDefinition of the intended variable related to the Evidence
            Control0..1
            TypeReference(VariableDefinition, Group, EvidenceVariable)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. Evidence.variableDefinition:outcome
            Slice Nameoutcome
            Definition

            Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

            ShortDescription, classification, and definition of a single variable
            Comments

            Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

            Control10..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
            42. Evidence.variableDefinition:outcome.modifierExtension
            Definition

            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 managable, 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).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            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.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 44. Evidence.variableDefinition:outcome.variableRole
              Definition

              Classification of the role of the variable.

              Shortpopulation | exposure | outcome | covariate
              Control1..1
              BindingThe codes SHALL be taken from EvidenceVariableRolehttp://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5
              (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

              The role that the variable plays.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Pattern Valueoutcome
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. Evidence.variableDefinition:outcome.comparatorCategory
              Definition

              The reference value used for comparison.

              ShortThe reference value used for comparison
              Comments

              Value should match EvidenceVariable.category.name in the EvidenceVariable referenced in the observed or intended element.

              Control0..01
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. Evidence.variableDefinition:outcome.observed
              Definition

              Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

              ShortDefinition of the actual variable related to the statistic(s)
              Control0..1
              TypeReference(VariableDefinition, Group, EvidenceVariable)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. Evidence.variableDefinition:outcome.intended
              Definition

              Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

              ShortDefinition of the intended variable related to the Evidence
              Control0..1
              TypeReference(EvidenceVariable, Group, EvidenceVariable)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

              Guidance on how to interpret the contents of this table can be foundhere

              0. Evidence
              2. Evidence.extension:publicationStatus
              Slice NamepublicationStatus
              Control0..1
              TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
              4. Evidence.relatesTo
              6. Evidence.relatesTo.extension:quotation
              Slice Namequotation
              Control0..1
              TypeExtension(RelatesToWithQuotation) (Extension Type: markdown)
              8. Evidence.relatesTo.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesToClassifier) (Extension Type: CodeableConcept)
              10. Evidence.variableDefinition
              Comments

              To report comparative evidence for a research question defined by Population, Intervention, Comparator, and Outcome (PICO), one would use three variableDefinition instances: the Population has variableRole of population, the Intervention and Comparator will be expressed as category values for a GroupAssignment EvidenceVariable with the variableRole of exposure, and the Outcome has variableRole of outcome. In some types of Comparative Evidence, where the groups being compared are not from the same Population (and thus not a PICO-style research question), the GroupAssignment EvidenceVariable may have the variableRole of exposure and express the populations being compared as categories, and a combination of these categories can be described in the variableDefinition with variableRole of population. This approach may be used for example to compare cats and dogs.

              Control3..?
              SlicingThis element introduces a set of slices on Evidence.variableDefinition. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ variableRole
              • 12. Evidence.variableDefinition:population
                Slice Namepopulation
                Control1..*
                14. Evidence.variableDefinition:population.variableRole
                Pattern Valuepopulation
                16. Evidence.variableDefinition:population.observed
                TypeReference(StudyGroup, ExposureGroup, ComparatorGroup, MetaanalysisStudyGroup)
                18. Evidence.variableDefinition:population.intended
                TypeReference(Group)
                20. Evidence.variableDefinition:exposure
                Slice Nameexposure
                Control1..1
                22. Evidence.variableDefinition:exposure.variableRole
                Pattern Valueexposure
                24. Evidence.variableDefinition:exposure.comparatorCategory
                Control1..?
                26. Evidence.variableDefinition:exposure.observed
                TypeReference(GroupAssignment)
                28. Evidence.variableDefinition:exposure.intended
                TypeReference(VariableDefinition)
                30. Evidence.variableDefinition:outcome
                Slice Nameoutcome
                Control1..*
                Must Supporttrue
                32. Evidence.variableDefinition:outcome.variableRole
                Pattern Valueoutcome
                34. Evidence.variableDefinition:outcome.comparatorCategory
                Control0..0
                36. Evidence.variableDefinition:outcome.observed
                TypeReference(VariableDefinition)
                38. Evidence.variableDefinition:outcome.intended
                TypeReference(EvidenceVariable)

                Guidance on how to interpret the contents of this table can be foundhere

                0. Evidence
                Definition

                The Evidence Resource provides a machine-interpretable expression of an evidence concept including the evidence variables (e.g., population, exposures/interventions, comparators, outcomes, measured variables, confounding variables), the statistics, and the certainty of this evidence.

                ShortSingle evidence bit
                Control0..*
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantscnl-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.exists() implies name.matches('^[A-Z]([A-Za-z0-9_]){1,254}$'))
                2. Evidence.id
                Definition

                The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                ShortLogical id of this artifact
                Comments

                Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resource id depends on the given use case.

                Control0..1
                Typeid
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                4. Evidence.meta
                Definition

                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.

                ShortMetadata about the resource
                Control0..1
                TypeMeta
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                6. Evidence.implicitRules
                Definition

                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. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the additionalImplicitRules extension.

                ShortA set of rules under which this content was created
                Comments

                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 its narrative along with other profiles, value sets, etc.

                Control0..1
                Typeuri
                Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                8. Evidence.language
                Definition

                The base language in which the resource is written.

                ShortLanguage of the resource content
                Comments

                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).

                Control0..1
                BindingThe codes SHALL be taken from AllLanguages
                (required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot5)

                IETF language tag for a human language

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                10. Evidence.text
                Definition

                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.

                ShortText summary of the resource, for human interpretation
                Comments

                Contained resources do not have a 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.

                Control0..1
                This element is affected by the following invariants: dom-6
                TypeNarrative
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Alternate Namesnarrative, html, xhtml, display
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. Evidence.contained
                Definition

                These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

                ShortContained, inline Resources
                Comments

                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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

                Control0..*
                This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
                TypeResource
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Alternate Namesinline resources, anonymous resources, contained resources
                14. Evidence.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, 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.

                ShortAdditional content defined by implementations
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Evidence.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 16. Evidence.extension:publicationStatus
                  Slice NamepublicationStatus
                  Definition

                  The status of the processing for making the artifact publicly available, not necessarily the same as artifact status (Resource.status).

                  ShortPublication status
                  Control0..1
                  TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  18. Evidence.modifierExtension
                  Definition

                  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 managable, 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).

                  ShortExtensions that cannot be ignored
                  Comments

                  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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Must Supportfalse
                  Summarytrue
                  Requirements

                  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.

