MyHealtheVet PHR FHIR API
0.3.9-current - ci-build United States of America flag

MyHealtheVet PHR FHIR API, published by VA Digital Services. This guide is not an authorized publication; it is the continuous build for version 0.3.9-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/department-of-veterans-affairs/mhv-fhir-phr-mapping/ and changes regularly. See the Directory of published versions

Resource Profile: VA MHV PHR problems

Official URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.condition Version: 0.3.9-current
Standards status: Trial-use Maturity Level: 4 Computable Name: MHVcondition

A profile on the Condition resource for MHV PHR exposing Problems using FHIR API.

  • based on US-Core Condition Resource profile
  • subject is a reference to this patient
  • identifier will hold the record identifier from Vista
  • a clinicalStatus of active inactive
  • verificationStatus only confirmed unconfirmed entered-in-error
  • category will be problem-list-item
  • code is the condition, problem or diagnosis
    • code.text will be the problem/condition
    • code.coding may be populated with an ICD-9 code
    • do not have any other codes available
  • recorder the responsible provider/observer
  • note may have notes
  • recordedDate indicate date recorded on Vista
  • onsetDateTime may hold the onsetDate
  • abatementDateTime may hold the abatement date
  • recorder.extension[location] may have hospital location / facility
  • no other elements are populated

Should search for entries that do not have verificationStatus=entered-in-error

GET {path}/Condition?patient={patient}&verification-status:not=entered-in-error

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreConditionProblemsHealthConcernsProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition 0..* USCoreConditionProblemsHealthConcernsProfile Detailed information about conditions, problems or diagnoses
... Slices for identifier 1..* Identifier External Ids for this condition
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..* Identifier External Ids for this condition
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `ProblemTO` | `.` | {ProblemTO.id}
... clinicalStatus 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Binding: Subset of condition clinical status (required)
... verificationStatus 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: Subset of condition verification status (required)
... category 1..* CodeableConcept category codes
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/condition-category
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: problem-list-item
... severity 0..0
... code
.... coding S 1..1 Coding Code defined by a terminology system
.... text S 1..1 string Plain text representation of the concept
... bodySite 0..0
... subject 1..1 Reference(US Core Patient Profile) Who has the condition?
... encounter 0..0
... onset[x] 0..1 dateTime Estimated or actual date, date-time, or age
... abatement[x] 0..1 dateTime When in resolution/remission
... recordedDate 0..1 dateTime Date record was first recorded
... recorder S 0..1 Reference(Practitioner) {c} Who recorded the condition
.... Slices for extension Content/Rules for all slices
..... location 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... value[x] 1..1 Reference(Location) {c} Value of extension
... asserter 0..0
... stage 0..0
... evidence 0..0
... note S 0..* Annotation Additional information about the Condition

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Condition.clinicalStatusrequiredConditionClinicalStatusVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionClinicalStatusVS
from this IG
Condition.verificationStatusrequiredConditionVerificationVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionVerificationVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorCondition.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition C 0..* USCoreConditionProblemsHealthConcernsProfile Detailed information about conditions, problems or diagnoses
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... assertedDate S 0..1 dateTime Date the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External Ids for this condition
Slice: Unordered, Open by pattern:use
.... identifier:TOid Σ 1..* Identifier External Ids for this condition
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ProblemTO` | `.` | {ProblemTO.id}
Example General: 123456
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Binding: Subset of condition clinical status (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: Subset of condition verification status (required)
... Slices for category S 1..* CodeableConcept category codes
Slice: Unordered, Open by pattern:$this
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/condition-category
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: problem-list-item
.... category:us-core S 1..* CodeableConcept problem-list-item | health-concern
Binding: US Core Problem or Health Concern (required)
.... category:sdoh S 0..1 CodeableConcept problem-list-item | encounter-diagnosis
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-tags
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: sdoh
... code SΣ 1..1 CodeableConcept Identification of the condition, problem or diagnosis
Binding: US Core Condition Codes (extensible): Valueset to describe the actual problem experienced by the patient

