QICore Patient - QI-Core Implementation Guide v7.0.0

QI-Core Implementation Guide
7.0.0 - STU7 United States of America flag

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

Resource Profile: QICore Patient

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient				Version: 7.0.0
Active as of 2018-08-22				Computable Name: QICorePatient

Profile of Patient for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

name: A name associated with the patient
identifier: An identifier for this patient
gender: male | female | other | unknown

QI Elements:

deceased[x]: (QI) Indicates if the individual is deceased or not
extension(race): (QI) US Core Race Extension
extension(tribalAffiliation): (QI) Tribal Affiliation Extension
birthDate: (QI) The date of birth for the individual
extension(ethnicity): (QI) US Core ethnicity Extension
address: (QI) An address for the individual
communication: (QI) A language which may be used to communicate with the patient about his or her health
extension(genderIdentity): (QI) The individual's gender identity
telecom: (QI) A contact detail for the individual
extension(sex): (QI) Sex Extension

NOTE TO BALLOT REVIEWERS:

US Core 7.0, and thus QI-Core 7.0, has a new approach to USCDI requirements.

As noted in the US Core 7.0 Must Support section, US Core 7.0 no longer highlights mandatory (cardinality 1..* or 1..1) and Must Support elements with a (USCDI) indicator as such items must be supported for interoperability.
Those USCDI elements that are not mandatory or Must Support now include an indicator (ADDITIONAL USCDI) in US Core. QI-Core 7.0 does not reference USCDI elements; rather, users should access US Core 7.0 to understand its implementation of USCDI version 4.

We invite comments about the approach and suggestions for other options that would also avoid unnecessary noise or reading load to the QI-Core profile representation.
Further, QI-Core 7.0 does not discuss USCDI+Quality because at the time of ballot preparation, no published version of USCDI+Quality is available. We seek reviewer advice regarding how QI-Core might address future USCDI+Quality.

Usage

See the patterns page for implementation and usage patterns.

Examples

Basic Patient Example

65+ Female Patient Example

Infant Patient Example

Usage:

Formal Views of Profile Content

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

Name	Flags	Card.	Type	Description & Constraints
Patient		0..*	USCorePatientProfile	Information about an individual or animal receiving health care services dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:race	C	0..1	(Complex)	(QI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both us-core-23: If "ASKU" or "UNK" are present, then no other OMB race categories can be present.
extension:ethnicity		0..1	(Complex)	(QI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:tribalAffiliation		0..*	(Complex)	(QI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:birthsex		0..1	code	Birth Sex Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex Binding: Birth Sex (required): Code for sex assigned at birth ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:sex		0..1	code	(QI) Sex Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex Binding: Sex (extensible): Concepts used for general documentation of sex representation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:genderIdentity		0..*	CodeableConcept	(QI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	1..*	Identifier	An identifier for this patient ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual \| official \| temp \| secondary \| old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique within the system. ele-1: All FHIR elements must have a @value or children Example General: 123456
active	?!Σ	0..1	boolean	Whether this patient's record is in active use ele-1: All FHIR elements must have a @value or children
name	SΣC	1..*	HumanName	A name associated with the patient ele-1: All FHIR elements must have a @value or children us-core-6: At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present.
use	?!Σ	0..1	code	(QI) usual \| official \| temp \| nickname \| anonymous \| old \| maiden Binding: NameUse (required): The use of a human name. ele-1: All FHIR elements must have a @value or children
family	SΣC	0..1	string	Family name (often called 'Surname') ele-1: All FHIR elements must have a @value or children
given	SΣC	0..*	string	Given names (not always 'first'). Includes middle names ele-1: All FHIR elements must have a @value or children This repeating element order: Given Names appear in the correct order for presenting the name
suffix	Σ	0..*	string	(QI) Parts that come after the name ele-1: All FHIR elements must have a @value or children This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	(QI) Time period when name was/is in use ele-1: All FHIR elements must have a @value or children
telecom	Σ	0..*	ContactPoint	(QI) A contact detail for the individual ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:telecom-preferred		0..1	boolean	Preferred URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
system	SΣC	1..1	code	phone \| fax \| email \| pager \| url \| sms \| other Binding: ContactPointSystem (required): Telecommunications form for contact point. ele-1: All FHIR elements must have a @value or children
value	SΣ	1..1	string	The actual contact point details ele-1: All FHIR elements must have a @value or children
use	?!SΣ	0..1	code	home \| work \| temp \| old \| mobile - purpose of this contact point Binding: ContactPointUse (required) ele-1: All FHIR elements must have a @value or children
gender	SΣ	1..1	code	male \| female \| other \| unknown Binding: AdministrativeGender (required) ele-1: All FHIR elements must have a @value or children
birthDate	SΣ	0..1	date	(QI) The date of birth for the individual ele-1: All FHIR elements must have a @value or children
deceased[x]	?!Σ	0..1		(QI) Indicates if the individual is deceased or not ele-1: All FHIR elements must have a @value or children
deceasedBoolean			boolean
deceasedDateTime			dateTime
address	SΣ	0..*	Address	(QI) An address for the individual ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:address-preferred		0..1	boolean	Preferred URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!Σ	0..1	code	(QI) home \| work \| temp \| old \| billing - purpose of this address Binding: AddressUse (required): The use of an address. ele-1: All FHIR elements must have a @value or children Example General: home
line	SΣ	0..*	string	Street name, number, direction & P.O. Box etc. ele-1: All FHIR elements must have a @value or children This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street Example General: 49 MEADOW ST
city	SΣ	0..1	string	Name of city, town etc. ele-1: All FHIR elements must have a @value or children Example General: Erewhon Example General: EVERYTOWN
state	SΣ	0..1	string	Sub-unit of country (abbreviations ok) Binding: USPS Two Letter Alphabetic Codes (extensible): Two Letter USPS alphabetic codes. ele-1: All FHIR elements must have a @value or children Example General: OK
postalCode	SΣ	0..1	string	US Zip Codes ele-1: All FHIR elements must have a @value or children Example General: 9132 Example General: 74047
period	Σ	0..1	Period	(QI) Time period when address was/is in use ele-1: All FHIR elements must have a @value or children Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication		0..*	BackboneElement	(QI) A language which may be used to communicate with the patient about his or her health ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
language	S	1..1	CodeableConcept	The language which can be used to communicate with the patient about his or her health Binding: Language codes with language and optionally a region modifier (extensible) ele-1: All FHIR elements must have a @value or children
link	?!Σ	0..*	BackboneElement	Link to another patient resource that concerns the same actual person ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
other	Σ	1..1	Reference(QICore Patient)	The other patient or related person resource that the link refers to ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	code	replaced-by \| replaces \| refer \| seealso Binding: LinkType (required): The type of link between this patient resource and another patient resource. ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Patient.identifier.use	required	IdentifierUse `http://hl7.org/fhir/ValueSet/identifier-use\|4.0.1` from the FHIR Standard
Patient.name.use	required	NameUse `http://hl7.org/fhir/ValueSet/name-use\|4.0.1` from the FHIR Standard
Patient.telecom.system	required	ContactPointSystem `http://hl7.org/fhir/ValueSet/contact-point-system` from the FHIR Standard
Patient.telecom.use	required	ContactPointUse `http://hl7.org/fhir/ValueSet/contact-point-use` from the FHIR Standard
Patient.gender	required	AdministrativeGender `http://hl7.org/fhir/ValueSet/administrative-gender` from the FHIR Standard
Patient.address.use	required	AddressUse `http://hl7.org/fhir/ValueSet/address-use\|4.0.1` from the FHIR Standard
Patient.address.state	extensible	UspsTwoLetterAlphabeticCodes (a valid code from `https://www.usps.com/`) `http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state`
Patient.communication.language	extensible	LanguageCodesWithLanguageAndOptionallyARegionModifier `http://hl7.org/fhir/us/core/ValueSet/simple-language`
Patient.link.type	required	LinkType `http://hl7.org/fhir/ValueSet/link-type\|4.0.1` from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Patient	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Patient	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Patient	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Patient	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Patient	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-6	error	Patient.name	At least name.given and/or name.family are present or, if neither is available, the Data Absent Reason Extension is present. : (family.exists() or given.exists()) xor extension.where(url='http://hl7.org/fhir/StructureDefinition/data-absent-reason').exists()
us-core-23	error	Patient.extension:race	If "ASKU" or "UNK" are present, then no other OMB race categories can be present. : extension.where(url = 'ombCategory').value.where(code in 'ASKU'\|'UNK').exists() implies extension.where(url = 'ombCategory').count() = 1