                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Evidence.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 20. Evidence.url
                    Definition

                    An absolute URI that is used to identify this evidence when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which an authoritative instance of this summary is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the summary is stored on different servers.

                    ShortCanonical identifier for this evidence, represented as a globally unique URI
                    Comments

                    In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

                    Control0..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Allows the evidence to be referenced by a single globally unique identifier.

                    Invariantscnl-1: URL should not contain | or # - these characters make processing canonical references problematic (exists() implies matches('^[^|# ]+$'))
                    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    22. Evidence.identifier
                    Definition

                    A formal identifier that is used to identify this summary when it is represented in other formats, or referenced in a specification, model, design or an instance.

                    ShortAdditional identifier for the summary
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..*
                    TypeIdentifier
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Allows externally provided and/or usable business identifiers to be easily associated with the module.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    24. Evidence.version
                    Definition

                    The identifier that is used to identify this version of the summary when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the summary author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.

                    ShortBusiness version of this summary
                    Comments

                    The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

                    NoteThis is a business version Id, not a resource version Id (see discussion)
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    26. Evidence.versionAlgorithm[x]
                    Definition

                    Indicates the mechanism used to compare versions to determine which is more current.

                    ShortHow to compare versions
                    Comments

                    If set as a string, this is a FHIRPath expression that has two additional context variables passed in - %version1 and %version2 and will return a negative number if version1 is newer, a positive number if version2 is newer, and a 0 if the version ordering can't successfully be determined.

                    Control0..1
                    BindingUnless not suitable, these codes SHALL be taken from VersionAlgorithm
                    (extensible to http://hl7.org/fhir/ValueSet/version-algorithm|6.0.0-ballot5)
                    TypeChoice of: string, Coding
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    28. Evidence.name
                    Definition

                    A natural language name identifying the evidence. This name should be usable as an identifier for the module by machine processing applications such as code generation.

                    ShortName for this summary (machine friendly)
                    Comments

                    The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

                    Control0..1
                    This element is affected by the following invariants: cnl-0
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    30. Evidence.title
                    Definition

                    A short, descriptive, user-friendly title for the summary.

                    ShortName for this summary (human friendly)
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    32. Evidence.citeAs
                    Definition

                    Display of the suggested method of how to cite this Evidence.

                    ShortDisplay of how to cite this Evidence
                    Control0..1
                    Typemarkdown
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    34. Evidence.status
                    Definition

                    The status of this summary. Enables tracking the life-cycle of the content.

                    Shortdraft | active | retired | unknown
                    Comments

                    Allows filtering of summaries that are appropriate for use versus not.

                    See guidance around (not) making local changes to elements here.

                    Control0..1
                    BindingThe codes SHALL be taken from PublicationStatus
                    (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot5)

                    The lifecycle status of an artifact.

                    Typecode
                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired Evidence without due consideration
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Meaning if MissingValue is unknown.
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    36. Evidence.experimental
                    Definition

                    A Boolean value to indicate that this resource is authored for testing purposes (or education/evaluation/marketing) and no version of this resource will ever be intended for genuine usage.

                    ShortFor testing only - never for real usage
                    Comments

                    Allows filtering of artifacts that are appropriate for use versus not. Experimental resources might include example instances in implementation guides, instances created solely for testing purposes, etc. If experimental is 'true' for any version of a resource, it should be true for all versions of the resource. (If experimental changes, then it is being misused or a resource that was never intended for real-world use has unexpectedly changed its purpose.).

                    Experimental resources are not expected to be stable and may well have breaking changes without a corresponding change to the 'version' element.

                    Control0..1
                    Typeboolean
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Meaning if MissingIf absent, this resource is treated as though it is not experimental.
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    38. Evidence.date
                    Definition

                    The date (and optionally time) when the summary was last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the summary changes.

                    ShortDate last changed
                    Comments

                    The date is often not tracked until the resource is published, but may be present on draft content. Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the summary. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

                    See guidance around (not) making local changes to elements here.

                    Control0..1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Alternate NamesRevision Date
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    40. Evidence.approvalDate
                    Definition

                    The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

                    ShortWhen the summary was approved by publisher
                    Comments

                    The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

                    See guidance around (not) making local changes to elements here.

                    Control0..1
                    Typedate
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    42. Evidence.lastReviewDate
                    Definition

                    The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

                    ShortWhen the summary was last reviewed by the publisher
                    Comments

                    If specified, this date follows the original approval date.

                    See guidance around (not) making local changes to elements here.

                    Control0..1
                    Typedate
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Requirements

                    Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    44. Evidence.author
                    Definition

                    An individual, organization, or device primarily involved in the creation and maintenance of the content.

                    ShortWho authored the content
                    Comments

                    Extensions to ContactDetail include: contactReference, contactAddress, and contributionTime (see Clinical Reasoning Module).

                    Control0..*
                    TypeContactDetail
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    46. Evidence.publisher
                    Definition

                    The name of the organization or individual responsible for the release and ongoing maintenance of the evidence.

                    ShortName of the publisher/steward (organization or individual)
                    Comments

                    Usually an organization but may be an individual. The publisher (or steward) of the evidence is the organization or individual primarily responsible for the maintenance and upkeep of the evidence. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the evidence. This item SHOULD be populated unless the information is available from context.

                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Helps establish the "authority/credibility" of the evidence. May also allow for contact.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    48. Evidence.contact
                    Definition

                    Contact details to assist a user in finding and communicating with the publisher.

                    ShortContact details for the publisher
                    Comments

                    Extensions to ContactDetail include: contactReference, contactAddress, and contributionTime (see Clinical Reasoning Module).

                    See guidance around (not) making local changes to elements here.

                    Control0..*
                    TypeContactDetail
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    50. Evidence.recorder
                    Definition

                    Who entered the data for the evidence.

                    ShortWho entered the data for the evidence
                    Comments

                    The Evidence.recorder element is structured to support a name (with a string datatype) and contact point information for the recorder, and is not structured to support unique identifiers for the recorder. If detailed contributorship data is needed, then one can create a Citation Resource for the Evidence Resource.

                    Control0..*
                    TypeContactDetail
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    52. Evidence.editor
                    Definition

                    An individual, organization, or device primarily responsible for internal coherence of the content.

                    ShortWho edited the content
                    Comments

                    Extensions to ContactDetail include: contactReference, contactAddress, and contributionTime (see Clinical Reasoning Module).

                    Control0..*
                    TypeContactDetail
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    54. Evidence.reviewer
                    Definition

                    An individual, organization, or device primarily responsible for review of some aspect of the content.