.... coding SΣ 1..1 Coding Code defined by a terminology system
.... text SΣ 1..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who has the condition?
... onset[x] SΣ 0..1 dateTime Estimated or actual date, date-time, or age
... abatement[x] SC 0..1 dateTime When in resolution/remission
... recordedDate SΣ 0..1 dateTime Date record was first recorded
... recorder SΣ 0..1 Reference(Practitioner) {c} Who recorded the condition
.... Slices for extension Content/Rules for all slices
..... location 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Location) {c} Value of extension
... note S 0..* Annotation Additional information about the Condition

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Condition.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Condition.clinicalStatusrequiredConditionClinicalStatusVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionClinicalStatusVS
from this IG
Condition.verificationStatusrequiredConditionVerificationVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionVerificationVS
from this IG
Condition.categoryextensiblePattern: problem-list-item
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.category:us-corerequiredUSCoreProblemOrHealthConcern
http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern
Condition.category:sdohextensiblePattern: sdoh
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.codeextensibleUSCoreConditionCodes
http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorCondition.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition C 0..* USCoreConditionProblemsHealthConcernsProfile Detailed information about conditions, problems or diagnoses
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... assertedDate S 0..1 dateTime Date the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External Ids for this condition
Slice: Unordered, Open by pattern:use
.... identifier:TOid Σ 1..* Identifier External Ids for this condition
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ProblemTO` | `.` | {ProblemTO.id}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Binding: Subset of condition clinical status (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: Subset of condition verification status (required)
... Slices for category S 1..* CodeableConcept category codes
Slice: Unordered, Open by pattern:$this
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/condition-category
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: problem-list-item
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
.... category:us-core S 1..* CodeableConcept problem-list-item | health-concern
Binding: US Core Problem or Health Concern (required)
.... category:sdoh S 0..1 CodeableConcept problem-list-item | encounter-diagnosis
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-tags
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: sdoh
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Identification of the condition, problem or diagnosis
Binding: US Core Condition Codes (extensible): Valueset to describe the actual problem experienced by the patient

.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..1 Coding Code defined by a terminology system
.... text SΣ 1..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who has the condition?
... onset[x] SΣ 0..1 dateTime S Estimated or actual date, date-time, or age
... abatement[x] SC 0..1 dateTime S When in resolution/remission
... recordedDate SΣ 0..1 dateTime Date record was first recorded
... recorder SΣ 0..1 Reference(Practitioner) {c} Who recorded the condition
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... location 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Location) {c} Value of extension
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... note S 0..* Annotation Additional information about the Condition

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Condition.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Condition.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Condition.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Condition.clinicalStatusrequiredConditionClinicalStatusVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionClinicalStatusVS
from this IG
Condition.verificationStatusrequiredConditionVerificationVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionVerificationVS
from this IG
Condition.categoryextensiblePattern: problem-list-item
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.category:us-corerequiredUSCoreProblemOrHealthConcern
http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern
Condition.category:sdohextensiblePattern: sdoh
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.codeextensibleUSCoreConditionCodes
http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Condition.recorder.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Condition.stage.summaryexampleConditionStage
http://hl7.org/fhir/ValueSet/condition-stage
from the FHIR Standard
Condition.stage.typeexampleConditionStageType
http://hl7.org/fhir/ValueSet/condition-stage-type
from the FHIR Standard
Condition.evidence.codeexampleManifestationAndSymptomCodes
http://hl7.org/fhir/ValueSet/manifestation-or-symptom
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorCondition.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from USCoreConditionProblemsHealthConcernsProfile

Summary

Mandatory: 5 elements
Must-Support: 4 elements
Prohibited: 6 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Condition.identifier

