# De-Identified UDS Plus Clinical Result Observation - De-Identified, Anonymized FHIR Profiles Library v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **De-Identified UDS Plus Clinical Result Observation**

## Resource Profile: De-Identified UDS Plus Clinical Result Observation 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-clinical-result-observation | *Version*:0.1.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 1 | *Computable Name*:UDSPlusClinicalResultObservation |

 
The UDS+ profile is based on the Observation resource and establishes the core elements, extensions, vocabularies and value sets for representing clinical result observations for UDS+ program. 

All canonical (Official) URLs will be changed in the future and are not available currently on the web.

### Introduction

This profile is used to represent de-identified Observation for Clinical Result information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The [HHS De-identification Guidance](https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/coveredentities/De-identification/hhs_deid_guidance.pdf) is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes Observation for Lab Result.period.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Observation for Clinical Result resource text element may contain information such as the Observation for Clinical Result date, patient information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

**Ids and References**

The original Observation for Clinical Result resource id should not be included in the De-identified Observation for Clinical Result instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original Observation for Lab Result. All resource references to the Observation for Clinical Result submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

* subject
* encounter

**Date Truncation**

The Data Submitter has to truncate the following dates to only have a precision of year

* effective[x]

**Usages:**

* This Profile is not used by any profiles in this Implementation Guide

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.dapl|current/StructureDefinition/uds-plus-clinical-result-observation)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-uds-plus-clinical-result-observation.csv), [Excel](StructureDefinition-uds-plus-clinical-result-observation.xlsx), [Schematron](StructureDefinition-uds-plus-clinical-result-observation.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "uds-plus-clinical-result-observation",
  "meta" : {
    "versionId" : "12",
    "lastUpdated" : "2022-07-12T02:03:11.293+00:00",
    "source" : "#3LDMUQYYwafwTzqK"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 1,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/dapl/ImplementationGuide/dapl"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/dapl/ImplementationGuide/dapl"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-clinical-result-observation",
  "version" : "0.1.0",
  "name" : "UDSPlusClinicalResultObservation",
  "title" : "De-Identified UDS Plus Clinical Result Observation",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-03-16T10:54:28+00:00",
  "publisher" : "HL7 International / Cross Group Projects",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    }]
  }],
  "description" : "The UDS+ profile is based on the Observation resource and establishes the core elements, extensions, vocabularies and value sets for representing clinical result observations for UDS+ program.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "sct-concept",
    "uri" : "http://snomed.info/conceptdomain",
    "name" : "SNOMED CT Concept Domain Binding"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "sct-attr",
    "uri" : "http://snomed.org/attributebinding",
    "name" : "SNOMED CT Attribute Binding"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Observation",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Observation",
      "path" : "Observation",
      "short" : "De-Identified UDS Plus Clinical Result Observation",
      "definition" : "The UDS+ profile is based on the Observation resource and establishes the core elements, extensions, vocabularies and value sets for representing clinical result Observations for UDS+ program."
    },
    {
      "id" : "Observation.id",
      "path" : "Observation.id",
      "short" : "The de-identified Observation identifier created by the health center to send data to UDS+ Data Receiver",
      "definition" : "De-dentified Observation resource identifier.",
      "mustSupport" : true
    },
    {
      "id" : "Observation.text",
      "path" : "Observation.text",
      "short" : "Cannot include any text in the resource as part of the de-identified data.",
      "min" : 0,
      "max" : "0",
      "mustSupport" : false
    },
    {
      "id" : "Observation.contained",
      "path" : "Observation.contained",
      "short" : "Cannot include any contained resources in the resource as part of the de-identified data.",
      "min" : 0,
      "max" : "0",
      "mustSupport" : false
    },
    {
      "id" : "Observation.status",
      "path" : "Observation.status",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Observation.category",
      "path" : "Observation.category",
      "min" : 1,
      "max" : "*",
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "The set of codes indicating the category of the observation",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-clinical-result-observation-category"
      }
    },
    {
      "id" : "Observation.code",
      "path" : "Observation.code",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "The set of codes indicating the Observations",
        "valueSet" : "http://hl7.org/fhir/ValueSet/observation-codes"
      }
    },
    {
      "id" : "Observation.subject",
      "path" : "Observation.subject",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/uds-plus/StructureDefinition/de-identified-uds-plus-patient"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.subject.display",
      "path" : "Observation.subject.display",
      "min" : 0,
      "max" : "0",
      "mustSupport" : false
    },
    {
      "id" : "Observation.encounter",
      "path" : "Observation.encounter",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-encounter"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.encounter.display",
      "path" : "Observation.encounter.display",
      "min" : 0,
      "max" : "0",
      "mustSupport" : false
    },
    {
      "id" : "Observation.effective[x]",
      "path" : "Observation.effective[x]",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Observation.issued",
      "path" : "Observation.issued",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Observation.performer",
      "path" : "Observation.performer",
      "min" : 0,
      "max" : "*",
      "mustSupport" : true
    },
    {
      "id" : "Observation.value[x]",
      "path" : "Observation.value[x]",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Observation.bodySite",
      "path" : "Observation.bodySite",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Observation.component",
      "path" : "Observation.component",
      "min" : 0,
      "max" : "*",
      "mustSupport" : true
    },
    {
      "id" : "Observation.component.code",
      "path" : "Observation.component.code",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "description" : "The set of codes indicating the Observations",
        "valueSet" : "http://hl7.org/fhir/ValueSet/observation-codes"
      }
    },
    {
      "id" : "Observation.component.value[x]",
      "path" : "Observation.component.value[x]",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    }]
  }
}

```