                    ShortWho reviewed the content
                    Comments

                    Extensions to ContactDetail include: contactReference, contactAddress, and contributionTime (see Clinical Reasoning Module).

                    See guidance around (not) making local changes to elements here.

                    Control0..*
                    TypeContactDetail
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    56. Evidence.endorser
                    Definition

                    An individual, organization, or device responsible for officially endorsing the content for use in some setting.

                    ShortWho endorsed the content
                    Comments

                    Extensions to ContactDetail include: contactReference, contactAddress, and contributionTime (see Clinical Reasoning Module).

                    See guidance around (not) making local changes to elements here.

                    Control0..*
                    TypeContactDetail
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    58. Evidence.useContext
                    Definition

                    The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate evidence instances.

                    ShortThe context that the content is intended to support
                    Comments

                    When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

                    Control0..*
                    TypeUsageContext
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Assist in searching for appropriate content.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    60. Evidence.purpose
                    Definition

                    Explanation of why this Evidence is needed and why it has been designed as it has.

                    ShortWhy this Evidence is defined
                    Comments

                    This element does not describe the usage of the Evidence. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this Evidence.

                    Control0..1
                    Typemarkdown
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    62. Evidence.copyright
                    Definition

                    A copyright statement relating to the Evidence and/or its contents. Copyright statements are legal notices of intellectual property ownership and may include restrictions on the use and publishing of the Evidence.

                    ShortIntellectual property ownership, may include restrictions on use
                    Comments

                    The short copyright declaration (e.g. (c) '2015+ xyz organization') should be sent in the copyrightLabel element without the copyright prefix (i.e., do not include '(c)' or the symbol).

                    Control0..1
                    Typemarkdown
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Requirements

                    Consumers must be able to determine any legal restrictions on the use of the Evidence and/or its content.

                    Alternate NamesLicense, Restrictions
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    64. Evidence.copyrightLabel
                    Definition

                    A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are restricted. (e.g. 'All rights reserved', 'Some rights reserved').

                    ShortCopyright holder and year(s)
                    Comments

                    The copyright symbol and the '(c)' textual representation SHOULD NOT be included in this string. It will be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.

                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summaryfalse
                    Requirements

                    Defines the content expected to be rendered in all representations of the artifact.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    66. Evidence.relatesTo
                    Definition

                    Relationships that this Evidence has with other FHIR or non-FHIR resources that already exist.

                    ShortRelationships to other Resources
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                    68. Evidence.relatesTo.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    70. Evidence.relatesTo.extension
                    Definition

                    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 managable, 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.

                    ShortAdditional content defined by implementations
                    Comments

                    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.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Evidence.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 72. Evidence.relatesTo.extension:quotation
                      Slice Namequotation
                      Definition

                      Specification of a portion quoted from the related artifact.

                      ShortQuoted portion from related artifact
                      Control0..1
                      TypeExtension(RelatesToWithQuotation) (Extension Type: markdown)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      74. Evidence.relatesTo.extension:classifier
                      Slice Nameclassifier
                      Definition

                      A classifier of the target artifact in a relatesTo element.

                      ShortA classifier of the target artifact in a relatesTo element
                      Control0..1
                      TypeExtension(RelatesToClassifier) (Extension Type: CodeableConcept)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      76. Evidence.relatesTo.modifierExtension
                      Definition

                      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 managable, 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).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      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.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      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.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Evidence.relatesTo.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 78. Evidence.relatesTo.type
                        Definition

                        The type of relationship to the related artifact.

                        Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as | reprint | reprint-of | summarizes
                        Control1..1
                        BindingUnless not suitable, these codes SHALL be taken from Artifact Relationship Type
                        (extensible to http://terminology.hl7.org/ValueSet/artifact-relationship-type)

                        The type of relationship to the related artifact.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        80. Evidence.relatesTo.target[x]
                        Definition

                        The artifact that is related to this Evidence Resource.

                        ShortThe artifact that is related to this Evidence
                        Control1..1
                        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        82. Evidence.description
                        Definition

                        A natural language summary of the evidence.

                        ShortDescription of the particular summary
                        Comments

                        This description can be used to capture details such as comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the evidence as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the evidence is presumed to be the predominant language in the place the evidence was created).

                        Control0..1
                        Typemarkdown
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supportfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        84. Evidence.assertion
                        Definition

                        Declarative description of the Evidence, such as conclusion or bottom line statement.

                        ShortDeclarative description of the Evidence
                        Control0..1
                        Typemarkdown
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        86. Evidence.note
                        Definition

                        Footnotes and/or explanatory notes.

                        ShortFootnotes and/or explanatory notes
                        Control0..*
                        TypeAnnotation
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        88. Evidence.classification
                        Definition

                        The assignment to an organizing scheme, including the type of classification and one or more classifier values.

                        ShortThe assignment to an organizing scheme
                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                        90. Evidence.classification.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        92. Evidence.classification.extension
                        Definition

                        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 managable, 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.

                        ShortAdditional content defined by implementations
                        Comments

                        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.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Evidence.classification.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 94. Evidence.classification.modifierExtension
                          Definition

                          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 managable, 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).

                          ShortExtensions that cannot be ignored even if unrecognized
                          Comments

                          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.

                          Control0..*
                          TypeExtension
                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                          Summarytrue
                          Requirements

                          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.

                          Alternate Namesextensions, user content, modifiers
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          SlicingThis element introduces a set of slices on Evidence.classification.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 96. Evidence.classification.type
                            Definition

                            The kind of classifier (e.g. population, intervention, comparator, outcome).

                            ShortThe kind of classifier (e.g. population, intervention)
                            Control0..1
                            BindingFor example codes, see EvidenceClassifierTypeExample
                            (example to http://hl7.org/fhir/ValueSet/evidence-classifier-type-example|6.0.0-ballot5)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            98. Evidence.classification.classifier
                            Definition

                            The specific classification value.

                            ShortThe specific classification value
                            Control0..*
                            BindingFor example codes, see ConditionProblemDiagnosisCodes
                            (example to http://hl7.org/fhir/ValueSet/condition-code|6.0.0-ballot5)
                            TypeCodeableReference(Resource)
                            Is Modifierfalse
                            Must Supportfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            100. Evidence.variableDefinition
                            Definition

                            Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

                            ShortDescription, classification, and definition of a single variable
                            Comments

                            To report comparative evidence for a research question defined by Population, Intervention, Comparator, and Outcome (PICO), one would use three variableDefinition instances: the Population has variableRole of population, the Intervention and Comparator will be expressed as category values for a GroupAssignment EvidenceVariable with the variableRole of exposure, and the Outcome has variableRole of outcome. In some types of Comparative Evidence, where the groups being compared are not from the same Population (and thus not a PICO-style research question), the GroupAssignment EvidenceVariable may have the variableRole of exposure and express the populations being compared as categories, and a combination of these categories can be described in the variableDefinition with variableRole of population. This approach may be used for example to compare cats and dogs.