Maturity: 4

Differential View

This structure is derived from USCoreConditionProblemsHealthConcernsProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition 0..* USCoreConditionProblemsHealthConcernsProfile Detailed information about conditions, problems or diagnoses
... Slices for identifier 1..* Identifier External Ids for this condition
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..* Identifier External Ids for this condition
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `ProblemTO` | `.` | {ProblemTO.id}
... clinicalStatus 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Binding: Subset of condition clinical status (required)
... verificationStatus 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: Subset of condition verification status (required)
... category 1..* CodeableConcept category codes
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/condition-category
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: problem-list-item
... severity 0..0
... code
.... coding S 1..1 Coding Code defined by a terminology system
.... text S 1..1 string Plain text representation of the concept
... bodySite 0..0
... subject 1..1 Reference(US Core Patient Profile) Who has the condition?
... encounter 0..0
... onset[x] 0..1 dateTime Estimated or actual date, date-time, or age
... abatement[x] 0..1 dateTime When in resolution/remission
... recordedDate 0..1 dateTime Date record was first recorded
... recorder S 0..1 Reference(Practitioner) {c} Who recorded the condition
.... Slices for extension Content/Rules for all slices
..... location 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... value[x] 1..1 Reference(Location) {c} Value of extension
... asserter 0..0
... stage 0..0
... evidence 0..0
... note S 0..* Annotation Additional information about the Condition

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Condition.clinicalStatusrequiredConditionClinicalStatusVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionClinicalStatusVS
from this IG
Condition.verificationStatusrequiredConditionVerificationVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionVerificationVS
from this IG

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorCondition.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition C 0..* USCoreConditionProblemsHealthConcernsProfile Detailed information about conditions, problems or diagnoses
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... assertedDate S 0..1 dateTime Date the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External Ids for this condition
Slice: Unordered, Open by pattern:use
.... identifier:TOid Σ 1..* Identifier External Ids for this condition
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ProblemTO` | `.` | {ProblemTO.id}
Example General: 123456
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Binding: Subset of condition clinical status (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: Subset of condition verification status (required)
... Slices for category S 1..* CodeableConcept category codes
Slice: Unordered, Open by pattern:$this
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/condition-category
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: problem-list-item
.... category:us-core S 1..* CodeableConcept problem-list-item | health-concern
Binding: US Core Problem or Health Concern (required)
.... category:sdoh S 0..1 CodeableConcept problem-list-item | encounter-diagnosis
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-tags
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: sdoh
... code SΣ 1..1 CodeableConcept Identification of the condition, problem or diagnosis
Binding: US Core Condition Codes (extensible): Valueset to describe the actual problem experienced by the patient

.... coding SΣ 1..1 Coding Code defined by a terminology system
.... text SΣ 1..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who has the condition?
... onset[x] SΣ 0..1 dateTime Estimated or actual date, date-time, or age
... abatement[x] SC 0..1 dateTime When in resolution/remission
... recordedDate SΣ 0..1 dateTime Date record was first recorded
... recorder SΣ 0..1 Reference(Practitioner) {c} Who recorded the condition
.... Slices for extension Content/Rules for all slices
..... location 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Location) {c} Value of extension
... note S 0..* Annotation Additional information about the Condition

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Condition.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Condition.clinicalStatusrequiredConditionClinicalStatusVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionClinicalStatusVS
from this IG
Condition.verificationStatusrequiredConditionVerificationVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionVerificationVS
from this IG
Condition.categoryextensiblePattern: problem-list-item
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.category:us-corerequiredUSCoreProblemOrHealthConcern
http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern
Condition.category:sdohextensiblePattern: sdoh
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.codeextensibleUSCoreConditionCodes
http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorCondition.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition C 0..* USCoreConditionProblemsHealthConcernsProfile Detailed information about conditions, problems or diagnoses
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... assertedDate S 0..1 dateTime Date the condition was first asserted
URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier External Ids for this condition
Slice: Unordered, Open by pattern:use
.... identifier:TOid Σ 1..* Identifier External Ids for this condition
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ProblemTO` | `.` | {ProblemTO.id}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... clinicalStatus ?!SΣC 0..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Binding: Subset of condition clinical status (required)
... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Binding: Subset of condition verification status (required)
... Slices for category S 1..* CodeableConcept category codes
Slice: Unordered, Open by pattern:$this
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/condition-category
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: problem-list-item
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
.... category:us-core S 1..* CodeableConcept problem-list-item | health-concern
Binding: US Core Problem or Health Concern (required)
.... category:sdoh S 0..1 CodeableConcept problem-list-item | encounter-diagnosis
Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-tags
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: sdoh
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... code SΣ 1..1 CodeableConcept Identification of the condition, problem or diagnosis
Binding: US Core Condition Codes (extensible): Valueset to describe the actual problem experienced by the patient