This structure is derived from USCorePatientProfile

Name	Flags	Card.	Type	Description & Constraints
Patient			USCorePatientProfile
Slices for extension				Content/Rules for all slices
extension:race		0..1	(Complex)	(QI) US Core Race Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
extension:ethnicity		0..1	(Complex)	(QI) US Core ethnicity Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity
extension:tribalAffiliation		0..*	(Complex)	(QI) Tribal Affiliation Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation
extension:sex		0..1	code	(QI) Sex Extension URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex Binding: Sex (extensible): Concepts used for general documentation of sex representation
extension:genderIdentity		0..*	CodeableConcept	(QI) The individual's gender identity URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity Binding: Gender Identity (extensible)
name		1..*	HumanName	A name associated with the patient
use	?!Σ	0..1	code	(QI) usual \| official \| temp \| nickname \| anonymous \| old \| maiden Binding: NameUse (required): The use of a human name.
suffix	Σ	0..*	string	(QI) Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name
period	Σ	0..1	Period	(QI) Time period when name was/is in use
telecom		0..*	ContactPoint	(QI) A contact detail for the individual
Slices for extension				Content/Rules for all slices
extension:telecom-preferred		0..1	boolean	Preferred URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred
birthDate		0..1	date	(QI) The date of birth for the individual
deceased[x]		0..1	boolean, dateTime	(QI) Indicates if the individual is deceased or not
address		0..*	Address	(QI) An address for the individual
Slices for extension				Content/Rules for all slices
extension:address-preferred		0..1	boolean	Preferred URL: http://hl7.org/fhir/StructureDefinition/iso21090-preferred
use	?!Σ	0..1	code	(QI) home \| work \| temp \| old \| billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
period	Σ	0..1	Period	(QI) Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
communication		0..*	BackboneElement	(QI) A language which may be used to communicate with the patient about his or her health
link		0..*	BackboneElement	Link to another patient resource that concerns the same actual person
other		1..1	Reference(QICore Patient)	The other patient or related person resource that the link refers to
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Patient.name.use	required	NameUse `http://hl7.org/fhir/ValueSet/name-use\|4.0.1` from the FHIR Standard
Patient.address.use	required	AddressUse `http://hl7.org/fhir/ValueSet/address-use\|4.0.1` from the FHIR Standard