                            Control3..*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supportfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on Evidence.variableDefinition. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ variableRole
                            • 102. Evidence.variableDefinition.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              104. Evidence.variableDefinition.extension
                              Definition

                              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 managable, 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.

                              ShortAdditional content defined by implementations
                              Comments

                              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.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on Evidence.variableDefinition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 106. Evidence.variableDefinition.modifierExtension
                                Definition

                                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 managable, 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).

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

                                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.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summarytrue
                                Requirements

                                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.

                                Alternate Namesextensions, user content, modifiers
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 108. Evidence.variableDefinition.description
                                  Definition

                                  A text description or summary of the variable.

                                  ShortA text description or summary of the variable
                                  Control0..1
                                  Typemarkdown
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  110. Evidence.variableDefinition.note
                                  Definition

                                  Footnotes and/or explanatory notes.

                                  ShortFootnotes and/or explanatory notes
                                  Control0..*
                                  TypeAnnotation
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  112. Evidence.variableDefinition.variableRole
                                  Definition

                                  Classification of the role of the variable.

                                  Shortpopulation | exposure | outcome | covariate
                                  Control1..1
                                  BindingThe codes SHALL be taken from EvidenceVariableRole
                                  (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

                                  The role that the variable plays.

                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  114. Evidence.variableDefinition.roleSubtype
                                  Definition

                                  Sub-classification of the role of the variable.

                                  ShortSub-classification of the role of the variable
                                  Comments

                                  See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                  Control0..1
                                  BindingFor example codes, see EvidenceVariableRoleSubtype
                                  (example to http://terminology.hl7.org/ValueSet/variable-role-subtype)

                                  The sub-role that the variable plays.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  116. Evidence.variableDefinition.comparatorCategory
                                  Definition

                                  The reference value used for comparison.

                                  ShortThe reference value used for comparison
                                  Comments

                                  Value should match EvidenceVariable.category.name in the EvidenceVariable referenced in the observed or intended element.

                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  118. Evidence.variableDefinition.observed
                                  Definition

                                  Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

                                  ShortDefinition of the actual variable related to the statistic(s)
                                  Control0..1
                                  TypeReference(Group, EvidenceVariable)
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  120. Evidence.variableDefinition.intended
                                  Definition

                                  Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

                                  ShortDefinition of the intended variable related to the Evidence
                                  Control0..1
                                  TypeReference(Group, EvidenceVariable)
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  122. Evidence.variableDefinition.directnessMatch
                                  Definition

                                  Indication of quality of match between intended variable to actual variable.

                                  Shortlow | moderate | high | exact
                                  Comments

                                  See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                  Control0..1
                                  BindingFor example codes, see EvidenceDirectness
                                  (example to http://terminology.hl7.org/ValueSet/directness)

                                  The quality of how direct the match is.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  124. Evidence.variableDefinition:population
                                  Slice Namepopulation
                                  Definition

                                  Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

                                  ShortDescription, classification, and definition of a single variable
                                  Comments

                                  Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

                                  Control1..*
                                  TypeBackboneElement
                                  Is Modifierfalse
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                  126. Evidence.variableDefinition:population.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  128. Evidence.variableDefinition:population.extension
                                  Definition

                                  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 managable, 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.

                                  ShortAdditional content defined by implementations
                                  Comments

                                  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.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  SlicingThis element introduces a set of slices on Evidence.variableDefinition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 130. Evidence.variableDefinition:population.modifierExtension
                                    Definition

                                    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 managable, 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).

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

                                    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.

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

                                    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.

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 132. Evidence.variableDefinition:population.description
                                      Definition

                                      A text description or summary of the variable.

                                      ShortA text description or summary of the variable
                                      Control0..1
                                      Typemarkdown
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      134. Evidence.variableDefinition:population.note
                                      Definition

                                      Footnotes and/or explanatory notes.

                                      ShortFootnotes and/or explanatory notes
                                      Control0..*
                                      TypeAnnotation
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      136. Evidence.variableDefinition:population.variableRole
                                      Definition

                                      Classification of the role of the variable.

                                      Shortpopulation | exposure | outcome | covariate
                                      Control1..1
                                      BindingThe codes SHALL be taken from EvidenceVariableRole
                                      (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

                                      The role that the variable plays.

                                      Typecode
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supportfalse
                                      Summarytrue
                                      Pattern Valuepopulation
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      138. Evidence.variableDefinition:population.roleSubtype
                                      Definition

                                      Sub-classification of the role of the variable.

                                      ShortSub-classification of the role of the variable
                                      Comments

                                      See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                      Control0..1
                                      BindingFor example codes, see EvidenceVariableRoleSubtype
                                      (example to http://terminology.hl7.org/ValueSet/variable-role-subtype)

                                      The sub-role that the variable plays.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      140. Evidence.variableDefinition:population.comparatorCategory
                                      Definition

                                      The reference value used for comparison.

                                      ShortThe reference value used for comparison
                                      Comments

                                      Value should match EvidenceVariable.category.name in the EvidenceVariable referenced in the observed or intended element.

                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      142. Evidence.variableDefinition:population.observed
                                      Definition

                                      Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

                                      ShortDefinition of the actual variable related to the statistic(s)
                                      Control0..1
                                      TypeReference(StudyGroup, ExposureGroup, ComparatorGroup, MetaanalysisStudyGroup)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      144. Evidence.variableDefinition:population.intended
                                      Definition

                                      Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

                                      ShortDefinition of the intended variable related to the Evidence
                                      Control0..1
                                      TypeReference(Group)
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      146. Evidence.variableDefinition:population.directnessMatch
                                      Definition

                                      Indication of quality of match between intended variable to actual variable.

                                      Shortlow | moderate | high | exact
                                      Comments

                                      See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                      Control0..1
                                      BindingFor example codes, see EvidenceDirectness
                                      (example to http://terminology.hl7.org/ValueSet/directness)

                                      The quality of how direct the match is.