.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..1 Coding Code defined by a terminology system
.... text SΣ 1..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(US Core Patient Profile) Who has the condition?
... onset[x] SΣ 0..1 dateTime S Estimated or actual date, date-time, or age
... abatement[x] SC 0..1 dateTime S When in resolution/remission
... recordedDate SΣ 0..1 dateTime Date record was first recorded
... recorder SΣ 0..1 Reference(Practitioner) {c} Who recorded the condition
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... location 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Location) {c} Value of extension
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... note S 0..* Annotation Additional information about the Condition

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Condition.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Condition.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Condition.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Condition.clinicalStatusrequiredConditionClinicalStatusVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionClinicalStatusVS
from this IG
Condition.verificationStatusrequiredConditionVerificationVS
https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/ValueSet/ConditionVerificationVS
from this IG
Condition.categoryextensiblePattern: problem-list-item
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.category:us-corerequiredUSCoreProblemOrHealthConcern
http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern
Condition.category:sdohextensiblePattern: sdoh
http://hl7.org/fhir/ValueSet/condition-category
from the FHIR Standard
Condition.codeextensibleUSCoreConditionCodes
http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Condition.recorder.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Condition.stage.summaryexampleConditionStage
http://hl7.org/fhir/ValueSet/condition-stage
from the FHIR Standard
Condition.stage.typeexampleConditionStageType
http://hl7.org/fhir/ValueSet/condition-stage-type
from the FHIR Standard
Condition.evidence.codeexampleManifestationAndSymptomCodes
http://hl7.org/fhir/ValueSet/manifestation-or-symptom
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorCondition.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from USCoreConditionProblemsHealthConcernsProfile

Summary

Mandatory: 5 elements
Must-Support: 4 elements
Prohibited: 6 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Condition.identifier

Maturity: 4

 

Other representations of profile: CSV, Excel, Schematron

Notes:

  • The mock example
  • maps to ProblemTO schema.
  • mapping to VIA
  • Vivian Condition
  • User Requirements for Conditions
  • based on US-Core for Condition Resource profile
  • should have meta.profile set to https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.condition to indicate the intent to be compliant with this profile
  • VIA will not include those that are removed, we should update our FHIR database in case the previous was recorded.
  • note to have as many indexes to handle all the ProblemTO.comments
  • icd is not always ICD-9, sometimes it is ICD-10. The following algorithm by Jay Lyle:
    • if the code starts with a number, its ICD-9
    • if the code starts with V and does not end with a letter, its ICD-9
    • if the code starts with Eand followed by 3 numerals before the dot, its ICD-9
    • else it is ICD-10
  • Service Related and the other more specific service related condition elements: at KBS encouragement, we will not keep any of these into FHIR. These are more related to VA payment than clinical condition, so should be managed elsewhere.
  • entered by, recording provider, responsible provider ? Historic MHV documentation seems to indicate responsible provider is used. (ProblemTO.observer)
  • status -> clinicalStatus: ACTIVE -> #active, INACTIVE -> #inactive
  • verified -> verificationStatus: true -> #confirmed, false -> #unconfirmed

