Colorado BHA FHIR Implementation Guide
0.1.0 - ci-build Unknown region code '840'

Colorado BHA FHIR Implementation Guide, published by Colorado Behavioral Health Administration. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RatioPBC/bha-test-ig/ and changes regularly. See the Directory of published versions

## Implementation Guidance

BHA aims to leverage data interoperability capabilities already available in certified EHRs, in order to reduce the overall effort required for implementations of this IG. In cases where federal regulatory requirements for data exchange via FHIR are not sufficient for BHA reporting, this IG has identified FHIR resources and data elements that will effectively capture the required information and that we believe will have long-term value to Colorado providers and to technology implementers for this and other core healthcare use cases.

Specifically, the profiles in this IG are based on US Core STU6 where possible. A notable exception is the BHA Service profile, which is based on the FHIR R4 EpisodeOfCare resource.

### Relationship to the BHA UDM

The BHA Unified Data Model (UDM) specifies the full data requirements for BHA reporting. This IG does not cover the entirety of the UDM. Instead, the specification provided here reflects the information that must be captured and transmitted from provider sites to Behavior Health Administrative Service Organizations (BHASOs).

#### UDM to FHIR Mapping

UDM File | UDM Field Name | FHIR Path | FHIR Profile or Resource
--- | --- | --- | ---
Client | Effective Date | Provenance.recorded | US Core Provenance
Client | Colorado PEAK State ID / Universal ID | QuestionnaireResponse | US Core QuestionnaireResponse
Client | Trails Identifier | QuestionnaireResponse | US Core QuestionnaireResponse
Client | CCAR Client Identifier | QuestionnaireResponse | US Core QuestionnaireResponse
Client | DACODS Client Identifier | QuestionnaireResponse | US Core QuestionnaireResponse
Client | DOB | Patient.birthDate | US Core Patient
Client | Last Name | Patient.name.family | US Core Patient
Client | First Name | Patient.name.given | US Core Patient
Client | Middle Name/Initial | Patient.name.given | US Core Patient
Client | Name Suffix | Patient.name.suffix | US Core Patient
Client | Social Security Number | Patient.identifier | US Core Patient
Client | County of Residence | Patient.address.district | Colorado BHA Client Profile
Client | Zip Code of Residence | Patient.address.postalCode | US Core Patient
Client | Race Codes | Patient.extension:race | US Core Patient
Client | Ethnicity | Patient.extension:ethnicity | US Core Patient
Client | Household Language | Patient.communication.language | US Core Patient
Client | Sex at Birth | Patient.extension:birthsex | US Core Patient
Client | Gender Identity | Patient.extension:gender | Colorado BHA Client Profile
Client | Sexual Orientation | Observation | US Core Observation Sexual Orientation
Client | Child Welfare Involvement | QuestionnaireResponse | US Core QuestionnaireResponse
Client | Disability Code(s) | QuestionnaireResponse | US Core QuestionnaireResponse
Client | Veteran Status | Patient.extension:military-service-veteran-status | Colorado BHA Client Profile
Client | Last known address line 1 | Patient.address.line | US Core Patient
Client | Last known address line 2 | Patient.address.line | US Core Patient
Client | Last known city | Patient.address.city | US Core Patient
Admission | Effective Date | Provenance.recorded | US Core Provenance
Admission | Provider Location NPI | Organization.identifer:NPI | US Core Organization
Admission | Admission Date | Encounter.period.start | CO BHA Encounter
Admission | Service Identifier | EpisodeOfCare.type | CO BHA Episode Profile
Admission | Date of First Contact | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Date of First Appointment Offered | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Medication Assisted Opioid Therapy | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Referral Source | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Arrests in Past 30 Days | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Employment Status | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Marital Status | Patient.maritalStatus | US Core Patient
Admission | Living Situation | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Monthly Income | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Primary Source of income/support for client (or for client's parent if client >18 years of age) | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Pregnancy Status | Observation | US Core Observation Pregnancy Status
Admission | Within 1 Year Postpartum Status | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Enrollment in Special Connections | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Enrollment in ACT? | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Enrollment in Ascent (FEP)? | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Number of Dependent Children | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Self Help Attendance (Last 30 days at admission)/ Peer Support Attendance | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Substance Use Prior Treatment (Total Lifetime admissions) | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Psychiatric Hospital Admission (Last 30 days) | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Legal Status | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Involuntary Reason | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Criminal Justice Involvement | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Education Level | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | School Attendance Status (in the previous 3 months) | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Visit to Psychiatric ER in last 6 months | QuestionnaireResponse | US Core QuestionnaireResponse
Admission | Communication Accomodations | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Effective Date | Provenance.recorded | US Core Provenance
Discharge | Date of Last Contact | Encounter.period | CO BHA Encounter
Discharge | Discharge Date | EpisodeOfCare.period.end | CO BHA Episode Profile
Discharge | Discharge Type / Status | EpisodeOfCare.status | CO BHA Episode Profile