                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      148. Evidence.variableDefinition:exposure
                                      Slice Nameexposure
                                      Definition

                                      Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

                                      ShortDescription, classification, and definition of a single variable
                                      Comments

                                      Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

                                      Control1..1
                                      TypeBackboneElement
                                      Is Modifierfalse
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                      150. Evidence.variableDefinition:exposure.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      152. Evidence.variableDefinition:exposure.extension
                                      Definition

                                      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 managable, 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.

                                      ShortAdditional content defined by implementations
                                      Comments

                                      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.

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      SlicingThis element introduces a set of slices on Evidence.variableDefinition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 154. Evidence.variableDefinition:exposure.modifierExtension
                                        Definition

                                        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 managable, 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).

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

                                        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.

                                        Control0..*
                                        TypeExtension
                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summarytrue
                                        Requirements

                                        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.

                                        Alternate Namesextensions, user content, modifiers
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 156. Evidence.variableDefinition:exposure.description
                                          Definition

                                          A text description or summary of the variable.

                                          ShortA text description or summary of the variable
                                          Control0..1
                                          Typemarkdown
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          158. Evidence.variableDefinition:exposure.note
                                          Definition

                                          Footnotes and/or explanatory notes.

                                          ShortFootnotes and/or explanatory notes
                                          Control0..*
                                          TypeAnnotation
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          160. Evidence.variableDefinition:exposure.variableRole
                                          Definition

                                          Classification of the role of the variable.

                                          Shortpopulation | exposure | outcome | covariate
                                          Control1..1
                                          BindingThe codes SHALL be taken from EvidenceVariableRole
                                          (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

                                          The role that the variable plays.

                                          Typecode
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supportfalse
                                          Summarytrue
                                          Pattern Valueexposure
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          162. Evidence.variableDefinition:exposure.roleSubtype
                                          Definition

                                          Sub-classification of the role of the variable.

                                          ShortSub-classification of the role of the variable
                                          Comments

                                          See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                          Control0..1
                                          BindingFor example codes, see EvidenceVariableRoleSubtype
                                          (example to http://terminology.hl7.org/ValueSet/variable-role-subtype)

                                          The sub-role that the variable plays.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          164. Evidence.variableDefinition:exposure.comparatorCategory
                                          Definition

                                          The reference value used for comparison.

                                          ShortThe reference value used for comparison
                                          Comments

                                          Value should match EvidenceVariable.category.name in the EvidenceVariable referenced in the observed or intended element.

                                          Control1..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          166. Evidence.variableDefinition:exposure.observed
                                          Definition

                                          Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

                                          ShortDefinition of the actual variable related to the statistic(s)
                                          Control0..1
                                          TypeReference(GroupAssignment)
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          168. Evidence.variableDefinition:exposure.intended
                                          Definition

                                          Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

                                          ShortDefinition of the intended variable related to the Evidence
                                          Control0..1
                                          TypeReference(VariableDefinition)
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          170. Evidence.variableDefinition:exposure.directnessMatch
                                          Definition

                                          Indication of quality of match between intended variable to actual variable.

                                          Shortlow | moderate | high | exact
                                          Comments

                                          See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                          Control0..1
                                          BindingFor example codes, see EvidenceDirectness
                                          (example to http://terminology.hl7.org/ValueSet/directness)

                                          The quality of how direct the match is.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          172. Evidence.variableDefinition:outcome
                                          Slice Nameoutcome
                                          Definition

                                          Description, classification, and definition of a single variable. The collection of variables defines what the evidence is about.

                                          ShortDescription, classification, and definition of a single variable
                                          Comments

                                          Comparative evidence is often defined with a population variable, an exposure variable and an outcome variable, while non comparative evidence is often defined with a population variable and an outcome variable.

                                          Control1..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                          174. Evidence.variableDefinition:outcome.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          176. Evidence.variableDefinition:outcome.extension
                                          Definition

                                          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 managable, 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.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          SlicingThis element introduces a set of slices on Evidence.variableDefinition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 178. Evidence.variableDefinition:outcome.modifierExtension
                                            Definition

                                            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 managable, 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).

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

                                            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.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summarytrue
                                            Requirements

                                            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.

                                            Alternate Namesextensions, user content, modifiers
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on Evidence.variableDefinition.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 180. Evidence.variableDefinition:outcome.description
                                              Definition

                                              A text description or summary of the variable.

                                              ShortA text description or summary of the variable
                                              Control0..1
                                              Typemarkdown
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              182. Evidence.variableDefinition:outcome.note
                                              Definition

                                              Footnotes and/or explanatory notes.

                                              ShortFootnotes and/or explanatory notes
                                              Control0..*
                                              TypeAnnotation
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              184. Evidence.variableDefinition:outcome.variableRole
                                              Definition

                                              Classification of the role of the variable.

                                              Shortpopulation | exposure | outcome | covariate
                                              Control1..1
                                              BindingThe codes SHALL be taken from EvidenceVariableRole
                                              (required to http://hl7.org/fhir/ValueSet/variable-role|6.0.0-ballot5)

                                              The role that the variable plays.

                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summarytrue
                                              Pattern Valueoutcome
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              186. Evidence.variableDefinition:outcome.roleSubtype
                                              Definition

                                              Sub-classification of the role of the variable.

                                              ShortSub-classification of the role of the variable
                                              Comments

                                              See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                              Control0..1
                                              BindingFor example codes, see EvidenceVariableRoleSubtype
                                              (example to http://terminology.hl7.org/ValueSet/variable-role-subtype)

                                              The sub-role that the variable plays.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              188. Evidence.variableDefinition:outcome.comparatorCategory
                                              Definition

                                              The reference value used for comparison.

                                              ShortThe reference value used for comparison
                                              Comments

                                              Value should match EvidenceVariable.category.name in the EvidenceVariable referenced in the observed or intended element.

                                              Control0..0
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              190. Evidence.variableDefinition:outcome.observed
                                              Definition

                                              Definition of the actual variable related to the statistic(s), i.e., the population being the actual study sample or the measured variable (exposure, outcome, or covariate) being the actual observation that occurred or will occur in the study.

                                              ShortDefinition of the actual variable related to the statistic(s)
                                              Control0..1
                                              TypeReference(VariableDefinition)
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              192. Evidence.variableDefinition:outcome.intended
                                              Definition

                                              Definition of the intended variable related to the Evidence, i.e., the population, exposure, or outcome for which the statistical finding is being interpreted.

                                              ShortDefinition of the intended variable related to the Evidence
                                              Control0..1
                                              TypeReference(EvidenceVariable)
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              194. Evidence.variableDefinition:outcome.directnessMatch
                                              Definition

                                              Indication of quality of match between intended variable to actual variable.