Mapping

Vista Vista Field Name VIA ProblemTO MHV eVault FHIR Condition Note
0.01 DIAGNOSIS type.name problem code.text string including SCT
    icd   code.coding (icd)  
0.02 PATIENT NAME patient (icn) subject  
0.03 DATE LAST MODIFIED modifiedDate eventTime   see note
0.04 CLASS (Personal, Family)        
0.05 PROVIDER NARRATIVE        
0.06 FACILITY facility (tag, text)   recorder[location]  
0.07 NMBR id   identifier  
0.08 DATE ENTERED        
0.12 STATUS(Active, Inactive) status status clinicalStatus  
0.13 DATE OF ONSET onsetDate   onsetDateTime  
1.01 PROBLEM        
1.02 CONDITION(Transcribed, Permanent, Hidden) verified (true/false)   verificationStatus  
1.03 ENTERED BY        
1.04 RECORDING PROVIDER        
1.05 RESPONSIBLE PROVIDER observer (id,name) provider recorder  
1.06 SERVICE        
1.07 DATE RESOLVED resolvedDate   abatementDateTime  
1.08 CLINIC location     see note
1.09 DATE RECORDED timestamp (hold) recordedDate see note
1.1 SERVICE CONNECTED serviceConnected (true/false)      
1.11 AGENT ORANGE EXPOSURE        
1.12 IONIZING RADIATION EXPOSURE        
1.13 PERSIAN GULF EXPOSURE        
1.14 PRIORITY (Acute, Chronic) acuity acuity ?  
1.15 HEAD AND/OR NECK CANCER        
1.16 MILITARY SEXUAL TRAUMA        
1.17 COMBAT VETERAN        
1.18 SHIPBOARD HAZARD & DEFENSE        
1101 NOTE FACILITY        
80001 SNOMED CT CONCEPT CODE        
80002 SNOMED CT DESIGNATION CODE        
80003 VHAT CONCEPT VUID (FUTURE)        
80004 VHAT DESIGNATION VUID (FUTURE)        
80005 SNOMED CT-TO-ICD MAP STATUS        
80101 UNIQUE NEW TERM REQUESTED        
80102 UNIQUE TERM REQUEST COMMENT        
80201 DATE OF INTEREST        
80202 CODING SYSTEM        
80300 MAPPING TARGETS        
    removed     data is false
    comments.text comments note[*].text  
    comments.timestamp   note[*].time  
    comments.author.name   note[*].authorString  
    providerNarrative     no data
    exposures     no data
    noteNarrative     no data
    priority     no data
    type.category     data is empty
    comment     no data
    organizationalProperties     no data
    providerNarrative     no data
    ../../tag stationNumber see note  
  • MHV would calculate the 36 hour hold based on ProblemTO.timestamp, but never expose this. Rather MHV would expose the ProblemTO.modifiedDate as the eventTime. This does not fit well into the FHIR Condition, which has an element appropriate for timestamp, but does not have a good element for modified. We could add an extension if this is deemed important. Note any extension we add will not be supported by OH, so better to change now.
  • what is displayed today for location is likely coming from ../../tag - e.g. "984". The current MHV code preserves this value, and does not seem to preserve the facility. This tag value only goes in Identifier.system values. We have historically not included this value in an element. Likely should be an Organization resource, but there is only a number.
  • clinic is available at the UI, but we are not preserving it as it is just a string. It was not previously saved by MHV.

Business Rule

  • Ignore those without a facility
  • Ignore those without an id
  • all conditions are held for 36 hours past the release date/time
    • 36 hour hold based on timestamp, (if no time is given, midnight on this day is presumed)
    • skip those with no timestamp or bad timestamp
  • Ignore non-active, deleted are filtered out by VIA

Mapping Concerns

  • not clear what acuity (likely 1.14 PRIORITY) is mock data is always C / CHRONIC vs A / ACUTE
Source-Code review
  • MHV seems to be adding midnight time to dates that don't have a time. - timestamp, recordedDate, and resolvedDate
    • Note timestamp does need to be processed as if it was midnight for the hold date calculation, but this should NOT affect how the data goes into FHIR.
  • MHV does not handle when only a year is given - e.g. 2990000 -> "1999", no month, day, or time.