Discharge | End of Treatment Reason | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Arrests in Past 30 Days | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Employment Status | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Living Situation | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Self Help Attendance/ Peer Support Attendance (Last 30 days at discharge) | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Education Level | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | School Attendance Status (in the previous 3 months) | QuestionnaireResponse | US Core QuestionnaireResponse
Discharge | Legal Status | QuestionnaireResponse | US Core QuestionnaireResponse
Diagnosis | Effective Date | Provenance.recorded | US Core Provenance
Diagnosis | MH Diagnosis Identifier 1 | EpisodeOfCare.diagnosis + EpisodeOfCare.diagnosis.role OR EpisodeOfCare.diagnosis + Condition.code + Condition.extension[diagnosisType] | CO BHA Episode Profile
Diagnosis | MH Diagnosis Identifier 2 | EpisodeOfCare.diagnosis + EpisodeOfCare.diagnosis.role OR EpisodeOfCare.diagnosis + Condition.code + Condition.extension[diagnosisType] | CO BHA Episode Profile
Diagnosis | MH Diagnosis Identifier 3 | EpisodeOfCare.diagnosis + EpisodeOfCare.diagnosis.role OR EpisodeOfCare.diagnosis + Condition.code + Condition.extension[diagnosisType] | CO BHA Episode Profile
Diagnosis | SUD Diagnosis Identifier | EpisodeOfCare.diagnosis + EpisodeOfCare.diagnosis.role OR EpisodeOfCare.diagnosis + Condition.code + Condition.extension[diagnosisType] | CO BHA Episode Profile
Diagnosis | SMI/SED Status | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Effective Date | Provenance.recorded | US Core Provenance
Substance Use Disorder | ASAM Level of Care | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Primary Substance Use | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Times Used Primary Substance in Last 30 Days | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Route of Use of Primary Substances | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Age of First Use of Primary Substances | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Secondary Substance Use | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Times Used Secondary Substance in Last 30 Days | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Route of Use of Secondary Substances | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Age of First Use of Secondary Substances | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Tertiary Substance Use | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Times Used Tertiary Substance in Last 30 Days | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Route of Use of Tertiary Substances | QuestionnaireResponse | US Core QuestionnaireResponse
Substance Use Disorder | Age of First Use of Tertiary Substances | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Effective Date | Provenance.recorded | US Core Provenance
SC Pregnancy/PostPartum | Evaluation Date | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Pregnancy/Postpartum Status | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Pregnancy/Postpartum Care Status | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Access to other drug/alcohol treatment | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Family/Social Support | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Family substance use disorder history | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Family substance use disorder current | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Drug using partner | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | HIV Risk | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Home Stability and Safety | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Personal Safety | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Prior Criminal Record | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Mental Health History | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Prior alcohol/drug treatment | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Children Living in home with you | QuestionnaireResponse | US Core QuestionnaireResponse
SC Pregnancy/PostPartum | Children Ages living in home with you | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Effective Date | Provenance.recorded | US Core Provenance
SC Baby | Live Birth | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby Date of Birth | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby Weight Pounds | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby Weight Ounces | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby Last Name | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby First Name | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby Middle Name or Initial | QuestionnaireResponse | US Core QuestionnaireResponse
SC Baby | Baby Sex at Birth | QuestionnaireResponse | US Core QuestionnaireResponse

#### CCAR and DACODS

The UDM incorporates elements of the CCAR and DACODS user manuals, and they may provide additional context for the information being gathered and transmitted to BHA. Those user manuals are publicly available at the following sites:

- 2025 CCAR User Manual
- Colorado Client Assessment Record (CCAR) resource page
- 2025 DACODS User Manual
- CO BHA Treatment Management System (TMS) resource page

### Key US Core Profiles

Certain US Core profiles are necessary for capturing the information needed for BHA reporting, without any additional constraint or modification. Those profiles therefore do not have corresponding BHA profiles in this IG, but implementers will need to be aware of them in order to ensure the full set of data is transmitted.

The US Core profiles that are used for BHA reporting without further constraint are:

- US Core Condition Encounter Diagnosis Profile
- US Core Observation Pregnancy Status Profile
- US Core Observation Sexual Orientation Profile
- US Core Provenance Profile
- US Core QuestionnaireResponse Profile

#### Profile-specific Guidance

In some cases, the BHA implementation guide leverages US Core profiles but has additional data requirements:

- US Core Provenance shall also be supported for the BHA Episode Profile.
- US Core Observation Sexual Orientation shall be supported and populated for all BHA Clients.

See the examples listed on the Artifacts page for instances of how those profiles are used.