                                              Shortlow | moderate | high | exact
                                              Comments

                                              See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                              Control0..1
                                              BindingFor example codes, see EvidenceDirectness
                                              (example to http://terminology.hl7.org/ValueSet/directness)

                                              The quality of how direct the match is.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              196. Evidence.synthesisType
                                              Definition

                                              The design of the synthesis (combination of studies) that produced this evidence. The design is described with any number of synthesis characteristics, such as type of meta-analysis.

                                              ShortThe design of the synthesis (combination of studies) that produced this evidence
                                              Comments

                                              See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                              Control0..*
                                              BindingFor example codes, see StatisticSynthesisType
                                              (example to http://terminology.hl7.org/ValueSet/synthesis-type)

                                              Types of combining results from a body of evidence (e.g. summary data meta-analysis).

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              198. Evidence.studyDesign
                                              Definition

                                              The design of the study that produced this evidence. The design is described with any number of study design characteristics.

                                              ShortThe design of the study that produced this evidence
                                              Comments

                                              See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                              Control0..*
                                              BindingUnless not suitable, these codes SHALL be taken from Study Design
                                              (extensible to http://terminology.hl7.org/ValueSet/study-design)

                                              This is a set of terms for study design characteristics.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              200. Evidence.statistic
                                              Definition

                                              Values and parameters for a single statistic.

                                              ShortValues and parameters for a single statistic
                                              Control0..*
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                              202. Evidence.statistic.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              204. Evidence.statistic.extension
                                              Definition

                                              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 managable, 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.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              SlicingThis element introduces a set of slices on Evidence.statistic.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 206. Evidence.statistic.modifierExtension
                                                Definition

                                                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 managable, 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).

                                                ShortExtensions that cannot be ignored even if unrecognized
                                                Comments

                                                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.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                Requirements

                                                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.

                                                Alternate Namesextensions, user content, modifiers
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                SlicingThis element introduces a set of slices on Evidence.statistic.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 208. Evidence.statistic.description
                                                  Definition

                                                  A natural language summary of the statistic.

                                                  ShortA natural language summary of the statistic
                                                  Control0..1
                                                  Typemarkdown
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  210. Evidence.statistic.note
                                                  Definition

                                                  Footnotes and/or explanatory notes.

                                                  ShortFootnotes and/or explanatory notes
                                                  Control0..*
                                                  TypeAnnotation
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  212. Evidence.statistic.statisticType
                                                  Definition

                                                  Type of statistic, e.g., relative risk. The statistic type is a classification that formally defines the relationship between the variables (noted in Evidence.variableDefinition) and the value specification (noted in Evidence.statistic.quantity).

                                                  ShortType of statistic, e.g., relative risk
                                                  Comments

                                                  See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from Statistic Type
                                                  (extensible to http://terminology.hl7.org/ValueSet/statistic-type)
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  214. Evidence.statistic.category
                                                  Definition

                                                  When the measured variable (outcome) is handled categorically, the category element is used to define which category the statistic is reporting.

                                                  ShortAssociated category for categorical variable
                                                  Comments

                                                  Simple strings can be used for descriptive purposes. Exact matching to EvidenceVariable.category.name for the Evidence.variableDefinition[variableRole=outcome].observed=Reference(EvidenceVariable) could facilitate validation within datasets.

                                                  Control0..1
                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  216. Evidence.statistic.quantity
                                                  Definition

                                                  Statistic value.

                                                  ShortStatistic value
                                                  Control0..1
                                                  TypeQuantity
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  218. Evidence.statistic.numberOfEvents
                                                  Definition

                                                  The number of events associated with the statistic, where the unit of analysis is different from numberAffected, sampleSize.knownDataCount and sampleSize.numberOfParticipants.

                                                  ShortThe number of events associated with the statistic
                                                  Comments

                                                  When the number of events is the statistic, use Evidence.statistic.quantity and set Evidence.statistic.type.coding.code=C25463 and Evidence.statistic.type.coding.display=Count. When the statistic is an Event Rate (where individual participants may have 2 or more events), use Evidence.statistic.numberOfEvents to record the total number of events rather than the number of participants with events.

                                                  Control0..1
                                                  TypeunsignedInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  220. Evidence.statistic.numberAffected
                                                  Definition

                                                  The number of participants affected where the unit of analysis is the same as sampleSize.knownDataCount and sampleSize.numberOfParticipants.

                                                  ShortThe number of participants affected
                                                  Comments

                                                  When the number affected is the statistic, use Evidence.statistic.quantity and set Evidence.statistic.type.coding.code=C25463 and Evidence.statistic.type.coding.display=Count. When the statistic is a Proportion, use Evidence.statistic.numberAffected and enter an integer as the value. When the statistic is an Event Rate (where individual participants may have 2 or more events), use Evidence.statistic.numberAffected to record the number of participants with events rather than the total number of events.

                                                  Control0..1
                                                  TypeunsignedInt
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  222. Evidence.statistic.sampleSize
                                                  Definition

                                                  Count of participants in the study sample.

                                                  ShortCount of participants in the study sample
                                                  Control0..1
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                                  224. Evidence.statistic.sampleSize.id
                                                  Definition

                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  This element is affected by the following invariants: ele-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  226. Evidence.statistic.sampleSize.extension
                                                  Definition

                                                  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 managable, 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.

                                                  ShortAdditional content defined by implementations
                                                  Comments

                                                  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.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  SlicingThis element introduces a set of slices on Evidence.statistic.sampleSize.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 228. Evidence.statistic.sampleSize.modifierExtension
                                                    Definition

                                                    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 managable, 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).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    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.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    SlicingThis element introduces a set of slices on Evidence.statistic.sampleSize.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 230. Evidence.statistic.sampleSize.description
                                                      Definition

                                                      Human-readable summary of study sample size. A human-readable string to clarify or explain concepts about the sample size.

                                                      ShortTextual description of sample size for statistic
                                                      Control0..1
                                                      Typemarkdown
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      232. Evidence.statistic.sampleSize.note
                                                      Definition

                                                      Footnote or explanatory note about the sample size.

                                                      ShortFootnote or explanatory note about the sample size
                                                      Control0..*
                                                      TypeAnnotation
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      234. Evidence.statistic.sampleSize.numberOfStudies
                                                      Definition

                                                      Count of studies or samples combined to become the total sample for the statistic.

                                                      ShortNumber of contributing studies
                                                      Control0..1
                                                      TypeunsignedInt
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      236. Evidence.statistic.sampleSize.numberOfParticipants
                                                      Definition

                                                      Count of members in the total sample for the statistic.

                                                      ShortTotal number of participants
                                                      Control0..1
                                                      TypeunsignedInt
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      238. Evidence.statistic.sampleSize.knownDataCount
                                                      Definition

                                                      Number of participants with known results for measured variables.

                                                      ShortNumber of participants with known results for measured variables
                                                      Control0..1
                                                      TypeunsignedInt
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      240. Evidence.statistic.sampleSize.numberAnalyzed
                                                      Definition

                                                      Total number of participants who were analayzed.

                                                      ShortTotal number of participants who were analayzed
                                                      Control0..1
                                                      TypeunsignedInt
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      242. Evidence.statistic.attributeEstimate
                                                      Definition

                                                      A statistical attribute of the statistic such as a measure of heterogeneity.

                                                      ShortAn attribute of the Statistic
                                                      Control0..*
                                                      TypeBackboneElement
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                                      244. Evidence.statistic.attributeEstimate.id
                                                      Definition

                                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      246. Evidence.statistic.attributeEstimate.extension
                                                      Definition

                                                      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 managable, 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.

                                                      ShortAdditional content defined by implementations
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      SlicingThis element introduces a set of slices on Evidence.statistic.attributeEstimate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 248. Evidence.statistic.attributeEstimate.modifierExtension
                                                        Definition

                                                        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 managable, 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).

                                                        ShortExtensions that cannot be ignored even if unrecognized
                                                        Comments

                                                        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.

                                                        Control0..*
                                                        TypeExtension
                                                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                        Summarytrue
                                                        Requirements

                                                        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.

                                                        Alternate Namesextensions, user content, modifiers
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        SlicingThis element introduces a set of slices on Evidence.statistic.attributeEstimate.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 250. Evidence.statistic.attributeEstimate.description
                                                          Definition

                                                          Human-readable summary of the estimate.

                                                          ShortTextual description of the attribute estimate
                                                          Control0..1
                                                          Typemarkdown
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          252. Evidence.statistic.attributeEstimate.note
                                                          Definition

                                                          Footnote or explanatory note about the estimate.

                                                          ShortFootnote or explanatory note about the estimate
                                                          Control0..*
                                                          TypeAnnotation
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          254. Evidence.statistic.attributeEstimate.type
                                                          Definition

                                                          The type of attribute estimate, e.g., confidence interval or p value.

                                                          ShortThe type of attribute estimate, e.g., confidence interval or p value
                                                          Comments

                                                          See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                                          Control0..1
                                                          BindingUnless not suitable, these codes SHALL be taken from StatisticAttributeEstimateType
                                                          (extensible to http://terminology.hl7.org/ValueSet/attribute-estimate-type)
                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          256. Evidence.statistic.attributeEstimate.quantity
                                                          Definition

                                                          The singular quantity of the attribute estimate, for attribute estimates represented as single values, which may include a unit of measure.

                                                          ShortThe singular quantity of the attribute estimate, for attribute estimates represented as single values, which may include a unit of measure
                                                          Comments

                                                          Often the p value

                                                          Control0..1
                                                          TypeQuantity
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          258. Evidence.statistic.attributeEstimate.level
                                                          Definition

                                                          Use 0.95 for a 95% confidence interval.

                                                          ShortLevel of confidence interval, e.g., 0.95 for 95% confidence interval
                                                          Control0..1
                                                          Typedecimal
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          260. Evidence.statistic.attributeEstimate.range
                                                          Definition

                                                          Lower and upper bound values of the attribute estimate.

                                                          ShortLower and upper bound values of the attribute estimate
                                                          Control0..1
                                                          TypeRange
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          262. Evidence.statistic.attributeEstimate.attributeEstimate
                                                          Definition

                                                          A nested attribute estimate; which is the attribute estimate of an attribute estimate.

                                                          ShortA nested attribute estimate; which is the attribute estimate of an attribute estimate
                                                          Comments

                                                          A nested attribute estimate; which is the attribute estimate of an attribute estimate

                                                          Control0..*
                                                          TypeSeettp://hl7.org/fhir/StructureDefinition/Evidence#Evidence.statistic.attributeEstimate
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          264. Evidence.statistic.modelCharacteristic
                                                          Definition

                                                          A component of the method to generate the statistic.

                                                          ShortAn aspect of the statistical model
                                                          Control0..*
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                                          266. Evidence.statistic.modelCharacteristic.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          This element is affected by the following invariants: ele-1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          268. Evidence.statistic.modelCharacteristic.extension
                                                          Definition

                                                          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 managable, 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.

                                                          ShortAdditional content defined by implementations
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          SlicingThis element introduces a set of slices on Evidence.statistic.modelCharacteristic.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 270. Evidence.statistic.modelCharacteristic.modifierExtension
                                                            Definition

                                                            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 managable, 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).

                                                            ShortExtensions that cannot be ignored even if unrecognized
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                            Summarytrue
                                                            Requirements

                                                            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.

                                                            Alternate Namesextensions, user content, modifiers
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            SlicingThis element introduces a set of slices on Evidence.statistic.modelCharacteristic.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 272. Evidence.statistic.modelCharacteristic.code
                                                              Definition

                                                              Description of a component of the method to generate the statistic.

                                                              ShortModel specification
                                                              Comments

                                                              See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                                              Control1..1
                                                              BindingFor example codes, see Statistic Model Code
                                                              (example to http://terminology.hl7.org/ValueSet/statistic-model-code)
                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              274. Evidence.statistic.modelCharacteristic.value[x]
                                                              Definition

                                                              Further specification of the value of the component of the method to generate the statistic.

                                                              ShortThe specific value (when paired with code)
                                                              Control0..1
                                                              TypeChoice of: Quantity(SimpleQuantity), Range, CodeableConcept
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              276. Evidence.statistic.modelCharacteristic.intended
                                                              Definition

                                                              The plan for analysis.

                                                              ShortThe plan for analysis
                                                              Control0..1
                                                              Typeboolean
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              278. Evidence.statistic.modelCharacteristic.applied
                                                              Definition

                                                              This model characteristic is part of the analysis that was applied, whether or not the analysis followed the plan.

                                                              ShortThis model characteristic is part of the analysis that was applied, whether or not the analysis followed the plan
                                                              Control0..1
                                                              Typeboolean
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Meaning if MissingTrue, unless modelCharacteristic.intended = true; if modelCharacteristic.intended = true and .applied is missing, then meaning Unknown.
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              280. Evidence.statistic.modelCharacteristic.variable
                                                              Definition

                                                              A variable adjusted for in the adjusted analysis.

                                                              ShortA variable adjusted for in the adjusted analysis
                                                              Control0..*
                                                              TypeBackboneElement
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                                              282. Evidence.statistic.modelCharacteristic.variable.id
                                                              Definition

                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              This element is affected by the following invariants: ele-1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              284. Evidence.statistic.modelCharacteristic.variable.extension
                                                              Definition

                                                              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 managable, 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.

                                                              ShortAdditional content defined by implementations
                                                              Comments

                                                              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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              SlicingThis element introduces a set of slices on Evidence.statistic.modelCharacteristic.variable.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 286. Evidence.statistic.modelCharacteristic.variable.modifierExtension
                                                                Definition

                                                                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 managable, 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).

                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                Summarytrue
                                                                Requirements

                                                                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.

                                                                Alternate Namesextensions, user content, modifiers
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                SlicingThis element introduces a set of slices on Evidence.statistic.modelCharacteristic.variable.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 288. Evidence.statistic.modelCharacteristic.variable.variableDefinition
                                                                  Definition

                                                                  Description and definition of the variable.

                                                                  ShortDescription and definition of the variable
                                                                  Control1..1
                                                                  TypeReference(Group, EvidenceVariable)
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  290. Evidence.statistic.modelCharacteristic.variable.handling
                                                                  Definition

                                                                  How the variable is classified for use in adjusted analysis.

                                                                  Shortboolean | continuous | dichotomous | ordinal | polychotomous | time-to-event | not-specified
                                                                  Comments

                                                                  See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                                                  Control0..1
                                                                  BindingUnless not suitable, these codes SHALL be taken from Evidence Variable Handling
                                                                  (extensible to http://terminology.hl7.org/ValueSet/evidence-variable-handling)
                                                                  TypeCodeableConcept
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  292. Evidence.statistic.modelCharacteristic.variable.valueCategory
                                                                  Definition

                                                                  Qualitative label used for grouping values of a dichotomous, ordinal, or polychotomous variable.

                                                                  ShortQualitative label used for grouping values of a dichotomous, ordinal, or polychotomous variable
                                                                  Control0..*
                                                                  TypeCodeableConcept
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  294. Evidence.statistic.modelCharacteristic.variable.valueQuantity
                                                                  Definition

                                                                  Quantitative label used for grouping values of a dichotomous, ordinal, or polychotomous variable.

                                                                  ShortQuantitative label used for grouping values of a dichotomous, ordinal, or polychotomous variable
                                                                  Control0..*
                                                                  TypeQuantity
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  296. Evidence.statistic.modelCharacteristic.variable.valueRange
                                                                  Definition

                                                                  Range of quantitative labels used for grouping values of a dichotomous, ordinal, or polychotomous variable.

                                                                  ShortRange of quantitative labels used for grouping values of a dichotomous, ordinal, or polychotomous variable
                                                                  Control0..*
                                                                  TypeRange
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  298. Evidence.statistic.modelCharacteristic.attribute
                                                                  Definition

                                                                  An attribute of the model characteristic.

                                                                  ShortAn attribute of the model characteristic
                                                                  Control0..*
                                                                  TypeSeettp://hl7.org/fhir/StructureDefinition/Evidence#Evidence.statistic.attributeEstimate
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  300. Evidence.certainty
                                                                  Definition

                                                                  Assessment of certainty, confidence in the estimates, or quality of the evidence.

                                                                  ShortCertainty or quality of the evidence
                                                                  Control0..*
                                                                  TypeBackboneElement
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                                                  302. Evidence.certainty.id
                                                                  Definition

                                                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                  ShortUnique id for inter-element referencing
                                                                  Control0..1
                                                                  This element is affected by the following invariants: ele-1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  304. Evidence.certainty.extension
                                                                  Definition

                                                                  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 managable, 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.

                                                                  ShortAdditional content defined by implementations
                                                                  Comments

                                                                  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.

                                                                  Control0..*
                                                                  TypeExtension
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Alternate Namesextensions, user content
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  SlicingThis element introduces a set of slices on Evidence.certainty.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 306. Evidence.certainty.modifierExtension
                                                                    Definition

                                                                    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 managable, 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).

                                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                                    Comments

                                                                    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.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                    Summarytrue
                                                                    Requirements

                                                                    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.

                                                                    Alternate Namesextensions, user content, modifiers
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    SlicingThis element introduces a set of slices on Evidence.certainty.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 308. Evidence.certainty.description
                                                                      Definition

                                                                      Textual description of certainty.

                                                                      ShortTextual description of certainty
                                                                      Control0..1
                                                                      Typemarkdown
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      310. Evidence.certainty.note
                                                                      Definition

                                                                      Footnotes and/or explanatory notes.

                                                                      ShortFootnotes and/or explanatory notes
                                                                      Control0..*
                                                                      TypeAnnotation
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      312. Evidence.certainty.type
                                                                      Definition

                                                                      Aspect of certainty being rated.

                                                                      ShortAspect of certainty being rated
                                                                      Comments

                                                                      See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                                                      Control0..1
                                                                      BindingFor example codes, see Evidence Certainty Type
                                                                      (example to http://terminology.hl7.org/ValueSet/certainty-type)

                                                                      The aspect of quality, confidence, or certainty.

                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      314. Evidence.certainty.rating
                                                                      Definition

                                                                      Assessment or judgement of the aspect.

                                                                      ShortAssessment or judgement of the aspect
                                                                      Comments

                                                                      See the Evidence Based Medicine on FHIR Implementation Guide (https://hl7.org/fhir/uv/ebm) for Extensible and Preferred value sets for evidence-related terminologies.

                                                                      Control0..1
                                                                      BindingFor example codes, see StatisticCertaintyRating
                                                                      (example to http://terminology.hl7.org/ValueSet/certainty-rating)

                                                                      The assessment of quality, confidence, or certainty.

                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      316. Evidence.certainty.rater
                                                                      Definition

                                                                      Individual or group who did the rating.

                                                                      ShortIndividual or group who did the rating
                                                                      Control0..*
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      318. Evidence.certainty.subcomponent
                                                                      Definition

                                                                      A domain or subdomain of certainty.

                                                                      ShortA domain or subdomain of certainty
                                                                      Control0..*
                                                                      TypeSeettp://hl7.org/fhir/StructureDefinition/Evidence#Evidence.certainty
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))